Embed Size (px)
Citation preview
A UNIVERSAL TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS
Patricia E. Zurita Ona, Psy.D. Matthew McKay, Ph.D. East Bay Behavior Therapy Center The Wright Institute
Universal protocol combines three universal treatments:
1. Acceptance and Commitment Therapy (ACT) 2. Dialectical Behavior Therapy (DBT) 3. Cognitive Behavioral Therapy (CBT)
A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS
WHY A UNIVERSAL PROTOCOL?
A UNIVERSAL PROTOCOL FOR EMOTIONAL DISORDERS
Seven trans-diagnostic factors
What is a trans-diagnostic factor?
Case Formulation:
Situation Emotional
experience
Coping responses
or Trans-
diagnostic mechanisms
Emotional
disorder
A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS
INTERVENTIONS FOR EACH TRANS-DIAGNOSTIC FACTOR
Trans-diagnostic factor Intervention
Short-term focus (1) Values
Rumination (2) Defusion Mindfulness and emotion
awareness
Negative appraisal (3) Cognitive Flexibility Defusion
Response persistence (4) Interpersonal effectiveness Doing the opposite
Experiential avoidance (5) Doing the opposite Situational exposure
Interoceptive exposure Imagery-based emotion
exposure
Hostility or aggression (6) Interpersonal effectiveness
Emotional masking (7) Imagery – based emotion exposure
A TRANS-DIAGNOSTIC GROUP
12 - week protocol 1 ½ hour weekly session 2 co-facilitators Offer to clients with different degrees of
emotional dysregulation problems Offer to clients with different diagnosis
including depression, anxiety, anger problems. Four different data points: pre-treatment, mid-
treatment, post-treatment, and a 1-month follow-up.
PRELIMINARY DATA DASS – 21 (2015)
Preliminary data Difficulties in Emotion Regulation Scale
(2015)
PRELIMINARY DATA COMPREHENSIVE COPING INVENTORY
(2015)
PRELIMINARY DATA NOVACO ANGER SCALE (2015)
A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS
How to assess the seven trans-diagnostic factors?
Comprehensive Coping Inventory (CCI) (Development and validation)
Psycho-education about emotions (Experiential exercise)
Identifying all types of avoidance: Situation avoidance Cognitive avoidance Protective avoidance Somatic avoidance Substitution avoidance
Cost of avoiding emotions Avoidance consequences worksheet (handout & video)
A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS
VALUES IDENTIFICATION
Values (experiential exercise)
Values in action log (handout)
Planning committed actions
MINDFULNESS (AWARENESS TRAINING)
DEFUSION
Noticing, naming it, and letting it go.
COGNITIVE FLEXIBILITY TRAINING
Categories of negative appraisal:
(a) negative predictions, (b) underestimating ability to cope, © focusing on negative, (d) negative attribution, (e) Shoulds.
Keeping a thought log ! (handout)
THOUGHT IDENTIFICATION EXERCISE (a) Negative Prediction. (b) Underestimating
Ability to Cope. (c) Focusing on the Negative. (d) Negative Attribution. (e) Shoulds.
1. I can’t handle another medical problem. 2.My son’s going to get kicked out of school. 3. People shouldn’t talk about their family
business. 4. The whole course was a waste 5. I ought to read good books instead of trash. 6. My friend is calling because she wants
something
Cognitive flexibility exercises for each type of negative appraisal
Thinking traps Exercises
Negative predictions about the future
Validity quotient
Underestimating ability to cope Coping history and worst-case scenario
Focusing on the negative Two sides of the coin
Negative attributions Finding alternative explanations
Shoulds Breaking the rules exercise
SELF SOOTHING
DOING THE OPPOSITE
Experiential exercise:
INTERPERSONAL EFFECTIVENESS
INTERPERSONAL EFFECTIVENESS
Assertiveness – knowing what you feel and want
Limit setting Listening mindfully
Mindfulness based exposure Brief imagery based exposure Prolonged imagery based exposure Interoceptive exposure Situational in-vivo exposure
IMAGERY BASED EMOTION EXPOSURE
A UNIVERSAL PROTOCOL FOR EMOTIONAL DISORDERS
Relapse prevention
