A UNIVERSAL TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS

Patricia E. Zurita Ona, Psy.D. Matthew McKay, Ph.D. East Bay Behavior Therapy Center The Wright Institute

Universal protocol combines three universal treatments:

1. Acceptance and Commitment Therapy (ACT) 2. Dialectical Behavior Therapy (DBT) 3. Cognitive Behavioral Therapy (CBT)

A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS

WHY A UNIVERSAL PROTOCOL?

A UNIVERSAL PROTOCOL FOR EMOTIONAL DISORDERS

Seven trans-diagnostic factors

  What is a trans-diagnostic factor?

 Case Formulation:

Situation Emotional

experience

Coping responses

or Trans-

diagnostic mechanisms

Emotional

disorder

A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS

INTERVENTIONS FOR EACH TRANS-DIAGNOSTIC FACTOR

Trans-diagnostic factor Intervention

Short-term focus (1) Values

Rumination (2) Defusion Mindfulness and emotion

awareness

Negative appraisal (3) Cognitive Flexibility Defusion

Response persistence (4) Interpersonal effectiveness Doing the opposite

Experiential avoidance (5) Doing the opposite Situational exposure

Interoceptive exposure Imagery-based emotion

exposure

Hostility or aggression (6) Interpersonal effectiveness

Emotional masking (7) Imagery – based emotion exposure

A TRANS-DIAGNOSTIC GROUP

 12 - week protocol  1 ½ hour weekly session  2 co-facilitators  Offer to clients with different degrees of

emotional dysregulation problems  Offer to clients with different diagnosis

including depression, anxiety, anger problems.  Four different data points: pre-treatment, mid-

treatment, post-treatment, and a 1-month follow-up.

PRELIMINARY DATA DASS – 21 (2015)

Preliminary data Difficulties in Emotion Regulation Scale

(2015)

PRELIMINARY DATA COMPREHENSIVE COPING INVENTORY

(2015)

PRELIMINARY DATA NOVACO ANGER SCALE (2015)

A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS

How to assess the seven trans-diagnostic factors?

 Comprehensive Coping Inventory (CCI) (Development and validation)

 Psycho-education about emotions (Experiential exercise)

  Identifying all types of avoidance:   Situation avoidance   Cognitive avoidance   Protective avoidance   Somatic avoidance   Substitution avoidance

 Cost of avoiding emotions Avoidance consequences worksheet (handout & video)

A TRANSDIAGNOSTIC PROTOCOL FOR EMOTIONAL DISORDERS

VALUES IDENTIFICATION

  Values (experiential exercise)

  Values in action log (handout)

  Planning committed actions

MINDFULNESS (AWARENESS TRAINING)

DEFUSION

  Noticing, naming it, and letting it go.

COGNITIVE FLEXIBILITY TRAINING

Categories of negative appraisal:

  (a) negative predictions,   (b) underestimating ability to cope,   © focusing on negative,   (d) negative attribution,   (e) Shoulds.

Keeping a thought log ! (handout)

THOUGHT IDENTIFICATION EXERCISE (a) Negative Prediction. (b) Underestimating

Ability to Cope. (c) Focusing on the Negative. (d) Negative Attribution. (e) Shoulds.

1. I can’t handle another medical problem. 2.My son’s going to get kicked out of school. 3. People shouldn’t talk about their family

business. 4. The whole course was a waste 5. I ought to read good books instead of trash. 6. My friend is calling because she wants

something

Cognitive flexibility exercises for each type of negative appraisal

Thinking traps Exercises

Negative predictions about the future

Validity quotient

Underestimating ability to cope Coping history and worst-case scenario

Focusing on the negative Two sides of the coin

Negative attributions Finding alternative explanations

Shoulds Breaking the rules exercise

SELF SOOTHING

DOING THE OPPOSITE

Experiential exercise:

INTERPERSONAL EFFECTIVENESS

INTERPERSONAL EFFECTIVENESS

  Assertiveness – knowing what you feel and want

  Limit setting   Listening mindfully

  Mindfulness based exposure   Brief imagery based exposure   Prolonged imagery based exposure   Interoceptive exposure   Situational in-vivo exposure

IMAGERY BASED EMOTION EXPOSURE

A UNIVERSAL PROTOCOL FOR EMOTIONAL DISORDERS

 Relapse prevention

For more information:

Patricia Zurita Ona, Psy.D. ebbehaviortherapycenter@gmail.com