第三章：正念接纳

Chapter 3 Mindful Acceptance Mindful acceptance is the second component of EET and is derived from the practice of mindfulness meditation and mindfulness-based stress reduction. It builds on the skill of emotion awareness (chapter 2) and prepares clients to practice emotion surfing (chapter 4). Mindful acceptance adds to emotion awareness an intention of nonjudgmental observation and acceptance. It also emphasizes perspective taking on emotional experience that helps clients distinguish themselves from their emotional experience, creating space and flexibility to respond to pain in a contextually adaptive, values-consistent manner. EET Skill Objective: Observe + Accept the emotion Psychoeducation on Mindful Acceptance In EET, we use the skill of mindful acceptance to facilitate a posture of nonjudgmental observation, flexibility, and curiosity about one’s experience in the present moment. Mindful acceptance is simply combining that posture with emotion awareness. By making contact with the present moment, and learning to observe and accept all components of emotion, clients can begin the practice of consciously and intentionally choosing their responses. By practicing mindful acceptance, clients also learn that they are not their emotions. They learn that, as the observer of their experience, they are constant while their emotions come and go. Similar to defusion exercises for thoughts (Hayes et al., 1999), clients learn to defuse from their emotions by observing and accepting all components of the emotion: sensations, feelings, thoughts, and urges. They learn that theycan watch and allow emotional experience without collapsing themselves with their emotions. This perspective-taking practice will create the space that allows clients to locate the moment of choice (covered later in this chapter) when they are emotionally triggered, and they can choose how to respond. Mindful acceptance is a radical departure from how people instinctually respond to difficult emotions, especially those who struggle with emotion problems. Humans are wired to survive difficult emotions by avoiding the experience of them, and/or reacting or acting on them to defend or shift the uncomfortable experience. Often, instead of observing and accepting the triggered experience, clients default to maladaptive responses that provide short-term relief, even though they do not ultimately help them effectively respond. Some clients may also struggle at first with exposing themselves to their pain. To experience pain without avoiding it, acting on it, or attempting to control it may feel like a brave, new, and terrifying world. Clients may have become so skilled in avoiding their emotional experience that they find it difficult just to connect to their experience of the present moment. Discomfort is to be expected, especially since it requires doing the opposite of what our brains are evolutionally wired to motivate us to do: avoid pain. As with any new behavior, responding to difficult emotions with mindful acceptance will take time and practice, but it is essential to emotion efficacy. As the treatment progresses, it will be beneficial to help your clients continually reflect on the ways in which avoiding pain, or trying to alter their emotional experience, keeps them trapped in a vicious cycle of emotion dysregulation. This maladaptive responding also prevents clients from showing up in a way that reflects their values and creating what they want. We will explore this in detail in chapters 5 and 6, Values- Based Action Part 1 and Values-Based Action Part 2. It may also be helpful to emphasize that mindful acceptance does not imply a condoning or approving of the pain or its trigger but rather an allowing of an experience outside of one’s control. And, ultimately, practicing mindfulacceptance is what will allow clients to respond to pain and difficult emotions in ways that are authentic and life enriching. Before you begin the session on mindful acceptance, you will want to check in with your clients to see what they may know about mindfulness, so you can gauge how much psychoeducation they may need. Below are a few “primer” videos on mindfulness that may be helpful to clients who are not familiar with mindfulness. Short animated clip on mindfulness: https://www.youtube.com/watch?v=5d46amlJEkI Brief introduction with mindfulness expert Jon Kabat- Zinn on mindfulness, taken from psychalive.org, 2013: https://www.youtube.com/watch?v=HmEo6RI4Wvs Following is a handout you can use to introduce mindful acceptance, along with a script for conducting mindful acceptance practice with clients. Mindful Acceptance | Observe + Accept Mindful acceptance is derived from the practice of mindfulness, which has been shown to reduce psychological stress and improve well- being in numerous studies. The practice of mindful acceptance is essential for emotion efficacy because it will help you better tolerate difficult emotions, recover more quickly, and respond in ways that enrich your life moment to moment. Mindful acceptance will help you practice observing and accepting emotions instead of reacting to them, avoiding them, or trying to control them. It doesn’t mean you have to “like” your emotions; it simply means that you don’t resist what you are experiencing. One helpful metaphor is to think of yourself as the atmosphere and your emotions as the weather. The atmosphere is constant, while the weather is ever-changing. In mindful acceptance, you simply observe and accept changing weather, without reacting, while you as the observer remain constant. There are many benefits to using mindful acceptance when you are emotionally triggered:• Practicing mindful acceptance can help you tolerate pain without acting on it. • Practicing mindful acceptance can help you recover more quickly from the distress of the trigger. • Practicing mindful acceptance can help you 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. Following is a simple description for practicing mindful acceptance you can use as you do your skills practice outside of session. Try to practice for at least 10 minutes a day when you are resting or when you get emotionally triggered. Sensation Acceptance Scan your body for sensations with the intention of observing and accepting them instead of reacting to them. Just notice all the details of the sensations: size, shape, temperature, tension, and movement. See if you can soften to the sensation and make space for it, without trying to change it…just allowing it to be exactly as it is. Feeling Labeling Try to identify the feeling that goes with the emotion. Name it and allow it to be exactly as it is, without judging it. Thought Watching Clear your mind, and then wait and watch for each thought as it arises; let the thought go without getting involved in it. Come back to the present moment and wait for the next thought to show up. When a thought arises, you might say to yourself, “There’s a thought,” and then just let it go. If you find yourself struggling to let the thought go, you might just acknowledge it as a “sticky thought” and then let it go. Urge Noticing Notice if the emotion comes with an urge to do or not do something. Allow yourself to sit with the urge, without acting on it or judging it. Then notice what it’s like not to act on it.The more you practice these mindful acceptance skills, the bigger your emotion efficacy muscle will grow. It will get easier and easier to observe and accept your emotions instead of acting on them. Practicing mindful acceptance will also prepare you to use the other skills you will learn in EET. Script for Guided Mindful Acceptance For the next ten minutes I’m going to lead you through a mindful acceptance practice exercise. You will practice observing and accepting your emotional experience in the present moment. Practicing mindful acceptance in a neutral state will build your emotion efficacy muscle and make it easier for you to use this skill when you are triggered. First, just sit comfortably, and either close your eyes or relax your gaze and pick a spot to focus on in front of you. Now, take a few minutes to notice any sensations in your body. Scan your body until you find a sensation and rest your attention on it. See if you can let it be just as it is and get curious about it. Notice its size and shape; whether it’s moving or staying the same; if there’s any temperature or tension to it. See if you can soften to it, or even lean into the sensation… Now, see if you can identify a feeling label that goes with the sensation…just name it and allow it to be as it is without judgment or reacting to it. Next, we’ll spend a few minutes just noticing and watching our thoughts. Our brains produce different kinds of thoughts all the time, and the key is not to get involved with them. Instead, as each thought arises, you can simply say, “There’s a thought,” and then let the thought go. Then, just return to the present moment, and wait for the next thought to arise. For the next few minutes, notice your thoughts until I say stop… Okay, now stop. Next, see if there’s an urge that goes with your sensations, feelings, or thoughts. Itcould be an urge to do something or not do something. Try to just sit with the urge. Notice what it’s like not to act on the urge, to just surf it. [Allow the client to sit with the urge for 30 seconds. Then repeat the sequence one more time.] Before you come out of this exercise, take a few deep breaths and slowly open your eyes as you bring your attention back to the room. Using Exposure in EET Research has shown that rehearsal in an activated state can improve learning, retention, and recall (Szymanski & O’Donahue, 1995). Too often treatment includes knowledge about what to do but not the practice that will help clients encode the new behavior. Many clients who struggle with emotion dysregulation lack both the knowledge and practice of using skills to respond to distress. By using exposure-based skills practice, clients are able to create the new neural pathways they need when they are triggered outside of session. In EET, we use two types of exposure as a way for clients to access difficult emotions and practice skills in an activated state. The first type, emotion exposure, involves exposing to all parts of emotion in an activated state. The second type, imaginal exposure, involves imagining a scenario, exposing to the emotion that goes with the scene, and, in an activated state, visualizing behavioral responses to the distressing situation. You’ll want to prepare your clients for exposure exercises by doing psychoeducation on how it works, as well as how to effectively engage in the exercise. Exposure can be especially difficult for clients who have low distress tolerance and who may also be especially sensitive to somatic sensations, as with panic disorder. It will be important to review guidelines for choosing an exposure stimulus that provides enough emotional activation to be effective but not so much that clients become completely dysregulated and can’t participate in the exercise.The following handout will help you provide guidance and psychoeducation to your clients about how to do exposure- based skills practice. Introduction to Exposure In this treatment we’ll be doing some skills practice we’ll call “exposure exercises.” The exercises are intended to help you “expose” yourself to the experience of difficult emotions so you can learn how to recover from distress as well as learn new ways of responding that enrich your life. Research shows that when you face distress instead of avoiding it, you can not only increase your tolerance of the distress but also recover more quickly. Here’s how it works. First pick a situation or scene that is distressing to you. For example, try to recall the last time you got upset, and see if you can feel yourself getting activated when you think about it. Then, assess whether it is activating enough to use for your exposure practice using the following SUDS tool. The SUDS Rating The SUDS rating stands for subjective units of distress scale. In plain terms, this just means how much distress you experience when you think about the situation on a scale of 1 to 10, with 1 being no distress and 10 being the most distress you can imagine. For each situation, you want to predict how upset you might become if you expose yourself fully to the emotion of the situation. Ideally, your distress will be in the 5 to 7 range. If your distress is too low, the exercise is unlikely to be effective, and if it’s too high, you may become distracted and unable to stay engaged. 1 = no distress 3 = noticeable distress 5 = moderate distress 7 = distressing and uncomfortable 10 = worst distress imaginable If at any point in the exposure exercise you begin to feel too distressed to stay with it, you should let the therapist know and/or stop the exercise. You are in the driver’s seat.Therapist-Client Dialogue Example: Introducing Mindful Acceptance with Emotion Exposure Therapist: Let’s try an exercise with mindful acceptance skills. Just take a few minutes to think of a recent situation that was distressing to you. You want to choose something you predict will be around a 5 to 7 on the SUDS scale, with 1 being no distress and 10 being the worst distress you can imagine. Client: [Pauses] Okay, like maybe when my boyfriend is always late to pick me up and doesn’t call. Therapist: Okay. How distressing do you predict that scene will be for you? Client: Oh, it gets me going. Probably like a 6.5. 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 you were waiting for him to pick you up. Put yourself in the physical location you were in. Remember what you can see around you, what you can hear. Can you see yourself there, and are you feeling the emotion? Client: Oh, yeah. I feel it. Therapist: Okay. Where do you feel the emotion in your body? Client: Wow. I hadn’t really thought about it, but my shoulders get really tight and I start to feel warm, even just sitting here thinking about it. Therapist: Okay, great. So let’s explore what it would be like to open to all these emotional experiences, starting with the tightness and warmth you’re feeling. Can you allow those sensations to just be there, without judging them, without reacting to them, and instead opening and softening to them? Client: Okay [takes a deep breath]. Therapist: And is there a feeling that goes with the sensation?Client: I’m angry. No…I’m scared. I guess I’m afraid he doesn’t really love me. If he did, he would be more excited about seeing me—he would be on time. Or at least have the decency to call and let me know he’s running late. Therapist: So you’re scared he doesn’t really love you. Client: Yeah. I know it sounds dramatic, but that’s the thought I’m having. Therapist: Okay, good. Let’s practice watching your thoughts and letting them go for a few minutes. Client: Okay. Just tell you? Therapist: Yes. You can just say, “I’m having the thought that he doesn’t really love me,” and then let that thought go, and wait for the next one to arise. Client: Okay. I’m having the thought that “I’m not pretty enough.” Therapist: Okay, now let that thought go, and wait for the next. Client: Okay… I’m having the thought that overreacting,” and now I’m letting it go. “I’m Therapist: Good. Client: [Pauses] I’m having the thought that “He doesn’t need me as much as I need him.” That one’s hard to let go [sighs]. Therapist: That’s okay. Just acknowledge it by saying, “There’s a sticky thought,” and let it go. Client: Okay. Therapist: Can you identify an urge that goes with these thoughts? Client: Hmm. Well, definitely the urge to shake him and tell him off! Therapist: Okay. Can you try to just sit with that urge by observing and accepting it? See if you can allow it tobe just as it is? Maybe you can imagine making space to feel that urge without acting on it. Client: I’ll try. Therapist: [Pauses fifteen seconds] What’s happening now in your body? Client: It just kind of relaxed…and my mind isn’t going so fast. Therapist: So the tension you were feeling has relaxed? Client: Yeah. It’s still there a little, but way less. Therapist: Okay. And your thoughts are slowing down? Client: Yeah. I’m still having the thought “He doesn’t really love me”…but…it stopped feeling so “sticky” once my body relaxed. Kind of like they were connected to each other. Therapist: Right. So let’s stay with that thought for a moment. See if you can just acknowledge that thought, without reacting to it, without judging it, and instead just letting go of it. Client: Okay. Therapist: What’s happening now? Client: I am having the thought that “This is really different.” Therapist: You mean letting go of your thoughts? Client: Yeah. I didn’t realize I had a choice. Maybe I can do this when it actually happens. Therapist: That’s the goal. So where is your SUDS level in this moment? Client: Um… I think it’s around a 2 or 3. Therapist: Okay, great. Let’s wrap up the exercise. Take a deep breath in and let it out slowly as you open your eyes and come back to the room. Moment of ChoiceOnce clients understand how to practice mindful acceptance, you’ll want to explain how to locate the moment of choice. Locating the moment of choice is important for emotion efficacy because this is how clients find the space to choose how to respond to difficult emotions in ways that are effective and hopefully life enriching. The moment of choice is 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), and distraction and time-outs (chapter 9). You’ll want to emphasize that finding and using this “moment” is essential to increasing emotion efficacy. Following is a handout you can share with your clients to introduce the moment of choice. (For a single-page version of the handout, visit http://www.newharbinger.com/34039, or see Appendix C.) Moment of Choice As humans, we don’t have control over whether or not we have emotions. Emotions will arise naturally in response to what’s happening inside us and around us. But we can control how we respond to our emotions, and that’s where we find true emotion efficacy. This concept was illuminated by neurologist and psychiatrist Victor Frankl as follows: Between stimulus and response there is space. In that space lies our freedom and power to choose our response. In those choices lie our growth and happiness. (n.d.) How effectively we respond to difficult emotions depends on being able to locate this “moment of choice.” This moment is the time when you realize that you’re emotionally triggered, and you realize you have the power to choose how to respond. You might think of it as a “sacred pause” when you can either react, avoid, or try to control it—or you can choose a response that is life enriching.In EET, you’ll learn a variety of skills you can choose to use in your moment of choice to help you respond to your emotions in a way that brings you close to what you want to create in the moment. EET Model = Observe + Accept Emotions > Locate Moment of Choice > Choose EET Skill Therapist-Client Dialogue Example: Talking to Clients about Locating the Moment of Choice Therapist: So now that you know how to observe and accept the components of an emotion, you’re ready to practice locating the moment of choice. Client: What’s that? Therapist: The moment of choice is the moment you recognize your choice in the face of distress. It’s when you recognize you could choose a response that is conscious and authentic rather than letting your emotions run the show. Client: But what if I can’t find it? What if I’m still so upset after practicing mindful acceptance that I still act on my emotion? Therapist: It takes practice to locate the moment of choice, but it gets easier the more you try it. All that’s needed to find it is to pause long enough to realize you have a choice in how you respond. Does that make sense? Client: I think so. Therapist: Let’s try it. How about we try to locate the moment of choice using a triggering situation right now? Can you think of a triggering situation that’s happened recently? Client: Sure. Last week when one of my coworkers took credit for an idea I came up with. Therapist: What was the trigger, or the moment you realized this had happened?Client: She announced it as her own idea in the middle of an office-wide marketing meeting. Therapist: Okay, let’s go with that. Just close your eyes, and we’ll take a few minutes to get into the scene. Just locate yourself at the meeting and remember what she said, and let yourself get emotionally activated. Client: [With eyes closed] Oh, I’m activated! Therapist: Good. So as you think about the moment when you realized she was taking credit for your idea, what comes up for you? Client: I wanna reach across the table and strangle her! She knows how hard I’ve been working to get promoted. Therapist: And what did you do? Client: I got up and left the meeting. Therapist: Okay, let’s work with that emotion. Let’s begin using mindful acceptance starting with what you sense in your body? Client: Yeah… My heart is racing…um…my stomach is tense, really tense. Almost like I got sucker punched. Therapist: Okay, let’s stay with that sensation of tension for a moment. Just notice the size and shape of the tension, and see if you can allow it to be exactly as it is. Client: Okay. Yeah. It’s the size and shape of a grapefruit… Therapist: Good, now notice if there’s any temperature to it… if it’s hot or cold or neutral. Client: It’s warm. Therapist: Now, notice what happens as you accept the sensation and make room for it… Does it change or stay the same? Client: It’s relaxing a little. Therapist: Okay, good. Now see if you can identify a feeling label that goes with the sensation and the urge tostrangle your coworker. Client: Just…outrage. Pure and simple. Therapist: Okay, good. Now see if you can soften to that feeling of outrage… Make space for it and just allow it to be as it is. Client: It’s intense, but okay. I’ll try. Therapist: Okay, just allow it to be intense then. Continue trying to soften to it, lean into it even. Therapist: [Pauses for 30 seconds] What’s happening to the feeling now? Client: It’s starting to feel a little boring. Therapist: Boring? Client: Yeah, like I’m tired of focusing on it…and it’s not that strong anymore. Therapist: Okay, let’s move into thought watching. Client: I’m having the thought “She betrayed me and I shouldn’t have trusted her. I’m so stupid!” Therapist: Okay. Can you acknowledge the thought that she betrayed you and let it go? Client: I don’t want to let it go, but I’ll try. Therapist: It makes sense… Your brain thinks you need to hold on to that thought so you don’t get hurt again. But see if you can just acknowledge that it’s a sticky thought, and let it go. You can always come back to it another time. Client: Okay. Now I’m having the thought “I am so emotionally messed up.” Therapist: Okay. Can you see that’s a judgment thought, and just acknowledge it and let it go? Client: Okay… there’s a judgment thought…bye-bye! Therapist: [Chuckles] Good for you. Now let’s check in to see what urge goes with the emotion.Client: Hmm. Well, I still want to strangle her, but it’s less intense. Therapist: Okay, so can you just notice what it’s like to have the urge to want to strangle her? Can you just sit with it for a moment? Client: Okay. Therapist: [Waits 30 seconds] What’s showing up now? Client: Well, I feel less like strangling her… It’s a pretty violent urge. I’m a little embarrassed. Therapist: I understand. Can you just allow that feeling to be there without judging it? Client: Yeah, okay. Therapist: Staying with the urge, can you see if you can imagine not acting on it, and just sit with it? Client: Yeah…you mean like not leaving the meeting? Therapist: Exactly. Just observe and accept that you had the urge to leave. Client: Okay. Therapist: Now, can you locate the moment when you had a choice about that? Client: Well, I might have had a choice right then if I did these mindful exercises when it happened. Therapist: Right, can you see that moment? Client: I think so… If when I got outraged I had paused and noticed the moment of choice, I could have chosen to just stay in the meeting? Therapist: Right. By using mindful acceptance, you might have seen your power in the situation—in the moment of choice. Client: Yeah, I can see that. Therapist. Okay, take a deep breath and let it out slowly as you open your eyes and come back to the room. In our next session we’ll learn a new mindful acceptanceskill called emotion surfing that you can use to just ride out the emotion, instead of acting on it. Summary Following is a synopsis of content covered in chapter 3: Mindful acceptance is the practice of observing and accepting (distinct from avoiding, reacting to, or trying to control or alter) the four components of emotional experience through: sensation acceptance, feeling labeling, thought watching, and urge noticing. The moment of choice is the space between an emotional trigger and action, when clients can consciously and intentionally choose their response. Mindfully accepting emotional experience is essential to locating the moment of choice during an emotionally triggering situation. Exposure to emotional experience allows clients to develop more facility and flexibility with how they respond to triggers. Practicing mindful acceptance in an activated state will enhance learning, retention, and recall.