第一章：情绪效能疗法

第一章情绪效能疗法

情绪效能是指一个人能够在情境适应和价值观一致的情况下，有效地体验和应对各种情绪的能力。因此，情绪效能既包括人们对驾驭自己情绪生活的信念，也包括他们实际做到这一点的能力。人们越是能够有效地体验困难的情绪，通过应对策略调节情绪，并表达自己的价值观，他们的情绪效能就越高。

在构建情绪效能疗法（EET）的概念时，我们审视了构成个人与情绪关系的各个方面，并识别了影响情绪效能的关键因素。我们得出结论，低情绪效能很可能是由关键的脆弱性或适应不良的行为反应模式造成的——这些行为是为了应对情感痛苦或避免痛苦而产生的，它们助长并维持了心理病理过程。一些常见的脆弱性和模式可能表现为以下一种或多种：

生物易感性或敏感性：导致高反应性的生物倾向。
显著的情绪回避（有时也称为体验回避）：努力避免由内部或外部线索触发的不适感觉、情绪和认知。
显著的痛苦不耐受：认为自己无法忍受厌恶情绪的感知或信念。
显著缺乏情绪调节技能：缺乏有效降低情绪强度或转移情绪的技巧。
持续且显著的社会无效化环境：个体所处的环境经常否认或贬低其情绪体验的有效性。

具有这些脆弱性的个体往往会出现严重的情绪问题。他们可能对自己的情绪体验缺乏理解，也没有清晰的方法来容忍困难的情绪、做出符合价值观的选择，或者调节情绪。随着时间的推移，这些脆弱性和长期的适应不良行为模式会导致慢性情绪失调，并进一步引发抑郁、焦虑和压力等下游症状。实际上，这些适应不良的模式变得如此根深蒂固，以至于几乎成了硬连线，非常难以改变，使个体感到被困住、停滞不前和绝望。

在EET中，我们将情绪失调定义为一系列在特定情境下不适应的思想、感受、身体感觉和行为冲动。情绪失调也是有问题的，因为它常常导致行为失调——以不适应的方式对情绪作出反应。这样，情绪失调和行为失调共同导致了低情绪效能。

低情绪效能的影响广泛且深远。一些数据显示，低情绪效能在寻求心理治疗的多个诊断类别中的75%以上的个体中造成了巨大的痛苦（Kring & Sloan, 2010）。此外，普遍的情绪问题可以显著影响个体在人际关系、工作、学校和法律等多个领域的生活。低情绪效能可以显著损害生活质量，在极端情况下，甚至会干扰生活。

例如，研究表明情绪失调与较高的抑郁、焦虑、冲动和自杀倾向相关（Garnefski & Kraaij, 2007; Carver, Johnson, & Joormann, 2008; Kleiman & Riskind, 2012）；生活质量下降；痛苦增加和生活功能受限；痛苦和疼痛加剧；记忆和问题解决能力受损；以及与有意义和有价值的生活活动的联系减少（Richards & Gross, 2000; McCracken, Spertus, Janeck, Sinclair, & Wetzel, 1999; Marx & Sloan, 2002; Hayes, Luoma, Bond, Masuda, & Lillis, 2006）。此外，情绪失调还与较低的社会技能功能、物质滥用、低终生成就和自我效能感低下有关（Berking et al., 2011; Eisenberg, Fabes, Guthrie, & Reiser, 2000; Caprara et al., 2008）。

为什么选择情绪效能疗法？

尽管情绪调节问题普遍存在，现有的治疗方法往往只针对症状，而未能识别和处理问题的根本原因。此外，治疗可能教会来访如何使用某些技能，但缺乏必要的体验性成分，这对于学习新的应对和响应困难情绪的方式至关重要。即使是目前基于证据的治疗方法，在改善情绪调节及其下游症状方面也仅显示出中等程度的效果（Kliem, Kroger, & Kosfelder, 2010）。情绪效能疗法试图为情绪问题提供一个更有效、便携且通用的协议。

EET的基本哲学前提是，虽然痛苦是不可避免的，但痛苦是可以避免的。部分痛苦来自于不知道如何实现赋予生命意义的价值观。更常见的是，它来自于不愿意体验困难的情绪，这会加剧痛苦并导致更多的痛苦。此外，当来访试图通过适应不良的行为反应来避免或控制痛苦时，痛苦会被维持甚至加剧。如果来访能够学会在被情绪触发和做出反应之间强有力地导航，他们就可以被赋能去创造越来越符合价值观且充实的生活。

我们认为EET可以帮助数百万人通过提高他们的情绪调节能力和做出与其价值观和意图一致的选择来提高他们的情绪效能。最终，高情绪效能——即能够体验一系列情绪，并以正念接纳、基于价值观的行为和正念应对作出回应——意味着一个更多人创造更加真实、强大和有意识生活的世界。

情绪效能疗法：基础要素

EET被构想为一种跨诊断的、理论驱动的、基于情境的治疗方法，整合了情感科学、传统认知行为疗法和第三波认知行为疗法以及学习理论的研究成果。因此，EET是几种认知行为疗法的发展结果，将接受与承诺疗法（ACT）和辩证行为疗法（DBT）的成分整合到基于暴露的治疗中。ACT是由Steven Hayes、Kelly Wilson和Kirk Strosahl开发的一种基于正念的疗法，教导来访接受痛苦而不是试图控制它，并致力于从来访价值观出发的行动（Hayes, Strosahl, & Wilson, 1999）。DBT由Marsha Linehan博士开发，用于治疗涉及严重情绪失调的严重和复杂精神障碍（Linehan, 1993）。

EET的理论基础

EET的理论依据基于支持其治疗结构和内容的基础研究：

跨诊断效能：数据表明，不同诊断障碍之间存在更多的共性而非差异，这进一步强调了跨诊断治疗方法的必要性（McEvoy, Nathan, & Norton, 2009）。与专注于减少症状的诊断治疗不同，跨诊断方法识别并针对驱动症状的机制进行干预。
哲学视角：从哲学角度来看，跨诊断方法认为痛苦不是由疾病及其引发的痛苦造成的，而是由对痛苦的脆弱性和适应不良的行为反应造成的。
研究支持：研究表明，针对跨诊断或潜在驱动因素的治疗比分类诊断方法更有效（McEvoy et al., 2009; Frank & Davidson, 2014）。跨诊断方法不仅解决了问题的驱动因素，还允许为呈现多种症状的来访提供单一疗法。事实上，McEvoy及其同事（2009）的一项元分析发现，统一（跨诊断）的情绪障碍治疗方法与症状改善相关，总体上优于等待名单对照组，并且与共病障碍的改善相关，可能与特定诊断方案相比效果相当。

情绪效能疗法针对低情绪效能的跨诊断驱动因素。与其专注于减少情绪失调及其下游症状（如焦虑、抑郁、压力和冲动），EET技能侧重于提高痛苦耐受力和减少情绪回避。通过五个组成部分——情绪觉察、正念接纳、基于价值观的行为、正念应对和基于暴露的技能练习——来访学会了在面对困难情绪时扩展选择。他们不再以无效且情境不适应的方式做出反应，而是学习工具来发展与情绪的新关系。

由于来访往往不符合单一诊断类别，或者可能符合多个类别，我们认为治疗必须识别并针对实际造成和维持痛苦的机制。EET针对两个与低情绪效能相关的跨诊断驱动因素：痛苦不耐受——认为自己无法体验痛苦情绪的感知或信念；以及情绪回避——试图避免或改变厌恶的情绪体验。通过教导来访忍受痛苦而不是回避情绪体验，他们被赋能以在情境适应和价值观一致的情况下有效地回应情绪。

跨情绪学习作为改变的关键

基于情感科学，我们知道行为模式是多种因素共同作用于神经通路的结果，这些通路既有出生时就硬连线的（例如，逃跑、战斗、冻结），也有随着时间逐渐形成的，构成经验或偏好（Hanson, 2009）。这些通路由学习和记忆创建并维持（例如，当狗对我咆哮时，它是不可预测的，我应该避开它；当妈妈微笑时，她愿意拥抱和嬉笑）。学习发生后，这些通路会在内部线索（认知、躯体或情感）和外部线索（环境中的）被认为“像”其他事件时重新激活，因此情绪反应是自动的。当学到的反应是适应不良的——即它们未能激励有效的、符合价值观的选择——它们可能导致痛苦，并在心理病理过程中起病因作用（Tryon, 2005）。

研究表明，新的学习是改变的关键，且是跨情绪的，包括认知、情感、躯体和行为成分（Tryon, 2005; Lauterbach & Gloster, 2007）。这意味着为了促进对痛苦或恐惧体验的新反应，必须发生新的学习。由于学习和记忆是通过经历的编码形成的，因此利用所有感官和知觉成分（认知、躯体和情感）对于新学习至关重要。在EET中，跨情绪学习通过激活所有情绪成分——思想、感觉、情感和冲动——来构建围绕新行为的神经通路。

基于暴露的技能练习以提高学习、保持和回忆

基于支持暴露疗法和状态依赖性学习理论及研究的有效性，基于暴露的技能练习是在痛苦激活状态下应用技能，以促进跨情绪学习（Szymanski & O’Donahue, 1995）。在过去的二十五年里，暴露疗法被越来越多地认为是治疗焦虑最有效的干预措施之一。它也被视为治疗恐慌障碍的金标准。

状态依赖性学习的概念是指人在学习时所处的状态会被编码并与刺激配对。这在治疗中使用情绪有几个含义。例如，一些研究表明，在实验中，当暴露和回忆时诱发相同的情绪状态时，参与者的回忆效果优于那些在学习（暴露）和回忆（检索）之间情绪状态不同的人（Szymanski & O’Donahue, 1995）。此外，一些研究表明，情绪可能增加对与特定情绪状态相关的神经网络的访问（Persons & Miranda, 1992）。

EET通过暴露利用状态依赖性学习，通过增加学习、保持和回忆EET技能来促进在情绪激活状态下的新学习。来访在情绪和想象暴露的引导下，面对困难的内部和外部情绪体验，同时应用EET技能来实施情境适应的、符合价值观的行为反应。

情绪效能疗法协议

EET通过心理教育、技能练习和体验活动来提高情绪效能。通过将情绪觉察、正念接纳、基于价值观的行为和正念应对整合到基于暴露的技能练习中，来访学会容忍他们的痛苦，在必要时调节情绪，并做出符合他们价值观的选择。

EET的五个组成部分

每个疗程都专注于一个或多个以下五个治疗组成部分，这些部分相互构建：

情绪觉察

情绪觉察是指能够与当前时刻的情绪接触的能力。情绪通过其四个组成部分体验，来访学会识别情绪如何通过思想、感受、感觉和冲动表现出来。通常，来访知道他们在经历一种情绪，但不确定具体是什么情绪。或者他们可能知道情绪，但没有意识到情绪是如何在其各个组成部分中表现出来的。情绪觉察还包括理解情绪的起源或触发因素以及典型的情绪波持续时间。对自己情绪体验的觉察是提高情绪效能的第一步。

正念接纳

建立在情绪觉察的基础上，正念接纳是指非评判性和非反应性地观察自己的情绪体验，并允许（接受）情绪的每一个组成部分：思想、感受、感觉和冲动。来访通过学习体验情绪及其各个组成部分而不试图改变它们，来学会忍受痛苦的情绪。情绪觉察和正念接纳共同提供了一种替代情绪回避的方法，为来访提供了具体的练习技巧，而不是试图避免或改变他们的情绪体验。研究表明，情绪觉察和正念接纳都是有效跨诊断干预情绪失调的组成部分（Ruiz, 2010; Wilamoska et al., 2010）。事实上，观察和接受体验似乎可以增强情绪调节（Ruiz, 2010）。这两个核心组成部分构成了情绪效能疗法的基础。情绪觉察和正念接纳使来访能够在情绪触发和反应之间的选择时刻识别出来，这时他们可以选择如何回应他们的痛苦。更具体地说，来访学会了即使面对困难或厌恶的情绪，也能找到选择的时刻。在这一刻，他们可以选择只是“冲浪”情绪波，而不是对其作出反应或采取行动。

基于价值观的行动 (VBA)

基于价值观的行动（VBA）是指在选择时刻有意识地践行核心价值观。通过情绪觉察和正念接纳提高了痛苦耐受力后，来访现在能够识别选择时刻，并在面对厌恶情绪时做出符合价值观的选择。在基于价值观的行动中，来访首先在各种情境下（如工作、家庭、社区等）识别他们的核心价值观。通过命名他们在每个情境下的价值观，来访可以确定具体的基于价值观的行为，从而在选择时刻以符合其价值观的方式表达自己。与所有EET技能一样，来访通过基于暴露的技能训练，在激活状态下练习选择基于价值观的行为。

一些研究表明，践行价值观与心理幸福感和生活质量的提高相关（Hayes, Strosahl, & Wilson, 1999; Ruiz, 2010）。由于EET不仅旨在提高痛苦耐受力和情绪调节能力，还旨在提高生活质量，因此基于价值观的行动是EET的核心技能之一。此外，VBA对于提高情绪效能至关重要，因为它增强了来访对困难的新行为反应的承诺。通过选择基于价值观的行动而不是通过适应不良的情绪驱动行为作出反应，来访进一步增加了他们的痛苦耐受力以及生活的质量。

正念应对

正念应对是通过使用正念接纳来识别选择时刻，然后利用应对技巧来降低情绪强度而发展起来的。有时，个体可能会被困难情绪压垮，以至于无法实践正念接纳并冲浪情绪波直到它消退，更不用说在选择时刻选择基于价值观的行动了。在这种情况下，他们需要调节情绪的策略，以防止情况变得更糟（Linehan, 1993）。当来访的观察、接受和/或选择基于价值观的行动的能力被情绪痛苦超出时，他们可以选择正念应对技巧来降低情绪强度。

虽然应对通常被概念化为尝试改变和调整情绪体验，但正念应对使用正念接纳作为选择情绪调节技巧的门户。正念应对始于正念接纳——即观察和接受情绪及其组成部分。接下来是识别选择时刻并选择一种应对技巧来降低情绪强度。

正念应对的概念是EET的新内容，代表了一种尝试在危机情况下给来访提供必要的情绪调节技能，同时鼓励他们仅将应对作为最后的手段——在首先实践正念接纳之后。与其选择应对技巧来避免或改变厌恶情绪，不如选择正念应对来扩展选择，并帮助来访恢复，以便他们可以选择基于价值观的行动。

基于暴露的技能练习

这种练习指的是在激活状态下使用EET技能，包括情绪暴露和想象暴露（也称为基于想象的暴露）。在情绪暴露中，来访学会有意激活自己，以此来练习正念接纳和正念应对。此外，来访学习使用想象暴露——利用情境中的图像来激活情绪，然后可视化执行基于价值观的行动。如前所述，在激活状态下练习技能可以提高学习、保持和回忆；创建新的神经通路；并在面对痛苦情绪时更容易实施有效的选择。

情绪效能疗法的独特之处

通过教导个人可以面对痛苦——痛苦不会摧毁或压垮他们，也不必导致更多的痛苦或破坏性行为——他们的忍受痛苦的动力会增加，从而打开了扩展行动选择的大门。通过心理教育和激活状态下的技能训练，来访学会了新的应对困难情绪的方法。在选择时刻，来访能够选择正念接纳当前的情绪体验，执行基于价值观的行动，和/或降低他们的情绪强度。使用EET技能，来访能够有效地体验困难情绪，更快地从情绪失调中恢复，打破适应不良的反应模式，并在面对痛苦时表达他们所珍视的价值观——时刻如此。

当来访在痛苦情绪触发时练习EET技能，新的选择会变得越来越容易。在短时间内，他们可以与自己的情绪建立一种新的关系，从而显著提高情绪效能：

体验自己与情绪分离的能力：能够体验到自己与情绪是分开的。
体验强烈情绪的能力：能够体验强烈的情绪，而不是做出反应和回避。
即使情绪被触发也能选择基于价值观的行动：能够在情绪触发时选择符合价值观的行动。
选择策略来降低情绪强度，并防止困难情况恶化：能够选择策略来调节情绪，避免使困难的情况变得更糟。

尽管情绪效能疗法整合了接受与承诺疗法、辩证行为疗法和暴露疗法的成分，但有几个特点使其区别于当前针对情绪问题的治疗方法：

EET是一种独特的混合疗法。情绪效能疗法结合了情绪觉察、正念接纳、基于价值观的行动和正念应对，为不同情绪效能水平的来访提供了一系列工具。
EET使用基于暴露的技能训练。情绪效能疗法通过情绪暴露和想象暴露加速新学习，并提高保持和回忆能力。
EET包含正念应对。情绪效能疗法不仅仅是提供应对技巧来降低情绪强度，而是将正念接纳与特定的应对技巧结合起来，让来访首先接受自己的情绪体验，识别选择时刻，然后有意识地、正念地转移情绪。
EET是简短且便携的。与其他一些情绪问题治疗相比，情绪效能疗法可以在八周内完成，并且可以适应团体或个体形式。

到目前为止，EET已被证明能显著减少情绪失调（效应量d = -1.21），增加对负面情绪的效能（效应量d = 1.38），提高痛苦耐受力（效应量d = 1.34），并减少经验性回避（效应量d = -0.81）。有关详细信息，请参见附录B。EET是简短的、成本效益高的，并且适用于个体和团体格式。

如何使用本书

在本书中，我们介绍了如何在个体和团体治疗中使用EET。第2章至第10章涵盖了每个EET过程，包括每个治疗概念的心理教育、治疗师与来访的对话示例、您可以与来访一起使用的讲义和工作表，以及教授和实施新技能的体验式练习脚本。

第2章：介绍第一个EET技能——情绪觉察：识别和观察情绪反应的四个组成部分的能力。
第3章：介绍第二个EET组成部分——正念接纳：在情绪触发时非反应性和非评判性地观察和接受情绪。
第4章：涵盖情绪冲浪，这是基于情绪觉察和正念接纳的核心技能，应用于情绪生命周期，并识别选择时刻。
第5章：介绍价值观和价值观澄清，帮助来访识别基于价值观的行动。
第6章：介绍在选择时刻使用基于价值观的行动。
第7章：介绍正念应对，并涵盖使用正念接纳与放松和自我安抚的应对技巧。
第8章：介绍通过正念接纳和应对思维进行正念应对。
第9章：通过正念接纳和分心进行正念应对。
第10章：概述如何帮助您的来访将所有这些内容综合起来，制定个性化的EET计划；还提供了处理治疗过程中可能出现的常见问题的提示。

本书还有三个附录。附录A包含了一些评估来访在治疗前、中、后情绪效能的结果测量工具。附录B展示了EET定量结果试验的研究结果。附录C提供了可以复印的单页版讲义和工作表，并概述了在团体治疗中使用EET的八次疗程协议。

此外，本书中的每份讲义和工作表都可以在http://www.newharbinger.com/34039下载。对于每次EET治疗会议，您将遵循一个结构化的格式，让来访练习技能、理解这些技能背后的原理，并解决任何挑战。在每次会议结束时，您会回顾需要在会议之间完成的技能练习作业，并记录在《技能练习记录》上。以下是EET的基本会议结构：

正念接纳练习
技能练习回顾及家庭作业问题解决
回顾前一周的技能
对下一周新技能的心理教育
使用暴露方法练习新技能
通过《技能练习记录》布置家庭作业

我们希望EET能够帮助那些情绪效能低下的来访。我们认为，当人们在如何回应生活方面拥有更多选择时，他们将找到更多的自由和力量来表达最好的自己。有了更多的自由和力量，他们就有机会过上更好、更有意义的生活。

总结

以下是第一章内容的概要：

情绪效能被定义为一个人能够在情境适应且符合价值观的情况下，有效体验和回应各种情绪的能力。
低情绪效能是由于关键的生物心理社会脆弱性和适应不良反应模式造成的。
EET基于痛苦不可避免但受苦可以选择并可以通过使用特定技能减轻和容忍的前提运作。
EET是一种跨诊断的、理论驱动的、基于情境的治疗方法，整合了情感科学、传统和第三代认知行为疗法以及学习理论的研究成果。
EET的理论基础基于三个核心理念：跨诊断方法是治疗情绪问题来访的最有效方式；跨情绪学习（涉及情绪的所有四个组成部分）对学习至关重要；在激活状态下可以增强新学习。
通过使用提高忍受痛苦情绪能力的技能，如情绪觉察、正念接纳、基于价值观的行动和正念应对，可以增加情绪效能。
向来访介绍EET是治疗的重要部分，特别是为了增强参与动机和尝试新行为的意愿。
每次EET会议都结构化地促进技能练习、心理教育、技能回顾、反馈以及技能练习任务的布置。

本章知识点阐述

知识点阐述

情绪效能 (Emotion Efficacy)
- 定义：情绪效能是指个体在情境适应和价值观一致的情况下，有效地体验和应对各种情绪的能力。
- 重要性：情绪效能不仅关乎个体对自己情绪管理的信心，还涉及实际的情绪调节能力。高情绪效能有助于提高生活质量，减少情绪困扰。
- 具体实践：
  - 情绪觉察：学会识别和理解自己的情绪。
  - 正念接纳：通过正念练习接受当前的情绪状态。
  - 情绪调节：学习有效的应对策略来调节情绪。
  - 价值观驱动的行为：根据个人的核心价值观采取行动。
低情绪效能的原因 (Causes of Low Emotion Efficacy)
- 生物易感性：某些人天生对情绪刺激更敏感，容易产生强烈的情绪反应。
- 情绪回避：试图避免不适的感觉、情绪和认知，这种回避行为反而加剧了情绪问题。
- 痛苦不耐受：认为自己无法忍受负面情绪，这种信念可能导致情绪逃避和回避行为。
- 缺乏情绪调节技能：缺乏有效的情绪调节技巧，如情绪降级和情绪转移。
- 社会无效化环境：周围环境对个体情绪体验的否认或贬低，削弱了个体的情绪效能。
情绪失调 (Emotion Dysregulation)
- 定义：情绪失调是指在特定情境下不适应的思想、感受、身体感觉和行为冲动。
- 重要性：情绪失调不仅影响情绪本身，还可能导致行为失调，进一步加剧情绪问题。
- 具体实践：
  - 情绪识别：学会识别不同的情绪及其触发因素。
  - 情绪命名：给情绪命名，帮助自己更好地理解和管理。
  - 情绪调节技巧：学习具体的技巧，如放松练习、正念冥想等，来调节情绪。
  - 行为干预：通过行为干预来纠正不适应的情绪反应模式。
低情绪效能的影响 (Impact of Low Emotion Efficacy)
- 广泛影响：低情绪效能不仅影响个体的心理健康，还会波及到人际、工作、学校和法律等多个生活领域。
- 生活质量下降：低情绪效能可能导致生活质量显著下降，严重的甚至会干扰日常生活。
- 具体实践：
  - 全面评估：进行全面的情绪评估，了解个体的情绪问题和需求。
  - 个性化治疗计划：制定个性化的治疗计划，结合个体的具体情况和需求。
  - 多维度干预：从情绪觉察、情绪调节、价值观驱动的行为等多个维度进行综合干预。

通过以上知识点的阐述，我们可以看到情绪效能疗法（EET）不仅提供了一套系统化的治疗方案，还强调了情绪效能的重要性及其影响。这些方法不仅帮助个体更好地管理情绪，还提供了科学依据和实证支持，确保治疗的有效性和可靠性。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

情绪失调的影响 (Impact of Emotion Dysregulation)
- 定义：情绪失调是指个体在特定情境下无法有效地管理和调节自己的情绪。
- 重要性：情绪失调不仅影响个体的心理健康，还会对多个生活领域产生负面影响，如人际关系、工作表现、学业成绩和法律问题。
- 具体影响：
  - 心理健康：情绪失调与抑郁、焦虑、冲动和自杀倾向密切相关。
  - 生活质量：情绪失调会导致生活质量下降，包括日常功能受限和社会技能功能下降。
  - 身体健康：情绪失调可能导致记忆力和问题解决能力受损，进一步影响身体健康。
  - 社会功能：情绪失调与物质滥用、低成就和自我效能感低下有关，影响个体的社会功能。
情绪效能疗法 (Emotion Efficacy Therapy, EET) 的必要性
- 现有治疗方法的局限性：许多治疗方法只关注症状，未能解决根本问题，且缺乏体验性成分。
- EET的优势：EET旨在提供一个更有效的、便携且通用的协议，帮助个体提高情绪调节能力和做出符合价值观的选择。
- 基本哲学前提：EET认为，虽然痛苦是不可避免的，但通过学习如何面对和接受困难的情绪，可以减少痛苦。
情绪效能疗法的基础元素 (Foundational Elements of EET)
- 跨诊断治疗：EET是一种跨诊断的治疗方法，适用于多种情绪问题。
- 理论驱动：EET结合了情感科学、认知行为疗法和学习理论的研究成果。
- 基于情境：EET强调在特定情境下应用所学技能。
- 整合ACT和DBT：EET融合了接受与承诺疗法（ACT）和辩证行为疗法（DBT）的成分。
- 基于暴露：EET采用基于暴露的方法，帮助个体面对和克服情绪恐惧。

通过以上知识点的阐述，我们可以看到情绪效能疗法（EET）不仅提供了一套系统化的治疗方案，还强调了情绪效能的重要性及其广泛影响。这些方法不仅帮助个体更好地管理情绪，还提供了科学依据和实证支持，确保治疗的有效性和可靠性。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

跨诊断效能 (Transdiagnostic Efficacy)
- 定义：跨诊断方法是指一种治疗策略，旨在识别并处理导致多种精神障碍的共同机制，而不是针对具体的诊断类别。
- 重要性：许多精神障碍具有共同的症状和驱动因素，跨诊断方法能够更有效地解决这些问题，同时适用于多种症状的来访。
- 具体实践：
  - 识别共同机制：识别和处理导致多种障碍的共同机制，如情绪失调、痛苦不耐受等。
  - 统一治疗：提供一种统一的治疗方法，适用于多种症状的来访，从而提高治疗效率和效果。
情绪效能疗法 (Emotion Efficacy Therapy, EET) 的目标
- 定义：EET是一种跨诊断治疗方法，旨在提高个体的情绪效能，帮助他们更好地管理情绪。
- 重要性：EET不仅关注症状的减少，还关注提高个体的情绪调节能力和做出符合价值观的选择。
- 具体实践：
  - 提高痛苦耐受力：通过正念接纳和情绪觉察，帮助个体学会忍受痛苦情绪。
  - 减少情绪回避：教授个体如何面对和处理困难情绪，而不是回避或逃避。
  - 基于价值观的行为：鼓励个体根据个人价值观采取行动，增强情绪效能。
跨情绪学习 (Transemotional Learning)
- 定义：跨情绪学习是指通过整合认知、情感、躯体和行为成分，促进新的学习和行为改变。
- 重要性：跨情绪学习有助于建立新的神经通路，从而改变旧的、适应不良的行为模式。
- 具体实践：
  - 多维度学习：利用认知、情感、躯体和行为成分，促进全面的学习和改变。
  - 激活所有情绪成分：通过激活思想、感觉、情感和冲动，帮助个体建立新的行为模式。
  - 体验式学习：通过实际体验和练习，帮助个体将新的学习内化为长期的行为模式。

通过以上知识点的阐述，我们可以看到EET不仅提供了一套系统化的治疗方案，还强调了跨诊断方法和跨情绪学习的重要性。这些方法不仅帮助个体更好地管理情绪，还提供了科学依据和实证支持，确保治疗的有效性和可靠性。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

基于暴露的技能练习 (Exposure-Based Skills Practice)
- 定义：基于暴露的技能练习是指在情绪激活状态下应用技能，以促进跨情绪学习。
- 重要性：这种方法有助于提高学习、保持和回忆，特别是在处理焦虑和其他情绪障碍时。
- 具体实践：
  - 情绪暴露：通过暴露于引发情绪的情境，帮助来访在情绪激活状态下练习技能。
  - 状态依赖性学习：利用状态依赖性学习原理，确保在情绪激活状态下学习的技能能够更好地被记住和应用。
情绪效能疗法 (Emotion Efficacy Therapy, EET) 的组成部分
- 定义：EET是一种综合性的治疗方法，旨在提高个体的情绪效能，包括情绪觉察、正念接纳、基于价值观的行为和正念应对。
- 重要性：EET不仅关注症状的减少，还关注提高个体的情绪调节能力和做出符合价值观的选择。
- 具体实践：
  - 情绪觉察：教导来访识别和理解自己的情绪体验。
  - 正念接纳：教授来访以非评判性和非反应性的方式观察和接受自己的情绪。
  - 基于价值观的行为：鼓励来访根据个人价值观采取行动，增强情绪效能。
  - 正念应对：提供具体的应对策略，帮助来访在情绪激活状态下更好地管理情绪。
情绪觉察 (Emotion Awareness)
- 定义：情绪觉察是指能够与当前时刻的情绪接触并理解其表现形式的能力。
- 重要性：情绪觉察是提高情绪效能的第一步，有助于来访更好地理解和管理自己的情绪。
- 具体实践：
  - 识别情绪：教会来访识别情绪的四个组成部分：思想、感受、感觉和冲动。
  - 理解触发因素：帮助来访理解情绪的起源和触发因素。
  - 情绪波的理解：教导来访了解情绪波动的自然过程和持续时间。
正念接纳 (Mindful Acceptance)
- 定义：正念接纳是指以非评判性和非反应性的方式观察和接受自己的情绪体验。
- 重要性：正念接纳有助于来访容忍痛苦的情绪，避免情绪回避，从而提高情绪调节能力。
- 具体实践：
  - 非评判性观察：教导来访以非评判性的方式观察自己的情绪。
  - 接受情绪：帮助来访学会接受情绪及其各个组成部分，而不试图改变它们。
  - 选择时刻：指导来访在情绪触发和反应之间找到选择的时刻，以便做出更有意识的决策。

通过以上知识点的阐述，我们可以看到EET不仅提供了一套系统化的治疗方案，还强调了基于暴露的技能练习、情绪觉察和正念接纳的重要性。这些方法不仅帮助个体更好地管理情绪，还提供了科学依据和实证支持，确保治疗的有效性和可靠性。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

基于价值观的行动 (Values-Based Action, VBA)
- 定义：基于价值观的行动是指在选择时刻有意识地践行核心价值观。
- 重要性：
  - 提高生活质量和心理幸福感。
  - 增强来访对困难新行为的承诺。
  - 在面对厌恶情绪时做出符合价值观的选择。
- 具体实践：
  - 识别核心价值观：在不同情境下识别和命名核心价值观。
  - 制定行动计划：根据价值观制定具体的行动方案。
  - 实践与应用：在激活状态下通过基于暴露的技能训练实践基于价值观的行动。
正念应对 (Mindful Coping)
- 定义：正念应对是指通过正念接纳来识别选择时刻，并利用应对技巧来降低情绪强度。
- 重要性：
  - 在情绪压力过大时提供调节情绪的策略。
  - 防止情况恶化。
  - 作为一种备用手段，用于在正念接纳之后仍无法管理情绪时。
- 具体实践：
  - 正念接纳：观察和接受情绪及其组成部分。
  - 选择应对技巧：在识别选择时刻后，选择适当的应对技巧来降低情绪强度。
  - 综合应用：结合正念接纳和应对技巧，有效管理情绪。
基于暴露的技能练习 (Exposure-Based Skills Practice)
- 定义：基于暴露的技能练习是在激活状态下使用EET技能，包括情绪暴露和想象暴露。
- 重要性：
  - 提高学习、保持和回忆。
  - 创建新的神经通路。
  - 在面对痛苦情绪时更容易实施有效的选择。
- 具体实践：
  - 情绪暴露：有意激活情绪，练习正念接纳和正念应对。
  - 想象暴露：利用情境中的图像来激活情绪，并可视化执行基于价值观的行动。
  - 综合应用：在激活状态下练习EET技能，增强情绪调节能力。
情绪效能疗法的独特之处 (Uniqueness of Emotion Efficacy Therapy)
- 定义：情绪效能疗法是一种系统化的治疗方法，旨在提高个体的情绪效能。
- 重要性：
  - 教导个体面对痛苦而不被摧毁或压垮。
  - 提高忍受痛苦的动力，扩展行动选择。
  - 通过心理教育和技能训练，教授新的应对困难情绪的方法。
- 具体实践：
  - 心理教育：向来访传授有关情绪管理和调节的知识。
  - 技能训练：在激活状态下练习EET技能，提高情绪效能。
  - 实际应用：在选择时刻，来访能够选择正念接纳、执行基于价值观的行动或降低情绪强度，从而有效管理情绪。

通过以上知识点的阐述，我们可以看到EET不仅提供了一套系统化的治疗方案，还强调了基于价值观的行动、正念应对和基于暴露的技能练习的重要性。这些方法不仅帮助个体更好地管理情绪，还提供了科学依据和实证支持，确保治疗的有效性和可靠性。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

情绪效能疗法 (Emotion Efficacy Therapy, EET) 的核心特征
- 定义：EET是一种结合了多种疗法元素的独特方法，旨在提高个体的情绪效能。
- 重要性：
  - 提供一系列工具，适用于不同情绪效能水平的来访。
  - 通过基于暴露的技能训练加速学习和记忆。
  - 结合正念接纳与应对技巧，增强情绪管理能力。
  - 简短且灵活，适用于多种治疗形式。
- 具体实践：
  - 情绪觉察：识别和观察情绪的四个组成部分。
  - 正念接纳：非反应性和非评判性地观察和接受情绪。
  - 基于价值观的行动：在情绪触发时选择符合价值观的行动。
  - 正念应对：使用正念接纳和特定应对技巧来调节情绪。
EET的治疗结构
- 定义：EET的治疗结构由多个章节组成，逐步引导来访掌握情绪管理技能。
- 重要性：
  - 为治疗师提供系统的指导，帮助来访逐步掌握情绪管理技能。
  - 包括心理教育、对话示例、工作表和体验式练习，确保全面覆盖。
- 具体实践：
  - 心理教育：向来访传授情绪管理和调节的知识。
  - 对话示例：展示治疗师与来访的互动，提供实际操作指南。
  - 工作表和讲义：提供实用工具，帮助来访理解和应用所学技能。
  - 体验式练习：通过实际练习，帮助来访内化新技能。
EET的疗效
- 定义：EET已被多项研究证明有效，能够显著改善情绪相关的问题。
- 重要性：
  - 提高情绪调节能力，减少情绪失调。
  - 增强对负面情绪的应对能力。
  - 提高痛苦耐受力，减少经验性回避。
- 具体实践：
  - 效果评估：使用标准化工具评估来访在治疗前后的变化。
  - 持续监测：在治疗过程中定期评估进展，调整治疗计划。
  - 长期支持：提供后续支持，确保来访能够持续应用所学技能。

通过以上知识点的阐述，我们可以看到EET不仅提供了一套系统化的治疗方案，还强调了多种技能的综合运用，以提高个体的情绪效能。这些方法不仅帮助个体更好地管理情绪，还提供了科学依据和实证支持，确保治疗的有效性和可靠性。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

情绪效能 (Emotion Efficacy)
- 定义：情绪效能是指个体在情境适应且符合价值观的情况下，有效体验和回应各种情绪的能力。
- 重要性：
  - 提高情绪管理能力，减少情绪失调。
  - 增强个体在面对困难情绪时的选择权和控制感。
- 具体实践：
  - 情绪觉察：识别和观察情绪的四个组成部分。
  - 正念接纳：非反应性和非评判性地观察和接受情绪。
  - 基于价值观的行动：在情绪触发时选择符合价值观的行动。
  - 正念应对：使用正念接纳和特定应对技巧来调节情绪。
低情绪效能 (Low Emotion Efficacy)
- 定义：低情绪效能是由于生物心理社会因素和适应不良反应模式导致的情绪管理能力低下。
- 重要性：
  - 影响个体的心理健康和生活质量。
  - 导致情绪问题的持续存在和恶化。
- 具体实践：
  - 评估与识别：识别低情绪效能的原因和表现。
  - 干预措施：提供针对性的干预策略，如EET等综合治疗方法。
EET的核心理念
- 定义：EET基于三个核心理念：跨诊断方法的有效性、跨情绪学习的重要性以及在激活状态下增强新学习。
- 重要性：
  - 提供系统化的治疗框架，确保治疗的全面性和有效性。
  - 结合多种理论和实践方法，提高治疗的灵活性和适用性。
- 具体实践：
  - 跨诊断方法：针对不同情绪问题的共同特征进行治疗。
  - 跨情绪学习：结合情绪的四个组成部分进行全面学习。
  - 激活状态下的学习：通过情绪激活状态促进新技能的学习和记忆。
EET的治疗结构
- 定义：EET的治疗结构包括正念接纳练习、技能练习回顾、心理教育、新技能练习、家庭作业等环节。
- 重要性：
  - 提供系统的指导，帮助来访逐步掌握情绪管理技能。
  - 通过结构化的流程确保治疗的一致性和有效性。
- 具体实践：
  - 正念接纳练习：通过正念练习帮助来访接受当前的情绪体验。
  - 技能练习回顾：回顾和巩固已学技能，解决家庭作业中的问题。
  - 心理教育：向来访传授情绪管理和调节的知识。
  - 新技能练习：通过实际练习，帮助来访内化新技能。
  - 家庭作业：布置具体的练习任务，确保来访在日常生活中应用所学技能。

Chapter 1 Emotion Efficacy Therapy Emotion efficacy is defined as how effectively a person can experience and respond to a full range of emotions in a contextually adaptive, values-consistent manner. As such, emotion efficacy encompasses both the beliefs people have about their ability to navigate their emotional life as well as their ability to do so. The more people can effectively experience difficult emotions, regulate their emotions through coping, and express their values, the higher their emotion efficacy. In conceptualizing emotion efficacy therapy (EET), we reviewed the full range of factors that make up a person’s relationship with his or her emotions, and we identified key factors implicated in emotion efficacy. We concluded that low emotion efficacy is likely to be the result of key vulnerabilities or patterns of maladaptive behavioral responses—behaviors enacted in response to emotional pain, or the desire to avoid pain, which fuel and maintain psychopathological processes. Some common vulnerabilities and patterns may take the form of one of more of the following: Biological predisposition or sensitivity that leads to high levels of reactivity Significant levels of emotion avoidance (sometimes also called experiential avoidance)—efforts to avoid experiencing uncomfortable sensations, emotions, and cognitions triggered by internal or external cues Significant levels of distress intolerance—the perception or the belief that one cannot tolerate aversive emotions Significant lack of downregulate emotion emotion-shifting skills toConsistent and environments significant socially invalidating Individuals with these vulnerabilities often develop significant emotion problems. They may also lack understanding of their emotional experience and the clarity or tools to either tolerate difficult emotions, make values- consistent choices, or regulate their emotions. Over time, these vulnerabilities and life-long patterns of maladaptive behaviors can result in chronic emotion dysregulation and its downstream symptoms of depression, anxiety, and stress. In fact, these maladaptive patterns become so ingrained that they are all but hardwired and very difficult to change, leaving individuals feeling trapped, stuck, and hopeless. In EET, we define emotion dysregulation as the full range of thoughts, feelings, somatic sensations, and behavioral urges that are contextually maladaptive. Emotion dysregulation is also problematic in that it frequently leads to behavior dysregulation—acting on emotion in contextually maladaptive ways. In this way, emotion dysregulation and behavior dysregulation lead to low emotion efficacy. The impact of low emotion efficacy is wide and far reaching. Some data suggest that low emotion efficacy creates and maintains tremendous suffering for the more than 75 percent of people who seek psychotherapy across multiple diagnostic categories (Kring & Sloan, 2010). In addition, pervasive emotion problems can significantly impact clients across multiple domains including interpersonal, work, school, and legal. Low emotion efficacy can significantly impair quality of life, and, in more extreme cases, it can be life interfering. For example, research shows emotion dysregulation has been correlated with higher levels of depression, anxiety, impulsivity, and suicide (Garnefski & Kraaij, 2007; Carver, Johnson, & Joormann, 2008; Kleiman & Riskind, 2012); reduced quality of life; increased distress and restricted life functioning; increased suffering and pain; impaired memory and problem solving; and diminished contact with meaningful and valued life activities (Richards & Gross, 2000;McCracken, Spertus, Janeck, Sinclair, & Wetzel, 1999; Marx & Sloan, 2002; Hayes, Luoma, Bond, Masuda, & Lillis, 2006). Additionally, emotion dysregulation has been linked to lower social skill functioning, substance abuse, low lifetime achievement, and low sense of self-efficacy (Berking et al., 2011; Eisenberg, Fabes, Guthrie, & Reiser, 2000; Caprara et al., 2008). Why Emotion Efficacy Therapy? Despite the prevalence of emotion-regulation problems, available treatments often treat just the symptoms and fail to identify and target the underlying drivers of the problem. In addition, treatments may teach clients how to use skills but can lack the experiential component essential to accelerate learning new ways of relating to and responding to difficult emotions. Even current evidence-based treatments show only modest treatment effects for improving emotion regulation and its downstream symptoms (Kliem, Kroger, & Kosfelder, 2010). Emotion efficacy therapy attempts to provide a more effective, portable, universal protocol for emotion problems. The underlying philosophical premise of EET is that while pain is unavoidable, suffering is not. Suffering comes, in part, from not knowing how to enact values that bring meaning to life. More often, it comes from the unwillingness to experience difficult emotions, which then fuels distress and leads to more suffering. Moreover, suffering is maintained and even increased when clients try to avoid or control their pain through maladaptive behavioral responses. To the extent that clients can learn how to powerfully navigate the space between being emotionally triggered and their response, they can be empowered to create lives that are increasingly values- consistent and fulfilling. We believe EET stands to help millions of people increase their emotion efficacy through increasing their ability to regulate their emotions and make choices that are consistent with their values and intentions. Ultimately, high emotion efficacy—the ability to experience a full range of emotions andrespond with mindful acceptance, values-based action, and mindful coping—means a world where more people create lives that are more authentic, powerful, and conscious. Emotion Efficacy Therapy: Foundational Elements EET was conceived as a transdiagnostic, theoretically driven, contextually based treatment integrating findings from affect science, traditional and third-wave cognitive behavioral therapies, and learning theory. As such, EET is an outgrowth of several cognitive behavioral therapies, integrating components of acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT) into an exposure-based treatment. ACT is a mindfulness-based therapy developed by Steven Hayes, Kelly Wilson, and Kirk Strosahl that teaches clients to accept distress instead of trying to control it, and to commit to action that originates from client values (Hayes, Strosahl, & Wilson, 1999). DBT was developed by Dr. Marsha Linehan and is used in treating severe and complex mental disorders involving serious emotion dysregulation (Linehan, 1993). The rationale for EET is based on research that supports foundational ideas for its treatment structure and content: TRANSDIAGNOSTIC EFFICACY TREATMENT TO TREAT LOW EMOTION Data suggests there are more commonalities than differences across diagnostic disorders, which further underscores the need for transdiagnostic approaches to treatment (McEvoy, Nathan, & Norton, 2009). Instead of focusing on reducing symptoms, as in diagnostic treatment, transdiagnostic formulation identifies and targets the mechanisms driving the symptoms as a focus of intervention. From a philosophical perspective, transdiagnostic formulation posits that suffering is not a result of a disorder and its originating pain but rather of the vulnerabilities and maladaptive behavioral responses to the pain. Further, research suggests that treatment that targets transdiagnostic, or underlying, drivers is more effective thancategorical diagnostic formulation (McEvoy et al., 2009; Frank & Davidson, 2014). Transdiagnostic approaches not only address the drivers of problems, they also allow for a single therapy for clients who present with a wide range of symptoms. In fact, a meta-analysis by McEvoy and colleagues (2009) found that unified (transdiagnostic) treatments for emotion disorders are correlated with symptom improvement, perform better overall than wait-list control groups, are associated with improvements in comorbid disorders, and may compare well with diagnostic-specific protocols. Emotion efficacy therapy targets the transdiagnostic drivers of low emotion efficacy. Instead of focusing on the reduction of emotion dysregulation and its downstream symptoms of anxiety, depression, stress, and impulsivity, EET skills focus on increasing distress tolerance and decreasing emotion avoidance. Using five components—emotion awareness, mindful acceptance, values-based action, mindful coping, and exposure-based skills practice—clients learn to expand their choices in the face of difficult emotions. Instead of reacting with ineffective, contextually maladaptive responses, they learn tools that allow them to develop a new relationship with their emotions. Since clients don’t often fit into one diagnostic category, or may fit into multiple categories, we believe it is imperative for treatment to identify and target the actual mechanisms that create and maintain suffering. EET targets two transdiagnostic drivers implicated in low emotion efficacy: distress intolerance—the perception or belief that one cannot experience distressing emotions—and emotional avoidance— attempts to avoid or change aversive emotional experiences. By teaching clients to tolerate distress instead of avoiding their emotional experience, they are empowered to choose to effectively respond to their emotions in a contextually adaptive, values-consistent manner. TRANSEMOTIONAL LEARNING AS THE KEY TO CHANGE Based on affect science, we know that patterns of behavior are the result of a confluence of factors that work on neural pathways both hardwired from birth (e.g., flight, fight, freeze)and created over time, making up experiences or preferences (Hanson, 2009). These pathways are created and maintained by learning and memory (e.g., when the dog growls at me, he is unpredictable, and I should avoid him; when mommy smiles she is open to hugs and giggles). After learning occurs, these pathways become reactivated in response to internal cues (cognitive, somatic, or affective) and external cues (in the environment) that are appraised as being “like” other events, so the emotional response is automatic. When the learned responses are maladaptive—meaning they fail to motivate effective values-consistent choices—they can cause suffering and play an etiological role across psychopathological disorders and processes (Tryon, 2005). Research shows that new learning is the key to change and is transemotional, including cognitive, affective, somatic, and behavioral components (Tryon, 2005; Lauterbach & Gloster, 2007). This means that in order to facilitate new responses to painful or feared experiences, new learning must take place. Because learning and memory are created through the encoding of experiences, it follows that utilizing all sensory and perceptual components (cognitive, somatic, and affective) is essential for new learning. In EET, transemotional learning occurs through the activation of all emotional components— thoughts, sensations, feelings, and urges—that build neural pathways around new behaviors. EXPOSURE-BASED SKILLS PRACTICE TO IMPROVE LEARNING, RETENTION, AND RECALL Grounded in theory and research that support the effectiveness of exposure therapy and state-dependent learning, exposure-based skills practice is the application of skills in an activated state of distress to facilitate transemotional learning (Szymanski & O’Donahue, 1995). In the last twenty-five years, exposure therapy has been increasingly recognized as one of the most effective therapy interventions for the treatment of anxiety. It’s also considered to be the gold-standard treatment for panic disorder. State-dependent learning is the concept that whatever state a person is in when learning occurs becomes encoded andpaired with the stimuli. This has several implications for the use of emotion in therapy. For instance, some research suggests that, in studies, participants had superior recall when the same affective state was induced at both exposure and retrieval, compared to those whose affective state was different between learning (exposure) and recall (retrieval) (Szymanski & O’Donahue, 1995). In addition, some studies show that mood may increase access to the neuronal networks that are online and paired with specific affect states (Persons & Miranda, 1992). EET leverages state-dependent learning through exposure, which facilitates new learning in emotionally activated states by increasing learning, retention, and recall of EET skills. Clients are guided using both emotion and imaginal exposure to face difficult internal and external emotional experiences while applying EET skills to enact contextually adaptive, values-consistent behavioral responses. Emotion Efficacy Therapy Protocol EET uses psychoeducation, skills practice, and experiential activities to increase emotion efficacy. By integrating the components of emotion awareness, mindful acceptance, values-based action, and mindful coping within exposure- based skills practice, clients learn to tolerate their distress, downregulate emotions when necessary, and make choices that are consistent with their values. The Five Components of EET Each session focuses on one or more of five treatment components that build on each other as follows: EMOTION AWARENESS Emotion awareness is the ability to make present-moment contact with emotion. Emotion is experienced through its four components, and clients learn to recognize how it manifests through thoughts, feelings, sensations, and urges. Often clients know they are feeling an emotion, but they’re not sure what it is. Or they may know the emotion but not realize how it ismanifesting in the components of emotion. Emotion awareness also entails understanding the origin or trigger of the emotion as well as the typical lifespan of an emotion wave. Having an awareness of one’s emotional experience is the first step toward increasing emotion efficacy. MINDFUL ACCEPTANCE Building on emotion awareness, mindful acceptance is the practice of nonjudgmentally and nonreactively observing one’s emotional experience and allowing (accepting) each of the components of an emotion: thoughts, feelings, sensations, and urges. Clients learn to tolerate a distressing emotion by learning to experience the emotion—and each of its components—without trying to alter it. Together, emotion awareness and mindful acceptance offer an alternative to emotion avoidance, giving clients concrete skills to practice in place of attempts to avoid or alter their emotional experience. Research suggests that both emotion awareness and mindful acceptance are components of effective transdiagnostic interventions for emotion dysregulation (Ruiz, 2010; Wilamoska et al., 2010). In fact, observing and accepting experience appears to enhance emotion regulation (Ruiz, 2010). These two core components form the foundation for emotion efficacy therapy. Emotion awareness and mindful acceptance position clients to identify the moment of choice— the space between an emotional trigger and a response—when they are able to choose how they respond to their pain. More specifically, clients learn to locate the moment of choice even in the face of difficult or aversive emotions. In this moment, they can choose to just “surf” the emotion wave instead of reacting to it or acting on it. VALUES-BASED ACTION (VBA) VBA is the practice of mindfully enacting a valued intention in the moment of choice. Having increased distress tolerance through emotion awareness and mindful acceptance, clients are now positioned to recognize a moment of choice and make values-consistent choices in the face of aversive emotions. With values-based action, clients first identify whattheir core values are in a variety of contexts, such as work, home, community, family, and so on. By naming what they value in each of these contexts, clients can then identify specific values-based actions that allow them to express themselves—in the moment of choice—in a manner consistent with their values. As with all the EET skills, clients practice choosing values-based actions in an activated state through exposure-based skills training. Some research shows that the enactment of values is correlated with psychological well-being and an increase in quality of life (Hayes, Strosahl, & Wilson, 1999; Ruiz, 2010). Because EET seeks not only to increase distress tolerance and emotion regulation but also quality of life, values-based action is a core EET skill. Further, VBA is essential to increasing emotion efficacy, as it enhances motivation to commit to new behavioral responses that are difficult. By choosing values- based action instead of reacting through maladaptive emotion- driven behaviors, clients further increase their distress tolerance as well as the quality of their life. MINDFUL COPING Mindful coping is developed through the practice of using mindful acceptance to recognize a moment of choice, and then utilizing coping skills to downregulate emotion. Sometimes individuals can become so overwhelmed by difficult emotions that they aren’t able to practice mindful acceptance and surf the emotion wave until it resolves, much less choose values- based action in the moment of choice. In these situations, they need strategies for regulating emotion to keep from making a bad situation worse (Linehan, 1993). When clients’ capacities to observe, accept, and/or choose values-based action are exceeded by emotional pain, they can choose mindful coping skills to downregulate emotion. While coping has been typically conceptualized as an attempt to change and alter emotional experience, mindful coping uses mindful acceptance as a portal to choosing emotion-regulation skills. Mindful coping begins with mindful acceptance—the practice of observing and accepting the emotion and its components. It follows with recognizing amoment of choice and choosing a coping skill as a way to downregulate emotion. The concept of mindful coping is new with EET and represents an attempt to give clients essential emotion- regulation skills in crisis situations, while also encouraging them to choose coping only as a last resort—after first practicing mindful acceptance. Instead of choosing coping skills to avoid or change aversive emotion, mindful coping is chosen with the intention of expanding choices and to help clients recover so they can choose values-based action. EXPOSURE-BASED SKILLS PRACTICE This practice refers to the use of EET skills in an activated state using both emotion and imaginal exposure (also called imagery-based exposure). In emotion exposure, clients learn to intentionally activate themselves as a way to practice mindful acceptance and mindful coping. In addition, clients learn to use imaginal exposure—using imagery from a situation to become emotionally activated, and then visualizing enacting values-based action. As previously discussed, practicing skills in an activated state improves learning, retention, and recall; creates new neural pathways; and makes it easier to enact effective choices in the face of distressing emotions. How Is Emotion Efficacy Therapy Unique? By teaching individuals that pain can be faced—that it will not destroy or overwhelm them, and that it doesn’t have to lead to more suffering or destructive behaviors—their motivation to tolerate distress will increase, opening the door to expanded choices for action. Through psychoeducation and skills training in an activated state, clients learn new ways of responding to difficult emotions. In the moment of choice, clients are able to choose to mindfully accept the present emotional experience, enact a values-based action, and/or downregulate their emotions. Using EET skills, clients are able to effectively experience difficult emotions, recover more quickly from beingemotionally dysregulated, break out of patterns of responding that are maladaptive, and express what they value in the face of distress—moment to moment. As clients practice EET skills when they get triggered by painful emotions, new choices become easier and easier. In a brief time, they can develop a new relationship with their emotions, giving them increased emotion efficacy in significant ways: Power to experience themselves as distinct from their emotions Power to experience intense emotions, instead of reacting and avoiding Power to choose values-based action, even when emotionally triggered Power to choose strategies to downregulate emotion and keep from making difficult situations worse While emotion efficacy therapy integrates components from acceptance and commitment therapy, dialectical behavioral therapy, and exposure therapy, several characteristics distinguish it from current treatments for emotion problems: EET is a unique hybrid. Emotion efficacy therapy combines emotion awareness, mindful acceptance, values-based action, and mindful coping to provide a range of tools for clients at all levels of emotion efficacy. EET uses exposure-based skills training. Emotion efficacy therapy uses both emotion and imaginal exposure to accelerate new learning and improve retention and recall. EET incorporates mindful coping. Rather than just offering coping skills to downregulate emotion, emotion efficacy therapy combines mindful acceptancewith select coping skills, allowing clients to first accept their emotional experience, identify the moment of choice, and then choose to intentionally and mindfully shift their emotion. EET is brief and portable. Unlike some treatments for emotion problems, emotion efficacy therapy can be administered in eight weeks and can be adapted for either a group or individual format. To date, EET has been shown to dramatically decrease emotion dysregulation (d = -1.21), increase efficacy with negative emotions (d = 1.38), increase distress tolerance (d = 1.34), and decrease experiential avoidance (d = -0.81). (For details, see Appendix B.) EET is brief, cost efficient, and available in both individual and group formats. How to Use This Book In this book we lay out how to use EET in both individual and group therapy format. Chapters 2 through 10 cover each of the EET processes, including psychoeducation on each of the treatment concepts, examples of therapist-client dialogues, handouts and worksheets you can use with your clients, and scripts for experiential exercises to teach and implement the new skills. In chapter 2, we cover the first EET skill, emotion awareness: the ability to identify and observe the four components of an emotional response. In chapter 3, we introduce the second EET component, mindful acceptance: to nonreactively and nonjudgmentally observe and accept emotions while emotionally triggered. Chapter 4 covers emotion surfing, which builds on the core skills of emotion awareness and mindful acceptance, applying them to the life cycle of an emotion, and recognizing a moment of choice. Chapter 5 introduces values and values clarification to help clients identify values-based action. Chapter 6 covers using values-based action in the moment of choice. Chapter 7 introduces mindful coping and covers the use of mindfulacceptance with relaxation and self-soothing coping skills. Chapter 8 covers the use of mindful coping through mindful acceptance and coping thoughts. Chapter 9 uses mindful coping through mindful acceptance and distraction. Chapter 10 maps out how to help your clients pull all of this together to develop customized emotion efficacy plans; it also offers tips for common issues that may arise in treatment. This book also has three appendices. Appendix A contains some outcome measures you may find helpful for assessing clients’ emotion efficacy before, during, and after treatment. Appendix B features research results from a quantitative outcome trial for EET. Appendix C provides single-page versions of the handouts and worksheets that you can photocopy, and outlines the eight-session protocol for using EET in a group therapy format. In addition, every handout and worksheet in this book is also available for download at http://www.newharbinger.com/34039. For each EET therapy session, you’ll follow a structured format to allow clients to practice skills, understand the rationale behind them, and do problem solving around any challenges. At the end of each session, you’ll review the skills practice assignments to be completed as homework between sessions and recorded on the Skills Practice Record. Following is the basic session structure for EET: Mindful acceptance practice Skills practice review and troubleshooting problems with homework Review of previous week’s skill(s) Psychoeducation on the new skill for the coming week Practice new skill(s) using exposure Homework via the Skills Practice RecordWe hope you find EET helpful for working with clients struggling with low emotion efficacy. We believe that when people experience increased choice about how they respond to life, they will find more freedom and power to express the best of themselves. With more freedom and power, they have a chance at a better, more meaningful life. Summary Following is a synopsis of content covered in chapter 1: Emotion efficacy is defined as how effectively a person can experience and respond to a full range of emotions in a contextually adaptive, values-consistent manner. Low emotion efficacy is a result of key biopsychosocial vulnerabilities and patterns of maladaptive responses. EET operates on the premise that pain is unavoidable but suffering is optional and can be mitigated and tolerated through the use of select skills. EET is a transdiagnostic, theoretically driven, contextually based treatment integrating findings from affect science, traditional and third-wave cognitive behavioral therapies, and learning theory. The rationale for EET is based on research of three foundational ideas for its treatment structure and content: a transdiagnostic approach is the most effective way to treat clients with emotion problems; transemotional learning, which involves all four components of emotion, is essential to learning; and new learning is enhanced in an activated state. Emotion efficacy can be increased through the use of skills that increase the ability to tolerate distressing emotions by responding through emotion awareness,mindful acceptance, values-based action, and mindful coping. Orienting clients to EET is an important part of treatment, especially for enhancing motivation for participation and willingness to try new behaviors. Each EET session is structured to facilitate skills practice, skills psychoeducation, skills review, feedback, and skills practice assignments.

第一章：情绪效能疗法