A UNIVERSAL TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS
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1 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
2 A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS Universal protocol combines three universal treatments: 1. Acceptance and Commitment Therapy (ACT) 2. Dialectical Behavior Therapy (DBT) 3. Cognitive Behavioral Therapy (CBT)
3 WHY A UNIVERSAL PROTOCOL?
4 A UNIVERSAL PROTOCOL FOR EMOTIONAL DISORDERS Seven trans-diagnostic factors What is a trans-diagnostic factor?
5 A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS Case Formulation: Emotional Situation experience Coping responses or Transdiagnostic mechanisms Emotional disorder
6 INTERVENTIONS FOR EACH TRANS- DIAGNOSTIC FACTOR Trans-diagnostic factor Short-term focus (1) Rumination (2) Negative appraisal (3) Response persistence (4) Experiential avoidance (5) Intervention Values Defusion Mindfulness and emotion awareness Cognitive Flexibility Defusion Interpersonal effectiveness Doing the opposite Doing the opposite Situational exposure Interoceptive exposure Imagery-based emotion exposure Hostility or aggression (6) Emotional masking (7) Interpersonal effectiveness Imagery based emotion exposure
7 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, midtreatment, post-treatment, and a 1-month follow-up.
8 PRELIMINARY DATA DASS 21 (2015)
9 Preliminary data Difficulties in Emotion Regulation Scale (2015)
10 PRELIMINARY DATA COMPREHENSIVE COPING INVENTORY (2015)
11 PRELIMINARY DATA NOVACO ANGER SCALE (2015)
12 A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS How to assess the seven trans-diagnostic factors? Comprehensive Coping Inventory (CCI) (Development and validation)
13 A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS 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)
14 VALUES IDENTIFICATION Values (experiential exercise) Values in action log (handout) Planning committed actions
15 MINDFULNESS (AWARENESS TRAINING)
16 DEFUSION Noticing, naming it, and letting it go.
17 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)
18 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
19 Cognitive flexibility exercises for each type of negative appraisal Thinking traps Negative predictions about the future Underestimating ability to cope Focusing on the negative Negative attributions Shoulds Exercises Validity quotient Coping history and worst-case scenario Two sides of the coin Finding alternative explanations Breaking the rules exercise
20 SELF SOOTHING
21 DOING THE OPPOSITE Experiential exercise:
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23
24 INTERPERSONAL EFFECTIVENESS
25 INTERPERSONAL EFFECTIVENESS Assertiveness knowing what you feel and want Limit setting Listening mindfully
26 IMAGERY BASED EMOTION EXPOSURE Mindfulness based exposure Brief imagery based exposure Prolonged imagery based exposure Interoceptive exposure Situational in-vivo exposure
27 A UNIVERSAL PROTOCOL FOR EMOTIONAL DISORDERS Relapse prevention
28 For more information: Patricia Zurita Ona, Psy.D. l.com
29
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