Foundations of the Positive Affect Tolerance Protocol: The Central Role of Interpersonal Positive Affect in Attachment and Self-Regulation

Research has highlighted the negative effects of early neglect and abuse on the development of emotional self-regulation and attachment. Attention has focused more on negative affect states related to past adverse and traumatic experiences than on the deactivating effects of the absence of early shared positive affect states from parent-infant play, warmth, and affection. Treatment strategies for survivors of early neglect and abuse have focused on methods to metabolize memories of traumatic events. Skills development models have emphasized the benefits of distress tolerance, acceptance, and mindfulness training for patients with persistent negative affect states. Research on the benefits of therapeutic interventions intended to increase positive affect indicates they promote prosocial behaviors and creativity, broaden the scope of attention, reduce emotional symptoms and behavioral problems, and improve physical health. Within the field of eye movement desensitization and reprocessing (EMDR) therapy, procedures to increase positive affect have generally focused on resource development and installation procedures intended to increase access to positive affect-related memories and images. A neglected clinical issue is the inability of survivors of early neglect to tolerate and integrate actual positive interpersonal experience into positive emotional states, interpersonal scripts, or self-concepts. These deficiencies, characteristic of those with dismissing insecure attachment, help produce and maintain profound psychological, medical, and social problems that limit the ability of patients with these histories from progressing in psychotherapy. This article explores research supporting the potential benefits of an EMDR-related procedure, the positive affect tolerance (PAT) and integration protocol, along with possible mechanisms by which the PAT protocol in general, and its bilateral stimulation procedures, might produce clinical benefits for survivors of early neglect. Case vignettes illustrate the potential challenges of implementing and the potential impact of the PAT protocol. Research designs and assessment tools are described that could clarify the potential benefits of the PAT protocol compared to other treatments designed to increase positive affect.