Improving self-regulation and social functioning for survivors of early emotional neglect and abuse with positive affect tolerance and integration protocol: A case series
Description
Survivors of early emotional neglect experience pervasive difficulties including vulnerability to adult psychiatric disorders and inability to regulate emotional states (Schore, 1996, 1997, 2000, 2001a, 2001b; Teicher, 2000, 2002; Teicher et al, 1993; Teicher et al., 1997). Their inability to regulate emotional states is not solely linked to effects of adverse events, but is significantly linked to insufficient exposure to normal, developmental attachment sequences that foster capacities for self-regulation.
A subset of adult survivors of early, pervasive, emotional neglect who meet full or partial criteria for posttraumatic stress disorder also present with comorbid Cluster C Axis II symptoms (Avoidant, Dependent, Obsessive-Compulsive) and meet criteria for dismissing (or fearful) insecure attachment (Cassidy & Shaver, 1999; Main, 1996).
Clinical assessment reveals these patients have low tolerance for positive interpersonal emotions and engage in defensive strategies to dismiss, minimize, deny or subtly avoid experiencing and assimilating this positive emotional states into their internal model of self. These strategies include overt and covert behavioral avoidance as well as dissociate defenses. Paradoxically, these patients may show superficial characteristics or competence, interpersonal skills, or emotional stability which on closer examination prove to be fragile or which collapse in the face of social stressors.
The general theoretical base for the Positive Affect Tolerance and Integration (PAT) protocol is related to McCullough’s (1996, 2003) model of affect phobia and recognizes McCullough’s emphasis on an anxiety regulating, titrated approach to developing tolerance for adaptive affect and associated coping behaviors. Putnam’s (1997) discrete behavioral states model provides an important conceptual framework for understanding these patients’ needs to gradually develop new discrete behavioral (psychophysiological and affective) states and new pathways (schemes and scripts) fostering access to these shared positive states often as a crucial early phase of treatment to help resolve their impairments in emotional self-regulation.
This presentation describes the use of standard EMDR procedural steps in a treatment plan that postpones the standard three pronged (past, present, future) PTSD protocol, but which is consistent with the consensus model for Complex PTSD (Brown, Scheflin & Hammond, 1998; Chu, 1998; Courtois, 1999; Hart, Nijenhuis, Steele, 2006) and other EMDR approaches focused initially on improving response to current stimuli (Hoffman, 2004; Leeds & Korn, 1998; Leeds & Shapiro, 2000) before attempting to target childhood traumatic memories. Targets for PAT are recent experiences in which the patient was exposed to positive, shared, interpersonal emotional states. The purposes for applying PAT to these targets are: to decrease defensive avoidance; dissociation and anxiety about shared positive emotional states; to increase capacity to tolerate and enjoy these shared positive emotional states; and to integrate these shared positive emotional states into positive schemas and self-concepts. Observed clinical gains following PAT included: improved mood and resilience, and decreased depersonalization during subsequent use of EMDR to reprocess traumatic memories.
The goal in presenting this “Positive Affect Tolerance and Integration Protocol” case series is to encourage research to evaluate the clinical effectiveness of this application of the standard EMDR procedures for a clinical subpopulation generally considered challenging to treat.
A subset of adult survivors of early, pervasive, emotional neglect who meet full or partial criteria for posttraumatic stress disorder also present with comorbid Cluster C Axis II symptoms (Avoidant, Dependent, Obsessive-Compulsive) and meet criteria for dismissing (or fearful) insecure attachment (Cassidy & Shaver, 1999; Main, 1996).
Clinical assessment reveals these patients have low tolerance for positive interpersonal emotions and engage in defensive strategies to dismiss, minimize, deny or subtly avoid experiencing and assimilating this positive emotional states into their internal model of self. These strategies include overt and covert behavioral avoidance as well as dissociate defenses. Paradoxically, these patients may show superficial characteristics or competence, interpersonal skills, or emotional stability which on closer examination prove to be fragile or which collapse in the face of social stressors.
The general theoretical base for the Positive Affect Tolerance and Integration (PAT) protocol is related to McCullough’s (1996, 2003) model of affect phobia and recognizes McCullough’s emphasis on an anxiety regulating, titrated approach to developing tolerance for adaptive affect and associated coping behaviors. Putnam’s (1997) discrete behavioral states model provides an important conceptual framework for understanding these patients’ needs to gradually develop new discrete behavioral (psychophysiological and affective) states and new pathways (schemes and scripts) fostering access to these shared positive states often as a crucial early phase of treatment to help resolve their impairments in emotional self-regulation.
This presentation describes the use of standard EMDR procedural steps in a treatment plan that postpones the standard three pronged (past, present, future) PTSD protocol, but which is consistent with the consensus model for Complex PTSD (Brown, Scheflin & Hammond, 1998; Chu, 1998; Courtois, 1999; Hart, Nijenhuis, Steele, 2006) and other EMDR approaches focused initially on improving response to current stimuli (Hoffman, 2004; Leeds & Korn, 1998; Leeds & Shapiro, 2000) before attempting to target childhood traumatic memories. Targets for PAT are recent experiences in which the patient was exposed to positive, shared, interpersonal emotional states. The purposes for applying PAT to these targets are: to decrease defensive avoidance; dissociation and anxiety about shared positive emotional states; to increase capacity to tolerate and enjoy these shared positive emotional states; and to integrate these shared positive emotional states into positive schemas and self-concepts. Observed clinical gains following PAT included: improved mood and resilience, and decreased depersonalization during subsequent use of EMDR to reprocess traumatic memories.
The goal in presenting this “Positive Affect Tolerance and Integration Protocol” case series is to encourage research to evaluate the clinical effectiveness of this application of the standard EMDR procedures for a clinical subpopulation generally considered challenging to treat.
Format
Conference
Language
English
Original Work Citation
Leeds, A. (2007, June). Improving self-regulation and social functioning for survivors of early emotional neglect and abuse with positive affect tolerance and integration protocol: A case series. Poster presented at the 8th EMDR Europe Association Conference, Paris, France
Citation
“Improving self-regulation and social functioning for survivors of early emotional neglect and abuse with positive affect tolerance and integration protocol: A case series,” Francine Shapiro Library, accessed May 18, 2024, https://francineshapirolibrary.omeka.net/items/show/19356.