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Cognitive Therapy and Research

, Volume 39, Issue 5, pp 564–577 | Cite as

Facilitating Emotional Processing: An Experimental Induction of Psychotherapeutically Relevant Affective States

  • Kristina B. Rohde
  • Maria Stein
  • Antonio Pascual-Leone
  • Franz Caspar
Original Article

Abstract

Psychotherapy research has shown that cognitive-affective meaning making is related to beneficial therapy outcomes. This study explores the underlying micro-processes by inducing specific cognitive-affective states and studying their immediate effects on emotional activation, the resolution of interpersonal grievances, and factors related to therapeutic progress, e.g., mastery experiences, clarification of meaning. Participants suffering from interpersonal grievances were randomly assigned to two conditions. A sentence completion task was employed to induce either the expression of emotional distress or cognitive-affective meaning making. Expressive writing was used to deepen processing. Findings of those participants adhering to the induction procedure (n = 85) showed no differences between conditions at baseline. During writing, participants in both conditions were equally emotionally activated. Directly after the writing task, participants in the meaning making condition (n = 50) reported less unresolved interpersonal grievances, and more mastery experiences, but, e.g., not more clarification, compared to those in the emotional expression condition (n = 35). Results suggest that engagement in specific states that promote meaning making of emotional experience facilitates emotional processing and is related to therapeutic benefit.

Keywords

Emotion Emotional processing Disclosure Experimental Interpersonal Expressive writing 

Notes

Conflict of Interest

Kristina B. Rohde, Maria Stein, Antonio Pascual-Leone, Franz Caspar declare that they have no conflict of interest.

Informed Consent

All procedures were in accordance with the ethical standards of the responsible committee. Informed consent was obtained from all the participants.

Animal Rights

No animal studies were carried out by the authors for this manuscript.

References

  1. Barrett, L. F. (2006). Are emotions natural kinds? Perspectives on Psychological Science, 1(1), 28–58. doi: 10.1111/J.1745-6916.2006.00003.X.CrossRefPubMedGoogle Scholar
  2. Barrett, L. F. (2011). Constructing emotion. Psychological Topics, 20(3), 359–380.Google Scholar
  3. Broderick, J. E., Stone, A. A., Smyth, J. M., & Kaell, A. T. (2004). The feasibility and effectiveness of an expressive writing intervention for rheumatoid arthritis via home-based videotaped instructions. Annals of Behavioral Medicine, 27(1), 50–59. doi: 10.1207/S15324796abm2701_7.CrossRefPubMedGoogle Scholar
  4. Chen, Z., Williams, K. D., Fitness, J., & Newton, N. C. (2008). When hurt will not heal: Exploring the capacity to relive social and physical pain. Psychological Science, 19(8), 789–795. doi: 10.1111/j.1467-9280.2008.02158.x.CrossRefPubMedGoogle Scholar
  5. Deacon, B. J., & Abramowitz, J. S. (2004). Cognitive and behavioral treatments for anxiety disorders: A review of meta-analytic findings. Journal of Clinical Psychology, 60(4), 429–441. doi: 10.1002/Jclp.10255.CrossRefPubMedGoogle Scholar
  6. Dolan, R. J. (2002). Emotion, cognition, and behavior. Science, 298(5596), 1191–1194. doi: 10.1126/science.1076358.CrossRefPubMedGoogle Scholar
  7. Flückiger, C., Regli, D., Zwahlen, D., Hostettler, S., & Caspar, F. (2010). Der Berner Patienten- und Therapeutenstundenbogen, 2000. Ein Instrument zur Erfassung von Therapieprozessen. Zeitschrift für Klinische Psychologie und Psychotherapie, 39(2), 71–79. doi: 10.1026/1616-3443/a000015.CrossRefGoogle Scholar
  8. Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35. doi: 10.1037/0033-2909.99.1.20.CrossRefPubMedGoogle Scholar
  9. Fosha, D. (2001). The dyadic regulation of affect. Journal of Clinical Psychology, 57(2), 227–242. doi: 10.1002/1097-4679.CrossRefPubMedGoogle Scholar
  10. Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132(6), 823–865. doi: 10.1037/0033-2909.132.6.823.CrossRefPubMedGoogle Scholar
  11. Frijda, N. H. (1986). The emotions. Cambridge: Cambridge University Press.Google Scholar
  12. Grawe, K. (1997). Research-informed psychotherapy. Psychotherapy Research, 7(1), 1–19. doi: 10.1080/10503309712331331843.CrossRefGoogle Scholar
  13. Grawe, K., Donati, R., & Bernauer, F. (1994). Psychotherapie im Wandel: Von der Konfession zur Profession. Göttingen: Hogrefe.Google Scholar
  14. Greenberg, L. S. (1993). Facilitating emotional change: The moment-by-moment process. New York: The Guilford Press.Google Scholar
  15. Greenberg, L. S., Auszra, L., & Herrmann, I. R. (2007). The relationship among emotional productivity, emotional arousal and outcome in experiential therapy of depression. Psychotherapy Research, 17(4), 482–493. doi: 10.1080/10503300701667433.CrossRefGoogle Scholar
  16. Greenberg, L. S., & Foerster, F. S. (1996). Task analysis exemplified: The process of resolving unfinished business. Journal of Consulting and Clinical Psychology, 64(3), 439–446.CrossRefPubMedGoogle Scholar
  17. Greenberg, L. S., & Malcolm, W. (2002). Resolving unfinished business: Relating process to outcome. Journal of Consulting and Clinical Psychology, 70(2), 406–416. doi: 10.1037//0022-006x.70.2.416.CrossRefPubMedGoogle Scholar
  18. Greenberg, L. S., & Pascual-Leone, A. (2006). Emotion in psychotherapy: A practice-friendly research review. Journal of Clinical Psychology, 62(5), 611–630. doi: 10.1002/Jclp.20252.CrossRefPubMedGoogle Scholar
  19. Greenberg, L. S., & Safran, J. D. (1987). Emotion in psychotherapy: Affect, cognition, and the process of change. New York: Guilford Press.Google Scholar
  20. Greenberg, L. S., Warwar, S. H., & Malcolm, W. M. (2008). Differential effects of emotion-focused therapy and psychoeducation in facilitating forgiveness and letting go of emotional injuries. Journal of Counseling Psychology, 55(2), 185–196. doi: 10.1037/0022-0167.55.2.185.CrossRefGoogle Scholar
  21. Greenberg, L. S., & Watson, J. C. (2006). Emotion-focused therapy for depression. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  22. Grisham, J. R., Flower, K. N., Williams, A. D., & Moulds, M. L. (2011). Reappraisal and rumination during recall of a sad memory. Cognitive Therapy and Research, 35(3), 276–283. doi: 10.1007/S10608-009-9288-0.CrossRefGoogle Scholar
  23. Grosse Holtforth, M., Grawe, K., & Castonguay, L.G. (2006). Predicting a reduction of avoidance motivation in psychotherapy: Toward the delineation of differential processes of change operating at different phases of treatment. Psychotherapy Research, 16(5), 626–630. doi: 10.1080/10503300600608215. Google Scholar
  24. Grosse Holtforth, M., Hayes, A. M., Sutter, M., Wilm, K., Schmied, E., Laurenceau, J.-P., & Caspar, F. (2012). Fostering cognitive-emotional processing in the treatment of depression: A preliminary investigation in exposure-based cognitive therapy. Psychotherapy and Psychosomatics, 81(4), 259–260. doi: 10.1159/000336813.CrossRefPubMedGoogle Scholar
  25. Guastella, A. J., & Dadds, M. R. (2006). Cognitive-behavioral models of emotional writing: A validation study. Cognitive Therapy and Research, 30(3), 397–414. doi: 10.1007/S10608-006-9045-6.CrossRefGoogle Scholar
  26. Guastella, A. J., & Dadds, M. R. (2009). Sequential growth in cognitive-behavioral emotion-processing: A laboratory study. Cognitive Therapy and Research, 33(4), 368–374. doi: 10.1007/S10608-008-9199-5.CrossRefGoogle Scholar
  27. Hayes, A. M., Beevers, C. G., Feldman, G. C., Laurenceau, J.-P., & Perlman, C. (2005). Avoidance and processing as predictors of symptom change and positive growth in an integrative therapy for depression. International Journal of Behavioral Medicine, 12(2), 111–122. doi: 10.1207/S15327558ijbm1202_9.CrossRefPubMedGoogle Scholar
  28. Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. doi: 10.1146/Annurev.Clinpsy.3.022806.091432.CrossRefPubMedGoogle Scholar
  29. Kramer, U., Pascual-Leone, A., Berthoud, L., de Roten, Y., Marquet, P., Kolly, S., Despland, J.-N., & Page, D. (2015a). Assertive anger mediates effects of dialectical behavior-informed skills training for borderline personality disorder: A randomized controlled trial. Clinical Psychology and Psychotherapy. doi: 10.1002/cpp.1956.PubMedGoogle Scholar
  30. Kramer, U., Pascual-Leone, A., Despland, J.-N., & de Roten, Y. (2015b). One minute of grief: Emotional processing in short-term dynamic psychotherapy for adjustment disorder. Journal of Consulting and Clinical Psychology, 83(1), 187–198. doi: 10.1037/a0037979.CrossRefPubMedGoogle Scholar
  31. Krohne, H. W., Egloff, B., Kohlmann, C.-W., & Tausch, A. (1996). Untersuchungen mit einer deutschen Version der “Positive and Negative Affect Schedule” (PANAS). Diagnostica, 42(2), 139–156.Google Scholar
  32. Lazarus, R. S. (2001). Emotion and adaption. New York: Oxford University Press.Google Scholar
  33. Lepore, S. J., & Greenberg, M. A. (2002). Mending broken hearts: Effects of expressive writing on mood, cognitive processing, social adjustment and health following a relationship breakup. Psychology and Health, 17(5), 547–560. doi: 10.1080/08870440290025768.CrossRefGoogle Scholar
  34. Liao, K. Y. H., Wei, M. F., Russell, D. W., & Abraham, W. T. (2012). Experiential self-focus writing as a facilitator of processing an interpersonal hurt. Journal of Clinical Psychology, 68(10), 1089–1110. doi: 10.1002/Jclp.21886.CrossRefPubMedGoogle Scholar
  35. Littrell, J. (1998). Is the reexperience of painful emotion therapeutic? Clinical Psychology Review, 18(1), 71–102. doi: 10.1016/S0272-7358(97)00046-9.CrossRefPubMedGoogle Scholar
  36. McCullough, M. E., Root, L. M., & Cohen, A. D. (2006). Writing about the benefits of an interpersonal transgression facilitates forgiveness. Journal of Consulting and Clinical Psychology, 74(5), 887–897. doi: 10.1037/0022-006x.74.5.887.CrossRefPubMedGoogle Scholar
  37. McNally, S., Timulak, L., & Greenberg, L. S. (2014). Transforming emotion schemes in emotion focused therapy: A case study investigation. Person-Centered and Experiential Psychotherapies, 13(2), 128–149. doi: 10.1080/14779757.2013.871573.CrossRefGoogle Scholar
  38. Murray, E. J., & Segal, D. L. (1994). Emotional processing in vocal and written expression of feelings about traumatic experiences. Journal of Traumatic Stress, 7(3), 391–405. doi: 10.1007/Bf02102784.CrossRefPubMedGoogle Scholar
  39. Nazarian, D., & Smyth, J. M. (2013). An experimental test of instructional manipulations in expressive writing interventions: Examining processes of change. Journal of Social and Clinical Psychology, 32(1), 71–96. doi: 10.1521/jscp.2013.32.1.71.CrossRefGoogle Scholar
  40. Orlinsky, D.E., Grawe, K., & Parks, B.K. (1994). Process and outcome in psychotherapy: Noch einmal. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 270–376). Oxford, England: John Wiley & Sons.Google Scholar
  41. Pachankis, J. E., & Goldfried, M. R. (2010). Expressive writing for gay-related stress: Psychosocial benefits and mechanisms underlying improvement. Journal of Consulting and Clinical Psychology, 78(1), 98–110. doi: 10.1037/A0017580.CrossRefPubMedGoogle Scholar
  42. Paivio, S. C., & Greenberg, L. S. (1995). Resolving “unfinished business”—Efficacy of experiential therapy using empty-chair dialogue. Journal of Consulting and Clinical Psychology, 63(3), 419–425.CrossRefPubMedGoogle Scholar
  43. Paivio, S. C., & Pascual-Leone, A. (2010). Emotion-focused therapy for complex trauma: An integrative approach. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  44. Pascual-Leone, A. (2009). Dynamic emotional processing in experiential therapy: Two steps forward, one step back. Journal of Consulting and Clinical Psychology, 77(1), 113–126. doi: 10.1037/a0014488.CrossRefPubMedGoogle Scholar
  45. Pascual-Leone, A. (2010). Emotion priming tasks for expressions of early distress and advanced meaning making. Unpublished measure, Department of Psychology, University of Windsor, Windsor, Canada.Google Scholar
  46. Pascual-Leone, A., & Greenberg, L. S. (2005). Classification of affective-meaning states. In A. Pascual-Leone, Emotional processing in the therapeutic hour: Why ‘The only way out is through’ (pp. 289–366). Unpublished Doctoral Thesis, York University, Toronto, Canada.Google Scholar
  47. Pascual-Leone, A., & Greenberg, L. S. (2007). Emotional processing in experiential therapy: Why “the only way out is through”. Journal of Consulting and Clinical Psychology, 75(6), 875–887. doi: 10.1037/0022-006x.75.6.875.CrossRefPubMedGoogle Scholar
  48. Pascual-Leone, A., Metler, S., Singh, T., Harrington, S., Yeryomenko, N., Crozier, M., et al. (2012). Experimental manipulation of emotion during a writing task: Implication for the practice of psychotherapy. Panel presentation at the 42nd annual congress of the European association of behavioral and cognitive therapies (EABCT), Geneva, Switzerland.Google Scholar
  49. Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8(3), 162–166.CrossRefGoogle Scholar
  50. Pennebaker, J. W., & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95(3), 274–281.CrossRefPubMedGoogle Scholar
  51. Plutchik, R. (2000). Emotions in the practice of psychotherapy. Clinical implications of affect theories. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  52. Pos, A. E., Greenberg, L. S., Goldman, R. N., & Korman, L. M. (2003). Emotional processing during experiential treatment of depression. Journal of Consulting and Clinical Psychology, 71(6), 1007–1016. doi: 10.1037/0022-006x.71.6.1007.CrossRefPubMedGoogle Scholar
  53. Primeau, J. E., Servaty-Seib, H. L., & Enersen, D. (2013). Type of writing task and college students’ meaning making following a romantic breakup. Journal of College Counseling, 16(1), 32–48. doi: 10.1002/j.2161-1882.2013.00025.x.CrossRefGoogle Scholar
  54. Rachman, S. (1980). Emotional processing. Behaviour Research and Therapy, 18(1), 51–60. doi: 10.1016/0005-7967(80)90069-8.CrossRefPubMedGoogle Scholar
  55. Rosnow, R. L., & Rosenthal, R. (2003). Effect sizes for experimenting psychologists. Canadian Journal of Experimental Psychology, 57(3), 221–237. doi: 10.1037/H0087427.CrossRefPubMedGoogle Scholar
  56. Samoilov, A., & Goldfried, M. R. (2000). Role of emotion in cognitive-behavior therapy. Clinical Psychology: Science and Practice, 7(4), 373–385. doi: 10.1093/Clipsy/7.4.373.Google Scholar
  57. Scherer, K. R. (2001). Appraisal considered as a process of multilevel sequential checking. In K. R. Scherer, A. Schorr, & T. Johnstone (Eds.), Apraisal processes in emotion: Theory, methods, research (pp. 92–120). New York: Oxford University Press.Google Scholar
  58. Segal, D. L., Tucker, H. C., & Coolidge, F. L. (2009). A comparison of positive versus negative emotional expression in a written disclosure study among distressed students. Journal of Aggression, Maltreatment and Trauma, 18, 367–381. doi: 10.1080/10926770902901345.CrossRefGoogle Scholar
  59. Singh, M. (1994). Validation of a measure of session outcome in the resolution of unfinished business of Work. (Unpublished doctoral thesis), York University, Toronto, Canada.Google Scholar
  60. Sloan, D. M., Marx, B. P., Epstein, E. M., & Lexington, J. M. (2007). Does altering the writing instructions influence outcome associated with written disclosure? Behavior Therapy, 38(2), 155–168. doi: 10.1016/J.Beth.06.005.PubMedCentralCrossRefPubMedGoogle Scholar
  61. Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types and moderating variables. Journal of Consulting and Clinical Psychology, 66(1), 174–184. doi: 10.1037//0022-006x.66.1.174.CrossRefPubMedGoogle Scholar
  62. Tschacher, W., Baur, N., & Grawe, K. (2000). Temporal interaction of process variables in psychotherapy. Psychotherapy Research, 10(3), 296–308. doi: 10.1093/Ptr/10.3.296.CrossRefGoogle Scholar
  63. Ullrich, P. M., & Lutgendorf, S. K. (2002). Journaling about stressful events: Effects of cognitive processing and emotional expression. Annals of Behavioral Medicine, 24(3), 244–250. doi: 10.1207/S15324796abm2403_10.CrossRefPubMedGoogle Scholar
  64. Watson, J. C., & Bedard, D. L. (2006). Clients’ emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies. Journal of Consulting and Clinical Psychology, 74(1), 152–159. doi: 10.1037/0022-006x.74.1.152.CrossRefPubMedGoogle Scholar
  65. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS Scales. Journal of Personality and Social Psychology, 54(6), 1063–1070. doi: 10.1037/0022-3514.54.6.1063.CrossRefPubMedGoogle Scholar
  66. Whelton, W. J. (2004). Emotional processes in psychotherapy: Evidence across therapeutic modalities. Clinical Psychology and Psychotherapy, 11(1), 58–71. doi: 10.1002/Cpp.392.CrossRefGoogle Scholar
  67. Zakowski, S. G., Herzer, M., Barrett, S. D., Milligan, J. G., & Beckman, N. (2011). Who benefits from emotional expression? An examination of personality differences among gynaecological cancer patients participating in a randomized controlled emotional disclosure intervention trial. British Journal of Psychology, 102, 355–372. doi: 10.1348/000712610x524949.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kristina B. Rohde
    • 1
  • Maria Stein
    • 1
    • 2
  • Antonio Pascual-Leone
    • 3
  • Franz Caspar
    • 1
  1. 1.Department of Clinical Psychology and PsychotherapyUniversity of BernBernSwitzerland
  2. 2.Department of Psychiatric NeurophysiologyUniversity Hospital of PsychiatryBern 60Switzerland
  3. 3.Department of PsychologyUniversity of WindsorWindsorCanada

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