Emotion-focused Psychotherapy Research Articles

The Efficacy of Emotion-Focused Psychotherapy on Perceived Stress and Psychological Well-being in Patients with Corona Anxiety during the Pandemic

Objective: The present study aimed to investigate the efficacy of emotion-focused psychotherapy on perceived stress and psychological well-being in patients with corona anxiety during the pandemic. Methods and Materials: This research was conducted using a quasi-experimental design with a pre-test, post-test, and a control group, along with a three-month follow-up period. The study population consisted of individuals suffering from corona anxiety who had contacted counseling centers in Isfahan for telephone counseling during the summer of 2021. Out of the study population, 33 individuals were selected through purposive sampling and randomly assigned to either the experimental or control group. Participants in the experimental group received emotion-focused psychotherapy over two months. The instruments used in this research included the Perceived Stress Scale (Cohen et al., 1983) (PSS), the Psychological Well-Being Questionnaire (Ryff, 1988) (PWBQ), and the Corona Disease Anxiety Scale (Alipour et al., 2019) (CDAS). The data were analyzed using mixed ANOVA with SPSS version 23. Findings: The results indicated that emotion-focused psychotherapy had a significant effect on perceived stress (P<0.0001; Eta=0.59; F=44.99) and psychological well-being (P<0.0001; Eta=0.68; F=66.28) in patients with corona anxiety. Conclusion: Based on the findings of the current study, emotion-focused psychotherapy, utilizing techniques of emotional awareness, emotional experience, regulation, transformation, and change, can be an effective method for reducing perceived stress and improving psychological well-being in patients with corona anxiety.

Daring to Feel: Emotion-Focused Psychotherapy Increases Amygdala Activation and Connectivity in Euthymic Bipolar Disorder—A Randomized Controlled Trial

BackgroundIn bipolar disorder (BD), the alternation of extreme mood states indicates deficits in emotion processing, accompanied by aberrant neural function of the emotion network. The present study investigated the effects of an emotion-centered psychotherapeutic intervention on amygdala responsivity and connectivity during emotional face processing in BD. MethodsIn a randomized controlled trial within the multicentric BipoLife project, euthymic patients with BD received one of two interventions over 6 months: an unstructured, emotion-focused intervention (FEST), where patients were guided to adequately perceive and label their emotions (n = 28), or a specific, structured, cognitive behavioral intervention (SEKT) (n = 31). Before and after interventions, functional magnetic resonance imaging was conducted while patients completed an emotional face-matching paradigm (final functional magnetic resonance imaging sample of patients completing both measurements: SEKT, n = 17; FEST, n = 17). Healthy control subjects (n = 32) were scanned twice after the same interval without receiving any intervention. Given the focus of FEST on emotion processing, we expected FEST to strengthen amygdala activation and connectivity. ResultsClinically, both interventions stabilized patients’ euthymic states in terms of affective symptoms. At the neural level, FEST versus SEKT increased amygdala activation and amygdala-insula connectivity at postintervention relative to preintervention time point. In FEST, the increase in amygdala activation was associated with fewer depressive symptoms (r = 0.72) 6 months after intervention. ConclusionsEnhanced activation and functional connectivity of the amygdala after FEST versus SEKT may represent a neural marker of improved emotion processing, supporting the FEST intervention as an effective tool in relapse prevention in patients with BD.

Adaptive disclosure, a combat-specific PTSD treatment, versus cognitive-processing therapy, in deployed marines and sailors: A randomized controlled non-inferiority trial

Adaptive Disclosure (AD) is a new emotion-focused psychotherapy for combat-related PTSD. As a second step in the evaluation process, we conducted a non-inferiority (NI) trial of AD, relative to Cognitive Processing Therapy – Cognitive Therapy version (CPT-C), an established first-line psychotherapy. Participants were 122 U.S. Marines and Sailors. The primary endpoint was PTSD symptom severity change from pre- to posttreatment, using the Clinician Administered PTSD Scale for DSM-IV. Secondary endpoints were depression (Patient Health Questionnaire-9; PHQ-9) and functioning (Veterans Rand Health Survey-12; VR-12). For cases with complete data, the mean difference in CAPS-IV change scores was 0.33 and the confidence interval (CI) did not include the predefined NI margin (95% CI =-10.10, 9.44). The mean difference in PHQ-9 change scores was -1.01 and the CI did not include the predefined margin (95% CI = -3.31, 1.28), as was the case for the VR-12 Physical Component and VR-12 Mental Component subscale scores (0.27; 95% CI = -4.50, 3.95, and -2.10; 95% CI = -7.03, 2.83, respectively). A series of intent-to-treat sensitivity analyses confirmed these results. The differential effect size for CAPS-IV was d = 0.01 (nonsignificant). As predicted, Adaptive Disclosure was found to be no less effective than a first-line psychotherapy.

Narrative-Informed, Emotion-Focused Psychotherapy in Synchronous, Online Chat Groups for Adolescents and Young Adults with Cancer: A Proof-of-Concept Study.

Few, scalable, evidence-based psychosocial interventions exist for adolescent and young adult cancer survivors (AYAs, 18–39 years old). Using an existing, facilitated, online synchronous chat group-plus-education model (OSG+E), we replaced their educational workbook with an AYA-created film to stimulate an age-specific, emotion-focused group discussion (OSG+V). This randomized proof-of-concept trial compared the two models' content suitability, group processes, and feasibility over 9 months in 34 male and female AYAs with a range of cancers. AYAs rated the OSG + V model more suitable, cohesive, and as having higher levels of important group processes than the OSG+E. A larger randomized trial is feasible for this AYA-appropriate, emotion-focused OSG + V model.

The role of pre-treatment interpersonal problems for in-session emotional processing and long-term outcome in emotion-focused psychotherapy

Objective: Interpersonal problems may lead to, uphold, or follow from depression. However, we know little of how depressed patients’ different interpersonal problems are associated with patients’ emotional processing during psychotherapy and whether distinct processes are helpful for their long-term reduction. Method: 23 adult outpatients who received emotion-focused therapies lasting 16–20 sessions filled the Inventory of Interpersonal Problems at pre- and post-treatment and 18-month follow-up. These problems were related to emotional processing in two mid-therapy sessions, rated by observers with the Classification of Affective-Meaning States. Results: All pre-treatment interpersonal problems were clearly associated with patients’ negative evaluations of themselves during therapy. Self-experiences of vindictiveness were most pronouncedly linked to in-session emotional expressions of rejecting anger, and self-experiences of social inhibition to expressions of fear and shame, following a circumplex model. In the long-term reduction of interpersonal problems, especially reaching emotional states of hurt and grief seemed beneficial for patients who experienced themselves as socially inhibited, non-assertive, self-sacrificing, or overly accommodating. Conclusions: For clients suffering from particular interpersonal problems, accessing particularly beneficial emotional processes, such as hurt and grief, may form specific therapeutic process goals. Further studies should verify these findings, which link interpersonal theory with research on emotional processing in psychotherapy.

Mapping patterns of change in emotion-focused psychotherapy: Implications for theory, research, practice, and training

An important objective in humanistic-experiential psychotherapies and particularly emotion-focused psychotherapy (EFT) is to map patterns of change. Effective mapping of the processes and pathways of change requires that in-session processes be linked to in-session resolutions, immediate post-session changes, intermediate outcome, final therapy outcome, and longer-term change. This is a challenging and long-term endeavour. Fine-grained descriptions of in-session processes that lead to resolution of specific interpersonal and intrapersonal issues linked with longer-term outcomes are the foundation of EFT, the process-experiential approach. In this paper, evidence in support of EFT as a treatment approach will be reviewed along with research on two mechanisms of change, viewed as central to EFT, clients’ emotional processing and the therapeutic relationship conditions. The implications for psychotherapy research are discussed. Given the methodological constraints, there is a need for more innovative methodologies and strategies to investigate specific psychotherapy processes within and across different approaches to map patterns and mechanisms of change to enhance theory, research, practice, and training.Clinical or methodological significance of this article: This paper was first presented at the International Society for Psychotherapy Research’ Annual Conference in Philadelphia in June 2015 as a Presidential Address. The manuscript reviews research that has contributed to the evolution and development of Emotion-Focused Psychotherapy, beginning with the work of Rogers and Gendlin in the 1950s. Evidence supporting the efficacy of the approach as well as research relevant to the process of change linking in-session processes with distal outcomes is reviewed. Two important issues that have dominated the field of psychotherapy research, the differential effectiveness of various psychotherapy approaches and the impact of the therapeutic relationship conditions in facilitating change are discussed. It is argued that progress in these two lines of research has been constrained by methodological issues and that novel and innovative ways to explore the mechanisms and processes of change need to be developed to enhance theory, research, and practice.

Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting.

Medically unexplained symptoms (MUS) are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 (d = 0.4). A statistically significant (23%) decrease in family physicians’ visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a ‘Primary Care Psychological Consultation and Treatment Service’.

Emotion-focused psychotherapy for GAD: individual case comparison of a good and poor outcome case

ABSTRACTEmotion-focused psychotherapy proposes that maladaptive emotional processing and a vulnerable sense of self is core to generalized anxiety disorder (GAD). This paper examined changes in clients’ maladaptive emotions and negative treatment of self in a good and a poor outcome case in emotion-focused psychotherapy. Transcribed sessions were coded using a measure of emotion derived from Plutchik’s wheel of emotion and a measure of negative treatment of self based on subscales of the Measure of Client Productive Processing. The changes observed across therapy for each client on each dimension were compared and contrasted and the trajectory of change plotted and described. The findings provide a preliminary model of change in GAD to inform future investigations of the change process in GAD and the development of a task analytic model of resolution for clients with GAD.

Targeting emotional impact in storytelling: Working with client affect in emotion-focused psychotherapy

Within emotion-focused therapy (EFT), the client’s ability to express and reflect on core emotional experiences is seen as fundamental to constructing the self and to entering into a change process. For this study, we 1) examine storytelling contexts in which clients do not disclose the emotional impact of their narrative, and 2) identify the interactional practices through which EFT therapists subsequently call attention to what the client may have felt. In doing so, we examine client stories drawn from video-taped individual psychotherapy sessions involving clinically depressed clients. Client stories and therapists’ responses to these stories were analysed using conversation analytic methods. Three different therapist response types were identified: eliciting, naming and illustrating the emotional impact of the client’s prior narrative. These responses also were found to differ in terms of how effectively they could display empathy and secure affiliation with clients. The implications of this work for therapeutic practice are discussed.

Active retreating: Person-centered practices to repair disaffiliation in therapy

This article examines how Emotion-focused therapists use person-centred relational practices to re-affiliate with clients after clients have disagreed with therapists’ formulations of clients’ personal experience. Using the methods of conversation analysis, 70 client disagreements were identified from 15 video-taped sessions of Emotion-focused psychotherapy. Our main finding is that, in contexts of disagreement, talk is organized in Emotion-focused therapy to (1) maintain affiliation by neutralizing the potential conflict; and (2) preserve the client's epistemic primacy of experience by privileging the client's viewpoint. Person-centred relational practices were realized in two different ways: Most commonly, therapists would retreat from own position by affiliating with the client's contrasting position through a range of non-verbal (nods) and verbal resources (mirroring repeats, joint completions, second formulations); less common was for therapists to confront the disagreement, primarily as a problem in understanding that requires repair. Whereas the practice of retreating would lead to mutual affiliation and consensus between the participants, confronting the disagreement did not always lead to successful re-affiliation. This is because the therapist's repair initiation would sometimes contest the client's viewpoint, thus fostering further disaffiliation and placing the client's epistemic primacy at risk.

Narrative change in emotion-focused psychotherapy: A study on the evolution of reflection and protest innovative moments

Innovative moments (IMs) are exceptions to a client's problematic self-narrative in the therapeutic dialogue. The innovative moments coding system is a tool which tracks five different types of IMs—action, reflection, protest, reconceptualization and performing change. An in-depth qualitative analysis of six therapeutic cases of emotion-focused therapy (EFT) investigated the role of two of the most common IMs—reflection and protest—in both good and poor outcome cases. Through this analysis two subtypes (I and II) of reflection and protest IMs were identified, revealing different evolution patterns. Subtype II of both reflection and protest IMs is significantly higher in the good outcome group, while subtype I of both IMs types does not present statistically significant differences between groups. The evolution from subtype I to subtype II across the therapeutic process seems to reflect a relevant developmental progression in the change process.

Narrative and emotion integration in psychotherapy: Investigating the relationship between autobiographical memory specificity and expressed emotional arousal in brief emotion-focused and client-centred treatments of depression

Clinically depressed individuals have consistently been shown to demonstrate a bias for overgeneral autobiographical memory (ABM) disclosure, a strategy used to protect against the access of intense, primary emotions that may accompany specific memories. The present study examined how ABM specificity in client narratives was related to expressed emotional arousal in brief emotion-focused and client-centred psychotherapy for depression. Emotion episodes identified in two early-, two middle-, and two late-therapy transcripts drawn from 34 clients from the York I Depression Study were rated for degree of ABM specificity and expressed emotional arousal. A hierarchical linear modelling analysis demonstrated that greater ABM specificity was associated with higher expressed emotional arousal for clients who were no longer depressed at therapy termination.

Bedeutung emotionsfokussierter Konzepte und Interventionen für die kognitive Verhaltenstherapie

Emotions are the central process of motivation and play a key role in adaptive behavior in humans. Although cognitive-behavioral therapy stresses the importance of changing both cognition and behavior, there is growing emphasis on direct therapeutic work on emotions and emotional processing, as problematic emotional processes are at the core of nearly all psychic disorders. This type of work is the goal of emotion-focused psychotherapy, which centers on direct change of problematic emotions, especially those which are usually suppressed resp. overregulated by the patient. This paper examines the basic phobic/emotional conflict, the problematic emotional processes arising from this conflict, and the importance to cognitive-behavioral therapy of their potentially integrative role.