ACT core processes from an emotion, affect, and mood regulation perspective Michel André Reyes Ortega -Asociación Mexicana por las Ciencias Conductual Contextuales- -Instituto de Terapia Cognitivo Conductual en México- -Universidad Iberoamericana Cd. De México-

PAPER OBJECTIVES Define emotion regulation Signal similarities between ACT and emotion regulations clinical perspectives Review 3 different emotion and affect theories and their clinical implications Signal ACT beneffits for emotion disregulation treatment Describe an example of an integrative approach

EMOTION REGULATION AND ACT ACT core processes from an emotion, affect, and mood regulation perspective

EMOTION REGULATION AND DYSREGULATION Emotion regulation: The modification of any aspect of an emotional response (Fairholme, Boisseau, Ellard, Ehrenreich & Barlow, 2010). Emotion dysregulation: Difficulty or inability in coping emotions. Manifests as and excessive intensification of emotion or excessive deactivation of emotion (Leahy, Tirch & Napolitano, 2011).

SIMILARITIES TO ACT ADAPTATIVE EMOTION REGULATION Flexible and context- sensitive, congruent with longer term personal goals (Barrett, Gross, Christensen, & Benvenuto, 2001; Linehan, 1993; McEwen, 2003). PSYCHOLOGYCAL FLEXIBILITY (Dahl, Plumb, Stewart & Lundgren, 2009) Repertoires of behavior that move the person in valued directions while contacting the present moment.

SIMILARITIES TO ACT MALADAPTATIVE EMOTION REGULATION (Werner & Gross, 2010) Does not change the emotional response in the desired way or when the long-term costs outweigh the benefits of short-term changes in emotion. EXPERIENTIAL AVOIDANCE (Hayes, Strosahl & Wilson, 1999) Tendency to escape or avoid private experiences even when doing so is futile or interferes with valued actions.

TRANSDIAGNOSTIC MALADAPTATIVE EMOTION REGULATION STRATEGIES (Werner & Gross, 2010) Situational avoidance Safety and control behaviors Treat monitoring Thought supression and Distraction Rumination and Worry Expressive emotional inhibition Impulsive emotional driven behaviors

EMOTION MODELS AND THEIR CLINICAL IMPLICATIONS ACT core processes from an emotion, affect, and mood regulation perspective

DISCRETE EMOTION MODELS BASIC IDEA Emotions are governed by two distinct but partially communicating systems (Gross & Muñoz, 1995; Levenson, 1994). – Core system: Automatic, rigid and relatively insensitive to learning. Designed to accomplish evolutionarily adaptive functions. – Control system: Voluntary, flexible and sensitive to learning. – Indirectly regulates the activity of the core system by manipulating attention or regulating overt responses (Levenson, 1999).

DISCRETE EMOTION MODELS -CLINICAL IMPLICATIONS- Characteristic clinical problem. – Impulsive and inflexible control system activity. Goal (values) incongruent. Favor emotional intensity and duration scalation. Clinical targets. – Control system training. Enhance distress tolerance (emotional experience acceptance) and behavioral change skills. Helpful clinical models – Dialectical Behavior Therapy.

DIMENSIONAL EMOTION MODELS BASIC IDEA 1 Affect results as a feedback loop that tracks and controls progress on personal goals achievement (Johnson, Carver & Fulford, 2010). – Progress toward a goal or avoidance of threat relates to positive affect. The contrary results in negative affect (Carver & Scheier, 1998). Behavioral responses linked to affective states lead to regulation of affect. Long-lasting extremes of affect occur when the system is not doing an effective job of self- regulating (Johnson, Carver & Fulford, 2010).

DIMENSIONAL EMOTION MODELS BASIC IDEA 2 Affective states can be undertood as activities of diferent bio-behavioral systems. Withdrawal systems, related to amygdala, limbic and serotoninergic activity (Gilbert, 2009; Gray, 1973). – Behavioral inhibition system - “anxious affect”. – Fight–flight system – “angry affect”. Approach systems, related to dopaminergic and oxytocin activity (Wang, 2005). – Behavioral activation system – “hapy affect” (Gilbert, 2007, 2009; Gray, 1973). – Afiliation focused system – “caring / loving affect” (Bowlby, 1968; Fonagy, 2002; Fonagy & Target, 2007; Sloman, Gilbert, & Hasey, 2003).

DIMENSIONAL EMOTION MODELS -CLINICAL IMPLICATIONS- Charactesistic clinical problems. – Ineffective goal congruent behavior. Leads to inhibition of approach systems and/or overactivity of withdrawal systems. Clinical targets. – Stimulation of inhibited sistems and moderation of overactive systems. Helpful clinical models. – Behavioral Activation therapy for Depression. – Exposure Therapies for Anxiety Disorders. – Sensate Focus for Sexual Disfunction.

ASSOCIATIONISTIC MODELS BASIC IDEA Emotions are stored in memory as linked associations about stimulus, responses, and stimulus and experience meaning. They are learned through associative process (e.g. respondent conditioning). If the person is exposed to information related to any the elements of the network, the emotion is triggered.

ASSOCIATIONISTIC MODELS -CLINICAL IMPLICATIONS- Characteristic clinical problem. – Problematic and impulsive behaviors as response to activation of condictioned propositional network. Goal (values) incongruent Reinforces problematic associations. Clinical targets – Emotional procesing (Foa et al. 2006, Foa & Kozak, 1986) / Habituation – extinction (Carey, 2011). Helpful clinical models. – Exposure Therapy for Anxiety Disorders.

ACT CHANGE MECANISMS AND EMOTION DISREGULATION TREATMENT ACT core processes from an emotion, affect, and mood regulation perspective

ACT CHANGE MECANISMS Acceptance and Mindfulness Processes Commited action and Behavioral change Processes

ACCEPTANCE & MINDFULNESS STRATEGIES Impact on emotion regulation mecanisms Prevent / Inhibit – Rumination and worry – Treat monitoring – Cognitive supression and stimulus distraction – Emotion rejection and Experiential avoidance Promote – Habituation – Extintion – Distress tolerance Relation to emotion models hhhh Prevent – Discrete emotions disregulation (emotional crisis) – Rigidization and generalization of conditioned emotions Promote – Automatic regulation of emotions – Emotional processing

COMMITMENT STRATEGIES Impact on emotion regulation mecanisms Prevent / Inhibit – Situational avoidance – Safety behaviors – Expressive emotional inhibition – Impulsive emotional driven behaviors Promote – Regulation of bio-behavioral systems – Impulse control Relation to emotion models hhhh Prevent – Affect disregulation Promote – Possitive affect induction – Stablishing of goal congruent behavioral agendas – Development of long term goal congruent emotion regulation strategies

CONCLUSIONS -ACT- Combines the benefits of – Exposure based therapies – Behavioral activation based therapies – Metacognitive based therapies – Skills training based therapies Could be – Reinforced (if needed) with strategies from this approaches without loosing theoretical consistency And adds – An integrative theoretical and filosophical model – An oportunity of developing a recilinet lifestyle

INTEGRATIVE EMOTION REGULATION TREATMENT PROPOSAL (Reyes, 2012) 1.Identify experiential avoidance pattern with spetial attention to Inefffective emotion regulation strategies. 2.Creative hopelessness to challenge utility of ineffective emotion regulation strategies. 3.Cognitive defusion and mindfulness strategies to facilitate, and as interoceptive exposure and experiential challenges of emotion rejection judgements. 4.Willingness and acceptance strategies in favor of in vivo exposure excercises 5.Values driven behavioral activation 6.Relapse prevention