Antonio Pascual-Leone

University of Windsor · Department of Psychology

Objective: We examined whether the emotions that clients experience within session are associated with treatment outcome in dialectical behavior therapy (DBT) for borderline personality disorder (BPD). Method: Participants were 52 adults who met criteria for BPD and were enrolled in a 12-month DBT treatment. The Classification of Affective-Meaning...

To improve the provision of psychotherapy, many countries have now established clinical practice guidelines for the treatment of specific disorders and mental health concerns. These guidelines have typically been based on evidence from meta-analyses of randomized clinical trials with minimal consideration of findings from qualitative research desig...

Objective The present study examined client profiles in observed emotion to explore possible subgroups among clients given that there is substantial heterogeneity in clients' expression of emotion in therapy. Subgroups were identified using the sequential model of emotional processing, which posits that global distress, shame/fear and rejecting ang...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...

The present study examines (a) the unique effects of chairwork on emotional process and intervention outcomes across treatments in the context of individual psychotherapy and (b) how these effects compare to other treatment interventions. Based on the appropriateness of the data available, meta-analyses with estimated effect sizes and narrative syn...

Self-contempt may be a frequent but overlooked clinical phenomenon, associated with a number of psychological problems such as increased sadness and shame. It was shown that self-contempt interferes with productive emotional processing and the quality of therapeutic alliance. This study aims to develop a reliable measure of expressed self-contempt...

Background: Both clinical and non-clinical levels of disordered eating behaviours have been associated with deficits in emotional processing. Methods: Through a correlational design, the present study examined the relationship between different types of disordered eating behaviours and various forms of emotional processing. N = 209 female underg...

In-session emotional processing is a central component of psychotherapy, but little is known about the types and the quality of emotional processing individuals engage in daily life. An ecological momentary assessment (EMA) schedule has been validated to assess distinct emotional experiences as they emerge in daily life. It remains an open question...

Therapist effects are well-established in the literature, but their presence in the earliest stages of a therapist’s career (i.e., training) is under-studied. The present study involved the investigation of between-therapist effects—differences between therapists’ average effectiveness (i.e., outcome ratings) across all patients in their caseloads—...

Psychological symptoms are nested within autobiographical narratives. The narrative emotion process coding system (NEPCS) describes how people tell stories, identifying problematic narratives: Same Old Story, Empty Story, Unstoried Emotion, and Superficial Story. These markers refer to observable narrative features rather than a story’s content. Al...

Background Emotional processing has been studied in psychotherapy as a state-dependent, sequential process of change. So far, no studies have applied this conceptualisation of emotional processing to the assessments of emotion in daily life. This is particularly important in the light of the pertinence of day-by-day fluctuations of emotions for und...

Through observational analysis, the present study examined the temporal relationship between the verbalization of unmet existential needs and levels of expressed emotional arousal. Participants were 39 undergraduate students with self-critical tendencies who completed an emotion-focused two-chair intervention for self-criticism during which they en...

Objective: The purpose of this study was to determine the extent to which therapeutic processes - working alliance and depth of experiencing - contributed to outcome. Method: Individual differences in these processes were examined at the early and working phases to determine their impact on symptom reduction. An archival data set of N = 42 indiv...

Objective: This study involves the first attempt to identify sudden gains in a sample of clients undergoing experiential therapy for depression while also investigating client and therapist change processes related to sudden gains. Method: Pre- and post-session Beck Depression Inventory, short form (BDI-SF) questionnaires were used to identify sudd...

Objective. We examined the role of expressed self-contempt in therapy for borderline personality disorder (BPD). Based on previous literature on BPD, we assumed an association between the self-contempt and the core symptoms of BPD. We also studied the progression of expressed self-contempt during the treatment and its effect on the alliance and the...

This study explored the change that unfolded when parents resolved their coparenting dissatisfaction during an Integrative Brief Systemic Intervention (IBSI) for parent couples. We conducted a task analysis (Greenberg, 2007) to build a model of resolving coparenting dissatisfaction. We compared a postulated model of change (rational model) based on...

Purpose of review: The present review summarizes the current state of the art in psychotherapy processes during treatments for clients with personality disorders. We outline some methodological challenges in the discipline of process research, give a brief historical account on process research, and then focus on specific processes studied from an...

This chapter provides an overview of the theory and practice of emotion-focused therapy (EFT), while giving special attention to the neuropsychological perspectives that help explain this approach to treatment. The authors elaborate how emotion theory is a fundamental part of the approach and discuss how this theory informs the treatment principles...

Objective The aim of this methodological paper was to present self‐contempt, and its assessment, in a broad transdiagnostic framework of psychopathology and related to change in psychotherapy. Self‐contempt may be a central phenomenon in many psychological disorders. We outline methodological recommendations for the study of complex transdiagnostic...

This study tested a model of emotional processes over the course of emotion-focused therapy for trauma. The model of emotional processing (Pascual-Leone & Greenberg, 2007) proposes a sequential order of shifting from "early expressions of distress" to "primary adaptive emotion" that aid in adaptive functioning. Thirty-eight participants were taken...

Changes in emotional processing (EP) and in theory of mind (TOM) are central across treatment approaches for patients with borderline personality disorder (BPD). Although the assessment of EP relies on the observation of a patient's self-criticism in a two-chair dialogue, an individual's TOM assessments is made based on responses to humorous stimul...

Research on emotion regulation has typically overlooked factors related to individual differences and situational contexts. The aim of the current study was to examine emotion regulation strategies used by 61 varsity athletes in different contexts; namely, before and after athletic competitions. Participant descriptions of pre- and post-competition...

Emotional knowledge about one's own and others' emotional experience are central features of mental health and may be characteristic of therapeutic processes leading to good outcome. Clients with personality disorders (PDs) often lack in their ability to access and accept emotional experiences, or to reflect on emotion and use it in adaptive ways....

Background: The current study examined expressive writing by investigating two aspects of emotional processing: depth of experiencing and order of emotional processing. Materials and methods: A sample of 110 undergraduates, who suffered traumas, were instructed to write based on differing theories of emotional processing. Participant narratives...

This process-outcome study aims at exploring the role of shame, self-compassion, and specific therapeutic interventions in psychotherapy for patients with narcissistic personality disorder (NPD). This exploratory study included a total of N = 17 patients with NPD undergoing long-term clarification-oriented psychotherapy. Their mean age was 39 years...

The automatic, involuntary reactivation of disturbing emotional memories, for example, of interpersonal pain, causes psychological discomfort and is central to many psychopathologies. This study aimed at elucidating the automatic brain processes underlying emotional autobiographical memories by investigating the neurophysiological dynamics within t...

Objective: The marked impulsivity and instability of clients suffering from borderline personality disorder (BPD) greatly challenge therapists' understanding and responsiveness. This may hinder the development of a constructive therapeutic relationship despite it being of particular importance in their treatment. Recent studies have shown that usi...

This paper reviews a body of research that has examined Pascual-Leone and Greenberg’s sequential model of emotional processing or used its accompanying measure (the Classification of Affective Meaning States). Research from 24 studies using a plurality of methods examined process–outcome relationships from micro to macro levels of observation and b...

Objective: Pascual-Leone and Greenberg's sequential model of emotional processing has been used to explore process in over 24 studies. This line of research shows emotional processing in good psychotherapy often follows a sequential order, supporting a saw-toothed pattern of change within individual sessions (progressing "2-steps-forward, 1-step-b...

The objective is to introduce work with victims of human trafficking by explaining the needs of victims, and clinical challenges. A case illustrates the complexity of working with this population. A narrative overview discusses issues of human trafficking as relevant to psychotherapists. Challenges that victims of human trafficking face include exp...

Different psychotherapy theories describe process patterns of emotional arousal in contradictory ways. To control both treatment and therapist responsivity, this study sought to test dynamic patterns in the arousal of negative affect using a controlled experimental study of expressive writing. There were 261 participants (78% women; M = 21 years ol...

Key practitioner message: A 20-session dialectical behaviour therapy (DBT)-informed skills training is a promising adjunct intervention for patients with borderline personality disorder, in particular for reducing problems related to social role. Increases in assertive anger mediate the effects of DBT-informed skills training, whereas rejecting an...

Objective: The experiencing scale (EXP) is an often used measure of client's depth of processing and meaning-making in-session. While research suggests that "client experiencing" predicts psychotherapy outcomes, this relationship has never been summarized in a meta-analysis. We examine this specific client factor as an in-session process predictor...

The marked impulsivity and affective instability of clients suffering from Borderline Personality Disorder (BPD) greatly challenge therapists’ understanding and responsiveness. This may hinder the development of a constructive therapeutic relationship despite it being of particular importance in their treatment. Recent studies have shown that using...

Instability in affect regulation as a characteristic of Borderline Personality Disorder leads to intensive pain (APA, 2005). The question arises as to how patients with BPD manage to feel an adaptive emotion in therapy. Analyzing the precise paths to a pleasant emotion provides implications for therapy. The present study examined this question with...

Objectives: New research-informed methods for case conceptualization that cut across traditional therapy approaches are increasingly popular. This paper presents a trans-theoretical approach to case formulation based on the research observations of emotion. Methods: The sequential model of emotional processing (Pascual-Leone & Greenberg, 2007) i...

Emotional experience is increasingly being measured using experimental tasks, but the stimuli used are often only proxies for the emotion being studied. Stimuli are intended to evoke a distinct emotional experience, but certain designs fail to adequately control for the actual experience in question. In this methodological paper, we review designs...

The present study examines the role of emotion in the self-critical process of individuals with anger problems. Self-criticism is a prevalent intra-personal feature which greatly impacts an individual’s emotion. So far, it is unclear, which emotions individuals with maladaptive anger experience when they work through their self-criticism. Using a q...

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 therap...

Four issues are discussed: (1) differences between cognition and emotion; (2) affect, emotion, and motivation differentials, including a neuropsychological model of motivation; (3) mental attention (working memory) as a resource neither affective nor cognitive, but applicable to both; and (4) explication of neuropsychological scheme units, which ha...

It is important to understand the change processes involved in psychotherapies for patients with personality disorders (PDs). One patient process that promises to be useful in relation to the outcome of psychotherapy is emotional processing. In the present process-outcome analysis, we examine this question by using a sequential model of emotional p...

We question memory reconsolidation and emotional arousal as sufficient determinants of therapeutic change. Generating new feelings and meanings must be contrasted with activating and stabilizing the evolving memories that reflect those novel experiences. Some therapeutic changes are not attributable to a memory model alone. "Emotional processing" i...

This study examines the effects of a borderline-specific treatment, called general psychiatric management, on emotional change, outcome and therapeutic alliance of an outpatient presenting with borderline personality disorder. Based on the sequential model of emotional processing, emotional states were assessed in a 10-session setting. The case sho...

The current paper introduces the notion of clinically relevant subtypes of emotion regulation behaviours. A new measure of emotion regulation, the Complexity of Emotional Regulation Scale (CERS), was established as psychometrically sound. It was positively correlated with a measure of emotional awareness (r = 0.28, p < 0.001) and negatively correla...

AimThis paper describes and contrasts the impact of two 13-week counsellor training programmes in integrative-experiential psychotherapy; one with 24 undergraduate psychology students presented in this paper, and the other with archival data from Pascual-Leone and Andreescu's study of 22 clinical psychology graduate students.Method The programmes t...

Aims: Alliance rupture and resolution processes are occasions for the client to have his or her core interpersonal patterns activated in the here and now of the therapy and to negotiate them with the therapist. So far, no studies have been conducted on emotional processing, from a sequential perspective using distinct emotion categories, in allianc...

Objective: Depth of emotional processing has shown to be related to outcome across approaches to psychotherapy. Moreover, a specific emotional sequence has been postulated and tested in several studies on experiential psychotherapy (Pascual-Leone & Greenberg, 2007). This process-outcome study aims at reproducing the sequential model of emotional p...

Unlabelled: Emotion-focused therapy (EFT) has increasingly made use of case conceptualization. The current paper presents a development in the case conceptualization approach of EFT. It takes inspiration from recent research on emotion transformation in EFT. The case conceptualization presented here can guide the therapist in listening to the clie...

This study examined a resource-based model of change whereby poor problem gambling (PG) treatment outcomes and relapse are viewed as resulting from client coping resources being diminished or overwhelmed. Specifically, client factors that work like resources to facilitate treatment (i.e., social support, self-efficacy, motivation, readiness for cha...

Abstract A variation of task analysis was used to build an empirical model of how therapists may facilitate client assimilation process, described in the Assimilation of Problematic Experiences Scale. A rational model was specified and considered in light of an analysis of therapist in-session performances (N = 117) drawn from six inpatient therapi...

Abstract After an introductory course in experiential-integrative psychotherapy, 21 graduate students provided personal narratives of their experiences, which were analyzed using the grounded theory method. Results produced 37 hierarchically organized experiences, revealing that students perceived multiple changes in both professional (i.e., skill...

This chapter describes emotion-focused therapy applied to anger-related problems that stem from complex child abuse trauma, that is, repeated exposure to violence and betrayal, usually at the hands of loved ones and caregivers. This therapy focuses on healing the emotional/attachment injuries perpetrated by particular abusive and/or neglectful othe...

This online resource provides information and instruction on empirically supported interventions for anger in various clinical contexts, including substance abuse, PTSD, the intellectually disabled, borderline personality disorder, children and adolescents, and others. Ten chapters focus on specific populations, while two additional chapters discus...

This paper explores applies emotion-focused theory, for the first time, to the emotions of hate, rage, and destructive anger. The general case formulation proposed in this paper is that these emotions are always an elaboration of secondary anger. The body of the paper describes three clinical case formulations. First, problem anger is described in...

Working with the empty chair or the two-chair dialogue techniques is used in experiential techniques. The latter are practiced in various psychotherapy forms. The present article demonstrates the origins of these techniques in the Gestalt and Person-centered models of psychotherapy, as well as presents their current developments in experiential psy...