The Positive Affect Tolerance and Integration Protocol: A Novel Application of EMDR Therapy Procedures to Help Survivors of Early Emotional Neglect Learn to Tolerate and Assimilate Moments of Appreciation, Praise, and Affection

Abstract

Survivors of early neglect and other adverse childhood experiences often struggle with general and social anxiety, depressive states, and negative self-concept. Trauma-informed treatment strategies for survivors, such as EMDR therapy, exposure therapy, and cognitive processing therapy, tend to focus on resolving memories of adverse and traumatic experiences. Coping skills development models, such as Dialectical Behavior Therapy and Skills Training in Affective and Interpersonal Regulation (STAIR), emphasize training in mindfulness, assertiveness, or self-soothing skills for patients with persistent negative affect states. In the era of trauma-informed psychotherapy, an often-overlooked clinical issue is the impaired ability of survivors of early neglect to tolerate and integrate moments of shared positive interpersonal experience into positive emotional states and positive self-concepts. Survivors of neglect tend to make use of overt or covert avoidance strategies and minimization responses to avoid the discomfort, anxiety, or confusion they experience in what others find to be pleasurable and enriching social interactions. The Positive Affect Tolerance and Integration (PAT) protocol focuses on helping survivors of early emotional neglect to learn to tolerate and assimilate moments of appreciation, praise, and affection. This paper offers principles and a specific series of interventions that incorporate standard EMDR therapy procedures with minor adaptations. In addition to a summary of the PAT protocol, three case examples are described to illustrate selection criteria and potential clinical responses.