Course Description

Emotional avoidance and low distress tolerance are core transdiagnostic processes underlying a wide range of psychological disorders, including anxiety, depression, trauma-related conditions, substance use, and relational dysfunction. While avoidance may provide short-term relief, it contributes to long-term emotional dysregulation, symptom persistence, and reduced psychological flexibility. This course provides clinicians with a comprehensive, evidence-based framework for understanding and treating these processes across diverse clinical presentations.  Participants will explore theoretical foundations, including behavioral, cognitive, acceptance-based, and emotion regulation models, as well as neurobiological mechanisms that contribute to distress intolerance. The course emphasizes practical application through integrative treatment strategies drawing from Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), mindfulness-based interventions, and somatic approaches.  Clinicians will develop skills in assessment, case conceptualization, and implementation of targeted interventions such as emotional exposure, distress tolerance training, cognitive defusion, and behavioral activation. Special attention is given to cultural, ethical, and contextual considerations, as well as therapist factors and countertransference.  By the end of this course, participants will be equipped to effectively identify, conceptualize, and treat emotional avoidance and low distress tolerance in clinical practice, enhancing client outcomes and long-term resilience. This is a NBCC and Florida Board Approved course for 3 CE hours.

Please review the course materials prior to purchasing the course. Often, individuals will print a copy of the course worksheet to complete while they view the course material. Once you are ready to complete the course, please enroll in the course and complete the course requirements, including the course post-test and course survey. You will receive your certificate automatically for printing or downloading after achieving an 80% or higher on the post-test and completing the course survey. 

Emotional Avoidance & Low Distress Tolerance Course Text.pdf

Emotional Avoidance & Low Distress Tolerance Course Worksheet.pdf

Course Author:  Bryan Glazier, PhD, LMFT, LMHC,, FL Qualified MHC/MFT Supervisor 

Course Time/Location: 3 CE Hours, Location: www.directceu.com (web-based, asynchronous/home study) 

Course Text: Emotional Avoidance & Low Distress Tolerance in Psychotherapy: A Transdiagnostic, Process-Based Approach by Bryan Glazier, PhD, LMFT, LMHC

Course Board Approval Statement(s): NBCC, Florida Board Approved

Directceu, llc has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7411. directceu, llc maintains responsibility for this program and its content.

directceu, llc (BAP # 50-17578) is approved by the Florida Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling. directceu, llc maintains responsibility for this program and its content.

 Financial Disclosure Statement

directceu, llc is committed to providing our professional colleagues with unbiased information. directceu does not accept commercial support and our course authors have no significant financial interests or other conflicts of interest pertaining to the material.

Learning Objectives:

Through the completion of this course, participants will be able to:

  1. Define emotional avoidance and distress tolerance and explain their transdiagnostic role in psychopathology. 
  2. Differentiate between adaptive emotion regulation and maladaptive avoidance processes. 
  3. Identify neurobiological, developmental, and attachment-based contributors to distress intolerance. 
  4. Apply evidence-based interventions from CBT, ACT, DBT, and mindfulness-based approaches to reduce avoidance. 
  5. Utilize clinical techniques including exposure, cognitive defusion, and behavioral activation in treatment planning. 
  6. Assess emotional avoidance patterns using clinical interviews and standardized measures. 
  7. Incorporate cultural, ethical, and contextual factors into treatment of avoidance and distress intolerance. 
  8. Recognize and manage therapist avoidance and countertransference reactions in clinical work.

 

Course Syllabus:

I. Introduction

  • Definition of emotional avoidance 
  • Distress tolerance conceptualization 
  • Transdiagnostic relevance 

II. Theoretical Foundations

  • Behavioral models (negative reinforcement) 
  • Cognitive models (catastrophic thinking) 
  • ACT and psychological flexibility 
  • Emotion regulation theories 
  • DBT framework 

III. Neurobiological and Physiological Mechanisms

  • Limbic system and threat detection 
  • Prefrontal regulation 
  • Autonomic nervous system 
  • Interoception and somatic processes 

IV. Developmental and Attachment Origins

  • Early emotional environments 
  • Attachment styles 
  • Trauma and adverse experiences 
  • Learned avoidance patterns 

V. Clinical Presentation Across Disorders

  • Anxiety and avoidance cycles 
  • Depression and withdrawal 
  • Trauma-related avoidance 
  • Substance use and behavioral addictions 

VI. Assessment and Case Conceptualization

  • Clinical interview strategies 
  • Functional analysis 
  • Standardized measures 
  • Integrative case formulation 

VII. Core Clinical Mechanisms

  • Negative reinforcement loop 
  • Emotional amplification 
  • Cognitive fusion 
  • Experiential narrowing 

VIII. Evidence-Based Interventions

  • CBT (exposure, restructuring) 
  • ACT (acceptance, values) 
  • DBT (distress tolerance skills) 
  • Mindfulness and somatic approaches 

IX. Clinical Techniques and Interventions

  • Psychoeducation strategies 
  • Emotional exposure 
  • Cognitive defusion 
  • Behavioral activation 
  • In-session coaching 

X. Special Populations and Contexts

  • Adolescents and impulsivity 
  • High-functioning professionals 
  • Trauma survivors 
  • Couples and relational dynamics 
  • Telehealth considerations 

XI. Cultural and Ethical Considerations

  • Cultural norms and emotion 
  • Socioeconomic influences 
  • Ethical practice and pacing 

XII. Therapist Factors and Countertransference

  • Therapist avoidance 
  • Countertransference reactions 
  • Therapist distress tolerance 

XIII. Integration and Future Directions

  • Integrative treatment models 
  • Neuroscience advancements
  • Technology and mental health