Affect Regulation Training: A Practitioners Manual


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A Practitioners' Manual

Product details Format Hardback pages Dimensions x x Back cover copy No one is immune to intense emotions--and whether we accept them and how we regulate them can mean the difference between mental health or illness. The critical role of these complex emotional skills in human well-being is at the core of Affect Regulation Training ART , which is gaining ground as both a preventive method and an adjunct to other therapies. Affect Regulation Training combines a step-by-step manual for conducting ART with patients with an extensive review of how and why the method works.

Introductory chapters analyze the relationship between deficits in emotion regulation and mental dysfunction, explain the theory behind the ART model, and offer practical ideas for optimizing treatment.


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The manual identifies component skills of ART such as nonjudgmental awareness and compassionate self-support, pinpoints situations in which the skills are beneficial, and provides exercises employing them individually and in combination. An evaluation section features empirical findings and feedback from therapists and clients. Included in the coverage: Emotion regulation: definition and relevance for mental health. Guidelines for effective delivery of ART. Linking ART skills to build successful interventions. Creating goals that result in effective self-management. Recommended education and training for therapists.

The richness and flexibility of the ART program makes Affect Regulation Training an important addition to the toolkits of psychologists, psychiatrists, marriage and family therapists, and clinical counselors and social workers, as well as practitioners and administrators in fields such as substance abuse, public mental health, education, medicine, military health, and the justice system.

Table of contents Emotion Regulation and Mental Health. About Matthias Berking Dr. He is also a licensed psychotherapist trained in a wide range of empirically-validated interventions. Because this covariate did not interact with any other variables, the other effects in the model can be interpreted as average effects across both measures. We included both measures in all subsequent analyses to enhance the statistical reliability.

These effects were not moderated by comorbidities exclusively meeting criteria for MDD vs. Further analyses indicated that in the ART group, The rate of remission in CFC was The results of the mediation analyses are illustrated in Fig 2. Consistent across both measures of depression, participants in the ART and CFC groups had significantly higher post-treatment levels of emotion regulation skills than did participants in the WLC group, controlling for pre-treatment levels of emotion regulation. Higher post-treatment levels of these skills were negatively associated with lower post-treatment levels of depressive symptoms, controlling for pre-treatment levels of depressive symptoms.

The primary aim of the present study was to evaluate the efficacy of a training of general emotion regulation skills with regard to reducing depressive symptoms in individuals meeting criteria for MDD.

The main findings of the study indicate that ART is superior to WLC with regard to reducing DSS, enhancing emotion regulation skills, and reducing psychopathological symptoms other than depression. Thus, with regard to the goal of enhancing our understanding of the role of emotion regulation in psychopathology, this study contributes to the literature by showing that experimentally manipulating emotion regulation skills in the field with the help of an intervention that focuses exclusively on strengthening adaptive responses toward undesired feelings was significantly associated with changes in DSS in clinically depressed patients.

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Affect regulation

As such, the findings go beyond previous findings from observational studies e. Another interesting finding from the present study is that CFC also led to significant improvement of emotion regulation skills although more sophisticated ways of utilizing common factors can be imagined e.

This finding indicates that such abilities can be fostered not only by systematically practicing skills that directly focus on responses toward undesired emotions as in ART but also by focusing on the misfit between motivation and perception as a significant antecedent of affective responses.

Consistent with this hypothesis, CFC also led to a significant reduction of depressive symptoms. Moreover, the results from the mediation analyses indicate that the increase of emotion regulation skills is an important mechanism of change in both ART and CFC. These findings are in line with research indicating that various evidence-based treatments for mental disorders reduce maladaptive emotion regulation [ 5 ].

The findings significantly add to the literature because of the regrettably rare use of mediation analyses in randomized clinical trials and because of the use of identical measures of emotion regulation in all conditions currently, findings on emotion regulation and psychopathology are often difficult to compare because they use different definitions or measures of emotion regulation [ 5 ]. Thus, the present study provides evidence for the assumption raised by some authors e.

If future studies provide further evidence in support of this hypothesis, research should attempt to clarify whether including the enhancement of emotion regulation into common factor approaches to psychotherapy e. For example, training therapists to recognize moments in treatment in which fostering adaptive emotion regulation is most helpful and to apply a broad range of interventions shown to foster emotion regulation may facilitate the proper balance of the use of standardized interventions and the flexible adaptation of the treatment to the specific needs, strengths and motivation of the individual patient.

To determine the implications of our findings for clinical practice, it is necessary to clarify how the effects of ART on depression compare to those of disorder-specific treatments for depression. When using these results as benchmarks, ART appears less effective than individual disorder-specific treatment and less effective than group-based disorder-specific treatments. Nevertheless, the present study provides significant proof of the principle that by systematically enhancing emotion regulation skills, depressive symptom severity can be reduced in individuals with MDD.

The present study provides no evidence that a comparatively brief, group-based, transdiagnostic emotion regulation skills training would be superior to current disorder-specific treatments. The comparatively small percentage of patients remitted after the six plus one group sessions provided in ART indicates that a large number of patients require further treatment. Future research should clarify to what extent the remission rate can be further enhanced by extending and intensifying transdiagnostic emotion regulation trainings.

Another question relevant to clinical practice is how ART relates to other transdiagnostic approaches targeting depression and other disorders. The most important distinction is that ART focuses exclusively on how to respond to undesired emotion without providing any information or training on how to cope with specific mental disorders.

Because of its entirely transdiagnostic format, ART has been proposed as a stand-alone intervention that can be used when enhancing emotion regulation skills alone is expected to suffice for preventing or coping with a mental disorder or used as an adjunctive intervention when strengthening the focus on emotion regulation skills appears promising to overcome a mental disorder. This proposal is based on the following assumptions: i any kind of cognitive or behavioral activity that plays a role in maintaining a mental disorder may initially reduce negative effects to some extent ; ii individuals experiencing negative emotions are tempted to engage in pathogenic cognitive or behavioral processes when they encounter negative affective states; iii engaging in pathogenic processes is reinforced by the subsequent short-term reduction of negative mood; and iv the likelihood of engaging in these pathogenic processes is reduced by providing adaptive ways of responding to undesired affective states which ideally reduce negative affect in both a short- and long-term perspective [ 22 ].

Empirical support for this line of argument comes from the rapidly growing number of studies associating various forms of mental disorders with deficits in emotion regulation e. Given preliminary evidence that emotion regulation skills can be enhanced with transdiagnostic trainings [ 2 , 66 , 82 , ], there is significant support for the hypothesis that strengthening emotion regulation skills might be a promising approach to treating mental disorders in general.

Major limitations of the present study include the exclusive focus on individuals meeting criteria for MDD. The potential contribution of ART to clinical practice is based on the fact that ART was developed to strengthen adaptive responses to any kind of negative affect without addressing the characteristics of specific mental disorders. From this, it can be concluded that ART can be applied to any kind of mental disorder. However, this does not mean that ART is effective in treating any kind of mental disorder.

Another major limitation of the study is the lack of a comparison between ART and the gold standard treatment of depression. Given the abundant evidence for the importance of disorder-specific maintenance factors e. Ideally, such studies should compare both individual- and group-based formats of transdiagnostic and disorder-specific treatments in patients who differ with regard to the number of disorders they meet criteria for. Moreover, although interventions such as ART may not be the most effective stand-alone intervention for specific disorders, some first-line treatments might benefit from a stronger focus on emotion regulation [ 66 ].

Further limitation of the present study include the lack of a long-term follow-up because all participants received individual CBT for depression to evaluate the potential augmenting effects of ART on subsequent individual therapy , the lack of data on adherence in a way that would allow for statistically relating adherence to outcome, and the lack of explicit assessment of adverse effects. Thus, it is presently unclear whether the differences found across groups would be stable of longer periods of time, whether the outcome is related to adherence, and to what extent adverse effects occurred in the treatment conditions.

With regard to the latter, it is of note that we systematically looked for adverse effects when supervising therapists in the active conditions and found none. Finally, it is of note that there was an above-average percentage of strain related drop-out in the waitlist control condition. Therefore, we presently assume that there are no specific adverse effects associated with the two active treatments. Nevertheless, future studies should assess and evaluate adverse effects with standardized instruments.

In addition to including follow-up assessments and adherence ratings for all treatments, these studies should also evaluate to what extent emotion regulation trainings can be used in later stages of treatment or as aftercare interventions to prevent patients from relapsing when confronted with undesired affective states [ 57 ]. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Deficits in general emotion regulation skills have been shown to be associated with various mental disorders. Materials and methods Design and procedure We evaluated the efficacy of ART in a multicenter, prospective, 3-armed, randomized controlled trial see Fig 1 for illustration.

Download: PPT. Participants To be included in the study, participants had to meet the following criteria: informed consent, current primary diagnosis of MDD, age 18 or above, and sufficient German language skills. Measures Diagnostics. Primary outcome measures. Secondary outcome measures. Treatment Affect regulation training ART.


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Waitlist control condition WLC. Common factor control condition CFC. Treatment integrity. Statistical analyses.

Affect Regulation Introduction

Results Sample characteristics Out of patients screened for eligibility, met the study criteria and were allocated to the study conditions see Fig 1 for more information on reasons for exclusion. Table 1. Sociodemographic characteristics and comorbidity at baseline. Preliminary analyses As shown in Fig 1 , of individuals applying for treatment at one of the study centers, met the study criteria and were randomly allocated to one of the three treatment conditions.

Table 2. Descriptive statistics for all measures by group at all assessment points. Table 3. Simple slopes, cross-level interaction effects and pairwise comparisons between groups for depression, comorbidity, and emotion regulation total scores. Table 4. Cross-level interaction effects and pairwise comparisons between groups for emotion regulation subscales measures. Mediation analysis The results of the mediation analyses are illustrated in Fig 2. Fig 2. Affect regulation mediates the effects of both active treatments on depression.

Affect Regulation Training - Matthias Berking, Brian Whitley - Häftad () | Bokus

Discussion The primary aim of the present study was to evaluate the efficacy of a training of general emotion regulation skills with regard to reducing depressive symptoms in individuals meeting criteria for MDD. Supporting information. S1 File. References 1. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review. Emotion-regulation skills as a treatment target in psychotherapy. Behaviour Research Therapy. Mennin D, Farach F. Emotion and evolving treatments for adult psychopathology. Clinical Psychology: Science Practice. View Article Google Scholar 4.

Emotion regulation and psychopathology. Annual Review of Clinical Psychology. Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: a systematic review. View Article Google Scholar 6. Emotion regulation flexibility. Cognitive Therapy Research. View Article Google Scholar 7. Association AP. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC Emotion regulation in acceptance and commitment therapy. Journal of clinical psychology.

Emotion regulation model in binge eating disorder and obesity-a systematic review. Neuroscience Biobehavioral Reviews. Negative life events, cognitive emotion regulation and emotional problems.

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Personality Individual differences. View Article Google Scholar Watkins ER. Depressive rumination and co-morbidity: evidence for brooding as a transdiagnostic process. Emotion regulation and sex addiction among college students. International Journal of Mental Health Addiction. Emotion generation and regulation in anorexia nervosa: a systematic review and meta-analysis of self-report data. Klonsky ED. The functions of self-injury in young adults who cut themselves: Clarifying the evidence for affect-regulation. Psychiatry research. Negative affect as mediator between emotion regulation and medically unexplained symptoms.

Journal of psychosomatic research. Deficits in emotion-regulation skills predict alcohol use during and after cognitive—behavioral therapy for alcohol dependence. Journal of consulting clinical psychology. Evidence of broad deficits in emotion regulation associated with chronic worry and generalized anxiety disorder. The role of emotion regulation in auditory hallucinations.

Berking M, Wupperman P. Emotion regulation and mental health: recent findings, current challenges, and future directions. Current opinion in psychiatry. Deficits in general emotion regulation skills—Evidence of a transdiagnostic factor. Prospective effects of emotion-regulation skills on emotional adjustment. Journal of Counseling Psychology. Berking M, Whitley B. Emotion regulation: Definition and relevance for mental health. New York: Springer; Linehan MM. Skills training manual for treating borderline personality disorder: Guilford Press; Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: a controlled trial.

Behaviour research therapy. Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder. Archives of general psychiatry. Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. The Journal of nervous mental disease. International Journal of Geriatric Psychiatry: A journal of the psychiatry of late life allied sciences. Dialectical behavior therapy for depressed older adults: A randomized pilot study.

The American Journal of Geriatric Psychiatry. Dialectical behavior therapy versus comprehensive validation therapy plus step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug alcohol dependence. Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry. Dialectical behavior therapy for binge eating disorder. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with week follow-up.

Emotion-focused cognitive-behavioral therapy for anxious youth: A multiple-baseline evaluation. Journal of Contemporary Psychotherapy. Emotion-focused therapy for couples in the treatment of depression: A pilot study. BMI, measured at baseline, post, 6 and 12 months 1. Waist, measured at baseline, post, 6 and 12 months 2. Psychological wellbeing as measured by: 2. Sleep pattern as measured by: 3. The CRSQ, measured at baseline, 6 and 12 months.

Age between 10 and 14 years.

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Comorbid medical disorders that cause a part of the weight gain i. Youngsters with medical problems where obesity is secondary. First year next to data collection: 1.

ISBN 10: 1493910213

Writing information for participants and their parents education folders and flyers 1. Feasibility analysis 1. Making movies and homework assignments to use in the training psycho- education 2. Second year next to data collection and analyzing: 2. Writing guidelines and manual 2. Train the trainer materials 2. Distributing knowledge newsletter 2. Information for partners 2. Press communications 2. Manuscript on the effects of the ER training on weight, psychological concepts stress, emotion regulation, emotional eating , on attention eating cues and the related psychophysiological measures, directly after training and at 6 and 12 months follow-up IPD sharing statement The data is saved on a server of the University Ghent.

Three types of data will be stored: questionnaire data, behavioural data and physiological data. Raw data of the questionnaires and behavioural data will be saved as. Data storage fact sheets are used to document the meta-data. These files describe the transition from raw data to processed data and contain information about the variables and the encompassing datasets. The data storage fact sheets are stored on the local server of the department of the UGhent.

In this study there will be personal or confidential data collected. No personal information of participants will be coupled to the gathered data in any way. Participants' codes will be in the entire study with the informed consents as only exception. Participants will be informed about this in the informed consent. For sharing data, a protected USB flash drive is provided, filtered according the limitations as stated in the privacy and ethical commissions.

Result of results found for within. Previous Trial Back to results Next Trial. Plain English Summary Background and study aims Childhood obesity is a growing problem, and because of the severity of the negative consequences, it needs to be dealt with as soon as possible. Study information Scientific title Improving weight control and long-term treatment effects in young adolescents with obesity via emotion regulation training Acronym Study hypothesis The trialists expect that adding an emotion regulation training ERT to the care as usual results in: 1. Ethics approval Ethics Committee of the Ghent University Hospital - approval pending Study design Randomised controlled trial Primary study design Interventional Secondary study design Randomised controlled trial Trial setting Hospitals Trial type Treatment Patient information sheet Not available in web format, please use the contact details to request a patient information sheet Condition Childhood obesity Intervention The recruitment consists of two waves of children entering the clinic and Feces, measured at baseline and 6 months Secondary outcome measures 1.

Eligibility Participant inclusion criteria 1. Results and Publications Publication and dissemination plan 1.

Affect Regulation Training: A Practitioners Manual Affect Regulation Training: A Practitioners Manual
Affect Regulation Training: A Practitioners Manual Affect Regulation Training: A Practitioners Manual
Affect Regulation Training: A Practitioners Manual Affect Regulation Training: A Practitioners Manual
Affect Regulation Training: A Practitioners Manual Affect Regulation Training: A Practitioners Manual
Affect Regulation Training: A Practitioners Manual Affect Regulation Training: A Practitioners Manual
Affect Regulation Training: A Practitioners Manual Affect Regulation Training: A Practitioners Manual
Affect Regulation Training: A Practitioners Manual Affect Regulation Training: A Practitioners Manual
Affect Regulation Training: A Practitioners Manual Affect Regulation Training: A Practitioners Manual

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