第八章：应对思维与彻底接纳

第8章

应对思维与彻底接纳

在情绪效能疗法（EET）中，接下来的正念应对技巧是应对思维和彻底接纳。这两种技巧都与我们对触发事件及其相关情绪的看法有关。作为情绪构成的四个组成部分之一，思维是创造和维持情绪的强大动力。

正如我们在前几章中讨论的那样，情绪会跟随大脑所认定的“真实”情况。如果思维内容是由于威胁性刺激引起的，情绪可能会表现为紧张感；感到恐惧、焦虑和恐慌；以及想要战斗、冻结或逃跑的冲动。相反，如果思维内容是由于愉悦性刺激引起的，情绪可能会表现为放松感；感到快乐、满足和自信；以及想要参与的冲动。如果来访难以应对自动负面思维，通过用应对思维替换这些思维或练习彻底接纳，可以帮助他们提高痛苦容忍度，并通过降低情绪强度来调节情绪。

EET技能目标：

观察 + 接纳 + 选择
正念应对（应对思维/彻底接纳）

应对思维

自动负面思维通常包含对自我或自我与世界关系的评判或危险想法。经常地，这些想法反映了个人的适应不良的核心信念，这些信念围绕着模式组织，导致并维持了令人困扰的情绪（Rafaeli, Bernstein & Young, 2011）。应对思维只是关于韧性的、基于力量的声明，它们可以转移来访的注意力，帮助有效地应对困难情绪。

与其他使用应对策略来增加情绪调节和痛苦容忍度的干预措施不同，EET中的所有应对技巧都是以正念的方式教授的。同样，应对思维在EET中的使用方式也与其他治疗干预不同。应对思维作为一种正念技能被教授，因为它们仅在来访观察并接受其情绪体验后才使用。例如，在来访练习了正念接纳并找到了选择时刻之后，他们可以选择使用应对思维来支持自己减少痛苦。

为了使用应对思维，重要的是要“提前应对”，即针对不同的触发因素预先准备一些认知。为了选择有效的应对思维，你需要与来访合作，识别他们在触发因素下常见的自动负面思维，然后提出可以用来替换它们的应对思维。以下是一个逐步指南，帮助来访识别自动负面思维并用应对思维替换它们。

通过应对思维进行正念应对

使用以下步骤向您的来访介绍应对思维：

步骤1：识别触发情境

开始时，请取出空白的《用应对思维替换自动思维》工作表（您可以在本节末尾、附录C或http://www.newharbinger.com/34039下载该工作表）。然后请来访回忆一个最近的触发情境，并将其写在“触发器”列中。

步骤2：识别自动负面思维

接下来，请来访尝试回忆在这种情况下出现的自动思维。您可以提示他们：“当你经历那个触发器时，你记得自己在想什么？”或“在那一刻，你对自己有什么看法？”请他们将思维写在“自动负面思维”列中。

步骤3：创建应对思维

现在是发挥创意的时候了。您需要指导来访创建一个应对思维来替换负面自动思维。有效应对思维的关键在于选择来访能够认同的陈述。如果他们选择了一个反映不现实可能性的想法，他们可能不会相信它，因此不太可能从中获得任何缓解。
- 例如，如果来访的自动负面思维是“我永远不够好”，一个有效的应对思维可能是“我总是尽我最大的努力。”
- 然而，一个无效的应对思维例子可能是“我是最好的”，这可能并不真实，取决于上下文，而且如果来访不相信它，实际上可能会强化负面自动思维。

应对思维的现实检查

在来访为每种情境创建应对思维时，你需要与他们进行现实检查，通过提问确保他们创建的应对思维是有效的。你可以问他们：“这个陈述对你来说是真的吗？”或“这现实吗？”一旦来访为这种情况创建了应对思维，引导他们完成工作表，记录更多的触发情境、自动思维和应对思维。给来访提供《来访应对思维》手册，以便他们可以记录应对过程。

步骤4：观察 + 接纳 + 选择 + 应对思维

下一步是向来访展示如何在想象暴露中使用应对思维。正如基于价值观的行动一样，使用想象暴露可以在来访实际遇到触发情境时加速新学习、记忆保持和回忆。首先，帮助来访练习观察和接纳情境。然后，在选择时刻，指导他们使用一个或多个先前开发的应对思维。本章后面提供的对话示例可以作为此步骤的模型。

以下是可以提供给来访的关于应对思维的手册，以帮助他们理解这项技能，以及一个空白的工作表，供他们记录触发因素、自动思维和应对思维。（两者均可在附录C中找到可复制格式，并可在本书网站上下载。）为了帮助他们理解这项练习，还提供了第二张工作表的填写样本。

来访应对思维

当你面对困难情绪时，可以使用应对思维。它们在你已经练习过观察和接受困难情绪之后尤其有用，但你仍然在特定的沉思中挣扎，或者重复的自动思维正在加剧你的情绪波动。

你现在知道，你的情绪会跟随你的注意力所及。如果你被触发，很可能会有负面的自动思维。容忍痛苦并转换情绪的一种方法是用应对思维替换负面的自动思维。应对思维的关键在于你相信它是真实且现实的。如果你不相信这种想法，它可能不会有效。

以下是一些应对思维的例子：

“这种情况不会永远持续下去。”
“我可以感到焦虑/悲伤/愤怒，而不做出反应。”
“我可以忍受这种情绪，直到情绪波消退。”
“这种情绪不会杀死我，只是现在感觉不好而已。”
“我以前处理过这种情况，这次也可以。”
“我可以花所有需要的时间来放松和释放。”
“我可以让这种情绪控制局面，或者我可以采取基于价值观的行动。”
“仅仅因为我有这种情绪，并不意味着我必须按照它行事。”
“我不是我的情绪……我可以选择下一步行动。”

用应对思维替换自动思维

使用此工作表记录具体的触发因素、伴随的自动思维，以及你可以用来替换它们的替代应对思维。

触发因素	自动思维	应对思维
1.	1.	1.
2.	2.	2.
3.	3.	3.
4.	4.	4.
5.	5.	5.

用应对思维替换自动思维（来访样本）

触发因素	自动思维	应对思维
1. 向老板提交项目	我的工作不够好。	我尽了最大的努力，这是我能做到的。
2. 在一个我不认识人的聚会上	如果我在聚会上说错话，人们会认为我是个失败者。	我可以有这种想法，但不需要根据它行动。
3. 妻子回家后直接去了卧室	我的妻子不再爱我了。	这是我的缺陷模式在说话，但我不会听它的。
4. 任何时候...	...	...
5. 老板在全公司午餐时没有和我说话	我有问题。	我有优点也有缺点，就像每个人一样。
	我的老板不喜欢我。	让人喜欢不是我的工作，我的工作是做好我的工作。

治疗师-来访对话示例：在暴露练习中使用应对思维

治疗师：既然你已经完成了《应对思维》工作表，让我们做一个暴露练习，来实践一下我们为某个触发情境和一个自动负面思维所开发的应对思维。

来访：好的。我应该选哪一个？

治疗师：看看你列出来的内容，选择一个你预测在SUDS量表上大约是5或6的情境，1表示没有痛苦，10表示你能想象到的最严重的痛苦。

来访：[停顿]嗯，我觉得当我的妻子回家后直接去卧室的时候。

治疗师：好的。你觉得这个场景对你来说有多痛苦？

来访：我会说6。

治疗师：好的，很好。让我们花几分钟时间进入那个场景。闭上眼睛，我会引导你。

来访：好的 [闭上眼睛]。

治疗师：想象上次你的妻子回家后直接去了卧室。把自己放在当时的位置。试着回忆你在做什么。记得周围能看到什么，听到什么，感受到什么。你能看到自己在那里，并且感觉到情绪吗？

来访：能。

治疗师：好的。你身体哪里感觉到这种情绪？

来访：我胃里有一种紧绷的感觉。

治疗师：好的，我们就从这里开始。试着让那种感觉就在那里，不加评判，不作反应，而是对它开放并放松。

来访：[停顿] 好的，我在尝试。

治疗师：你可以想象不是逃避这种感觉，而是迎向它……

来访：好的。

治疗师：注意这种感觉是否在变化或者保持不变；注意它的大小和形状……是否有温度。

来访：是的。它是硬的、紧绷的，大概有一个棒球那么大。它没有动。我没有感觉到温度。

治疗师：自从你观察它以来，它有变化吗？

来访：现在稍微不那么强烈了。

治疗师：好的，很好。你能识别出与这种感觉相关的情绪吗？

来访：呃，可能是恐惧？我感到害怕。

治疗师：所以你的胃里有一种紧绷的感觉，伴随这种感觉的是恐惧？

来访：是的。

治疗师：好。有没有想要做某事或不做某事的冲动？

来访：嗯，我不想跟她说话……我担心会发现她真的不想跟我说话。还有想关上办公室门……躲起来的冲动。

治疗师：好的。试着坐一会儿，允许这种不想跟她说话的冲动存在，以及关上门躲起来的冲动。注意允许这种冲动存在的感受是什么样的。

来访：感觉很糟糕。

治疗师：好的，你能允许它感觉很糟糕……只是给它空间让它如其所是吗？

来访：可以。我只是希望它能改变。

治疗师：当然——感觉很糟糕，你自然希望不要有这样的感觉。看看你能否再坚持一会儿，允许这种感觉存在，并对其保持好奇。

来访：好的。嗯。

治疗师：你有什么想法？

来访：当我接受它确实感觉很糟糕时，这种感觉就变得稍微不那么糟糕了。

治疗师：当你停止逃避或抵抗时，情绪波减弱了吗？

来访：是的。

治疗师：好的。现在让我们想想在这种情况下出现的自动负面思维。

来访：“我的妻子不再爱我了。”

治疗师：你的SUDS评分呢？

来访：6分或稍微多一点。

治疗师-来访对话示例：在暴露练习中使用应对思维

治疗师：好的，现在让我们先停止那个关于你妻子的场景，然后开始练习应对思维。你觉得哪种应对思维对你最有帮助？

来访：我想是我不需要听从我的缺陷模式？

治疗师：好的。你可以对自己说：“我有这个想法，她不再爱我了。” 然后再说你的应对思维。

来访：好的。“我的缺陷模式在说话，但我可以选择不听。”

治疗师：你觉得这样做怎么样？

来访：嗯，这让我把注意力从恐惧上转移开了。而且……它让我质疑她是否真的不再爱我了。

治疗师：好的。再坚持一会儿，多对自己说几次这句话。[等待45秒] 现在你有什么感觉？

来访：嗯，我觉得好多了……

治疗师：你的SUDS评分下降了吗？

来访：是的。之前几乎到了7，但当我用了应对思维后，降到了大约4。

治疗师：所以，认为这是你的缺陷信念在说话而不是绝对的事实，这对你是有帮助的？

来访：是的。实际上我很惊讶这种恐惧的感觉变化这么大……就像我的整个视角都变了……

治疗师：很好。我们现在尝试第二个应对思维。你觉得现在哪种应对思维最有帮助？

来访：嗯……可能是“我的情绪并不是事实”？

治疗师：好的，你的感觉并不是事实。试着默默地对自己说几次这句话。

来访：好的……

治疗师：[等待约20秒] 那么你现在对触发情境的看法有所不同了吗？

来访：是的……我在想也许她去房间是因为她想换衣服，或者想要一些独处的时间。因为她工作时是一名护士，整天都在和人打交道，所以她可能只是需要一点休息时间。也许这和我无关。

治疗师：很好。所以这个想法帮助你以不同的方式看待这个问题？

来访：是的，允许情绪存在，然后使用应对思维确实有帮助。

治疗师：很好。那么我们再检查一下。你现在的情绪痛苦水平是多少？

来访：大概在2左右。

治疗师：好的，非常好。让我们结束这个练习，深呼吸，慢慢地呼气，睁开眼睛，回到房间。

彻底接纳

彻底接纳是辩证行为疗法（DBT）的一个关键组成部分，由Marsha Linehan（1993）开发。它是指完全接受事物的现状，而不去抵抗或试图改变它们。为了理解彻底接纳的概念，可以先了解它是什么以及它不是什么：彻底接纳是对不可改变现实的完全和全面的拥抱。彻底接纳并不等同于赞同、被动、宽恕、同情或爱。

通过练习对触发情境、事件或记忆的彻底接纳，来访学会了在降低情绪强度的同时保持正念。他们会发现，他们有更多自由来选择如何回应。当生活痛苦、令人失望或恐惧时，选择彻底接纳是一项困难的技能；这与我们大多数人在事情不如所愿时想要做的事情相反。

重要的是要注意，彻底接纳与正念接纳有所不同。彻底接纳意味着接受“事实”这一不可改变的现实；而正念接纳则意味着接受自己的情绪体验。

以下是一份可以帮助您的来访理解彻底接纳的手册。

彻底接纳的艺术

什么是彻底接纳？

成功应对强烈情绪的一部分在于知道何时应该尝试改善你的处境，何时应该接受它。彻底接纳是一种正念应对技巧，允许你接受“事实”，并停止因拒绝眼前的现实而遭受痛苦。我们在每一刻都有一个选择：拒绝事实或接受它。我们做出的选择将决定我们是否继续受苦，或者为其他事物的存在创造空间。

面对痛苦情绪时，我们的自然反应是与我们认为导致这些情绪的现实作斗争。这样做会使自己和他人更加痛苦。选择彻底接纳——即接受“事实”——对于大多数人来说是一个巨大的转变。这种选择感觉上与你在遇到痛苦时情绪所驱使的行为完全相反。

彻底接纳不是什么？

彻底接纳并不意味着你喜欢或认可所发生的事情。它只是意味着你接受了它已经发生的事实。换句话说，生活中有些情况是不公平或不公正的。在其他情况下，你可能对所发生的事情负有一定责任。无论哪种情况，仅仅因为你接受了它发生了，并不意味着你在认同它。

你越练习彻底接纳，就越容易停止抗拒那些你无法改变的事情。

以下是几个彻底接纳的例子：

“我的女朋友和我分手了，但这并不意味着我必须报复或试图赢回她的爱。”
“我总是有自杀的想法，但这并不意味着我喜欢这些想法或会采取行动。”
“我没有设置提醒来支付电话账单，所以我必须承担后果。”

彻底接纳需要一种愿意以不同方式看待事物的态度。有时我们的失望和挫折是可以避免的。我们也可以通过接受本可以做得不同的事情，并对没有做到的部分承担责任来实践彻底接纳。例如，你能预防约会迟到、忘记完成工作任务或表现不佳吗？此外，你能预防说谎伤害他人或让自己被仇恨所驱动吗？很多时候，我们在“事实”中负有责任。接受这一点是实践彻底接纳的关键。

尽管这些情况的结果可能会带来严重的后果，但如果你能将它们视为学习的机会，它们也可以成为成长的机会。通常，那些与强烈情绪作斗争的人认为生活是发生在他们身上的事情，而不是认识到自己在创造经历中的力量。

好消息是，如果我们对正在发生的事情负有责任，那么我们也拥有做出不同选择的力量——这些选择可以减轻痛苦，并让我们更接近按照价值观生活的理想状态。

来访往往难以理解彻底接纳，特别是如果他们难以接受的情况是创伤性的。以下是一个治疗师与来访的对话示例，展示了如何与来访讨论彻底接纳。本章末尾的《彻底接纳工作表》是另一个帮助来访理解和练习这项技能的工具。

治疗师-来访对话示例：彻底接纳

治疗师：你听说过彻底接纳吗？

来访：嗯，我好像听说过。是佛教的东西吗？

治疗师：我认为佛教徒确实会实践这一点，但我们在这里将其用作一种正念应对技巧。

来访：我明白了。那么它“彻底”在哪里呢？

治疗师：好问题。“彻底”的部分指的是接受的完整性和全面性。换句话说，你不仅仅是部分接受现实——而是完全接受存在的事实是不可改变的。

来访：好的……

治疗师：那么让我们用一个你一直在挣扎或希望改变但无法改变的事情作为例子。你可以使用工作表，从“评估情境”部分开始。

来访：我想应该是我有慢性疼痛，无论我做什么，似乎都无法摆脱它。

治疗师：好的，这是一个很好的例子。因为你已经尽了自己最大的努力，对吧？你锻炼、健康饮食、充足睡眠，就像医生建议的那样？

来访：是的。但我每天还是感到疼痛 [眼睛湿润]。

治疗师：是的。这对你来说是一个持续的挑战。

来访：嗯。

治疗师：那么我们继续看工作表。下一步是什么？

来访：[看着工作表] 所以情况是我的疼痛……我不确定是否有任何过去的事件导致了这种情况，因为医生也不知道为什么我会痛。

治疗师：好的。下一步是什么？

来访：[继续看工作表] 我不认为我自己或其他人在我疼痛中扮演了什么角色。我真的对此没有多少控制权，而我能控制的部分我已经在做了。

治疗师：没错。你已经在做医生说可以帮助缓解疼痛的所有事情了。

来访：而且我无法控制它每天都还在痛。

治疗师：对。

来访：[继续看工作表] 所以一开始我对疼痛的反应是非常沮丧。我只是想着所有因为疼痛而不能做的事情。我很生气。

治疗师：你在生谁的气？

来访：我不知道……上帝？我的父母给了我这些基因？

治疗师：好的。这对你的想法和感受有什么影响？

来访：天哪，我变得非常痛苦和沮丧！我一直在反复纠结。现在虽然好一些了，因为我至少接受了我有疼痛，但我还没有接受我不能做的事情……比如跑步。

治疗师：很好的点。你只接受了它一半，而不是全部？

来访：是的。

治疗师：这对你有什么影响？

来访：我还是很沮丧。我是说，我从来都不喜欢其他运动。没有什么能给我那种自由的感觉。

治疗师：我理解。那么这种沮丧对你和你的生活有什么影响？

来访：好吧，因为我情绪低落，所以我根本没有锻炼，体重增加了……现在我最喜欢的那些衣服都穿不上了。而且我也不愿意和朋友出去，因为我对自己的外表感到自卑。现在我的朋友们对我也很失望，因为我不再像以前那样和他们一起玩了。

治疗师：所以无法彻底接受疼痛带来的限制真的对你有很大影响？

来访：是的，确实如此。

治疗师：如果你将彻底接纳应用到你有慢性疼痛这一现实中，会是什么样子？

来访：嗯……应该会比现在好。

治疗师：好的。那么我们通过工作表来一步步看看这可能是什么样子。

来访：好的。

治疗师：当你想到你的疼痛时，你能感受到你对它限制你活动的抗拒吗？

来访：哦，是的！

治疗师-来访对话示例：彻底接纳

治疗师：好的。那么我们继续进行第二步。

来访：好的。我知道如何进行正念接纳……我现在就直接说出来吗？

治疗师：没错。如果你觉得有帮助，可以闭上眼睛，然后注意与这种抗拒情绪相关的每一个成分。告诉我你在练习观察和接纳时的感受。

来访：好的……我首先注意到的是胸腔和喉咙的紧绷感。我只是在注意这种感觉……试着允许它的存在。

治疗师：很好。给它一些空间，观察它是否变化或转移，是否有温度的变化。

来访：嗯，没有温度变化，但当我开始给它空间时，这种感觉变弱了。

治疗师：很好。你还注意到了什么？

来访：我在想这不公平！

治疗师：好的。你能只是承认这个想法，然后试着放下它吗？

来访：嗯……但现在我感到很生气。

治疗师：好的，让我们暂时停留在这个情绪上。

来访：嗯……[开始有点哭] 我只是非常、非常……失望。

治疗师：是的。不能跑步对你来说是一个巨大的调整。

来访：是的。感觉太不公平了……那个想法又出现了。

治疗师：所以试着允许愤怒和失望的情绪，同时承认这个想法并让它过去……

来访：好的 [还在抽泣]。

治疗师：再停留一会儿……允许这些情绪并让这个想法过去。

来访：[过了三十秒] 好的……我不那么生气了，但我还是忍不住想这有多不公平。

治疗师：这个想法一直在反复出现？

来访：是的。

治疗师：好的。让我们进入选择彻底接纳的步骤。首先，练习放下抗拒。继续允许情绪的存在，同时尝试放下对无法跑步这一现实的拒绝。告诉我你的感受。

来访：好的……所以我不会抗拒我的疼痛让我无法跑步的事实，我会告诉自己我无法改变这一点？

治疗师：没错。不要抗拒。如果你发现自己在心理、身体、情感或冲动上有所抗拒，试着通过告诉自己无法跑步的现实是不可改变的来彻底接纳，并观察你的情绪。

来访：好的。我还是感到愤怒，所以我会告诉自己事实是我有慢性疼痛，这让我无法跑步，而且事情只能这样，因为这就是现实。

治疗师：做得很好……当你对自己说这些时，感觉怎么样？

来访：嗯 [沮丧地叹气]，实际上这让我觉得生气是没有意义的。

治疗师：为什么这么说？

来访：嗯，这让我清楚地意识到，生气只会毁了我的生活。只要我生气，我就感到失望和沮丧，然后我就不去做我想做的事情。

治疗师：好的。所以看起来继续为无法跑步而感到愤怒和失望是没有意义的，因为你无法改变这一点？

来访：它只会让我停滞不前。

治疗师：那么你的情绪发生了什么变化？

来访：它改变了……现在我有一种冲动去找出我能做些什么，以避免一直感到沉重，并且重新找回外出的动力。

治疗师：好的，很好。看来你正在关注你能控制的事情，并放下那些你无法控制的事情？

来访：是的。我们可以谈谈这个吗？

治疗师：当然！

彻底接纳

评估情境

思考一个你无法控制但难以接受的情境，然后回答以下问题：

简要描述令人困扰的情境：
哪些过去的事件导致了这个情境？
你在创造这个情境中扮演了什么角色（如果有）？
其他人在这个情境中扮演了什么角色（如果有）？
在这个情境中你能控制什么？
在这个情境中你不能控制什么？
你对这个情境的反应是什么？
你的反应如何影响了你自己的想法和感受？
你的反应如何影响了他人的想法和感受？
你如何改变你的反应以减少自己和他人的痛苦？
如果你选择彻底接纳这个情境，情况会如何不同？

如何练习彻底接纳

一旦你识别了情境并对其有了清晰的理解，你可以使用以下步骤在想象暴露或情绪激动时练习彻底接纳：

认识到你对“事实”的抗拒。
练习正念接纳与情境或现实相关的情绪。利用情绪的四个组成部分（想法、感受、身体感觉和冲动），为所有这些成分留出空间，允许它们存在而不做出反应或行动。
通过提醒自己事实来停止抗拒，例如：“这就是事实，我无法改变它”或“我必须接受我的行为带来的后果”。

就像所有技能一样，掌握这些技能需要时间和练习。提醒你的来访，当他们被触发时，越多地练习使用应对思维和彻底接纳，这些技能就越容易掌握，并且能带来更多的缓解。

总结

以下是第8章涵盖内容的概要：

应对思维是一种正念应对技巧，用于用替代性思维替换负面自动思维，从而强化适应性的应对方式。
彻底接纳是一种正念应对技巧，用于减少抗拒并增加对不可改变现实的接受度。
因为情绪跟随我们关注的事物，使用应对思维和彻底接纳可以帮助提高痛苦耐受力并减少负面情绪。
像所有正念应对技巧一样，应对思维和彻底接纳是在观察和接受情绪的四个部分后，以及当来访情绪过于激动而无法继续进行正念接纳或选择基于价值观的行为时使用的。
在激活状态下练习应对思维和彻底接纳将增强学习，并帮助来访在被触发时回忆起这些技能。

本章知识点阐述

知识点阐述

应对思维
- 定义：应对思维是指用积极的、基于力量的声明来替代自动负面思维，以帮助来访更好地管理情绪。
- 重要性：
  - 自动负面思维通常是导致情绪困扰的重要因素。
  - 通过用积极的应对思维替换这些负面思维，来访可以更有效地管理情绪，提高痛苦容忍度。
- 具体实践：
  - 识别触发情境：帮助来访识别触发负面思维的情境。
  - 识别自动负面思维：引导来访回忆在这些情境下的自动负面思维。
  - 创建应对思维：与来访合作，创建可以替代负面思维的积极应对思维。
彻底接纳
- 定义：彻底接纳是指完全接受当前的情绪和情境，而不是试图逃避或改变它们。
- 重要性：
  - 彻底接纳可以帮助来访减少对负面情绪的抵抗，从而减轻痛苦。
  - 通过接受当前的情绪状态，来访可以更有效地处理情绪，避免情绪升级。
- 具体实践：
  - 观察情绪：引导来访观察并描述他们的情绪。
  - 接纳情绪：帮助来访接受这些情绪的存在，而不是试图否认或改变它们。
  - 选择行动：在接纳情绪的基础上，选择基于价值观的行动。
正念应对
- 定义：正念应对是指在观察和接纳情绪的基础上，选择合适的应对策略。
- 重要性：
  - 正念应对可以帮助来访在面对情绪困扰时更加冷静和理性。
  - 通过正念应对，来访可以更好地管理情绪，提高生活质量。
- 具体实践：
  - 观察：引导来访观察自己的情绪和身体感受。
  - 接纳：帮助来访接受当前的情绪状态。
  - 选择：在接纳情绪的基础上，选择合适的应对策略，如应对思维或彻底接纳。

通过以上知识点的阐述，我们可以看到应对思维和彻底接纳不仅有助于来访在面对情绪困扰时更好地管理和调节情绪，还能提高他们的整体生活质量。希望这些信息能为您提供有价值的见解，并在实践中有所帮助。

知识点阐述

现实检查
- 定义：现实检查是指通过提问来验证来访创建的应对思维是否符合实际情况。
- 重要性：
  - 有助于确保来访创建的应对思维是真实且现实的，从而提高其有效性。
  - 通过现实检查，来访可以更好地识别哪些应对思维是可信的，哪些可能是不切实际的。
- 具体实践：
  - 提问：询问来访应对思维的真实性，例如，“这个陈述对你来说是真的吗？”或“这现实吗？”
应对思维的应用
- 定义：应对思维是在面对困难情绪时使用的积极、现实的声明，以替代负面的自动思维。
- 重要性：
  - 通过替换负面的自动思维，应对思维可以帮助来访更有效地管理情绪。
  - 应对思维可以提高来访的痛苦容忍度，帮助他们在面对挑战时保持冷静。
- 具体实践：
  - 记录：使用工作表记录触发因素、自动思维和应对思维。
  - 练习：在想象暴露中练习使用应对思维，以加速学习和记忆。
正念应对与应对思维
- 定义：正念应对是指在观察和接纳情绪的基础上，选择合适的应对策略，如使用应对思维。
- 重要性：
  - 通过正念应对，来访可以更好地管理情绪，避免情绪升级。
  - 正念应对结合应对思维，可以帮助来访在面对困难情绪时更加冷静和理性。
- 具体实践：
  - 观察：引导来访观察自己的情绪和身体感受。
  - 接纳：帮助来访接受当前的情绪状态。
  - 选择：在接纳情绪的基础上，选择合适的应对策略，如使用应对思维。

通过以上知识点的阐述，我们可以看到应对思维不仅有助于来访在面对情绪困扰时更好地管理和调节情绪，还能提高他们的整体生活质量。希望这些信息能为您提供有价值的见解，并在实践中有所帮助。

知识点阐述

暴露练习中的正念
- 定义：在暴露练习中，治疗师引导来访通过正念的方式面对触发情境，观察和接纳当前的感受。
- 重要性：
  - 通过正念，来访能够更清晰地感知自己的情绪和身体感受。
  - 正念帮助来访减少对负面情绪的回避和抵抗，从而降低情绪强度。
- 具体实践：
  - 观察：引导来访观察自己的情绪和身体感受，如胃部的紧绷感。
  - 接纳：帮助来访接受这些感受的存在，而不是试图改变或逃避它们。
  - 体验：让来访体验这些感受，同时保持好奇和开放的态度。
应对思维的应用
- 定义：在暴露练习中，治疗师指导来访使用之前开发的应对思维来替换自动负面思维。
- 重要性：
  - 应对思维可以帮助来访重新评估和调整他们对情境的看法。
  - 通过替换自动负面思维，来访可以减轻痛苦，提高情绪调节能力。
- 具体实践：
  - 选择情境：选择一个适度痛苦的情境进行练习。
  - 识别自动负面思维：识别来访在该情境下的自动负面思维。
  - 应用应对思维：引导来访使用应对思维来替换自动负面思维，并观察其效果。
情绪波动的管理
- 定义：通过正念和应对思维，帮助来访管理和调节情绪波动。
- 重要性：
  - 有效的情绪管理有助于来访更好地应对生活中的挑战。
  - 通过正念和应对思维，来访可以学会如何在面对困难情绪时保持冷静和理性。
- 具体实践：
  - 正念练习：定期进行正念练习，以增强情绪觉察和接纳能力。
  - 应对思维训练：不断练习使用应对思维，以逐步替代自动负面思维。
  - 持续反馈：在练习过程中，治疗师提供反馈和支持，帮助来访调整和改进。

通过以上知识点的阐述，我们可以看到在暴露练习中使用正念和应对思维不仅有助于来访更好地理解和管理自己的情绪，还能提高他们的整体情绪调节能力和生活质量。希望这些信息能为您提供有价值的见解，并在实践中有所帮助。

知识点阐述

应对思维的应用
- 定义：应对思维是在面对困难情绪时使用的积极、现实的声明，用以替代自动负面思维。
- 重要性：
  - 应对思维可以帮助来访重新评估和调整他们对情境的看法。
  - 通过替换自动负面思维，来访可以减轻痛苦，提高情绪调节能力。
- 具体实践：
  - 识别自动负面思维：明确来访在特定情境下的自动负面思维。
  - 选择应对思维：与来访合作，选择一个或多个能够替代自动负面思维的应对思维。
  - 练习应用：在想象暴露练习中，引导来访多次重复应对思维，观察其效果。
正念与情绪管理
- 定义：正念是一种专注于当前体验而不加评判的态度，帮助来访更好地觉察和接纳自己的情绪。
- 重要性：
  - 正念有助于减少对负面情绪的回避和抵抗，从而降低情绪强度。
  - 通过正念，来访可以更清晰地感知自己的情绪和身体感受。
- 具体实践：
  - 观察情绪：引导来访观察并描述他们的情绪和身体感受。
  - 接纳情绪：帮助来访接受这些感受的存在，而不是试图改变或逃避它们。
  - 体验情绪：让来访体验这些感受，同时保持好奇和开放的态度。
情绪痛苦的量化
- 定义：使用SUDS（主观痛苦单位量表）来量化来访的情绪痛苦程度。
- 重要性：
  - SUDS提供了一个客观的度量标准，帮助治疗师和来访了解情绪的变化。
  - 通过量化情绪痛苦，可以更准确地评估干预措施的效果。
- 具体实践：
  - 初始评估：在开始练习前，询问来访的SUDS评分。
  - 持续监测：在练习过程中，定期检查来访的SUDS评分，以观察情绪的变化。
  - 反馈与调整：根据SUDS评分的变化，提供反馈，并根据需要调整应对策略。

通过以上知识点的阐述，我们可以看到在暴露练习中使用应对思维不仅有助于来访更好地理解和管理自己的情绪，还能提高他们的整体情绪调节能力和生活质量。希望这些信息能为您提供有价值的见解，并在实践中有所帮助。

知识点阐述

彻底接纳的定义
- 定义：彻底接纳是指完全接受当前的事实，而不去抵抗或试图改变它们。
- 重要性：
  - 帮助个体减少因拒绝现实而产生的痛苦。
  - 通过接受不可改变的事实，个体可以更好地管理情绪，提高生活质量。
- 具体实践：
  - 识别现实：明确哪些是不可改变的事实。
  - 接受现实：练习接受这些事实，而不是抗拒或逃避。
  - 情绪调节：通过接受现实来降低情绪强度，从而更好地应对挑战。
彻底接纳与正念接纳的区别
- 彻底接纳：接受不可改变的现实，如已经发生的事情。
- 正念接纳：接受自己的情绪体验，如悲伤、愤怒等。
- 重要性：
  - 彻底接纳帮助个体处理外部现实，而正念接纳帮助个体处理内部情绪。
  - 两者结合使用，可以更全面地管理和调节情绪。
- 具体实践：
  - 彻底接纳：练习接受不可改变的事实，如分手、失败等。
  - 正念接纳：练习接受自己的情绪，如悲伤、焦虑等。
彻底接纳的应用
- 定义：通过接受不可改变的事实，个体可以减少痛苦，更好地应对挑战。
- 重要性：
  - 有助于个体从创伤性经历中恢复。
  - 通过接受现实，个体可以找到新的应对策略，促进个人成长。
- 具体实践：
  - 案例分析：通过具体例子，如分手、失败等，练习彻底接纳。
  - 反思与调整：反思自己在特定情境下的反应，调整应对策略。
  - 持续练习：定期练习彻底接纳，逐步内化这一技能。

通过以上知识点的阐述，我们可以看到彻底接纳不仅有助于个体更好地应对生活中的挑战，还能促进个人成长和情绪调节。希望这些信息能为您提供有价值的见解，并在实践中有所帮助。

知识点阐述

彻底接纳的概念
- 定义：彻底接纳是指完全接受当前的事实，而不去抵抗或试图改变它们。
- 重要性：
  - 帮助个体减少因拒绝现实而产生的痛苦。
  - 通过接受不可改变的事实，个体可以更好地管理情绪，提高生活质量。
- 具体实践：
  - 识别现实：明确哪些是不可改变的事实，如慢性疼痛。
  - 接受现实：练习接受这些事实，而不是抗拒或逃避。
  - 情绪调节：通过接受现实来降低情绪强度，从而更好地应对挑战。
彻底接纳与情绪管理
- 定义：通过彻底接纳，个体可以减少对不可改变事实的情绪反应，从而更好地管理情绪。
- 重要性：
  - 有助于减轻抑郁和焦虑等负面情绪。
  - 通过接受现实，个体可以找到新的应对策略，促进个人成长。
- 具体实践：
  - 案例分析：通过具体例子，如慢性疼痛，练习彻底接纳。
  - 反思与调整：反思自己在特定情境下的反应，调整应对策略。
  - 持续练习：定期练习彻底接纳，逐步内化这一技能。
彻底接纳的应用
- 定义：通过接受不可改变的事实，个体可以减少痛苦，更好地应对挑战。
- 重要性：
  - 有助于个体从创伤性经历中恢复。
  - 通过接受现实，个体可以找到新的应对策略，促进个人成长。
- 具体实践：
  - 案例分析：通过具体例子，如慢性疼痛，练习彻底接纳。
  - 反思与调整：反思自己在特定情境下的反应，调整应对策略。
  - 持续练习：定期练习彻底接纳，逐步内化这一技能。
彻底接纳与生活质量
- 定义：通过彻底接纳，个体可以减少情绪困扰，提高生活质量。
- 重要性：
  - 有助于改善人际关系，避免因情绪问题而产生的社交障碍。
  - 通过接受现实，个体可以更积极地参与生活，提升整体幸福感。
- 具体实践：
  - 案例分析：通过具体例子，如因疼痛而减少社交活动，练习彻底接纳。
  - 反思与调整：反思自己的行为模式，调整生活方式，以适应不可改变的事实。
  - 持续练习：定期练习彻底接纳，逐步内化这一技能，并将其应用于日常生活中。

知识点阐述

彻底接纳的过程
- 定义：彻底接纳是指完全接受当前的事实，而不去抵抗或试图改变它们。
- 重要性：
  - 有助于减少因抗拒现实而产生的痛苦。
  - 通过接受不可改变的事实，个体可以更好地管理情绪，提高生活质量。
- 具体实践：
  - 识别抗拒：明确哪些情绪或想法是对现实的抗拒。
  - 允许情绪：允许这些情绪的存在，而不是压抑或逃避。
  - 观察变化：观察情绪的变化，包括强度、温度等。
  - 放下抗拒：通过正念和自我对话，放下对不可改变事实的抗拒。
情绪管理与彻底接纳
- 定义：通过彻底接纳，个体可以更好地管理情绪，减少负面情绪的影响。
- 重要性：
  - 有助于减轻抑郁和焦虑等负面情绪。
  - 通过接受现实，个体可以找到新的应对策略，促进个人成长。
- 具体实践：
  - 正念练习：通过正念练习，观察和接受当前的情绪。
  - 自我对话：使用积极的自我对话，承认并放下负面的想法。
  - 持续练习：定期练习彻底接纳，逐步内化这一技能。
从抗拒到接受的转变
- 定义：从抗拒现实到彻底接纳的过程中，个体的情绪和行为会发生变化。
- 重要性：
  - 有助于个体从消极情绪中解脱出来，找到新的行动方向。
  - 通过接受现实，个体可以更积极地参与生活，提升整体幸福感。
- 具体实践：
  - 情绪观察：观察情绪的变化，包括愤怒、失望等。
  - 放下抗拒：通过彻底接纳，放下对现实的抗拒。
  - 寻找新方向：在彻底接纳的基础上，寻找新的行动方向和目标。
控制与放手
- 定义：彻底接纳意味着区分可以控制的事物和无法控制的事物，并专注于可以控制的部分。
- 重要性：
  - 有助于个体集中精力在可以改变的事情上，提高解决问题的能力。
  - 通过接受无法改变的事实，个体可以减少无谓的努力和痛苦。
- 具体实践：
  - 识别可控因素：明确哪些事物是可以控制的，哪些是无法控制的。
  - 专注可控部分：将注意力集中在可以控制的事情上，制定行动计划。
  - 放手不可控部分：接受无法改变的事实，避免无谓的努力和情绪消耗。

知识点阐述

彻底接纳的定义与重要性
- 定义：彻底接纳是指完全接受当前的事实，而不去抵抗或试图改变它们。
- 重要性：
  - 有助于减少因抗拒现实而产生的痛苦。
  - 通过接受不可改变的事实，个体可以更好地管理情绪，提高生活质量。
- 具体实践：
  - 识别抗拒：明确哪些情绪或想法是对现实的抗拒。
  - 允许情绪：允许这些情绪的存在，而不是压抑或逃避。
  - 观察变化：观察情绪的变化，包括强度、温度等。
  - 放下抗拒：通过正念和自我对话，放下对不可改变事实的抗拒。
评估情境的重要性
- 定义：评估情境是指全面了解一个特定情境，包括其原因、个人角色、可控因素和不可控因素。
- 重要性：
  - 有助于个体更清晰地理解情境，从而做出更有效的应对。
  - 通过评估情境，个体可以区分哪些是自己可以控制的，哪些是无法控制的，从而更好地分配精力。
- 具体实践：
  - 描述情境：简要描述令你困扰的情境。
  - 分析原因：分析导致该情境的原因。
  - 角色分析：分析自己和他人在情境中的角色。
  - 控制分析：分析哪些是可以控制的，哪些是无法控制的。
彻底接纳的步骤
- 定义：彻底接纳的步骤包括识别抗拒、正念接纳情绪、停止抗拒。
- 重要性：
  - 有助于个体从消极情绪中解脱出来，找到新的行动方向。
  - 通过接受现实，个体可以更积极地参与生活，提升整体幸福感。
- 具体实践：
  - 识别抗拒：明确哪些情绪或想法是对现实的抗拒。
  - 正念接纳：练习正念接纳情绪，允许其存在而不做出反应。
  - 停止抗拒：通过提醒自己事实，停止对不可改变现实的抗拒。
应对思维与彻底接纳的关系
- 定义：应对思维和彻底接纳都是正念应对技巧，用于管理情绪和提高生活质量。
- 重要性：
  - 应对思维通过替换负面自动思维来增强适应性应对。
  - 彻底接纳通过减少抗拒和增加对不可改变现实的接受度来减少痛苦。
- 具体实践：
  - 应对思维：用积极的替代性思维替换负面自动思维。
  - 彻底接纳：通过正念接纳和停止抗拒来接受不可改变的现实。
在激活状态下的练习
- 定义：在激活状态下练习应对思维和彻底接纳是指在情绪激动时进行这些技巧的练习。
- 重要性：
  - 有助于增强学习效果，使个体在实际情境中更容易回忆和应用这些技能。
  - 通过在激活状态下练习，个体可以在面对真实挑战时更好地管理情绪。
- 具体实践：
  - 情景模拟：在安全的环境中模拟触发情境，练习应对思维和彻底接纳。
  - 实时练习：在实际遇到触发情境时，立即应用这些技巧。

Chapter 8 Coping Thoughts and Radical Acceptance The next mindful coping skills in EET are coping thoughts and radical acceptance. Both skills have to do with the way we think about the triggering event and the emotions that go with it. As one of the four contributing components of an emotion, thoughts are powerful forces in creating and maintaining emotion. As we have discussed in previous chapters, emotions follow whatever the brain is registering as “true.” If thought content is a result of threatening stimuli, emotions may manifest as tense sensations; feelings of fear, anxiety, and dread; and the urge to fight, freeze, or flee in some way. Or if thought content is a result of pleasurable stimuli, emotions may manifest as relaxed sensations; feelings of joy, contentment, and confidence; and the urge to engage. If clients struggle with automatic negative thoughts, replacing those thoughts with coping thoughts or practicing radical acceptance can help them increase distress tolerance and regulate their emotions by downshifting emotion. EET Skill Objective: Observe + Accept + Choose mindful coping (coping thoughts/radical acceptance) Coping Thoughts Automatic negative thoughts are often made up of judgment or danger thoughts about the self and/or the self in relationship to the world. Frequently, these thoughts reflect a person’s maladaptive core beliefs organized around schemas, which contribute to and maintain distressing emotions (Rafaeli,Bernstein & Young, 2011). 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. Distinct from some other interventions that use coping strategies to increase emotion regulation and distress tolerance, all coping skills in EET are taught to be used mindfully. Similarly, coping thoughts are used differently than in other treatment interventions. Coping thoughts are taught as a mindful skill because they are used only after clients observe and accept their emotional experience. For example, after clients have practiced mindful acceptance and have located the moment of choice, they may choose to use coping thoughts to support them in decreasing distress. In order to use coping thoughts, it’s important to “cope ahead” by having some preselected cognitions in response to different triggers. To select effective coping thoughts, you’ll work with your clients to identify common automatic negative thoughts they have in response to triggers and then come up with coping thoughts that can be used to replace them. Following is a step-by-step guide to help clients recognize automatic negative thoughts and replace them with coping thoughts. Mindful Coping with Coping Thoughts Use the following steps to introduce your clients to coping thoughts: Step 1: Identifying triggering situations. Start by pulling out the blank Replacing Automatic Thoughts with Coping Thoughts worksheet (which you’ll find at the end of this section, in Appendix C, and in downloadable format at http://www.newharbinger.com/34039). Then ask your clients to recall a recent triggering situation and have them write it down in the “Trigger” column.Step 2: Identifying automatic negative thoughts. Next, ask your clients to try to remember the automatic thought(s) that came up for them in the situation. You can prompt them with questions such as, “When you experienced that trigger, do you remember what you were thinking?” or “What did you believe about yourself in that moment?” Ask them to write their thought(s) in the “Automatic Negative Thoughts” column. Step 3: Creating coping thoughts. Now it’s time to get creative. You want to guide your clients in creating a coping thought to replace the negative automatic thought. The key with effective coping thoughts is to choose statements that the clients can get on board with. If they choose a thought that reflects an unrealistic possibility, it’s unlikely they will believe it, and therefore unlikely they will get any relief from it. For example, if a client’s automatic negative thought is “I’ll never be good enough,” an effective coping thought might be “I always try my best.” However, an example of an ineffective coping thought might be “I am the best,” which may not be true, depending on the context, and may actually reinforce the negative automatic thought if the client doesn’t believe it. You’ll want to do a reality check with your clients for each coping thought, asking your clients questions to ensure that they are creating coping thoughts that will be effective. Ask them, “Is that statement true for you?” or “Is that realistic?” Once your clients have created a coping thought for this situation, guide them through completing the worksheet by recording a few more triggering situations, automatic thoughts, and coping thoughts. Give clients the Client Coping Thoughts handout so they can record the coping sequence.Step 4: O+A+C + coping thoughts. The next step is to show your clients how to practice using coping thoughts during imaginal exposure. Just as with values- based action, using imaginal exposure will accelerate new learning, retention, and recall when clients encounter a triggering situation in vivo. First, you’ll help clients practice observing and accepting the situation. Then, in the moment of choice, guide them to use one or more previously developed coping thoughts. The dialogue example provided later in this chapter can be a model for this step. Following is a handout on coping thoughts you can give to clients to help them understand this skill, and a blank worksheet for clients on which to log their triggers, automatic thoughts, and coping thoughts. (Both are available in reproducible format in Appendix C, and for download at the website for this book.) To help them understand this exercise, a filled-out sample of the second worksheet is also provided for clients. Client Coping Thoughts Coping thoughts can be used when you are facing a difficult emotion. They may be especially helpful after you’ve practiced observing and accepting the difficult emotion, and you’re still struggling with specific ruminations, or a repetitive automatic thought is fueling your emotion wave. You now know that your emotions will follow whatever you pay attention to. If you’re triggered, you’re likely to have negative automatic thoughts. One way to tolerate the distress and shift your emotion is to replace the negative automatic thought with a coping thought. The key with a coping thought is that you believe it to be true and realistic. If you don’t believe the thought, it’s unlikely to be effective. Following are some examples of coping thoughts: “This situation won’t last forever.” “I can feel anxious/sad/angry without reacting.” “I can tolerate this emotion until the wave goes down.”“This emotion won’t kill me, it just doesn’t feel good right now.” “I’ve dealt with this situation before, and I can do it again.” “I can take all the time I need to just let go and relax.” “I can let this emotion run the show, or I can use values-based action.” “Just because I feel this emotion, doesn’t mean I have to act on it.” “I am not my emotions… I can choose my next action.” Replacing Automatic Thoughts with Coping Thoughts Use this worksheet to record specific triggers, the automatic thoughts that go with them, and alternative coping thoughts with which you can replace them. TriggerAutomatic ThoughtCoping Thought 1.1.1. 2.2.2. 3.3.3. 4.4.4. 5.5.5. Replacing Automatic Thoughts with Coping Thoughts (Client Sample) Trigger

Turning in a project to my boss. Automatic ThoughtCoping Thought
My work isn’t as good as it should be.1. I’m doing my best, which is all I can do.2. Being at a party with people I don’t know.2. If I don’t say the right thing at this party, people are going to think I’m a loser.2. I can have this thought without acting on it.
My wife comes home and goes straight to the bedroom.3. My wife doesn’t love me anymore.3. My defectiveness schema is talking, but I’m not listening.
Anytime…

My boss doesn’t talk to me at the office-wide lunch. 4. Something’s wrong with me. 5. My boss doesn’t like me. 4. I have strengths and weaknesses, just like everybody else. 5. It’s not my job to be liked. It’s my job to do my job. Therapist-Client Dialogue Example: Using Coping Thoughts in Exposure Therapist: Now that you’ve completed the Coping Thoughts worksheet, let’s do an exposure exercise to practice using the coping thoughts we’ve developed for one of the triggering situations and an automatic negative thought. Client: Okay. Which one should I choose? Therapist: Just take a look at what you have there, and choose a situation that you predict will be somewhere around a 5 or 6 on the SUDS scale, with 1 being no distress and 10 being the worst distress you can imagine. Client: [Pauses] Well, I think when my wife comes home and goes straight to the bedroom. Therapist: Okay. And how distressing do you predict that scene will be for you? Client: I would say a 6. Therapist: Okay, good. Let’s take a few minutes to get into that scene. Just close your eyes and I’ll talk you through it.Client: Okay [closes eyes]. Therapist: Imagine the last time your wife came home and went to the bedroom. Put yourself in the physical location you were in. Try to remember what you were doing. Remember what you can see around you, what you can hear, anything you can sense. Can you see yourself there, and are you feeling the emotion? Client: Yes. Therapist: Okay. Where do you feel the emotion in your body? Client: I have a tight feeling in my stomach. Therapist: Okay, let’s start with that. See if you can allow that sensation to just be there, without judging it, without reacting to it, and instead opening and softening to it. Client: [Pauses] Yeah, I’m trying. Therapist: You might imagine that instead of avoiding the sensation, you are leaning into it… Client: Okay. Therapist: Just notice if the sensation is changing or staying the same; notice what size and shape it is…whether there’s a temperature to it. Client: Yeah. It’s hard and tight, about the size of a baseball. It’s not moving. I don’t feel any temperature. Therapist: Has it changed since you’ve been observing it? Client: It’s a little less intense now. Therapist: Okay, good. Can you identify a feeling that goes with the sensation? Client: Uh, maybe fear? I feel afraid. Therapist: So there’s a tight sensation in your stomach, and the feeling that goes with it is fear? Client: Yeah.Therapist: Okay. And is there an urge to do something or not do something? Client: Well, I don’t want to talk to her… I think I’m scared I’ll see that she really doesn’t want to talk to me. The urge is also to shut my office door…to hide out. Therapist: Okay. Just see if you can sit with that urge to not talk to her, and also the urge to shut the door and hide. Notice what it’s like to allow that urge to be there. Client: It feels terrible. Therapist: Okay, can you allow it to feel terrible…? Just make space for it to be exactly as it is? Client: Yeah. I just wish it would change. Therapist: Sure—it feels terrible and it makes sense you’d rather not feel that. See if you can stay with this and instead allow the feeling, and be curious about it for a few moments longer. Client: Okay. Hmm. Therapist: What came up for you? Client: Well, it got a little less terrible as soon as I just accepted that it felt terrible. Therapist: When you stopped avoiding or resisting, the emotion wave went down? Client: Yeah. Therapist: Okay. Let’s now think about the negative automatic thought that comes up for you in this situation. Client: That “My wife doesn’t love me anymore.” Therapist: Your SUDS? Client: A 6 or a little more. Therapist: Okay, let’s shut off the scene with your wife now and work on coping thoughts. What’s the coping thought that might help you most?Client: I guess that I don’t have to listen to my defectiveness schema? Therapist: Okay. So you can just say, “I’m having the thought that she doesn’t really love me anymore,” and then say your coping thought. Client: Okay. “My defectiveness schema is talking, but I don’t have to listen.” Therapist: How is that working for you? Client: Well, it takes my attention off of the fear. And…it makes me question whether it’s true that she doesn’t love me anymore. Therapist: Okay. Stay with it for a moment, just saying it to yourself a few times. [Waits 45 seconds] What’s showing up for you now? Client: Well, I feel better… Therapist: Your SUDS dropped? Client: Yeah. I was up to almost 7, and then once I said the coping thought I dropped to about a 4. Therapist: So the thought that it’s your defectiveness belief talking and not the absolute truth was helpful? Client: Yes. I’m actually surprised how much the feeling of fear changed… It’s like my whole perspective changed… Therapist: Great. Let’s try a second coping thought now. What do you think might most help now? Client: Hmm. Maybe that “My emotions aren’t the truth”? Therapist: Okay, your emotions aren’t the truth. So try saying that to yourself a few times silently. Client: Okay… Therapist: [Waits twenty seconds or so] So are you thinking differently about the trigger? Client: Yeah… I’m thinking that maybe she went to her room because she wants to change clothes and have a fewmoments to herself. Since she works as a nurse when she’s at her job, she’s with people nonstop, so maybe she just needs a little time-out. Maybe it has nothing to do with me. Therapist: Great. So that thought helped you look at this differently? Client: Yes, it helped to just allow the emotion, and then using the coping thought definitely helped too. Therapist: Good. So let’s just check in again. Where is your SUDS level in this moment? Client: It’s around a 2. Therapist: Okay, great. Let’s wrap up the exercise, take a deep breath, and let it out slowly as you open your eyes and come back to the room. Radical Acceptance Radical acceptance is a key component of dialectical behavior therapy, which was developed by Marsha Linehan (1993). It is the practice of accepting the reality of things exactly as they are without resisting or trying to change them. To grasp the concept of radical acceptance, it can be helpful to understand what it is and what it isn’t: Radical acceptance is a complete and total embracing of an unchangeable reality. Radical acceptance is not approval, passivity, forgiveness, compassion, or love. By practicing radical acceptance of a triggering situation, event, or memory, clients learn to be mindful while downregulating emotion. Clients will find that they have more freedom to choose how they respond. Radical acceptance can be a difficult skill to choose when life is painful, disappointing, or scary; it’s the opposite of what most of us want to do when things are different than what we would hope. It’s important to note that radical acceptance is distinct from mindful acceptance. Radical acceptance means acceptingthe unchangeable reality of “what is”; mindful acceptance means accepting one’s emotional experience. Following is a handout you can use to help your clients understand radical acceptance. The Art of Radical Acceptance What It Is Part of successfully navigating intense emotions is knowing when it’s time to try to improve your situation and when it’s time to accept it. Radical acceptance is another mindful coping skill that allows you to accept “what is” and stop suffering from rejecting the reality in front of you. We have a choice in every moment: to reject the reality of what is or to accept it. The choice we make will determine whether we continue to suffer or create space for something else to exist. Our natural response to distressing emotions is to fight against the reality that we think caused them. In doing this, we can make ourselves and others miserable. Choosing radical acceptance—to accept “what is”—is a huge shift for most people. It feels like the opposite of what your emotions urge you to do when you encounter pain. What It’s Not Radical acceptance does not mean you like or condone what happened. It just means that you accept the reality that it happened. In other words, some situations in life are simply unjust or unfair. In other situations, you may share responsibility for what happened. Either way, just because you accept that it happened doesn’t mean you’re condoning it. The more you practice radical acceptance, the easier it will become to stop resisting what you cannot change. Following are a few examples of radical acceptance: “My girlfriend broke up with me, but it doesn’t mean I have to retaliate or try to win her love back.” “I have suicidal thoughts all the time, but that doesn’t mean I like having them or that I will act on them.” “I didn’t set a reminder to pay that phone bill, so I will have to take responsibility for the consequences.”Radical acceptance requires a willingness to look at things differently. Sometimes our disappointments and moments of frustration were preventable. We can also practice radical acceptance by accepting what we might have done differently, and taking responsibility for how we didn’t. For example, could you have prevented being late to an appointment, forgetting to do work assignments, or behaving in a way that was less than stellar? Moreover, could you have prevented lying to hurt someone or allowing yourself to be motivated by hate? Many times we have culpability in “what is.” Accepting that is key to practicing radical acceptance. While the outcomes of these situations may have serious consequences, they can also be opportunities for growth if you can view them as moments of learning. Often people who struggle with intense emotions believe that life is something that “happens” to them, instead of recognizing their own power in creating their experience. The good news is that if we have responsibility in the things happening, we also have the power to make different choices— choices that can alleviate suffering and bring us closer to living the life we want in accordance with our values. It’s not unusual for clients to struggle with understanding radical acceptance, especially if the situation they are struggling to accept was traumatic. Following is a sample therapist-client dialogue of how you can talk to you clients about radical acceptance. The Radical Acceptance worksheet at the end of this chapter is another tool to help your clients understand and practice this skill. Therapist-Client Dialogue Example: Radical Acceptance Therapist: Have you heard of radical acceptance? Client: Um, I think so. Is it a Buddhist thing? Therapist: I believe it is something that Buddhists practice, but we are using it here as a mindful coping skill. Client: I see. So what’s radical about it?Therapist: Good question. The radical part of radical acceptance refers to how complete and total the acceptance is. In other words, you don’t just partly accept the reality of what is—you fully accept that what exists is unchangeable. Client: Okay… Therapist: So let’s use an example of something you’ve been struggling with, or wish would change, but that you can’t change. You can use the worksheet, starting with the section “Assessing the situation.” Client: I guess the fact that I have chronic pain, and no matter what I do, I can’t seem to get rid of it. Therapist: Okay, great example. Because you have done everything in your power, right? You exercise, eat healthy, and get plenty of sleep just like your doctor has told you to? Client: Yep. And I still hurt every day [eyes well up]. Therapist: Yeah. This is an ongoing challenge for you. Client: Uh-huh. Therapist: So let’s continue with the worksheet. What’s next? Client: [Looks at the worksheet] So the situation is my pain… I’m not really sure that any past events led to the situation because the doctor doesn’t really know why I hurt. Therapist: Okay. What’s next? Client: [Continuing with the worksheet] I don’t think I or anyone else played a role in my pain. I really don’t have much control over it, and what control I do have I’m already taking. Therapist: That’s right. You’re already doing all the things your doctor says can help the pain. Client: And I can’t control the fact that it still hurts every day. Therapist: Right.Client: [Continuing with the worksheet] So my response to the pain at first was to be really depressed. I just thought about all the things I can’t do anymore because it makes the pain worse. And I was really mad. Therapist: Who were you mad at? Client: I don’t know… God? My parents for giving me these genes? Therapist: Okay. And how did that affect your thoughts and feelings? Client: Gosh, I ended up miserable and depressed! I just went round and round with it. I mean, now it’s better because I at least accept I have the pain, but I still haven’t accepted what I can’t do…like running for example. Therapist: Good point. You’ve accepted it halfway, but not all the way? Client: Yeah. Therapist: And how is that affecting you? Client: I’m still pretty down about it. I mean, I just never really liked any other exercise. Nothing else gives me that feeling of being so…free. Therapist: I get it. And how does being down affect you and your life? Client: Well, I haven’t been exercising at all because I’m down, so I’ve gained weight…and can’t really fit into my favorite clothes now. And it makes me not want to go out with my friends because I’m self- conscious about how I look. And now my friends are frustrated with me that I don’t want to hang out like I used to. Therapist: So it’s really affecting you to not be able to radically accept the limitations that come with your pain? Client: Yeah. It really is.Therapist: What would it look like if you applied radical acceptance to the reality that you have chronic pain. Client: Yeah…it’s got to be better than this. Therapist: Okay. So using the worksheet, let’s walk through what they might look like. Client: Okay. Therapist: When you think about your pain, can you connect to the resistance you have about how it limits your activity? Client: Oh, yeah! Therapist: Okay. So move on to step 2. Client: Okay. So I know how to do mindful acceptance… should I just talk through it right now? Therapist: Exactly. Go ahead and close your eyes, if it’s helpful, and just notice each component of the emotion that goes with that resistance. Tell me what you’re experiencing as you practice observing and accepting. Client: All right… So the first thing I notice is a tightness in my chest and throat. So I’m just noticing that sensation…trying to allow it. Therapist: Great. Just make room for it and observe whether it changes or shifts, whether it has any temperature to it. Client: Yeah, there’s no temperature, but it got less strong as soon as I started making room for it. Therapist: Great. What else are you aware of? Client: I’m having the thought that this isn’t fair! Therapist: Okay. Can you just acknowledge that thought, and try to let it go? Client: Yeah…but now I’m angry. Therapist: Okay, let’s stay with that for a moment.Client: Yeah… [Starts to cry a little] I’m just so, so… disappointed. Therapist: Yeah. Not being able to run has been a huge adjustment for you. Client: Yeah. It feels so unfair…there’s the thought again. Therapist: So see if you can allow the anger and the disappointment, and also acknowledge the thought and let it go… Client: Okay [still sniffling]. Therapist: Just stay with that for a moment…allowing and letting the thought go. Client: [After thirty seconds] Okay… I’m feeling less angry, but I have the urge to keep thinking about how unfair this is. Therapist: The thought just keeps coming up over and over again? Client: Yeah. Therapist: Okay. Let’s move into choosing radical acceptance. First, just practice letting go of the resistance. Continue to allow the emotion while also trying to let go of any rejection of the reality that you can’t run. Let me know what’s coming up. Client: All right…so I am not going to resist that I have pain that keeps me from running, and I’m going to tell myself that I can’t change that? Therapist: Exactly. No resisting. If you start to notice your mind, body, feelings, or urges are resisting, try to radically accept it by telling yourself that the reality of not being able to run is unchangeable, and just watch your emotion. Client: Okay. I’m feeling the anger still, so I’m going to tell myself that the facts are that I have chronic pain that keeps me from running, and it can’t be any other way, because it just is this way.Therapist: Good work… What’s it like when you tell yourself that? Client: Well [exasperated sigh], it actually makes it seem senseless for me to be angry. Therapist: Why’s that? Client: Well, it makes it so clear that it’s not going to do anything but ruin my life. And as long as I’m angry, I’m disappointed and depressed, and then I don’t do anything I want. Therapist: Okay. So it seems like it makes more sense not to continue feeling angry and disappointed about not being able to run, because you can’t change that? Client: It’s just keeping me stuck. Therapist: And what’s happening to the emotion? Client: It’s shifted…and now I have the urge to figure out what I can do so I don’t stay heavy and so I feel like going out again. Therapist: Okay, great. So it seems like you’re focusing on what you can control and are letting go of what you can’t? Client: Yeah. Can we talk about that? Therapist: Sure! Radical Acceptance Assessing the Situation Think of a situation you have no control over, but about which you struggle to accept. Then answer the following questions: Describe briefly the distressing situation: What past events led to the situation? What role, if any, did you play in creating the situation? What roles, if any, did others play in the situation? What do you have control of in this situation?What do you not have control of in this situation? What was your response to this situation? How did your response affect your own thoughts and feelings? How did your response affect the thoughts and feelings of others? How could you have changed your response to this situation so that it led to less suffering for yourself and others? How could the situation have occurred differently if you had chosen to radically accept the situation? How to Practice Radical Acceptance Once you’ve identified the situation and have a clear understanding of it, you can use these steps to practice radical acceptance during imaginal exposure or when you get upset. Recognize your resistance to the reality of “what is.” Practice mindful acceptance of the emotion that goes with the situation or reality. Using the four components of emotion, make room for all your thoughts, feelings, sensations, and urges, allowing them to be there without reacting or acting on them. Stop resisting by reminding yourself of the facts, such as: “This is just the way it is, I can’t change it” or “I have to accept the consequences of my actions.” As with all skills, it takes time and practice to master them. Remind your clients that the more they practice using coping thoughts and radical acceptance when they get triggered, the easier these skills will be—and the more relief they will bring. Summary Following is a synopsis of content covered in chapter 8: The use of coping thoughts is a mindful coping skill used to replace negative automatic thoughts withalternative thoughts that reinforce adaptive ways of responding. Radical acceptance is a mindful coping skill used to decrease resistance and increase acceptance of unchangeable realities. Because emotions follow what we pay attention to, using coping thoughts and radical acceptance can help increase distress tolerance and decrease negative emotion. Like all mindful coping skills, coping thoughts and radical acceptance are used mindfully, after observing and accepting the four parts of emotion and when clients are too emotionally triggered to continue mindful acceptance or to choose a values-based action. Practicing coping thoughts and radical acceptance in an activated state will enhance learning and help clients recall the skills when they are triggered.