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1. Emotion Efficacy Therapy
A Brief, Exposure-Based
Treatment for Emotion Regulation
Integrating ACT & DBT
Presented by: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs
AllCEUs.com Unlimited CEUs and Specialty Certifications $59

2. Objectives
 Define EET
 Explore the underlying theory
 Identify techniques used in EET and their
rationale
 Theorize about how EET might be helpful to your
clients

3. What is Emotion Efficacy Therapy
 An 8-Session protocol
 Targets the transdiagnostic drivers of low emotion
efficacy in people with emotion dysregulation,
anxiety, depression, stress, and impulsivity
 The philosophical premise of EET is that while pain is
unavoidable, suffering is not.
 EET skills focus on increasing distress tolerance and
decreasing emotion avoidance. Using five
components— emotion awareness, mindful
acceptance, values- based action, mindful coping,
and exposure-based skills practice

4.  Because learning and memory are created through
the encoding of experiences, it follows that utilizing
all sensory and perceptual components (cognitive,
somatic, and affective) is essential for new learning.
 In EET, transemotional learning occurs through the
activation of all emotional components— thoughts,
sensations, feelings, and urges— to build neural
pathways around new behaviors.
 EET leverages state- dependent learning through
exposure, which facilitates new learning in
emotionally activated states by increasing learning,
retention, and recall of EET skills

5. Summary of the Foundation
 EET is based on research of three foundational
ideas for its treatment structure and content
 A transdiagnostic approach is the most effective way to
treat clients with emotion problems
 Transemotional learning, which involves all four
components of emotion, is essential to learning
 New learning is enhanced in an activated state

6. Why
 There are more commonalities than differences across
diagnostic disorders, underscoring the need for
transdiagnostic approaches to treatment (McEvoy, Nathan,
& Norton, 2009).
 Transdiagnostic formulation identifies and targets the
mechanisms driving the symptoms (as opposed to the
symptoms themselves) as a focus of intervention.
 Transdiagnostic approaches allow for a single therapy for
clients who present with a wide range of symptoms

7. Goals of Treatment
 Power to experience themselves as distinct from their
emotions
 Power to experience intense emotions, instead of reacting
and avoiding
 Power to choose values- based action, even when
emotionally triggered
 Power to choose strategies to downregulate emotion and
keep from making difficult situations worse
 Apply to the following
 Anger
 Addiction
 Self-harm

8. Vulnerabilities for Low Emotional Efficacy
 Biological predisposition/sensitivity causing high levels of
reactivity
 High emotionality or experiential avoidance of uncomfortable
sensations, emotions, and cognitions triggered by internal or
external cues
 Significant levels of distress intolerance
 Significant lack of emotion- shifting/downregulate skills
 Consistent and significant socially invalidating environments
 Lack of understanding of their emotional experience
 Ineffective tools to either tolerate difficult emotions, make
values- consistent choices, or regulate their emotions.

9. 5 Components of EET
 Emotional Awareness
 Thoughts, feelings, sensations, urges
 Mindful Acceptance
 Nonjudgmental acceptance
 Values-Based Action
 Proactive choice vs. reactive avoidance
 Mindful Coping
 Coping skills are usually used to avoid or change aversive
emotion
 Mindful coping helps clients expand their choices, so they
can choose values- based action.
 Exposure based skills practice

10. Typical Session
 Mindful acceptance skills practice
 Skills practice review and troubleshooting challenges
 Review of previous week’s psychoeducation and skill
 Psychoeducation on new skill
 Practice of new skill
 Imaginal or emotion exposure using new skill
 Homework via skills practice record

11. Emotion Awareness
 Emotions encompass
 Thoughts
 Feelings
 Physical sensations
 Behavioral urges
 Emotions can be contextually unhelpful or helpful
 Emotions are messages sent by the brain to help respond
to perceived threats and opportunities.
 Emotions are not the “truth”
 Emotions urge us to action
 Trigger Identification/Emotional Reaction Worksheet

12. Mindful Acceptance
 Benefits to using mindful acceptance when you
are emotionally triggered:
Learn to tolerate pain without acting on it.
Learn to recover more quickly from the distress of the
trigger.
Learn to find the space you need to thoughtfully and
consciously choose how you will respond to the pain.
 Mindful acceptance is practiced by learning to
observe and accept the four parts of emotion:
sensations, feelings, thoughts, and urges

13. Mindful Acceptance (Awareness) 10 Minutes
 Sensation Acceptance
 Scan your body for sensations with the intention of
observing and accepting them instead of reacting to
them.
 Feeling Labeling
 Identify the feeling that goes with the sensation
 Thought watching and sticky thoughts
 Urge Noticing
 Sit with the urge, without acting on it or judging it.
 Then notice what it’s like not to act on it.

14. Moment of Choice
 The moment of choice is…
 The moment between stimulus and response
 When clients will choose to use EET skills
Emotion surfing (chapter 4)
Values- based action (chapter 5)
Relaxation and self- soothing (chapter 7)
Coping thoughts (chapter 8)
Distraction and time- outs (chapter 9)

15. Emotion Surfing
 4 Possible Reactions
 Emotion surfing
 Emotion avoidance
 Rumination
 Emotion-driven behaviors

16. Emotion Surfing 5 Key Abilities
 Observing and accepting the emotion wave as it
comes.
 Identifying where you are on the wave and how
triggered you are
 Noticing and watching thoughts without getting
fused with them.
 Noticing any desire to escape the emotion, and
continuing to observe it instead
 Noticing any urges or impulses to act on the
emotion, and seeing the moment of choice (not
engaging in emotion- driven behavior)

17. Note
 Excellent section on explaining
 Emotional avoidance, rumination,
 Identifying how the person engages in it
 Identifying the consequences of it

18. Values Based Action
 Clarifying values across life domains is the first step to
being able to identify VBA in the moment of choice.
 Barriers to choosing values- based action
 Lack of clarity about values
 A hard- wiring to avoid pain
 The habit of acting on emotion
 Short- term reinforcement for acting on emotion- driven behavior,
or emotion avoidance
 Understanding the benefits of VBA can increase motivation
to choose an action based on values in the moment of
choice instead of an emotion- driven behavior.

19. Values Based Action
 Values- based action— in the face of emotional
triggers— is only made possible by recognizing the
moment of choice, which can be found using the
following sequence:
1. Noticing painful emotion, including the components of
feelings, thoughts, and sensations;
2. observing the action urge;
3. remembering situation- relevant values/intentions;
and
4. deciding to act (on values/intentions or emotion-
driven urges).

20. Relaxation and Self Soothing
 Diaphragmatic breathing
 Relaxation without tension (with cued breath)
 Cue- controlled breathing
 The five- senses exercise (30 seconds per sense)
 Positive examples of each sense can be used for
emotional downregulation

21. Coping Thoughts
 Coping thoughts are simply personalized,
strength- based declarations about resiliency,
history, or perspective that shifts the client’s
attention to help effectively navigate the difficult
emotion
 Identify triggers
 Identify automatic negative thoughts
 Create coping thoughts

22. Radical Acceptance
 Radical acceptance does not mean you like or
condone what happened. It just means that you
accept the reality that it happened.
 Practicing coping thoughts and radical acceptance
in an activated state will enhance learning and
help clients recall the skills when they are
triggered.

23. Distraction Time Out
 Distraction follows the exposure of observing and
accepting.
 Distraction allows clients to shift attention away
from stimuli that trigger emotion: provoking
thoughts, sensations, and situations.
 Distraction is used mindfully— to intentionally
shift attention to alternative present- moment
experiences after observing and accepting
emotions

24. Summary
 Emotional dysregulation can keep people stuck
 EET helps people learn to
 Identify their emotions
 Observe mindfully without reacting
 Use the moment of choice to decide on the best course
of action based on what is important to them

25. Summary
 Mindful acceptance is the practice of observing and
accepting the four components of emotional
experience through:
 sensation acceptance
 feeling labeling
 thought watching
 urge noticing.
 The moment of choice is the space between stimulus
and response when clients can consciously and
intentionally choose their response.

26. Summary
Based on Emotion Efficacy Therapy
A Brief, Exposure-Based Treatment
for Emotion Regulation Integrating
ACT and DBT
By: Matthew McKay PhD, Aprilia West
PsyD, MT
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