Emotion regulation therapy

Domain II · Behavioural & cognitive · Douglas Mennin, David Fresco · 2015

What it is

Emotion regulation therapy (ERT) was developed by Douglas Mennin and David Fresco. It is a mechanism-targeted, integrative CBT that combines skills training and exposure with ideas from acceptance, mindfulness, emotion-focused therapy and basic affective science. It was built for people with…

Format

• Format. ERT is delivered individually, in weekly sessions. The current manual has 16 sessions; an earlier version had 20. Session length is not stated in the Frontiers paper; the 8-session AR-ERT protocol uses 60-minute sessions. Other versions exist:
• an 8-session ERT that was being tested for dosing and access;

Who practises it, and how they are trained or regulated

• Assessment and ongoing monitoring. There is no single assessment instrument. The therapist keeps a running clinical impression of four things: emotional intensity, a narrowed focus on security, reactive responding, and reduced pursuit of reward. Before every session the client completes a short self-report battery covering worry, rumination, anxiety, depression, attention regulation, decentering and reappraisal. The…
• Phase I: mindful emotion regulation skills (the first half; in the 16-session manual roughly sessions 1–8).
• Goals: (a) psychoeducation on emotions, security and reward motivations, and reactive responding; (b) cue detection using Catch Yourself Reacting monitoring; (c) four regulatory skills taught in order: Orienting, Allowing, Decentering/Distancing, Reframing (with self-compassion built in); (d) taking counteraction. Phase I ends with the ERT Toolbox.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• The same consent and safety points as 4.15.
• The review sliding into problem-solving the content. Keep it at the level of process.
• Anxiety about ending showing up as new crises. Name it, and treat ending itself as a proaction.
• Do not present this as part of the core 16-session manual. The Frontiers paper does not mention it.
• Rising scores during exposure phases. These can be expected, so interpret them alongside approach behaviour.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.