Transcript No Slide Title

Emotion Then and Now: Emotionfocused Therapy and the
Transforming Power of Affect
Leslie S Greenberg
Overview
•Current views of Emotion
•Emotion -focused Therapy (EFT)
•Research on EFT
•Future of Psychotherapy
Shift in View of Emotion
• Views of emotion have varied greatly over the history of
emotion in psychology & particularly in psychotherapy theory.
• Emotions initially were seen as discharge products of drives
(Freud), as epiphenomena (Skinner), and then during the recent
cognitive revolution as post-cognitive phenomena (Beck)
• There however has been a marked shift in the last decades
from a cognitive to an adaptive view of emotional functioning.
• Due in large part to compelling findings in the affective and
cognitive neurosciences in the past two decades (Damasio,
1994, 2003; LeDoux, 1996, 2002) emotions have clearly been
shown to be an independent and an adaptive component of
human functioning and not simply secondary to cognition.
Evolutionary Function
• As many emotion researchers have pointed out primary
emotional responses have been evolutionarily preserved
because they serve an adaptive function (Lane 2008, Panksepp
2008 , Frijda 1988).
• Emotions provide an assessment of the degree to which goals
or needs have been met in interaction with the environment.
• They also reset the organism physiologically, behaviourally
and cognitively to adjust to changing circumstances.
• From birth on, emotion also is a primary signalling system
that communicates intentions and regulates interaction
Rapid and Automatic Response
•Emotional processing of simple sensory features occurs
extremely early in the processing sequence (Whalen et al 2001)
•This initial "pre-cognitive", perceptual, emotional processing
of the “low” road, fundamentally, is highly adaptive because it
allows people to respond quickly to important events before
complex and time-consuming processing has taken place by the
prefrontal cortex “high” road to emotion (LeDoux 1996)
• Because the shorter amygdala pathway transmits signals more
than twice as fast as the neocortex route, the thinking brain
often can’t intervene in time to stop emotional responses.
• Automatic emotional responses occur, before one can stop
them, be it jumping back from a snake, snapping at a spouse,
crying at a sad ending or feeling joy at a baby’s smile.
Emotion Cognition Interaction
• Neuro and psychological research on emotion thus shows
that emotion is pre-cognitive but it also shows that emotion
interacts with cognition to form complex affective cognitive
structures termed emotion schemes (Oatley 1992,Greenberg 2002)
• These are a primary meaning system in that they
automatically evaluate what is significant for our well being
and are carriers of personal meanings for the self.
• Emotions also include automatic attentional and evaluative
processes, and are themselves cognitive in the broad sense of
cognition but are more than computational or propositional
forms of knowledge.
• Emotion and conscious thought interact in language to
create meaning
New Agenda
• This ‘new look’ in emotion research has begun to set a new
agenda for psychological research – to determine under what
conditions emotions play a determining role in human
experience and how this occurs.
• The question does emotion precede cognition or vice versa
has been superseded by one asking “under which conditions
do emotions influence thought or vice versa?”.
• The questions especially relevant to psychotherapy are
how can we best facilitate a) emotion awareness
b) overcoming the avoidance of
emotion to promote access to its adaptive benefits.
c) emotion transformation.
Four Key Research Findings
•Awareness and symbolization of bodily felt emotional
experience down regulates emotional (Lieberman,
Eisenberger, Crockett, et al 2004, Pennebaker,1995)
•Emotion influences memory, thought, decisions and
narrative construction (Bower,1981, Damasio 1999, Forgas,
(2000)
• Emotion changes emotion (Davidson 2000, Fredrickson,
Mancuso, Branigan, & Tugade, 2000)
• Emotion changes memory during its reconsolidation period.
(Nadel, & Moscovitch, 1997, Nader, Schafe& Le Doux, J. E.
2000;Schiller D Monfils, Raio, Johnson, LeDoux & Phelps
2010)
Emotion Awareness
•Research has shown that emotions rather than sitting fully
formed in the unconscious exist in an undifferentiated form
consisting of sensori - motor schemes that are pre-ideational
and pre-verbal (Lane 2008).
• Implicit emotion, or bodily felt sensations, can be turned into
conscious experiences of specific emotions by putting the felt
sensations into words (Lane 2008; Barrett et al. 2007).
•Through this process an individual can feel specific emotions
and “know” what it is that they are feeling.
•This suggests a dialectically constructivist view of emotion in
which we construct what we feel by attending to a bodily felt
sense and symbolising it in awareness.
Clinical Implications
•Because much emotional processing occurs independently of
and prior to conscious, deliberate cognitive operations,
therapeutic work on a purely cognitive level of processing is
unlikely to produce enduring emotional change in “low” road
emotion.
• Emotion needs to be activated if we want to change emotion.
•Low road emotions can be changed by opposing emotions
•Emotion memories need to be activated to add new
experience for reconsolidation.
•Bodily felt experience needs to be symbolized in awareness
to create new thoughts, meanings and narratives
The Duality of Emotion
• An important duality however occurs in working with
emotion
• We need to activate it to make sense of it but we also need
to protect ourselves from it and regulate it
• Emotions serve a unique combination of epistemological
and hedonic functions - as both carriers of knowledge and
givers of pleasure-pain.
• Feelings provide us with immediate, intimate, personally
meaningful knowledge about ourselves and others
• Feelings also are carriers of suffering and pain at intensities
that cannot be tolerated (or of pleasure) and can become a
source of threat and a danger to psychological existence.
Working With the Duality of Emotion
• Feelings thus inform us about ourselves, and our
surrounding in an unmediated and personally specific manner.
• These feelings need articulation and this sharpens and
clarifies what is felt and promotes
But there comes a point when feelings change their function.
• Given their powerful dimension as pain/pleasure feelings
can loose their meaning giving function and become
overwhelming or destructive.
• In this instance they need regulation to preserve a sense of
self-coherence
The Second Duality
• Emotional problems from the “low” road need to be dealt
with in a different manner than “high” road emotions
• Low road processing as we have seen is rapid, automatic
and wholistic and is a source of adaptive information that
needs to be in awareness to orient to the environment.
• When dysfunctional and under-regulated, however it is a
source of distress and needs to be regulated and transformed
using emotion change principles.
• High road processing is cognitively derived and culturally
influenced by higher level goals/plans. Reason is involved in
its generation, dysfunction is based on cognitive error, and
change involves cognitive change principles.
Overview of EFT
• EFT views emotions as centrally important in both
adaptive and maladaptive functioning, and in
therapeutic change.
• EFT takes emotion as the fundamental datum of
human experience while recognizing the importance
of meaning making, and views emotion and cognition
as inextricably intertwined.
• EFT offers a dialectical constructivist model of
functioning in which optimal adaptation is seen as
involving an integration of reason and emotion by
symbolizing bodily felt experience to make sense of it.
In EFT therapists are empathically attuned to
emotion and work to enhance clients’
emotion-focused coping by helping them
arrive at their core emotional experience by
1. approaching and becoming aware of it
2. regulating, tolerating and accepting it and,
having experienced it, help them to leave it
by
3. transforming that which is maladaptive by
generating alternate adaptive emotional
responses
4. and by constructing new narratives
Characteristics of the Therapeutic Relationship
Therapeutic Presence (Geller & Greenberg, 2011).
1. Being completely in the moment
2. Bringing one’s whole self into the encounter with the
client, physically, emotionally, cognitively, and spiritually
3. Being grounded in one’s own body
4. Receptively taking in the verbal and bodily expression of
the client’s moment by moment emotional experience
5. Extending to meet the other in an empathic and congruent
manner
Assessment
1. Primary
2. Secondary
3. Instrumental
Biologically adaptive
Maladaptive
Principles of Emotional Change
Based on six empirically supported principles of
change that guide differential intervention;
•Emotion Awareness,
•Expression,
• Regulation,
• Reflection
•Transformation
•Corrective Experience
•A major premise guiding intervention is that one
cannot leave a place until one has arrived at it.
Experiencing Tasks
Task Marker Intervention Process
End State
Problematic Reaction
Point (puzzling overreaction to specific
situation)
Systematic
Evocative
Unfolding
New view of
self
Unclear Feeling
(vague, external or
abstract)
Experiential
Focusing
Symbolization
of felt sense
Enactment tasks
Task Marker
Intervention
Process
End State
Self-Evaluative
Split (Selfcriticism, tornness)
Two-Chair
Dialogue
Self acceptance
Self-Interruption
Split (Blocked
feelings,
resignation)
Two-Chair
Enactment
Self-expression
Unfinished
Business
(Lingering bad
feeling re:
significant other)
Empty
Chair Work
Let go of
Integration
Empowerment
resentments, unmet
needs affirm self;f
understand,forgive
or hold other
accountable
Model of Resolution of Self Criticism
Self
Critical
Marker
Role
Play
Critic
Role play
Experiencer
Harsh
criticism
Affective
reaction
Specific
criticisms
Values
standards
Differentiated Emerging
feelings
experiences
Wants
and
needs
Softening
Negotiation
Integration
Secondary
Maladaptive
Adaptive
Research
Evidence of Effectiveness of Emotion-focused Treatments
•Evidence Based Treatment of Depression
Goldman,Greenberg, Angus,(2006).PsychotherapyResearch,16,536-546.
Watson, Gordon, Stermac, Kalogerakos, & Steckley(2003). Journal of
Consulting and Clinical Psychology, 71, 773-781).
Greenberg, & Watson, (2006). Emotion-focused therapy for depression.
Washington D.C.: American Psychological Association
Ellison,J., Greenberg, L., Goldman, R.N., & Angus, L. (2009).
Maintenance of gains in Experiential therapy of depression. Journal of
Consulting and Clinical Psychology, 77, 103-112.
•Trauma Paivio & Nieuwenhuis (2001).Journal of Traumatic Stress,14,
115-133. Pavio & Pascual-Leone(2010) Emotion-focused Therapy for
Complex Trauma. Washington D.C.: American Psychological Association
Greenberg, Warwar, & Malcolm, (2008). Differential Effects of Emotion
-focused therapy and psycho-education in facilitating forgiveness.
Journal of Counseling Psychology,55, 456-464
Change Process Research
To become a true applied science
psychotherapy research needs not only
to provide evidence of effectiveness but
also to specify the processes of change
that lead to the effects
Relating Process to Outcome
Correlation between the working
alliance and outcome in York 1
BDI
WAI
-.35*
Session 3


*p< .05
N=38
IIP
RSE
GSI
-.24
.37*
-.20
Relationship Conditions ,
Working Alliance in OISE Study
Watson Geller 2005 JCCP
•Relationship conditions( E, P.R & C)
predicted outcome in both treatments
•This relationship was mediated by
alliance
Depth of Experience
•Does Depth of Experience(EXP) predict
outcome
•Does increase in EXP over treatment
predict outcome
Relating Process to Outcome
T
Therapist
T.EXP
P
Patient
EXP
O
Outcome
Symptom
Reduction
Experiencing Scale
1. Objective and intellectual, giving no evidence of
the personal significance of events they describe.
2. Personal but detached; no explicit reference to
feelings, reactions, or internal states.
3. Reactions to external events begin to appear.
4. Marked shift inward with a focus on exploration
of feelings and internal experiences. Clients are in
direct contact with their fluid experience and speak
'from' it as opposed to 'about' it.
5. Questions about experience and the self are
raised and explored from an internal perspective.
6. Newly realized feelings and experiences are
integrated and explored to produce personally
meaningful constructions and resolve issues.
7. Shifts and new understandings in one
particular area of experience are broadened to a
wider range of experiences giving clarity and
meaning.
Experiencing in Therapy of Depression
•Experiencing and increase in EXP on Core
Themes predicted reduction in depression in
Experiential Therapy over and above WAI
(Goldman & Greenberg &Pos, 2005)
• Experiencing and increase in EXP on Emotion
Episodes predicted reduction in depression in
Experiential Therapy over and above WAI
(Pos, Greenberg &Warwar 2003)
• Experiencing has also predicted reduction of
depression in CBT (Castonguay, Goldfried, &
Hayes, 1996).
Therapist’s Depth of Experiential Focus
• Depth of Experiential Focus of therapist
responses relates to moment-by-moment
level of patient experiencing and
increases the probability that the client
will focus inward, by a factor of eight
(T P)
• Depth of Experiential focus of therapist
predicts improvement in BDI, RSE
( T O1, O2)
EXP in EFT(YORK) & CBT (NIMH)
Modal EXP in CBT and EFT
Peak EXP in CBT and EFT
4
EFT
2.5
CBT
1.5
Peak EXP
Modal EXP
3.5
EFT
3
CBT
2
Early
Working
Phase
Session
Early
Working
Phase
Session
• Signif. interaction between therapy type and session p<.01 (ES=.17)
• Signif. increase in depth of EXP over time in EFT, p<.01
Hierarchical Regression: Peak Emotional Experiencing on Outcome
Therapy Predictor Total
R square
F
df
Beta
Type
Variable R square change change
EFT Peak EXP
BDI
Early
.16
.16
4.24*
1,23
-.40*
Working
.31
.15
4.83* 1,22
-.51*
Peak EXP
SCL
Early
.20
.20
5.59*
1,23
-.44*
Working
.42
.22
8.46** 1,22
-.62**
CBT Peak EXP
BDI Early
.15
.15
4.29*
1,24
-.39*
Working
.32
.16
5.47*
1,23
-.47*
•p < .05, ** p < .01; N = 25 in all cells; EXP = Experiencing; BDI = Beck
Depression Inventory; SCL-90R = Symptom Checklist R.
* Note: There was a unique significant contribution of peak EXP
in the working-phase on the BDI and SCL-90R measures for EFT;
and significant only on the BDI for CBT.
EXP in EFT & CBT(OISE)
(Watson & Bedard, 2006)
• Mean modal EXP significantly higher in the good
outcome group regardless of treatment
• Mean modal EXP ratings increased from early to
mid therapy
• EFT significantly higher mean modal EXP than
CBT
Relating Emotional Arousal to Outcome
• Deepening experiencing may be a core
ingredients of change for many therapy
approaches
BUT
Does emotional arousal predict outcome?.
Client Emotional Arousal Scale-III
1.Person does not express emotions.
Voice or gestures do not disclose any emotional arousal
2. Acknowledgement but very little arousal in
voice or body. Almost completely restricted
3. Person acknowledges emotions.
Arousal is mild in voice and body
4. Arousal is moderate in voice and body
Emotional voice is present, arousal still somewhat restricted
5. Arousal is fairly intense in voice and body
Speech patterns deviate markedly from the client’s baseline
6. Arousal is very intense and extremely full
Freely expressing emotion, with voice and body.
7. Arousal is extremely intense and full
Complete disruption of speech, uncontrollable
Central EFT Hypothesis: Making sense of
aroused emotion leads to good outcome
1)Emotional arousal in the middle phase of
therapy predicted final outcome( added14%
of outcome variance).
2)High levels of Experiencing in late phase of
therapy substantially increased the outcome
variance predicted (13%) (Warwar 2003).
Peak Emotional Arousal and Experiencing for the BDI (N=32)
Variable
Total R2 Change in R2 F Change Dfs
Beta
Block One
Early EXP
.19
.19
6.86*
1,30 .08
Block Two
Mid Arousal
Block Three
.33
.14
6.15*
1,29
.26
Mid EXP
Late EXP
-.30
.46
.13
3.161
2,27
.29
Note: Overall F (4,27)=5.65**
*p<.05, **p<.01, 1p<.06
Peak Emotional Arousal and Experiencing for the SCL-90R (N=32)
Variable
Total R2 Change inR2 FChange Dfs Beta
Block One
Early EXP
.12
.12
4.25* 1,30 .30
Block Two
Mid Arousal
.37
.25
11.42** 1,29
Block Three
Mid EXP
-.30
Late EXP
.58
.21
Note: Overall F(4,27)=9.36***
*p<.05, **p<.01, ***p<.001
6.75**
-.36*
2,27 -.44*
Emotional Arousal and Perceptual Processing
•Clients’ emotional arousal and perceptual processing
strategies during Emotion episodes (EEs) were
examined in relation to treatment outcome (21%).
•Emotional arousal in conjunction with perceptual
processing during mid-therapy predicted reductions in
depressive and psychopathological symptomatology
better than either of these variables alone (10%).
Hierarchical Regression Analysis for Mid Therapy Variables Predicting Depression at Outcome
Variable
Step 1
BDI (pre)
Step 2
BDI (pre)
Mid Arousal
Step 3
BDI (pre)
Mid Arousal
Mid LCPP
Step 4
BDI (pre)
Mid arousal
Mid LCPP
Mid WAI
R
R
R2
R2
F
Total
Change
Total
Change
Change
.093
-.093
.009
.009
.253
.550
-.026
-.542
.637
-.101
-.289
-.321
.642
-.100
-.235
-.297
-.077
.303
.406
.412
.294
.103
.006
11.809
4.686
.260
df
β
1, 29
-.093
1, 28
-.026
-.546**
1, 27
-.105
-.343a
-.383*
1, 26
-.104
-.304
-.363b
-.093
Note. BDI = Beck Depression Inventory; LCPP = Levels of High Client Perceptual Processing; WAI = Working Alliance Inventory.
* p < .05.
** p < .01. a = .062.
b = .059.
Emotional arousal
What is an Optimal Level?
Frequency of Emotional Arousal
Hypothesis: Moderate level of frequency will relate
to good outcome and account for significantly more
outcome variance than the alliance alone.
Given that the idea of a non-linear relationship
between general arousal and performance has been
an accepted psychological premise since at least the
turn of the century (Yerkes & Dodson, 1908), it is
surprising that it has not been applied to
psychotherapy.
• Being too emotionally aroused interferes with the ability
to think clearly, and distress reduction has been shown to
entail moving from states of hi arousal and lo meaning to lo
arousal and hi meaning (Pascual-Leone & Greenberg 2008).
• Maintaining a level of expressed emotional arousal that
is otherwise beneficial to emotional processing for too long
might have a similar detrimental effect.
• Extended periods of highly aroused emotional expression
might produce mental fatigue, or some process that
interferes with the processes that lead to beneficial outcome.
• Too-frequent activation is probably a sign of repeated
lack of resolution rather than signalling a working through
of material
Ratings Emotional Arousal
•Raters viewed videotape of three sessions, one
minute at a time noting the highest arousal level on
the CEAS within that minute.
•The highest peak arousal rating for five-minute
blocks was used.
Scatter Plot of FHEA against BDI
40.00
50
35.00
407
409
411
30.00
freq. of EA 5+
415
422
78
428
433
403
404 437
423
419
20.00
401
431
15.00
452
427
414
426
430
413
10.00
405
421 417
33
25.00
435
418
402
3
436
25
420
80
429
425
410
0.00
-2.00000
0.00000
Stdized Resid BDI
2.00000
Results
• Hierarchical regressions showed that a nonlinear
pattern of expressed emotional arousal predicted
outcome significantly above the alliance.
• The working alliance was found to predict 14% of
outcome variance on the Beck Depression Inventory
Moderate frequency (25%) of heightened emotional
arousal added significantly to the prediction of outcome
variance (15%).
• The combination predicted 30% of outcome variance on
the BDI.
• An optimal frequency (25%) of highly aroused emotional
expression was found to relate to outcome, with
deviation from this optimal frequency predicting poorer
outcome.
Conclusions
• Too much or too little emotion was found to be
not as helpful as a moderate amount.
• Intense and full level of emotional expression is
seen as being predictive of good outcome, as long
as the client does not maintain this level of
emotional expression for too long or too often.
Is All Emotional Arousal Equally Productive?
Emotional Productivity
An emotional expression is considered therapeutically
productive if a client experiences a primary emotion
in such a way that ...
a. A client can extract the useful information
inherent in an adaptive emotion
(Emotion Utilization)
b. A maladaptive emotion has the potential to be
transformed into a more adaptive emotional
experience (EmotionTransformation)
Measure of Productive/Unproductive Emotion
Is the emotion
I experienced in
the present?
No
Unproductive
No
Unproductive
Yes
II
Is the emotion
primary?
Yes
Does the person
take the stance
of a victim?
Yes
Is the
activated
Is the emotion
primary No overwhelming? Yes
emotion
adaptive
Is the emotion
stuck or blocked? Yes
Yes
All No
Productive
Unproductive
% of total amount of emotions
10080604020
- 078e
Productive Emotions Overall
vs Arousal 4 or Above
Poor
Good
% of
productive
emotions
% of
productive
emotions 4
or above
440e 423c407c 418e 412e 413c 415c
Client number
Manner of Processing
Contactfully Aware
Attending
Symbolization
Congruence
Acceptance
Agency
Regulation
Differentiation
© Auszra, Greenberg, Herrmann,
2008
Hypotheses
1. Emotional Productivity will increase from the
beginning phase towards the working phase and the
termination phase.
2. Working phase emotional productivity will predict
outcome over and above; beginning phase emotional
productivity; high expressed emotional arousal; and
the working alliance.
• Clients:
– Total N of 74 drawn from the York 1 and York
2 depression studies.
© Auszra, Greenberg, Herrmann,
2008
Results – Reliability
A random sample of 2/3 of all sessions was rated by a
second coder
Scale
Reliability
Client Emotional
Arousal Scale - III
(Warwar, S. & Greenberg, L.S.,
1999)
Client Emotional Productivity
Scale
(Auszra, L.; Greenberg, L.S. &
Herrmann, I.R., 2006)
Cohen’s Weighted Kappa = 0.90
Cohen’s Kappa = 0.85
© Auszra, Greenberg, Herrmann,
2008
Process variable
Step 0:
WAI
Step 1:
WAI
Beginning CEP
Step 2:
WAI
Beginning CEP
Beginning CEE
WAI
Beginning CEP
Beginning CEE
Working CEP
Total R2
Changes in R2
Beta
.114*
-.356**
.190*
.076
-.309*
-.297*
.014
-.281*
-.279*
-.160
.342
-.068
-.156
-.114
-.641**
.204
.546**
© Auszra, Greenberg, 2011
Summary of Results
• Emotional productivity increases towards
the working and the termination phase
• Working phase emotional productivity
predicts outcome over and above beginning
phase emotional productivity, high
expressed emotional arousal and the
working alliance
• CEP is the sole independent predictor of
outcome, explaining independently 34.2 %
of the variance for the BDI
Tests of the Basic Change Process
Secondary Distress
Primary Maladaptive
NEED
Primary Adaptive
Types of Emotion
Hypotheses
In samples of chair dialogue across treatment:
1-3) Proportion of, and increase in Secondary,
Primary Adaptive and Primary
Maladaptive Emotions will relate to
outcome
Emotional Sequences
Hypotheses
4. The Sequence of Primary Maladaptive
Emotion followed by Primary Adaptive
Emotion will predict good outcome.
5. The Sequence of Secondary Emotion
followed Primary Maladaptive followed by
Primary Adaptive Emotion will predict
good outcome.
Sampling
 N = 30 of EFT Clients
 3 sessions were coded:
First chair work session; (approx. 4th
session)
Best chair work session according to the
degrees of resolution scale (DRS);
Better of two sessions preceeding the best
chair work session (according to DRS);
Summary of Results
1.Proportion of Secondary Emotions in the Working Phase
negatively predicts Outcome over and above Emotion
Activation.
2.Moderate Levels of Primary Maladaptive Emotions in the
Middle Working Session are significantly associated with
outcome.
3.The Frequency of the Emotion Sequence Primary
Maladaptive Emotion to Primary Adaptive Emotion in the
Middle Working Session predicts Outcome over and above
Emotion Activation. The Sequence also significantly predicts
Outcome independently of the Proportion of Secondary
Emotions.
© Herrmann, Greenberg & Auszra, 2011
Summary of Results
4.Proportion of Primary Adaptive Emotions is the best
Predictor of Outcome.
It predicts outcome over and above Emotion
Activation.
It mediates the effect of Secondary Emotions on
outcome.
For Better Outcome Clients, the Proportion of Primary
Adaptive Emotions increases significantly across the
Sessions in Comparison to Poorer Outcome Clients.
© Herrmann, Greenberg & Auszra, 2011
Conclusion
What seems central for good therapy outcome:
With regard to Primary Maldadaptive Emotions moderate
levels seem to be beneficial; there is no “the less the better”
or “the more the better”.
Moving through and leaving Primary Maldaptive Emotions
towards Primary Adaptive Emotions seems to be important.
Not only reduction of symptomatic Secondary Emotions but
also the increase of Primary Adaptive Emotions over the
course of Treatment seems to be central to successful
therapeutic process.
© Herrmann, Greenberg & Auszra, 2011
Percentage of Negative, Anger-, and
Positive Primary Adaptive Emotions
35.71
40
39.18
35
30
25
19.49
20
15
10
5
0
Negative
Anger
Positive
© Herrmann, Greenberg & Auszra,
2011
Basic Change Process
Secondary Distress
Primary Maladaptive
NEED
Primary Adaptive
Start
Degree of
Resolution
Scale
Global
Distress
Rejecting
Anger
Secondary
Distress
1
Fear /
Shame
2
Primary
Maladaptive
3
5

The model is
flattened into a
9-point ordinal
scale
Negative
Evaluation
Need
4
Need
6
8
Assertive
Anger / SelfSoothing
Grief / 7
Hurt
Adaptive
Acceptance,
letting go
9
Regression of the model against time
Degrees of Resolution Scale


Time
Looking at the
regression slope
for each of the
34 cases
Good outcomes
have a
significantly
steeper slope
(p=.01; Wilcox
signed rank test)
Narrative modes of Processing(Angus et al
1999)
Landscape of Action : what is
happening?
Landscape of Consciousness : what does
it mean ?
*Landscape of Feeling: what does it feel
like?
Narrative Processes Model and Coding System
(NPCS) (Angus et al 1999;1996)
• External Narrative Mode : what happened ?
Personal Storytelling/Information
• Internal Narrative Mode : what did I feel ?
Emotional Differentiation
• Reflexive Narrative Mode : what does it mean?
Meaning exploration in relation to stories & emotions
Narrative Process Modes Over Time (Angus et al 1999)
25
20
15
external
10
internal
5
reflexive
Good
Outcome
0
stage
1G
stage
2G
stage
3G
stage
4G
stage
5G
25
20
15
external
hi
internal
10
lo
5
reflexive
0
stage
1P
stage
2P
stage
3P
stage
4P
stage
5P
Poor
Outcome
Narrative Process Mode Patterns
E-R + R-E = storytelling & meaning-making
E-I + I-E = storytelling & emotions
R-I + I-R = emotions & meaning-making
Narrative Processes in Psychotherapy
York I Depression Study : Emotion-focused Therapy
Dyads
Narrative Mode Shifts x Outcome
E -I/ I - E
Outcome
I - R/ R to I
R - E /E -R
Good
06.0 %
42.0%
52.0%
Poor
20.6 %
21.4%
58.0 %
Schematic Model of Narrative Process Modes
(Angus et al 1999)
Poor Outcomes
• Client Personal Storytelling : External Narrative
Mode (Landscape of Action)
• Therapist shift to meaning-making : Reflexive
Narrative Mode (Landscape of Consciousness)
Good Outcomes
• Client meaning making: Reflexive Narrative Mode
(Landscape of Consciousness)
• Therapist shift to emotional differentiation :
Internal Narrative Mode ( Landscape of feeling)
Schematic Model of Narrative Process Modes
(Angus et al 1999)
Personal Storytelling : External Narrative Mode (Landscape of
Action)
Poor Outcomes
Client story
Telling
Meaning-making : Reflexive Narrative Mode (Landscape of
Consciousness)
Good Outcomes
Therapist shift to
Emotional Differentiation : Internal Narrative Mode
In a Chair Dialogue with her Father
Reflexive
C: I don’t know why you were so unable to stop
(gambling). It was so bad for us all (sighs and tears)
Internal
T : stay with the sadness, I know that might be hard to stay
there, but it seems important … can you tell him about
sadness, is that what it is, sadness, is that what if feels like?
C : uh, kind of anger
T : okay, so tell him about the anger /
C I’m so angry at what you did to us
T Uh huh
Reflexive
C : um, why don’t you ever do anything about it ? (the
gambling) you’re a responsible adult and it’s your own
problem
T : alright, tell him that, it’s real important …your
responsible, I hold you responsible for your actions as an
adult
C: you’re responsible for your own – actions, you’re an
adult – why did, me and mom and the rest of my brothers
have to be um, (sniff) affected by it?
Internal
T : mmhm tell him how you were affected by it
C: Not to bring up how we felt, it was to be kept a secret
T: I had to push everything down, I had to pretend it wasn’t
happening, right?
C: yeah… not to be real
T: can you tell him, I resented having to pretend ?
C: I resented to pretend living that way, it makes me angry
T: that really makes me so angry
Reflexive
C: it wasn’t fair to be brought up that way. I think you’re
selfish
Conclusion
Making narrative sense of moderately aroused
emotions that are deeply experienced and reflected
on in the context of an empathically attuned
relationship predicts therapeutic outcome
Toward the Future
• In this talk a number of principles for working with
emotion have been suggested in order to promote the inclusion
of emotion focused work into all treatment approaches.
• In the future “school” wars will end and the therapeutic
relationship, emotion/ motivation, the cognitive, and the
behavioral systems will all be valued as important in
therapeutic work.
• Privileging one system for therapeutic attention over the
others leads to a narrowing of perspective.
• We will develop a true understanding of the conditions
under which it is optimal to intervene therapeutically with
which system.
• There currently are proposals for Emotion-focused
experiential therapies( Greenberg 2002) Emotion-focused
Cognitive and Cognitive Behavioral approaches, (Kendall
2008 , Powers 2010). Experiential Dynamic approaches
(Fosha 2002 McCullough 2005) and Emotion-focused
Systemic approaches (Greenberg &Goldman 2008,
Diamond and Diamond 2004)
• This indicates the move towards integrative approaches
for the new millennium that all will include emotion.
• A key question for the future is under what conditions
cognition is governed by emotion processes and vice versa
and under what conditions both are governed by social
cultural and biological processes.
THE END
Emotion Process in Depression
Think
•Perceive
Secondary
critical
/coercive
thoughts
•Think
Automatic thought
Im worthless/
unloved
Loss, humiliation,
entrapment
•Feel
•Feel
Disappointed/sad
Primary emotion
Fear and
shame
“I’m
weak/bad”
Maladaptive
emotion
•Act
“Should Inactive/low
energy
get
moving”
•Feel
Fast Automatic
Slow Automatic
Depressed/hopeless
Secondary
emotion
Disclaimed/disowned
Results
Reliability
 on Identification of Emotion Activation
(Cohen‘s kappa 0.887)
•
on Emotion Categorization
(Cohen‘s kappa 0.825)
© Herrmann, Greenberg & Auszra, 2011
Correlation Matrix
Emotion Categories and Outcome
Pearson R correlations between ECs and outcome
Emotion Category
BDI (standardized residual gain)
SEC/INST First Working Session (fws)
-.020
SEC/INST Middle Working Session (mws)
.431*
SEC/INST Best Working Session (bws)
.580**
PMA First Working Session (fws)
.286
PMA Middle Working Session (mws)
-.009
PMA Best Working Session (bws)
.256
PA First Working Session (fws)
-.227
PA Middle Working Session (mws)
-.577**
PA Best Working Session (bws)
-.732**
*p < .05, ** p < .001
© Herrmann, Greenberg & Auszra,
2011
Secondary Emotions
Results of Hierarchical Regression Analysis: BDI on Working Phase Activation
and Working Phase Secondary Emotion
Independent
Variables
Total
adjusted R 2
Adjusted R 2
change
F change
df
Standardized
β weights
3.996
1, 28
-.353
Step 1:
Activation
.094
Step 2:
Activation
SEC/INS
-.283
.442
.348
12.472
*p <. 05, ** p < .001
© Herrmann, Greenberg & Auszra,
2011
2, 27
-.600**
Primary Maladaptive Emotions
Results of Regression Model Including a Quadratic Term for PMA
in the Middle Working Session in Predicting Change on BDI
Independent
Variables
Total
adjusted R 2
F change
df
PMA
PMA squared
Standardized
β weights
-1.973*
.272
6.410
2, 27
*p < .05
© Herrmann, Greenberg & Auszra,
2011
2.044*
Primary Maladaptive Emotions
© Herrmann, Greenberg & Auszra,
2011
Sequence Primary Maladaptive to
Primary Adaptive Emotion
Pearson R correlations between Sequence PMA to PA and BDI in the sessions
SEQ PMA-PA
BDI
in First Working Session
-.123
in Middle Working Session
-.532 **
in Best Working Session
-.150
** p < .001
© Herrmann, Greenberg & Auszra,
2011
Hierarchical Regression Analysis
Results of Hierarchical Regression Analysis: BDI on Working Phase Primary Adaptive
Emotion including potential confounding variables
Independent
Variables
Total adjusted R 2
Adjusted R 2
change
F change
df
Standardized β
weights
18.782
1, 28
.634**
Step 1:
SEC/INS
.380
Step 2:
SEC/INS
SEQ PMA-PA
.498*
.488
.108
12.848
2, 27
SEC/INS
.211
SEQ PMA-PA
PA
*p < .05, ** p < .001
-.323*
-.239
.655
.167
16.470
© Herrmann, Greenberg & Auszra,
2011
3, 26
-.527*
Longitudinal Multilevel
Modeling
Results from Multilevel Modeling of Primary Adaptive over Sessions as a Function of the BDI
Equation:
Primary Adapativeit = βoi + β1i Sessiont + β2i BDI.rg + β4 iBDI.rg2 + β5i Sessiont × BDI.rg + εit
Coefficient
St. Err.
df
t-value
p-value
Intercept
0.137
0.086
56
1.602
0.115
Session
0.046
0.034
56
1.383
0.172
BDI.rg
-0.007
0.010
27
-0.703
0.488
BDI.rg2
0.001
0.001
27
3.388
0.002*
Session × BDI.rg
-0.010
0.004
56
-2.447
0.018*
*p < .05, ** p < .001
© Herrmann, Greenberg & Auszra,
2011
Average proportion of Primary Adaptive Emotions for various levels of
treatment success (BDI.rg) at best working session (session 1), middle
working session (session 2) and best working session (session 3)
© Herrmann,
Greenberg & Auszra,
A 3-Dimensional visualization for the expected trajectory in Primary Adaptive emotions
over the three therapy sessions for various treatment outcomes as measured by the
residual gain score on BDI
© Herrmann, Greenberg & Auszra,
2011
Sequential hypothesis
• Newly emerging emotions occur in
ordered patterns (Pascual Leone &
Greenberg 2007).