All problems are in the end emotional

All problems are in the end emotional • The majority of people come into psychotherapy because they experience significant personal, social or occupational dysfunction due to emotion or its consequences. • Emotional states such as anxiety, depression, extreme mood swings, and intense emotional pain can be subjectively intolerable experiences. • Apathy, flatness, and blocked emotion can also be a concern, as well as the preponderance of one emotion over others. • The inability to control actions or the opposite problem, the inability to act because of emotion can be problematic and can cause unpleasant consequences. • Lack of control and/or faulty reality testing of thoughts that trigger and maintain emotion may also be problematic.

Basic emotion components • Stimulus: Emotions are about something • Appraisals: Interpretations of the stimulus situation and the self • Physiological changes: Arousal • Action tendency-evidence and part of arousal • Phenomenal experience- the subjective experience in consciousness

Approaches to psychotherapy • A historical lineage of psychotherapy goes like this: • Psychoanalytic-Freud • Behavioral-Skinner • Cognitive Behavioral-Beck • Client Centered (Rogers) /Gestalt (Perls) • Emotion-focused therapies: • Process/Experiential or EFT (Greenberg) • Integrative CBT (Segal/Saffran) • “Neo-analytic” (Sandler) • Dialectical Behavior Therapy (Linehan)

Psychoanalysis and emotion • Historical events and family history both thwart and developed needs that cause conflict neurosis. • Originally problems were viewed as the result of blocked emotion, once emotion was experienced the memories relating to emotions would come to consciousness and could be worked through with insight. Understanding would regulate and change emotion. • Emotions seen as part of the id or instinctive process that were in conflict with super-ego or societal demands. They had to be tamed with reaso

Behavioral Approaches and emotion • Learning theory is the heart of this therapy. • Problems result of: • Skills deficits cause dysfunctional behavior that receives little positive reinforcement. Teach and learn new behaviours that can be strengthened with positive reinforcement. • Inadvertent reinforcement of undesirable behaviors via operant conditioning, as in phobia and avoidance. Extinguish the behaviour by removing the reinforcement. For example- don’t allow the escape behavior so that it can’t be rewarded by anxiety reduction, as in exposure treatment. • Finding and eliminating the stimulus or associated cues that elicit inappropriate behavior.

Cognitive-behavioral therapy • Psychological states are the product of our thoughts, assumptions and beliefs that function automatically. • People can become aware of these and have some control over their thoughts. • Bring more controlled awareness to thoughts, in the form of: • self-observation • reality testing/rational thinking- test the validity of assumptions • Evidence will change beliefs and thinking and impact mood.

Commonalities in all approaches • Focused on problematic emotion, the emotion that should be gotten rid of (i.e., anxiety, depression, anger) • Focused on the power of the rational mind, and the ability to interrupt emotion with rational thinking or understanding and distance to regulate and take the edge off. • Focused on executive powers, the ability to inhibit responding, that is, de-link the automatic connection between feeling and behavior. • Did not value emotion as information, did not view the information value of emotion or see it as a complex phenomenon.

Client-centered therapy (Rogers) • The first therapy to value emotion • A model of health. All human beings will grow toward healthy functioning and reach their potential, given conditions that foster growth. • Growth needs a safe interpersonal environment. • In early environment where love is conditional. Child learns to conform to values of others at expense of inner feelings and needs. • Clients must be brought into stronger contact with their true feelings and values. • Provide a non-conditional interpersonally safe environment. Clients will contact who they are and what they need/feel. This will help them solve problems and act in the service of their goals.

Experiential therapies assume • That emotion is a vital regulator of action that provides awareness to an organism of what is important in terms of adaptive function in its environment • Experience of emotion is essential to fully accessing the information value in feeling. Increased emotional awareness is essential, and experiential psychotherapies can be seen as a form of training in this awareness (Greenberg & Safran, 1987). • The belief is that once one makes sense of emotional experience by fully-processing it, emotion can clearly guide decision making and action.

Information value in emotion • Several emotion theorists (Frijda, 1986; Izard, 1991; Oatley and Jenkins, 1992; Tomkins, 1963) have now formulated emotion as an rapidly-acting meaning system that is activated in response to events that have significance to our well-being. Emotion also organizes us for adaptive action in response to these events. • Emotion provides information about: • events that are occurring • our needs, goals, and concerns • our sense of self • adaptive actions to take in the service of our needs

What's happening? • Discrete emotions naturally occur in response to particular classes of self-relevant events. They tell us if we have been violated or treated unfairly (anger), are in danger (fear), have lost someone important to us (sadness) (Frijda, 1986; Scherer, 1984). • What do I need? • Discrete emotions inform of us our needs. They tell us if we need to assert boundaries (anger), if we need security and safety (fear) or we need companionship and comfort (sadness) (Greenberg & Paivio (1997).

What's going on with me ? • Emotions inform us about our sense of self in the situation (Scherer, 1984). When we are angry we experience ourselves as strong, with resources to deal with the situation. When we are afraid our sense of self is one of weakness, without the ability to deal with the event. In shame our sense as unacceptable. • What should I do? • Emotion guides action (Frijda, 1986). When we are violated and angry it is adaptive to hit out and defend oneself. When we are afraid it is adaptive to freeze or run. When sad and alone it is adaptive to seek comfort and companionship.

The complex emotional world • We do not live in worlds in which the only emotional scenarios we meet are simply and automatically running away from scary animals, or hitting people who try to steal our belongings. We live in worlds in which bosses betray us, parents thwart our choices, and the media stirs up feelings for which we may have no target to direct our longings. • Emotion has been complicated by consciousness, learning, experience, and memory, as well as our ability to regulate emotions.

Maladaptive emotions • Emotional processes can also go wrong. • Emotions are not always adaptive in the straightforward manner described by emotion theory. • Individuals can feel fear when approached by loving others, go into a panic at being successful, and feel love for abusers.

What is now agreed upon by all approaches • Emotional is a complex and dynamic integration of affective programs and cognitive processes like memory and learning. • It’s best viewed as a affective/cognitive structure (Greenberg & Paivio, 1997; Beck, 1996). • Some affective-cognitive structures are healthy / adaptive, while others are not.

How do you identify the healthy from unhealthy emotions and schemes? • Greenberg & Safran were the first to suggest emotional assessment and differential intervention based on such an assessment (1987; Greenberg & Paivio, 1997) • Emotions are varied: • Primary adaptive- normal fear in the face of danger • Primary maladaptive- fear when shown love • Secondary or self-protective- anger when really scared • Instrumental- acting angry to get what you want

Primary adaptive emotion • should be mined for information about needs and adaptive actions. • Primary maladaptive emotion • should be explored for the maladaptive meaning structures that elicit them so that meaning can be deconstructed and transformed into new meaning/appraisals that support adaptive emotion in the situation instead of maladaptive.

Secondary emotions • need to be explored for their self protective purpose • resolve the beliefs that interrupt the primary emotion • eventually the primary emotions underlying them unpacked for their information. • Instrumental emotion • requires examination and awareness concerning the manipulative function so that the desired goals can be achieved in more adaptive ways.

Working with emotion • Experiences are generated by emotion schemes (programs). • Emotion schemes are triggered automatically, and affect thoughts and experience automatically (challenge to Beck/CBT). • Can’t change emotion schemes with thoughts alone, need emotion ‘on-line’ to change it. • Provide clients with the interpersonal safety needed to approach emotional experience. • Access emotion schemes by arousing emotional experience in sessions. • Generate new emotional experiences in therapy. • Support the emergence of adaptive emotion.

Other approaches now concur • Beck (1996) himself, in a chapter entitled “Beyond Belief”, recently suggested that certain biologically based modes of functioning determine whether a belief will be activated. • Samoilov and Goldfried (2000) have called for an “expansion” in Cognitive Behavioral Therapy toward making use of emotion in therapy and they note that core affective structures are subject to different change principles than those involving cognition, as they are not affected by logic. • Foa and Kozak (1986) argued for the importance of arousing emotion in order to expose it to new input in behavioural treatment of panic and trauma. • Rachman (1981), another behaviourist entertains the possibility that desynchronies between affect and cognition are possible and has initiated a discussion of the importance of emotional processing in exposure therapy. • Stein (1991) in a comprehensive review of psychoanalytic theories of affect remarks that treatment now often consists of helping clients approach and tolerate emotional experiences such that emotions transform, not through simple discharge, but by meaningfully connecting emotions to self and situation.

Experiencing emotion on line • All approaches are also beginning to concede that because emotion schemes function automatically, and are therefore out of awareness, emotion schemes have to be turned on and brought into awareness in order for therapy to lead to change. Individuals need to experience the emotional relevance of what they are talking about in therapy for therapy to be successful. When they do they and the therapist both gain access to all the components more readily.

Emotional arousal • One possible marker of emotional experience can be inferred from emotional arousal. When emotion is aroused to a significant degree the probability that it will enter awareness increases. • Research indicates that arousal of emotion in therapy does relate to good outcome.

1. In a recent study attempting to match treatment to patient variables in a combined sample of varying treatments and problems, Beutler, Clarkin and Bongar (2000) found that session emotional intensity was one of the strongest predictors of outcome. • 2. Jones and Pulos (1993) found that the strategies of, evocation of affect, and, the bringing of troublesome feelings into awareness, were correlated positively with outcome in both dynamic and cognitive behavioural therapies in the NIMH collaborative study of depression. • 3. Behavioral treatment of anxiety disorders has long demonstrated that clients who profited most from systematic desensitization (Borkovec & Stiles, 1979; Lang, Melamed & Hart, 1970) and flooding (Watson & Marks, 1971) exhibited higher levels of physiological arousal during exposure. • 4. More recently methods that increase arousal have also been found to be effective in treating panic (Clarke, 1996; Mineka & Thomas, 1999). These and other findings suggest that the arousal of the fear-activated phobic memory structures is important for change. • 5.Mahrer and colleagues (Mahrer, Dessaulles, Nadler, Gervaize & Sterner, 1987) have also shown that certain good moments in therapy are characterized by emotional arousal and expression and these are associated with change in personality states in the session (Mahrer, Lawson, Stalikas & Schacter, 1990). • 6.Studies by Beutler and his group have shown significant effects for a treatment involving the arousal and expression of anger in the treatment of depression and argued for the importance of anger expression in therapy (Mohr, Shoham-Solomon, Engle & Beutler, 1991). • 7. Greenberg and colleagues also have shown that emotional arousal and expression is significantly related to outcome in the resolution of unfinished business (Greenberg & Foerster, 1996; Greenberg & Malcolm, in press; Paivio & Greenberg, 1995). Together these studies provide evidence for the value of emotion awareness, arousal and expression in individual therapy.

Arousal or Catharsis Sometimes is not Enough • Although research suggests that the expression and arousal of emotion can contribute to change, this is true only for some people with some types of concerns (Pierce, Nichols & DuBrin, 1983), • This suggests that awareness, arousal and expression of emotion alone may be inadequate in promoting change. • Venting has not been found to be effective in reducing laboratory induced distress (Bushman, Baumeister & Stack, 1999; Kennedy-Moore & Watson, 1999). • This points to the importance of the further processing of aroused emotion to make sense of it by symbolizing it in awareness, and by clarifying the sources of its arousal. Making sense of emotion in new ways also helps to break cycles of maladaptive automatic emotion processes.

Measuring emotional experience Segments of psychotherapy are given ratings according to a 7-pt ordinal scale (Klein et al., 1969) • Level 1: Client talks about external events in impersonal, detached or journalistic way. • Level 2: Client talks about external events with behavioural or intellectual self-description, self-as-object style, in an interested personal manner suggesting self-participation. • Level 3: Client now talks about personal reactions to external events, limited self-descriptions, and some reports of feelings appear in reaction to events. Manner is reactive and emotionally involved. • Level 4: The majority of communication is of feelings and personal experiences told from the internal and personal perspective. Manner is self-descriptive and associative. • Level 5: Problems and propositions about the self and experiences are explored and worked through, feelings elaborated and searched. • Level 6: Synthesis of readily accessible feeling and experiences occurs. Feelings vividly expressed, experienced in an affirmative and conclusive manner. • Level 7: Full and easy presentation of experience, all elements confidently integrated. Manner is expansive, illuminating, confident and buoyant.

Experiential therapy: Emotional processes • Make sure the client can regulate and tolerate emotion. • Activate emotion schemes. • Notice which emotion type you are working with • Intervene in the appropriate fashion depending on the emotion type.

Research on Emotional Experience • Research on depth of experiencing has been shown consistently to relate to outcome across orientations (Klein,Mathieu‑Couglan & Kiesler, 1986; Orlinsky & Howard 1978). • Foa and Kozak (1986, behaviorists) have argued that the two conditions necessary for the reduction of pathological fear are the activation of the fear structure, and the introduction of new information incompatible with the phobic structure. Foa and Jaycox (1998) also have demonstrated that emotional processing of trauma facilitates recovery. How people make sense of their emotional experience is proving to be important in predicting both onset of and recovery from phobias and trauma (Ehlers & Clark, 2000). • In a recent review of twenty-seven studies, Hendriks (2001) reports that higher experiencing from averaged early, middle, and late sessions have all been shown to relate to outcome within a number of different therapeutic orientations and differing diagnostic categories (cf Greenberg, Korman & Pavio, 2001; and Hendricks, 2001, for reviews). • Experiencing has been shown to be related to outcome in cognitive behavioural therapy (Castonguay, Goldfried, & Hayes, 1996) • Reflecting on emotional experience has also been shown to relate to change in dynamic therapy (Mergenthaler, 1996). • Pos (1999) demonstrated, using a hierarchical regression analysis that while early differences in emotional experiencing did predict outcome, the level of experiencing reached at the end of therapy was the only significant independent predictor of change in depression. This demonstrated that experiential therapy did deepen the experiential process and that it was this increased deepening of emotional experiencing that predicted change. • Pennebaker (1995) has explained that the disclosure process involved in writing is congruent with the beneficial aspects of disclosure in psychotherapy. Emotional disclosure may provide structure for emotional events by translating experience into words. "Through language, individuals are able organise, structure and ultimately assimilate both their emotional experiences and the events that may have provoked the emotions"

Importance of emotion regulation • While emotional experience can be a source of useful information, intense arousal / physiological activation can also interfere with one’s ability to function. • This often causes individuals to find emotional experiences stressful in themselves. • Especially troublesome for individuals who are unable to use emotional information, or for those in whom emotions trigger dysregulation. • Therefore, before one can experience emotion in awareness (in a productive manner) one has to be able to first regulate that experience.

Experiencing may be difficult • “ I’m afraid if I start crying I’ll never stop.” or………worse

Emotion regulation- the first task • Before arousal and experience of emotion can be of value an individual must be able to regulate emotion, that is, have an emotional experience but then be able to come back to baseline without being seriously disorganized, shattered, deeply shamed, or negatively affected by it.

1. Therapeutic alliance: Helps regulate emotion • Unconditional positive regard, empathy, and genuineness provide a safe interpersonal environment. • Secure attachment appears to have an effect on the ability to regulate / tolerate arousal and distress.

2. Symbolizing: Regulation through language • Approaching emotion with attention and finding words for feelings: ‘Containing’ them in language has a regulating effect. • Gottman, Katz, & Hooven, (1996) found that parents who acted as emotion coaches with their childrenat age 5 (ability to approach feelings with awareness and verbal labeling), had children with better physiological regulation 3 years later. • This may include psychoeducation of the very basic sort, such as getting to know the basic relationships between body-sensations, situations and feelings that can help • Help individuals become aware of the meanings of emotion words and when to apply them to their experience.

3. Creating self-soothing & tolerance skills • Imagery: Safe place. • Mindfulness and radical acceptance. • Distraction. • Alternate sensation. • Grounding techniques.

Summary • Not all emotion is problematic, or all good. • There are different types of emotion. Have to know what you’re working with to know if it should be changed or used to inform adaptive action. • Change in psychotherapy requires emotion to be activated or aroused so that the emotion scheme is accessible and available for editing. • Activation is often not enough. Information from emotion is also available to be used in adaptive ways. Experience of emotion, and processing it in awareness, brings the information value forward, while at the same time allowing for choices in action, delayed action, planning for action.

All problems are in the end emotional