Transcript Person-Centred and Experiential Therapies for Depression and

Person-Centred and Experiential
Therapies for Depression and
Anxiety
Ladislav Timulak
Trinity College Dublin
Person-Centred and Experiential
Therapies
• Have a great tradition starting with Rogers and
now primarily through the emotion-focused
therapy researchers
• Nevertheless somewhat ambivalent with regard
the mainstream classification of psychological
disorders
• Recognising human suffering in ‘classifiable’
psychopathological symptoms
• But also seeing that optimal human state involves
also vulnerability (which for instance is an
invitation to human connection) and perhaps
conflictual resolve
Depression
• Most studied person-centred/experiential
therapies:
• Person-centred Therapy (NICE, 2009
recognised 1 RCT; King et al., 2000)
• Emotion-Focused Therapy (NICE, 2009
recognised 3 RCTs; Greenberg & Watson,
1998; Goldman et al., 2006; Watson et al.,
2003)
Elliott et al., 2013 cover 27 studies (34
client samples) of humanistic-experiential
therapies for depression
• not all RCTs and include various therapies (incl.
person-centered, emotion-focused, Gestalt,
Focused Expressive, attachment-based family
therapy, groups versions of some of those
therapies, etc.)
• Equivalent to compared treatments (mainly CBTs)
• Process-guiding treatments appearing more
effective
Humanistic Psychological Therapies
competences framework (Roth, Hill, &
Pilling, 2009)
• In the context IAPT and the roll out of CBT
• Identifying basic competences common to
humanistic therapies
• Identifying specific competences not shared
by all humanistic therapies
Counselling for Depression
competences framework
• In the context of Humanistic Psychological Therapies
competences
• Using person-centred (PCT) and a selection of emotionfocused (EFT) competences (adapted by Hill, 2014)
• Formulated in a book format (Sanders & Hill, 2014)
• Now being tested in PRaCTICED trial (Barkham et al.)
• IAPT providing training (curriculum developed by Hill,
2011)
• British Association for Counselling & Psychotherapy
(BACP) collaborates with several universities that
provide the CfD training (they are listed on BACP
website)
Some features of CfD
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Knowledge of depression
Time-limited work (6-10 sessions; up to 20 if required)
Goals, assessment and review of progress
Basic person-centred stance
Accessing and expressing emotions
Reflecting on them and making sense
Tasks: clearing a space, systematic evocative unfolding,
promotion of emotion regulation, work with conflicting
parts of the self and unfinished business issues.
Anxiety
• Elliott et al. (2013) overview and meta-analysis
suggested (of mainly supportive and PCT
therapies):
– Uncontrolled pre-post studies (19 studies, 20 samples)
suggesting large effects
– Controlled studies (n=4) medium effects
– Comparative studies (n=19), mainly against CBT
showing small to medium negative effect, that shrunk
to small when controlled for allegiance
• Majority studies used variations of supportive therapy rather
than genuine PCT
• Most studies for GAD
Anxiety
• The studies that would test person-centred or
experiential therapy developed as a treatment
for some anxiety disorders where almost
entirely missing
• Recent years: development of genuine
experiential treatments informed by
knowledge about anxiety disorders and their
treatment
Anxiety Projects
• Emotion-Focused Therapy (EFT) and PCT for
Social Anxiety (Elliott, Glasgow)
• EFT for Social Anxiety (Shahar, Israel)
• EFT for Generalised Anxiety Disorder (Watson,
Toronto)
• EFT for Generalised Anxiety Disorder (Timulak,
Dublin)
First outcomes
Elliott, 2012; Elliott & Rodgers, 2012
• Partially randomised comparison of EFT (n=21)
and PCT (n=29) for social anxiety
• The effects sizes on the principal measure
Social Phobia Inventory (SPIN):
– EFT (d=1.75)
– PCT (d=1.01)
Shahar (2014)
• EFT for Social Anxiety (multiple baseline case
studies – delayed start, n=12)
• Effect size on the principal measure, Cohen’s
d=1.24
Timulak et al., 2014 – EFT for GAD
study
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A treatment development study
An open trial n=14
A comparative RCT with CBT in preparation
The first results presented at SPR
Cross-case Quantitative Analysis of Pre-post Outcome data: Participants (n-11)
Scale
Caseness
RCI
Pre-
Post-
Effect
Treatment
Treatment
Size
(n=11)
(n=10)
(Cohen’s
d)
Mean
SD
Mean
SD
GAD-7
10
4
16.18
3.19
*5.3
5.31
2.48
GADSS
7
n/a/
16.09
2.46
*6.80
4.80
2.43
BDI-II
10
9
27.63
10.86
*5.90
4.84
2.58
CORE
1.29(1.19)
0.48
1.91
0.45
*0.60
0.37
3.18
PSWQ
46
9
67.81
8.73
*48.90
8.49
2.19
PSWQ-
n/a
28
69.22a
8.16
*34.22b
18.54
2.44
PW
a
The analysis carried out with respect to this measurement had a smaller sample size (n = 9) due to the late introduction of the
measure to the research.
b
The analysis carried out with respect to this measurement had a smaller sample size (n = 9) due to missing data from one
participant
GAD-7 = Generalised Anxiety Disorder–7; GADSS = Generalised Anxiety Disorder Severity Scale;
BDI-II = Beck Depression Inventory; CORE-OM = Clinical Outcomes in Routine Evaluation – Outcome Measure;
PSWQ = Penn-State Worry Questionnaire; PSWQ-PW = Penn-State Worry Questionnaire (Past Week).
* The pre-post difference on all measures was found to be statistically significant (paired t-tests) p < .05
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Benchmarking using the principal
measure (GAD-7)
• Clarke et al. (2009) of two UK ‘IAPT
demonstration sites’ offering CBT related therapy
to people with anxiety and depression (not only
GAD)
• the Timulak et al.’s study Cohen’s d=2.48;
• while Clarke et al.’s data for one site indicate a
pre-post Cohen’s d=1.36 (N=1647; pre mean
13.9, post mean 6.8;), and for the other site
Cohen’s d=1.35 (N=221; pre mean 13.7, post
mean 6.8;).
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• Titov and colleagues’ (2011) RCT studying
transdiagnostic internet treatment for anxiety
and depression reported data on the GAD-7
for the treatment (anxiety) group indicated a
pre-post Cohen’s d=0.76 (N=19; pre mean
11.68, post mean 7.63;),
• Our study d=2.48
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Second principal measure benchmark
GADSS
• When compared to Craske and colleagues’ (2011)
internet-based study of Disorder-Specific Impact
of Coordinated Anxiety Learning and
Management Treatment for Anxiety Disorders in
Primary Care,
• The Timulak et al. study reported a pre-post
difference on the GADSS of d =2.43,
• While Craske and colleagues report data which
indicated a base-line to 6-month difference, in
the intervention group, d=0.44 (base-line 13.36,
6-month 8.85;),
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• Stanley and colleagues (2009) CBT for older
adults in primary care , data indicated a prepost difference on the GADSS for the CBT
group of d=0.77 (N=115; pre mean 11.4, post
mean 8.9),
• The Timulak et al. study d =2.43,
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Common features of the EFTs for anxiety
(apart from Empathic relationship and experiential tasks)
• Anxiety is seen as a secondary emotion that leads to
avoidance
• The clients are avoiding underlying core painful emotions
such as shame in social anxiety
• Avoidance is overcome by working on the self-interrupting,
self-scaring or self-worrying process
– (awareness and compassion and boundary setting experiences
are used to mobilise resolve to overcome the avoidance)
• Core painful emotions (e.g. shame, loneliness, primary fear)
are accessed in treatment and made more tolerable
• Unmet needs are articulated (e.g., acceptance in case the
underlying shame)
• Painful maladaptive emotions are transformed by the
generation of adaptive emotions such as
– compassion and healthy protective anger
Conclusion
• Exciting developments in Personcentred/experiential therapies for anxiety
disorders
• The first attempts at developments of genuine
person-centred/experiential well underway with
promising first data
• Genuine person-centred/emotion-focused
theoretical framework for working with anxiety is
being developed
– although there is some overlap with dominant CBT
theories (e.g., overcoming avoidance), the PCT/EFT
models distinctively different