BABCP spring meeting: David Barlow's unified protocol - emotional awareness training & cognitive reappraisal (fourth post)
Last updated on 6th March 2012
I have already written three posts about the David Barlow workshop at this year's Spring BABCP conference. The most recent was "Motivation enhancement & treatment rationale" - the first two modules of the new eight module transdiagnostic "Unified protocol" intervention for emotional disorders (including anxiety & depression). Today's post is about the next two modules - "Emotional awareness training" and "Cognitive appraisal & reappraisal". This pair are apparently the first two of the five module core of the treatment. The other three core components are "Emotion driven behaviours (EDB's) & emotional avoidance", "Awareness & tolerance of physical sensations" and "Interoceptive & situational emotion exposures".
David commented that "Emotional awareness training" usually takes anywhere from 1 to 3 sessions. This "mindfulness" intervention is, for him, more a means to an end rather than an end in itself, although he did highlight the value of living in the present rather than being trapped by frequent worry and rumination. In the "Client workbook" this awareness training is covered by three chapters - "Understanding your emotions", "Recognizing and tracking your emotional responses" and "Learning to observe your emotions and your reactions to your emotions". I've practised and taught mindfulness for many years ... and I find the "Unified protocol" approach to this area intriguing. The initial emphasis is educational. It's an approach to understanding emotions that I'm very sympathetic to. I think the important distinction with emotions is not whether they are positive/pleasant or negative/unpleasant but much more significantly whether they are adaptive/functional/constructive/helpful or maladaptive/dysfunctional/destructive/unhelpful. I've written a lot about this over the years on this website. For personal experience, see "Walking in the Mamores: anxiety as a friend" and "Ways of coping: theory & personal experience" and a bit more theoretically, see "Both negative & positive emotions can be functional or dysfunctional" and the many handouts on the "Emotions, feelings & personality" page. The "Unified protocol" encourages participants to begin understanding emotions with this adaptive/ maladaptive distinction. It also introduces a three part model of emotions that involves physical sensations/feelings (what I'm feeling), thoughts (what I'm thinking) and behaviours (what I'm doing). I personally prefer the fuller picture provided an adaptation of Les Greenberg's "Five part emotional awareness" model, with its separation of "impulse or action tendency" from "wish or need" ... although it may well be that the more obvious three-part sensations/feelings, behaviours, and thoughts model may be easier to teach and track. And this is what this third module of the protocol focuses on, using a series of explanations and practical exercises to encourage this process.
The fourth module in the eight part unified protocol is "Cognitive appraisal & reappraisal" (usually apparently covered in one or two sessions). David commented that the unified protocol emphasises the importance of increasing cognitive flexibility in appraisals. And he went on to say that it boiled "cognitive errors" down into two general types - overestimation of the probability that a particular outcome will occur, and overestimation of how disastrous the outcome would be if it did occur (catastrophising). He showed us an ambiguous picture and we discussed the various ways we could put different interpretations on what was happening. We know that when people are anxious they tend to "scan for danger" and then misinterpret their experience in ways that make it appear more threatening than it probably actually is. Reappraisal processes are important here in encouraging a more level, less upsetting, more helpful view of what's going on. I've written a previous post on "Reappraising reappraisal" that explains this area more fully, and you can access further useful information on this important subject by clicking the "Reappraisal" tag. Interesting. As with so much of the material in the unified protocol, the developers of this approach have concentrated down bigger, fuller research areas into fairly simple sets of explanation and therapeutic intervention. Some times I wonder how good a job particular modules actually do in giving justice to the power & extent of a specific therapeutic option (e.g. mindfulness or reappraisal), but clearly there is also a need to keep things simple and relatively straightforward.
For a description of the next two modules in the eight module unified protocol, see tomorrow's post "Emotional avodance & emotion driven behaviours (EDB's), and awareness & tolerance of physical sensations".