第二章：情绪觉察

Chapter 2 Emotion Awareness In this chapter you will learn how to introduce emotion efficacy therapy and how to teach the first EET skills component, emotion awareness. Emotion awareness is the foundation for the rest of treatment, so you’ll want to take your time to be sure clients understand how to recognize the components of an emotion before you move forward. Introducing EET is an important part of the treatment, because it may be the first time clients have considered how they experience or respond to emotions, much less a new way of relating to them. By laying out the what, how, and why of the treatment, clients begin to imagine what is possible for them through their participation, and you can increase motivation for treatment compliance. Keep in mind that many clients who struggle with emotions have a lifelong history of experiencing their emotions as confusing, overwhelming, unpredictable, destructive, and even dangerous. As such, you’ll want to regularly validate clients for seeking treatment and recognizing that being willing to face intense emotions and try new ways of responding can feel challenging and takes practice. EET Skill Objective: Observe the emotion Orienting Clients to Treatment The first step to beginning EET is to orient your clients to the treatment. As with any therapeutic intervention, building rapport with your clients is essential. You’ll want to validate them for seeking treatment and for being willing to take the challenging steps necessary to change. You might also highlight the motivation required to change and how their lives would look different if they had higher emotion efficacy.Because the goal of the treatment is to increase emotion efficacy, it’s especially important to explain the rationale and goals of EET so clients can begin to imagine what is possible for them by participating. Specifically, introducing treatment as a new way of responding to emotional experience can help motivate clients to try the new skills, as well as instill a sense of hope that by learning new behaviors they can create a more meaningful, enriching life. Following is a handout you can use to summarize how your clients can benefit from EET. (A single-page version of this— and all other handouts in this book—is available in Appendix C and online at http://www.newharbinger.com/34039.) What You Can Expect from Emotion Efficacy Therapy EET will help you learn skills so you can be more powerful in how you respond to your emotions: • You can learn to watch your emotions, seeing them rise and fall like a wave, rather than being overwhelmed or controlled by them. • You can see the parts of your emotions—thoughts, feelings, physical sensations, and urges—so they are less mysterious and less outside of your awareness. • You can learn to experience difficult emotions instead of feeling like you have to run away from them. You can learn to accept the emotion without being driven to do something that hurts you, your relationships, or your life. • You can learn to recognize the “moment of choice”—when you can either do what your emotion is driving you to do, or choose to do something that expresses your values that will enrich your life. • You can identify your core values—how you want to show up, even when you’re emotionally triggered and upset. • You can learn to act on your values in the moment of choice, rather than act on what your emotions tell you to do. • You can learn new strategies to dial down your emotions, even when they are very intense.• You can practice watching, accepting, and dialing down your emotions until you are really good at it. Emotion Efficacy The simplest way to EET is to explain to clients that pain is an inevitable part of life, as are the emotions that go with it. And while we cannot avoid pain or difficult emotions, we can reduce suffering by how we understand and respond to our emotional experience. This is what emotion efficacy—and EET—is all about. In chapter 1, we defined emotion efficacy as how well individuals can—and believe they can—experience a full range of emotions in varying frequency, intensity, and duration in an effective, contextually adaptive, values-consistent manner. In other words, high emotion efficacy facilitates the ability to experience distressing emotions without avoiding them or reacting to them. Rather, clients will be able to identify a moment of choice—an opportunity in time between the emotion trigger and the individual’s response—when they can choose to mindfully accept the experience; choose a valued action; and/or, when necessary, choose to cope mindfully. Increased emotion efficacy also means that clients will be able to break out of patterns of emotional responding that are maladaptive and create what is life enriching, in accordance with their values. Following is a handout you can share with clients to explain emotion efficacy and its components and goals. You’ll want to use this to show how EET can help to build emotion efficacy, one skill at a time. Articulating the goals of treatment will help clients begin to imagine a different relationship with their emotions. It will also help them begin to internalize the key skills EET provides. What Is Emotion Efficacy? Emotion efficacy is how well you can—and believe you can—respond to emotions, including intense emotions, effectively. This might mean responding by doing nothing, doing something that reflects what you care about in the moment, or practicing skills that decrease the emotion to keep from making the situation more difficult.This treatment is based on the idea that pain is an inescapable part of being human, as are the emotions that go with it. And while we cannot avoid pain or difficult emotions, the good news is that we can reduce suffering and increase our quality of life by how we understand and respond to our emotional experience. Another way of saying this is that, while we can’t escape painful emotions, we can choose how we respond to them. That’s what emotion efficacy is all about. The skills you’ll learn from emotion efficacy therapy (EET) will help increase your emotion efficacy through the following five components: • Emotion awareness: recognizing and understanding your emotional experience • Mindful acceptance: observing and accepting emotions, instead of reacting to them • Values-based action: responding to painful emotions with actions that reflect your values, instead of your emotions • Mindful coping: when necessary, using skills to decrease the intensity of your emotions • Exposure-based skills practice: using EET skills in an emotionally activated state We’ll be talking about these skills in every session, and by the end of treatment you’ll know about and have experience using each of them. Increasing Emotion Awareness Once clients have been introduced to the basic goal of EET and understand what emotion efficacy is, the next step is to teach them about emotion awareness. In this section, clients will develop better awareness of their emotional experience through understanding the nature of emotions, the role emotions play in motivation and choices, and how they experience them. By understanding their emotions from a process level, clients will be more able to observe their emotional experience without getting overwhelmed or caught up in it. In addition, clients will learn how to watch emotion by observing its four components: thoughts, feelings, sensations, and urges.Clients often believe that their emotions are facts. They think that they have no choice but to react and act on their emotions. Emotion awareness is the first step toward developing the ability to simply observe one’s emotional experience. Start by explaining what emotions are and what they are not. Emotions are messages sent by the brain to help respond to perceived threats and opportunities. Emotions are not the “truth,” nor are they static. Rather, they change like the weather. Emotions urge us to action. Sometimes those actions help us, but often they are dysfunctional and result in chronic suffering. Bottom line: being easily or constantly triggered doesn’t lend itself to quality of life. Emphasize the good news: while one can’t escape distressing emotions, one can choose how to respond to them. That means not assuming that emotions are “true.” Rather, one can conceptualize emotions as messages that are based on what the brain thinks is “true.” Many clients with emotion regulation problems show up with low distress tolerance and a heightened vulnerability to stress. Given the natural imperative of distressing emotions— even once skills are learned—your clients will wonder how they can respond differently to distressing emotions. Most clients seeking help for emotion problems have long histories of becoming emotionally dysregulated, reacting through contextually maladaptive behaviors, and/or attempting to alter their reactions (control, suppression, numbing, emotion substitution, etc.) (Brach, 2003). Reassure your clients that skills practice is key, both in session and during the week outside of session. Like any behavior that is repeated, responding adaptively to emotional distress will get easier the more it is practiced. And knowing there may be other ways of relating to their emotional experience leaves clients with more flexibility and choice in how they respond.Following is a handout you can use to introduce emotion awareness to your clients. Emotion Awareness What Are Emotions? What are emotions, really? Most simply, emotions are signals that help you respond to what your brain thinks is happening. Here’s how they work: the brain responds to internal and external cues (events or observations from our environment). Then the brain produces biochemical messengers, which we experience as emotions. These emotions motivate us to make choices. For example, the emotion we know as anxiety helps us choose to avoid danger. Anger helps us choose to fight when we feel threatened. Sadness helps us choose to withdraw when we need to process a loss or failure. From birth, our amazing brains are evolutionarily wired to protect us from harm—to help us survive. That means any time your brain is sensing a threat to your well-being, it will do everything it can to send you emotional messages to motivate you to protect yourself. You may have heard about this process referred to as “flight, fight, or freeze,” all of which are common responses to intense emotions. However, while our emotional wiring has been adaptive for the survival of the human race over time, the survival wiring doesn’t always serve us when it gets activated in a non-survival situation. Over time, your brain develops a “negativity bias,” whereby it constantly scans your environment for anything negative that could be interpreted as a threat so it can protect you. The downside of this protective negativity bias is that you can end up in a state of constant anxiety, or you can be easily triggered—whether or not there is an actual threat. Author and psychotherapist Tara Brach explains how the negativity bias impacts us: “The emotion of fear often works overtime. Even when there is no immediate threat, our body may remain tight and on guard, our mind narrowed to focus on what might go wrong. When this happens, fear is no longer functioning to secure our survival. We are caught in the trance of fear and our moment-to-moment experience becomes bound in reactivity. We spend our time and energy defending our life rather than living it fully” (2003, p. 168).EET can help you learn how to respond to non-survival emotions using skills that will help you respond effectively. Why Do Some People Struggle with Emotions? You’ve probably noticed that some people tend to be more emotionally reactive than others. We are all unique human beings, and how we experience emotions also depends on the wiring in our brains. While we are all born wired for survival, some of us are born with a tendency toward heightened emotional sensitivity. Others develop this tendency as a result of difficult experiences that leave them more emotionally reactive to certain cues. If you are someone who has heightened sensitivity, you may have an increased vulnerability to stress. Even more, the heightened sensitivity to certain cues can become so ingrained and the emotional reactions so automatic that you may forget you have choices when you get triggered. Unfortunately, this emotional reactivity can negatively affect your well-being, quality of life, relationships, personal goals, and long-term health. For this treatment, we will focus on how you can respond to distressing emotions and increase your emotion efficacy. You will learn how to stop being controlled by your emotions, how to respond in ways that reflect your values, and how to create more of what you want in your life. Following is a sample therapist-client dialogue of how you could introduce emotion awareness to your clients. Therapist-Client Dialogue Example: Introducing Emotion Awareness Therapist: Let’s talk a bit about emotions and how we understand them. What do you think of when you think of an emotion? Client: It’s something that tells me how I’m feeling? Therapist: Right. Your brain sends you messages to help you make choices. So what kind of messages might the brain send if, for example, you see a black bear? Client: Fear! Therapist: Exactly. And what might the fear make you want to do?Client: Run far, far away! Therapist: Yes. Let’s try another example. You know how you’ve shared that you feel very hurt when you’re friends don’t call you back? Client: Yeah, that’s really tough for me. I feel really hurt when that happens. Therapist: What do you think your brain is trying to tell you through the feeling of hurt? Client: Hmm…maybe it’s telling me to watch out? Therapist: So it could be telling you there’s something you need to pay attention to…something that could be negative? What else? Client: Well, it also makes me just want to withdraw. I will go to my room and put music on and just try to get some perspective about it—whether I should be mad or let it go. Therapist: Right. So your brain is sending you emotional messages to motivate you to take some space? Client: Yeah. I guess the message is something like: you’re feeling hurt because something bad happened, and you need some time before you can know what to do… Therapist: Right. That’s what your brain thinks is true—that something bad happened. And it motivates you to withdraw so you can try to figure it out. Client: Okay. I’d never thought about it that way. Therapist: Uh-huh. Emotions are just messages from your brain based on what it thinks is happening. The more you understand this, the more you’ll be able to choose to respond to emotional messages in ways that are helpful. What Are Emotions Made Of? In this next section, you will help clients understand the four components of emotion. You might emphasize that, in our culture, emotion is a construct commonly collapsed with justone aspect of emotion that we know as “feeling.” However, emotions are much more complex. Distinct from a mere feeling state, emotions are constructs composed of thoughts, feelings, physiological or somatic sensations, and urges. Understanding the four components of emotions will help clients become better observers of their emotions and more clear and articulate about how they experience them. Being able to deconstruct emotional experience will also position clients to create space to find the moment of choice, when they learn to choose to respond adaptively. Following is a handout you can use to introduce the four components of emotion as well as how emotions are experienced. Anatomy of an Emotion There are four components that make up your experience of an emotion: thoughts sensations urges feelings • Thoughts: Thoughts are the content of what you’re thinking. For example, “I never do anything right,” or “I want to get out of here.” • Feelings: Feelings are the label or interpretation we give the emotion, for instance, sadness, frustration, joy, and so on. • Sensations: Sensations are anything you feel in the body. This might be a sense of looseness and ease in the body when relaxed or muscle tension when anxious. • Urges: Urges are impulses to do something—or not to do something. Examples include the urge to leave, the urge to yell, the urge to withdraw. Let’s consider one example: If something great happens, you may have the thought, “There is so much to look forward to!” The feeling may be excitement. You may notice sensations of looseness and energy in your body. You may experience the urge to engage with people and/or dance around.Two more examples: When you feel sad, you may have the thought, “I will always be alone.” You may sense tightness in your stomach and a lack of energy in your body. You may have the urge to withdraw from people. If someone threatens you, you may feel angry, you may think, “How dare he say that?!” You may notice the sensation of increased heart rate and energy. You may have the urge to attack the person. Therapist-Client Dialogue Example: Introducing the Four Components of Emotion Therapist: I wonder if we could go a little deeper to explore the components of emotion and how they work? Client: Okay…or how they don’t work [laughs mirthlessly]. Therapist: Right [smiles]. So our brain is wired so that when we get cues from our bodies, or our environments, it interprets those cues and sends us messages about how to respond. But it’s more complex than that. Do you remember the four components of emotion? Client: Uh, I think so…feelings, thoughts, sensations, and urges? Therapist: Great. So let’s look at how they work together to make up an emotion. If you were to see a big black bear standing outside your door, what do you imagine you’d feel? Client: Freaked out! I mean, really scared. Therapist: Okay. So the feeling would be fear? Client: Yeah. Therapist: And what’s the thought that goes with seeing that bear? Client: Probably that I could get hurt! Therapist: Okay. And what sensations do you think you might experience? Client: Hmm. I guess my heart rate would go up? And I might get really warm, like I usually do when I get freaked out. Therapist: Okay, great. And what would you have the urge to do?Client: Run and hide! Therapist. Exactly. We’ve just walked through the four components of an emotion. Upon seeing a black bear, you had the feeling of fear; you had the thought that you could get hurt; you had the sensation of a racing heart and warmth; and you had the urge to run and hide. Client: Yeah. So how does that help me? Therapist: Good question. You probably don’t run into many black bears. But let’s look at that situation last week when your boss invited you into her office. What was the feeling then? Client: Fear [laughs]. Almost the same as a bear. Therapist: And the thought? Client: I’m in trouble. She’s gonna tell me I’ve screwed up. She’ll give me a box and tell me to pack my desk. Therapist: Right. And the physical sensation? Client: Hot, sweaty. Heart racing. Throat tight. Therapist: Okay, and the action urge? Client: Go home and say I’m sick. Get critical of the boss and my job. Say something pissed off; be defensive. Therapist: Does seeing these four parts of an emotion help you in any way? If you were observing yourself during that situation? Client: I could see I was scared and freaking myself out with those thoughts. And maybe I could see the urges and choose to do something else. Therapist: Terrific. That’s what observing the four components of an emotion can do; it helps you see how your thoughts can intensify feelings and that you have a choice in how you respond. Learning to observe your emotions, and to notice their components, will help you experience them as less overwhelming, less confusing—and you won’t get so caught up in them. Any questions about that? [Answers and/or clarifiesany questions.] Now you can practice emotion watching on your own, too, using the Emotion Watching Worksheet. Following is a worksheet clients can use to practice emotion awareness by observing and recording the four components of emotion when they get triggered, as part of their skills practice outside of session. Also shown is a list of feeling words to assist clients in identifying the specific feeling label that goes with the emotion. Both are available in Appendix C and at the website for this book. Emotion Watching Worksheet Observing the Four Components of Emotion Use this worksheet to record the four components of emotion you experience from specific triggers. Triggers Thoughts Feelings Word List Adored Afraid Amazed Angry Annoyed Anxious Ashamed Blessed Blissful Bored Bothered Broken Feelings Sensations UrgesBubbly Cautious Comfortable Concerned Confident Confused Content Curious Delighted Depressed Determined Disappointed Discouraged Disgusted Disturbed Eager Embarrassed Empty Energetic Enlightened Enlivened Enraged Envious Exhausted Flirtatious FoolishFragile Frightened Frustrated Fulfilled Glad Guilty Happy Helpless Hopeful Horrified Hurt Hysterical Impatient Indifferent Infatuated Inspired Interested Irritated Jealous Joyful Lively Lonely Loved Loving Mad MovedNervous Obsessed Optimistic Overwhelmed Passionate Pleased Proud Puzzled Regretful Relieved Reluctant Respected Restless Sad Satisfied Scared Scattered Secure Shy Smart Sorry Stimulated Strong Surprised Suspicious TerrifiedThankful Thrilled Tired Touched Trusting Uncomfortable Unsure Upset Vivacious Vulnerable Worried Worthless Worthy Now that your clients understand the goal of emotion efficacy therapy, the nature of emotions, and the components of emotions, they are ready to begin experiencing their emotions with increased awareness. Emotion awareness will set them up to learn the mindful acceptance skills introduced in chapter 3. Session Structure You’ll want to orient your clients to the structure of each EET session as follows: Mindful acceptance skills practice Skills practice review and troubleshooting challenges Review of previous week’s psychoeducation and skill Pyschoeducation on new skill Practice of new skillImaginal or emotion exposure using new skill Homework via skills practice record Skills Practice Record A new skill or skills will be taught each week, and clients are asked to practice these skills each day and to keep a record of it using the Skills Practice Record (in reproducible form in Appendix C). As part of skills practice, clients are also encouraged to do their own emotion or imaginal exposure, using the new skill they’ve learned. Instructions on how to do this are included in chapter 3. In addition, clients are encouraged to keep track of any events that are emotionally triggering to them, with the goal of identifying any recurring patterns or themes. Be sure to leave at least ten minutes at the end of your session to answer any questions about the skills they’ve learned previously or in session, or how to complete the assigned homework. Ask clients to bring their Skills Practice Record each week so you have a sense of how their practice is going outside of session. This will also help you troubleshoot any challenges that come up. After session 2, skills practice will always include at least ten minutes of daily mindful acceptance practice. While some clients will gravitate toward some of the skills more than others, you may encourage them to practice all of them, especially the ones they find more difficult. Often the skills that feel the most difficult will be the most helpful to them. You can let clients know that, by the end of the treatment, they will be asked to create their individualized emotion efficacy plan, but that during treatment they are encouraged to practice all of the skills. Skills Practice Record Emotion Efficacy Therapy Directions: Place a check mark next to the skill you practice each day. Record any triggers at the bottom. Bring this record to your next session.Day 1 Observe the four parts of an emotion: sensations, feelings, thoughts, and urges. Observe, accept, and surf your emotion wave, with SUDS. Observe, accept, and choose a values- based action. Observe, accept, and choose a relaxation skill. Observe, accept, and choose a self- soothing skill. Observe, accept, and choose a coping thought. Observe, accept, and choose to practice radical acceptance. Observe, accept, and Day 2 Day 3 Day 4 Day 5 Day 6 Day 7choose a distraction strategy. Observe, accept, and choose a time-out. Emotional triggers: Record any events or emotions that are distressing during this week. Summary Following is a synopsis of content covered in chapter 2: EET operates on the belief that pain is an inescapable part of life, but we can reduce suffering and increase quality of life by how we respond to the pain. Emotions are messengers that play an important role for our survival. Emotions are not facts. They are just the messages our brain sends to help us survive what it perceives as real. They are messages that urge us to action. Emotions are effective messages unless they occur as intense and overwhelming in non-survival situations. Humans have a bias toward negativity that sometimes leads us to interpret neutral or non-survival situations as threatening. Watching emotion involves observing the four components: thoughts, feelings, sensations, and urges. Being aware of these components is the first step toward learning to respond to emotions in a new way. EET skills are taught in an emotionally activated state to enhance learning and help clients recall the skills when they are triggered. Emotion awareness is the first step toward learning to observe emotions instead of reacting to them or acting onthem.