Moving UP from Here

Chapter 13 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook reviews the treatment program. (1) All emotions, even the ones that feel negative or uncomfortable, provide important information that can motivate us to take action in helpful ways. (2) Staying present in the moment and taking a nonjudgmental view of emotions can help to prevent emotions from increasing in intensity. The way we think about a situation influences how we feel, and how we feel affects the way we interpret a situation. (3) Although avoiding uncomfortable emotional experiences can work well in the short-term, it isn’t an effective long-term coping strategy. The chapter helps us to evaluate our progress and revisit our treatment goals. The most effective way to maintain progress and to keep improving is to continue to practice the skills learned in this program, and therefore a practice plan is developed in this last chapter.

Understanding and Confronting Physical Sensations

Chapter 10 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at the third part of an emotional experience—the physical sensations associated with our emotions. Physical sensations refer to any physical symptoms that we might experience during strong emotions (e.g., racing heart, sweating, or nausea). We learn to identify these physical sensations and how they impact our experience of emotions. We then learn to confront uncomfortable physical sensations through physical exercises designed to bring on the sensations that come up when we have strong emotions. We do this because facing physical sensations over and over makes them easier to tolerate.

Mindful Emotion Awareness

Chapter 7 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook presents the benefits of applying mindful awareness, a nonjudgmental present-focused stance, to emotional experiences. Mindful awareness is first practiced through a formal meditation exercise that introduces readers to applying this quality of attention to their emotions. Next, readers are encouraged to continue practicing mindful emotion awareness though the use of a Mindful Mood Induction exercise. Finally, the chapter continues by focusing on the Anchoring in the Present skill, which allows us to apply the concept of mindful emotion awareness to emotional experiences as they are coming up in daily life.

Setting Goals and Maintaining Motivation

Chapter 4 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook focuses on identifying ways that your emotional responding is interfering with your lives—the top problems you would like to change and how determine the specific steps needed to address these problems. The importance of maintaining motivation for making these difficult changes is also discussed. The topics covered in this chapter form the necessary foundation for building a healthier relationship with our emotions. The rest of the skills in this book build upon this groundwork. This chapter also explores the costs and benefits of changing and remaining the same.

Learning to Record Your Experiences

Chapter 3 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook teaches the importance of monitoring emotions and experiences, as well as about record-keeping. Keeping ongoing records of experiences helps us understand how changing our relationship with our emotions corresponds to the gains made in treatment. The chapter introduces questionnaires to be used throughout treatment to monitor emotions and teaches how to track progress throughout treatment.

The Role of Medication in the Treatment of Emotional Disorders

Chapter 12 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook describes medications that are commonly prescribed for emotional disorders. These include anti-anxiety medications such as benzodiazepines and beta blockers, as well as antidepressant medications like selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors. In addition, individuals with emotional disorders are sometimes prescribed mood stabilizers or antipsychotic medications. The chapter answers frequently asked questions about medications. It also provides recommendations for how to discontinue medications under the supervision of the prescribing physician. This treatment program can be completed in combination with the use of medication and considerations for this practice are described in this chapter.

Putting It Into Practice—Emotion Exposures

Chapter 11 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook explains what emotion exposures are and why they are so important. Facing strong emotions give us the opportunity to learn that (a) any uncomfortable emotions we feel are temporary—even without engaging in any avoidance, our negative emotions will eventually subside; (b) we can cope with negative emotions better than we thought; and (c) we can perform tasks and activities that are important to us even when experiencing strong emotions. The chapter teaches how to design effective emotion exposure exercises as well as to develop an emotion exposure hierarchy. We then repeatedly practice confronting strong emotions through emotion exposure exercises.

Countering Emotional Behaviors

Chapter 9 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at another part of our emotional experiences—emotional behaviors, which refer to the things we do to manage our emotions. This chapter presents skills to help us identify and evaluate our emotional behaviors by examining both the short term and long term consequences of these actions. In general, unhelpful emotional behaviors provide short term relief from strong emotions but set us up to experience even more strong emotions in the future. Lastly, we learn to counter unhelpful emotional behaviors by replacing current emotional behaviors with new, alternative behaviors, a skill called choosing an Alternative Action.

Cognitive Flexibility

Chapter 8 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook looks at one part of our emotional experiences—our thoughts—and describes how thoughts are very important for influencing how we feel. The chapter describes our tendency to get stuck in automatic patterns of thinking, which we refer to as thinking traps. This treatment describes two specific types of thinking traps: jumping to conclusions and thinking the worst. Next, readers are encouraged to identify their own patterns of negative thinking to generate alternative interpretations. The overall goal is to be more flexible in our thinking, referred to as cognitive flexibility.

Understanding Your Emotions—Following the ARC

Chapter 6 of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Workbook teaches us to put our emotional experience in context by examining what happens before and after we feel a strong emotion. First, we look for patterns in the situations or events that trigger emotions. Next, we continue to break-down our emotional response into thoughts, physical sensations, and behaviors. Finally, we look at the consequences for how we respond to our emotions, both in the short term and in the long term. The way we respond in the midst of an emotional response can have consequences for the emotions we feel in the future, and this understanding may help motivate us to make changes in the way we’re currently coping.