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Immersion and distancing during assimilation of problematic experiences in a good-outcome case of emotion-focused therapy
Psychotherapy Research
Abstract
Objective: Some studies have suggested that a decrease in immersion (egocentric perspective on personal experiences) and an increase in distancing (observer perspective on personal experiences) are associated with the resolution of clinical problems and positive outcome in psychotherapy for depression. To help clarify how this change in perspectives relates to clinical change, the present study compared changes in immersion and distancing across therapy with progress in one client's assimilation of her problematic experiences.
Method: We analyzed all passages referring to the central problematic experience in a good outcome case of emotion-focused therapy for depression using the Measure of Immersion and Distancing Speech and the Assimilation of Problematic Experiences Scale.
Results: Results showed that immersion and distancing were associated with different stages of assimilation. Immersion was associated with stages of emerging awareness and clarification of the problem and in the application of new understandings to daily life. Distancing was associated with problem solving and attaining insight.
Conclusion: The decrease of immersion and increase of distancing associated with therapeutic improvement should not be taken as a recommendation to avoid immersion and encourage distancing. Immersion and distancing may work as coordinated aspects of the processes of psychotherapeutic change.
... Rumination can prevent the creation of new meanings, while the emotional arousal exacerbates the negative states, making people feel overwhelmed (Nolen-Hoeksema et al., 2008). In contrast, distancing facilitates reconstruction of experience, and analyses have shown that distancing helps people to make meaning out of problematic experiences and to gain a sense of closure, improving the emotional well-being (Ayduk & Kross, 2010;Barbosa et al., 2018). ...
... Immersion and distancing play a fundamental role in facilitating adaptive coping, and rather than considering one to be superior over the other, a number of studies have shown that the timely coordination of both is essential to arrive at a positive outcome (Ayduk & Kross, 2010;Barbosa et al., 2018). It has been shown that less recounting (i.e., describing the specific chain of events and emotions one experienced during these events) and more reconstructing (i.e., describing new realizations about or changes in the way one understands the causes underlying one's feelings) leads people to feel less upset after analyzing their feelings (Kross & Ayduk, 2017). ...
It is a well known problem that qualitative researchers in the social health sciences are potentially at risk of experiencing emotional burden when confronted with sensitive topics, such as death and dying. A number of research papers and reviews suggest that self-reflection could be helpful in dealing with the associated emotional burden. These publications however typically mention strategies that deal with the problem when emotional burden is already present. In this article I explored if a proactive self-reflective approach could be useful to prevent emotional problems when dealing with dying patients and their relatives during my research project. For this paper I used an autoethnographic approach to describe the self-reflective process I undertook before the start of my research project to identify, reconstruct and analyze a number of critical personal experiences that were likely to cause emotional problems. Five themes emerged: seeing people suffer or die, dealing with bereaved family members, difficulties regarding interdisciplinary research, unresolved personal issues from the past, and unwillingness to take part in my research study. From a methodological point of view, a proactive self-reflective approach deserves consideration as a tool to help better prepare researchers in the social health sciences to conduct research into delicate topics. Not only does it enhance researcher wellbeing, it also increases the quality of the researcher-as-instrument. This article is a worked example of how to engage in such proactive self-reflection and illustrates the added value of including this step at the start of a research project looking into sensitive topics.
... Across several therapeutic approaches and psychopathological conditions, processoutcome research has pointed out a positive relationship between a higher psychological change in terms of APES levels and better therapeutic outcome (such as reductions in depression; Detert et al., 2006;, 1999Shapiro et al., 1992;Stiles et al., 1991Stiles et al., , 1995. This relationship has been consistently observed in cases diagnosed with Major Depressive Disorder (Barbosa et al., 2018;Basto et al., 2016Basto et al., , 2017Brinegar et al., 2008;Caro-Gabalda, 2003, 2006bField et al., 1994;Gonçalves et al., 2014;, 1999, 2003Knobloch et al., 2001;Leiman & Stiles, 2001;Meystre et al., 2017;Mosher et al., 2008;Osatuke et al., 2005Osatuke et al., , 2007Stiles et al., 2006). ...
The Assimilation Model describes therapeutic change as a gradual integration of problematic experiences into the self. Previous studies associated higher assimilation levels with a reduction of depressive symptoms throughout therapy and better therapeutic outcomes at the end. We explored the relation between the assimilation of problematic experiences during therapy and the maintenance of therapeutic gains after the therapeutic process. Three depressed clients were studied: one remained asymptomatic throughout the follow-up; one relapsed after the end of therapy; and one become asymptomatic during the follow-up. The assimilation process was assessed through the Assimilation of Problematic Experiences Scale (APES) and depressive symptoms through the Beck Depression Inventory-II (BDI-II). Higher APES levels were associated with lower intensity of symptoms across sessions. The client who maintained gains and the client who recovered during follow-up achieved higher APES levels during treatment than did the client who relapsed. APES levels of at least 4 were associated with good outcomes during therapy and further improvement after therapy and levels of at least 6 were associated with maintenance of therapeutic gains. These results suggest that a more thorough assimilation of problematic experiences may help clients maintain therapeutic gains and/or recover after therapy, thereby reducing the likelihood of relapse.
... Finally, Barbosa et al. (2018), using data from a good outcome case of EFT for depression, found that lower levels of client assimilation were associated with what they referred to as immersion. characterized by a narrow, self-absorbed perspective on difficult experiences, which were more common early in therapy. ...
We review recent research on humanistic-experiential psychotherapies (HEPs), which include person-centered therapy (PCT), emotion-focused therapy (EFT), gestalt, and psychodrama approaches, along with generic relationship control conditions characterized as supportive or nondirective. A key part of this review is a meta-analysis of 91 studies of the effectiveness/efficacy of HEPs, published between 2009 and 2018, which produced the following results: (1) HEPs were associated with large pre-post client change (d = .86). (2) In controlled studies, clients in HEPs generally showed large gains relative to clients who received no therapy (.88). (3) In comparative outcome studies, HEPs in general were statistically and clinically equivalent in effectiveness to other therapies (-.08). (4) Overall, CBT appeared to have an equivocal advantage over HEPs (-.26). However, these studies were overwhelmingly delivered by CBT researchers in largely non-bona fide versions of HEPs as comparison conditions. Overall, the strongest results were found for EFT, followed by PCT; generic supportive-nondirective approaches were least effective, especially when compared to CBT. HEPs appeared to be most effective with relationship/interpersonal difficulties, self-damaging activities, coping with chronic medical conditions, and psychosis. Findings were more mixed for depression and anxiety. In addition, we offer an updated meta-synthesis of the qualitative outcomes of these therapies, which fell into three main categories: appreciating experiences of self; appreciating experience of self in relationship to others; and changed view of self/others. We also provide narrative reviews of recent qualitative research on helpful and unhelpful factors in HEPs, along with quantitative process-outcome research on HEPs including process-outcome research and work on mediating processes. In an integrative summary we identify a core set of interwoven client change processes involving emotional expression, deepening and transformation, the emergence of new client narratives, and the assimilation of problematic experiences. We conclude with a set of recommendations for research, practice and mental health guideline development. Humanistic-Experiential Psychotherapies Update, p. 2 Content Outline
... Gonçalves et al. 2010) or bound by a silenced problematic experience (Honos-Webb and Stiles 1998). The models construct the therapy process as establishing contact with and communication among different experiences, taking distance from the problem and formulating it more clearly, looking at it from a metaperspective, and finally, consolidating these reconceptualizations in a larger context (Barbosa et al. 2018;Gonçalves et al. 2014). These descriptions of the client's stance at the outset of therapy resonate with the notion of the client's so-called object position, in which the client feels beleaguered by the problem or acted upon by it (Leiman 2012;Todd 2014). ...
This multiple case study investigated how clients construct nonagentic positions when formulating their problems in the beginning of their first psychotherapy session. The initial problem formulations of nine clients entering psychotherapy were analyzed with a detailed model drawing on discursive methodology, the 10 Discursive Tools model (10DT). We found ten problem formulation categories, each one distinguished by the tool from the 10DT model primarily used to construct nonagency. All clients gave several problem formulations from different categories and constructed nonagentic positions with a variety of discursive tools. When the resulting problem formulation categories were read in comparison with the descriptions of the client’s stance at the outset of psychotherapy as presented in two change process models, the Assimilation of Problematic Experiences Sequence and the Innovative Moments Coding System, some similarities were found. However, the 10DT model brought out much variation in the client’s nonagentic positioning in the formulations, forming a contrast with the more simplified presentations of the client’s initial nonagency given in the change process models. Therapists should pay close attention to how clients express their sense of lost agency at the outset of psychotherapy and how this positions both the client and the therapist as future collaborators in psychotherapy.
... Depressive and general clinical symptoms were routinely monitored with the BDI-II and OQ-45.2 during the pre-treatment assessment and immediately before sessions 1, 4, 8, 12, and 16. Several previous studies have used cases drawn from the ISMAI Depression study (Barbosa et al., 2016;Basto, Pinheiro, Mendes, et al., 2016;; however none has previously focused on these two cases of Julia and Afonso specifically. ...
Objective:
The Assimilation model argues that therapists should work responsively within the client's therapeutic zone of proximal development (TZPD). This study analyzed the association between the collaborative processes assessed by the Therapeutic Collaboration Coding System (TCCS) and advances in assimilation, as assessed by the Assimilation of Problematic Experiences Scale (APES).
Method:
Sessions 1, 4, 8, 12, and 16 of two contrasting cases, Julia and Afonso (pseudonyms), drawn from a clinical trial of 16-sessions emotion-focused therapy (EFT) for depression, were coded according to the APES and the TCCS. Julia met criteria for reliable and clinically significant improvement, whereas Afonso did not.
Results:
As expected, Julia advanced farther along the APES than did Afonso. Both therapists worked mainly within their client's TZPD. However, Julia's therapist used a balance of supporting and challenging interventions, whereas Afonso's therapist used mainly supporting interventions. Setbacks were common in both cases.
Conclusions:
This study supports the theoretical expectation that EFT therapists work mainly within their client's TZPD. Therapeutic exchanges involving challenging interventions may foster client change if they occur in an overall climate of safety.
Change process research in psychotherapy is the study of the processes by which change occurs in psychotherapy. Since depression is a problem with high prevalence and various complications, it is an unavoidable task for clinicians to be able to understand how the process of change occurs in patients with this diagnosis. Therefore, this study aims to carry out a systematic review of the literature, to explore and analyze the empirical investigation of the process of change in individual psychotherapy in adulthood in patients with depression, in the last ten years. The review was carried out in the Web of Science, APA PsycNet, PubMed and EBSCO databases, following the guidelines indicated by the PRISMA methodology. After the screening and review process, 39 articles were selected and analyzed. There is a clear tendency to use mixed research methodologies, that is, qualitative and quantitative, with longitudinal designs in almost all the studies and a wide range of instruments for data collection. The results suggest that the change process tends to follow a non-linear development, commonly causing deep positive changes in diverse areas and with trajectories that tend to common patterns.
Keywords: change process research, psychotherapy, depression, systematic review
Objective: Recent studies on immersion (first-person perspective) and distancing (third-person perspective) in psychotherapy have shown the potential of both perspectives in the treatment of depression. High levels of change were associated with transitions between immersion and distancing, suggesting that a dynamic pattern between them may result in a more adaptive view of reality. This study aimed to assess if higher flexibility between these perspectives, during clientś reflection on negative experiences in the intermediate phase, is associated with lower levels of depressive symptoms at the end of treatment. Method: We analyzed the flexibility through frequency and magnitude of transitions between immersion and distancing, in representative sessions of the intermediate phase of therapy in 17 cases with depression. Results: The results showed that the higher frequency and lower magnitude in the intermediate phase predicted lower levels of depressive symptoms at the end of treatment. Conclusion: Immersion and distancing seem to work as dynamic processes, and greater flexibility between them in intermediate phase of therapy, characterized by frequent and fast transitions between the two perspectives, may be an adaptive pattern due to its effect on post treatment depressive symptoms.
Objective:
The potential benefit or harm of immersion (egocentric perspective) and distancing (observer perspective) on negative experiences are unclear and have not been empirically investigated in therapy. This is a first exploratory study aimed to analyze and compare the perspectives adopted on reflection (immersion and distancing) of negative experiences across therapy and the relationship between them and depressive symptoms in contrasting therapeutic outcomes of emotion-focused therapy (EFT).
Method:
Three good-outcomes cases and three poor-outcomes cases of EFT, diagnosed with mild to moderate depression at the beginning of therapy, were randomly selected. Immersion and distancing on negative experiences were analyzed using the measure of immersed and distanced speech. The depressive symptoms were assessed by the Beck Depression Inventory-II.
Results:
Significant differences across sessions were only found in the good-outcome cases which showed a significant decrease of immersion and an increase of distancing, and this evolution pattern was found related to the reduction of symptoms. Moreover, at the beginning of therapy, distancing was higher in the poor-outcome cases rather than in the good-outcome cases.
Conclusion:
The progressive and significant evolution from higher immersion at the initial phase to higher distancing in the final phase may be helpful in EFT for depression.
The assimilation model is an integrative model that can be applied to any kind of therapeutic setting for describing the process of change. The Assimilation of Problematic Experiences Scale (APES) describes the process of assimilation of problematic experiences in therapy. Although the APES presents an orderly sequence, studies have shown that assimilation process is not smooth; instead it seems to follow a sawtoothed path, with advances followed by setbacks or reversals, particularly in cognitive psychotherapies. In this paper, we report an analysis of assimilation setbacks in the process of of a good-outcome client, María, treated with linguistic therapy of evaluation are analyzed. The sample is composed of 105 setbacks taken from analysis of María's assimilation of three main problems. The reasons for most of the setbacks could be classified in one of three categories: the zone of proximal development, the balance metaphor, and multiple strands. Each of these categories can be understood as a consequence of the cognitive strategy and thus part of the process of cognitive therapy rather than a deviation or failure. In this sense setbacks, framed in the assimilation model, reflect some of the main characteristics of cognitive therapy. Nevertheless, we could not exclude the possibility that setbacks could mark a prospective drop-out; therefore, therapists should pay attention and resolve them.
Objective:
Research on the assimilation model has suggested that psychological change takes place in a sequence of stages punctuated by setbacks, that is, by transient reversals in the developmental course. This study analyzed such setbacks in one good outcome case and one poor outcome case of Emotion-focused therapy (EFT) for depression.
Method:
Intensive analyses of five transcribed sessions from each case identified 26 setbacks in the good outcome case and 27 in the poor outcome case. The reason for each setback was classified into one of four categories: balance strategy, exceeding the therapeutic zone of proximal development either induced by the therapist (ZPD-T) or induced by the client (ZPD-C), or spontaneous switches.
Results:
In the good outcome case the most frequent reasons for setbacks were balance strategy and spontaneous switches, whereas in the poor outcome case the most frequent reason for setbacks was ZPD-T.
Conclusions:
As in previously studied therapies, setbacks in EFT, usually represent productive work on relatively less advanced strands of the client's major problems. Results point to the importance of the therapist attending to the limits of the client's therapeutic ZPD.
The logical operations involved in theory-building case studies include deduction (logical consistency and interconnection), induction (applying observations to theory), and abduction (creating, refining, and elaborating theory). The product of theory-building research is an account of a phenomenon in the form of words and other signs. Scientific quality control on theory is accomplished by comparing theoretical statements with observations. In case studies, detailed case observations are compared to detailed clinical theories. Stable meanings of terms and logical (deductive) interconnection allow empirical (inductive) observations on one tenet of a theory to affect confidence in other tenets. Researchers creatively modify their theories by (abductively) adding to them or altering them so that they correspond to accumulating observations. In this way, observations on cases permeate the theories, so that the words of the theory convey the accumulated experience of previous researchers.
Warded off traumatic experiences can have pathological effects by impinging on consciousness (e.g., recurrent nightmares), on behavior (e.g., avoidance of intimacy), or on the body (e.g., pains). Assimilation or integration of these problematic experiences is a common goal for different psychotherapies. In this article, we describe the psychoanalytic therapy of a political refugee who had suffered traumatic losses. Using assimilation analysis, we tracked the emergence of her warded off memories of loss. The interaction and alliance with the therapist seemed to promote a long and complicated process of mourning, in which she explored and assimilated (integrated) the loss. The analysis focuses on the early stages of assimilation, from warded off to problem formulation, stressing the complexity and pain of this process. It also illustrates a progression from somatic (symptomatic) expression to verbal symbolic expression of the problematic experience.
investigating disclosure in psychotherapy requires a measure of disclosure, and I will begin this chapter with some conceptual distinctions among measures, as a way of introducing the measure used / after reviewing some of my research on disclosure in psychotherapy, I will conclude with some theoretical speculations
[Verbal Response Model] disclosure in psychotherapy [clients disclose a lot, disclosure correlated with good process, disclosure uncorrelated with psychotherapy outcome, disclosure correlated with psychological distress, experimental link between anxiety and disclosure] / theoretical accounts: the fever model and beyond [responsiveness and the process–outcome correlation problem, the assimilation model and some final speculations] (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article reports the development of a marker-based method for rating assimilation in psychotherapy with a case study of a woman, Sarah, who was treated for depression with process-experiential psychotherapy. To increase the rigor of the qualitative case study methodology, independent judges rated passages--taken out of context and randomly ordered--from the qualitative analysis. The authors examined levels of training required to make quantitative judgments by comparing ratings from 4 graduate students and 4 undergraduate students. Pooled reliabilities of the 2 groups of caters were high (.90 and .84), and the estimated reliability of single graduate student raters was acceptable (.70). Consistent findings across a series of related case studies are reviewed to address the generalizability of the findings. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The paradox of distress expression is that expression of negative feelings is both a sign of distress and a possible means of coping with that distress. This article describes research illustrating the paradox of distress expression. It reviews evidence concerning 3 possible mechanisms by which expression might alleviate distress, focusing on the role of expression in (a) reducing distress about distress, (b) facilitating insight, and (c) affecting interpersonal relationships in a desired way. The authors conclude by highlighting the circumstances under which expression is most likely to be adaptive. Overall, the authors argue that expression of negative feelings is adaptive to the extent that it leads to some kind of resolution involving the source or significance of distress. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Changes in 4 clients' ideas across a series of exploratory psychotherapy sessions were traced to explore the theory (W. B. Stiles et al; see record
1991-10592-001) that the assimilation of problematic experiences follows a predictable path. Passages dealing with a common topic were extracted from recordings and examined for movement along the predicted path. The Assimilation of Problematic Experience Scale was developed to assess the degree of assimilation. Two case studies illustrate the themes of pain and anger in social relationships and of emptiness. By measuring change in specific ideas, this new approach circumvents many conceptual and methodological problems in relating psychotherapy process to outcome. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article examines concepts of the trustworthiness, or credibility, of qualitative research. Following a "researcher-as-instrument," or self-reflective, statement, the paradigmatic underpinnings of various criteria for judging the quality of qualitative research are explored, setting the stage for a discussion of more transcendent standards (those not associated with specific paradigms) for conducting quality research: social validity, subjectivity and reflexivity, adequacy of data, and adequacy of interpretation. Finally, current guidelines for writing and publishing qualitative research are reviewed, and strategies for conducting and writing qualitative research reports are suggested. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article explores the implications of a multivoiced construction of the self for the assimilation model (W. B. Stiles et al,
1991-10592-001). The result is a theoretical reformulation of the model in terms of voices. According to the reformulation, assimilation is conceived as a process of dialogue between a previously unwanted voice and a representative of the dominant community of voices. A successful dialogue reconciles the problematic voice with the community of voices that comprise the self. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Although use of psychotherapy transcripts is becoming increasingly important in psychotherapy research, large-scale collaborative work is hindered by lack of suitable transcription standards. Guidelines are presented for the transcription of discourse, such as psychotherapy sessions, for research and educational purposes. Transcripts generated by following these standards will be readable by human judges; they will also be easily submitted for computer-aided text analysis, such as formal concordance.
Although analyzing negative experiences leads to physical and mental health benefits among healthy populations, when people with depression engage in this process on their own they often ruminate and feel worse. Here we examine whether it is possible for adults with depression to analyze their feelings adaptively if they adopt a self-distanced perspective. We examined this issue by randomly assigning depressed and nondepressed adults to analyze their feelings surrounding a depressing life experience from either a self-distanced or a self-immersed perspective and then examined the implications of these manipulations for depressotypic thought accessibility, negative affect, implicit and explicit avoidance, and thought content. Four key results emerged. First, all participants were capable of self-distancing while analyzing their feelings. Second, participants who analyzed their feelings from a self-distanced perspective showed lower levels of depressotypic thought accessibility and negative affect compared to their self-immersed counterparts. Third, analyzing negative feelings from a self-distanced perspective led to an adaptive shift in the way people construed their experience--they recounted the emotionally arousing details of their experience less and reconstrued them in ways that promoted insight and closure. It did not promote avoidance. Finally, self-distancing did not influence negative affect or depressotypic thought accessibility among nondepressed participants. These findings suggest that whether depressed adults' attempts to analyze negative feelings lead to adaptive or maladaptive consequences may depend critically on whether they do so from a self-immersed or a self-distanced perspective.
Extant research suggests that self-distancing facilitates adaptive self-reflection of negative emotional experiences. However, this work operationalizes adaptive self-reflection in terms of a reduction in the intensity of negative emotion, ignoring other important aspects of emotional experience such as emotion duration. Moreover, prior research has predominantly focused on how self-distancing influences emotional reactivity in response to reflecting on negative experiences, leaving open questions concerning how this process operates in the context of positive experiences. We addressed these issues by examining the relationship between self-distancing and the duration of daily negative and positive emotions using a daily diary methodology. Discrete-time survival analyses revealed that reflecting on both daily negative (Studies 1 and 2) and positive events (Study 2) from a self-distanced perspective was associated with shorter emotions compared with reflecting on such events from a self-immersed perspective. The basic science and clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved).
O modelo de assimilação é um modelo integrativo que pode ser aplicado a qualquer tipo de setting terapêutico para a descrição do processo de mudança. A Escala de Assimilação de Experiências Problemáticas (EAEP) descreve o processo de assimilação de experiências problemáticas em terapia. Ainda que a EAEP apresente uma sequência ordenada, estudos demonstram que o processo de assimilação não é contínuo; contrariamente, o processo parece seguir um padrão de altos e baixos, com progressos seguidos de retrocessos, particularmente em psicoterapias cognitivas. Neste artigo, apresentamos uma análise dos retrocessos no processo de uma cliente com um bom prognóstico, Maria, em tratamento com terapia linguística de avaliação. A amostra é composta por 105 retrocessos retirados da análise da assimilação de Maria de três problemas principais. As razões para a maioria dos retrocessos podem ser classificadas numa de três categorias: a zona de desenvolvimento próximo, a metáfora de equilíbrio e as linhas múltiplas. Cada uma destas categorias pode ser compreendida como uma consequência da estratégia cognitiva e ainda como parte do processo da terapia cognitiva e não como um desvio ou insucesso. Neste sentido, os retrocessos, enquadrados no modelo de assimilação, reflectem algumas das principais características da terapia cognitiva. No entanto, não podemos excluir a possibilidade dos retrocessos no desenvolvimento poderem indicar uma perspectiva de insucesso e, como tal, os terapeutas devem estar atentos e procurar solucioná-los.
The assimilation model is a theory of psychological change that depicts the self as a community of internal voices, composed of traces of the person's experiences. The model suggests that disconnection of certain voices from the community underlies many forms of psychopathology and psychological distress. Such problematic voices may be assimilated through psychotherapeutic dialogue by building meaning bridges. Meaning bridges are signs (e.g., words, images, gestures, narratives) that have similar meaning to author and addressee, that is, to the signs' producer and recipient, which may be different people or interacting internal voices. Building meaning bridges is thus a process of coming to terms with problematic voices, which reduces distress and gives access to experiential resources within the self. This article describes and illustrates meaning bridges, voices, signs, and associated concepts as elaborated in a program of research on the assimilation model.
Although recent experimental work indicates that self-distancing facilitates adaptive self-reflection, it remains unclear (a) whether spontaneous self-distancing leads to similar adaptive outcomes, (b) how spontaneous self-distancing relates to avoidance, and (c) how this strategy impacts interpersonal behavior. Three studies examined these issues demonstrating that the more participants spontaneously self-distanced while reflecting on negative memories, the less emotional (Studies 1-3) and cardiovascular (Study 2) reactivity they displayed in the short term. Spontaneous self-distancing was also associated with lower emotional reactivity and intrusive ideation over time (Study 1). The negative association between spontaneous self-distancing and emotional reactivity was mediated by how participants construed their experience (i.e., less recounting relative to reconstruing) rather than avoidance (Studies 1-2). In addition, spontaneous self-distancing was associated with more problem-solving behavior and less reciprocation of negativity during conflicts among couples in ongoing relationships (Study 3). Although spontaneous self-distancing was empirically related to trait rumination, it explained unique variance in predicting key outcomes.
The authors reviewed the application of consensual qualitative research (CQR) in 27 studies published since the method's introduction to the field in 1997 by C. E. Hill, B. J. Thompson, and E. N. Williams (1997). After first describing the core components and the philosophical underpinnings of CQR, the authors examined how it has been applied in terms of the consensus process, biases, research teams, data collection, data analysis, and writing up the results and discussion sections of articles. On the basis of problems that have arisen in each of these areas, the authors made recommendations for modifications of the method. The authors concluded that CQR is a viable qualitative method and suggest several ideas for research on the method itself.
Reliability coefficients often take the form of intraclass correlation coefficients. In this article, guidelines are given for choosing among 6 different forms of the intraclass correlation for reliability studies in which n targets are rated by k judges. Relevant to the choice of the coefficient are the appropriate statistical model for the reliability study and the applications to be made of the reliability results. Confidence intervals for each of the forms are reviewed. (23 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
In 1984, Jacobson, Follette, and Revenstorf defined clinically significant change as the extent to which therapy moves someone outside the range of the dysfunctional population or within the range of the functional population. In the present article, ways of operationalizing this definition are described, and examples are used to show how clients can be categorized on the basis of this definition. A reliable change index (RC) is also proposed to determine whether the magnitude of change for a given client is statistically reliable. The inclusion of the RC leads to a twofold criterion for clinically significant change.
Response styles theory posits that rumination represents a trait vulnerability to depression. Recent evidence has suggested that rumination predicts changes in depression more strongly among individuals with high levels of negative cognition. Three studies evaluated this model of interactive vulnerabilities. Study 1 provided empirical support for the distinction between rumination and negative cognitive content. The next 2 studies investigated the interactive model in the laboratory. Study 2 randomly assigned participants to either ruminate or distract following a sad mood induction. This study found that rumination was more strongly associated with dysphoria among individuals who report high levels of negative cognition. Similarly, Study 3 found that rumination and negative cognition interact to predict changes in dysphoria across a no-task delay period following a sad mood induction. These studies provide support for an interactive model in which rumination amplifies the deleterious effects of negative cognition.
Both researchers and practitioners need to know more about how laboratory treatment protocols translate to real-world practice settings and how clinical innovations can be systematically tested and communicated to a skeptical scientific community. The single-case time-series study is well suited to opening a productive discourse between practice and laboratory. The appeal of case-based time-series studies, with multiple observations both before and after treatment, is that they enrich our design palette by providing the discipline another way to expand its empirical reach to practice settings and its subject matter to the contingencies of individual change. This article is a user's guide to conducting empirically respectable case-based time-series studies in a clinical practice or laboratory setting.
Two studies examined the psychological processes that facilitate adaptive emotional analysis. In Study 1, participants recalled a depression experience and then analyzed their feelings from either a self-immersed (immersed-analysis) or self-distanced (distanced-analysis) perspective. Participants in the distanced-analysis group focused less on recounting their experience and more on reconstruing it, which in turn led to lower levels of depressed affect. Furthermore, comparisons to a distraction group indicated that distanced-analysis was as effective as distraction in reducing depressed affect relative to the immersed-analysis group. Study 2 replicated these findings and showed that both 1 day and 7 days after the experimental manipulations, participants in the distanced-analysis group remained buffered against depressed affect and reported experiencing fewer recurring thoughts about their depression experience over time compared to both the immersed-analysis and distraction groups.
Researchers have suggested that self-efficacy can predict and prevent depression, while negative coping strategies, as typified by rumination, can lead to depression. The authors examined the relationship between self-efficacy, rumination, and depression in Japanese nursing students. The result of a structural equation model showed that rumination, but not self-efficacy, predicted depression. The result of simultaneous multiple group analysis indicated that there was homogeneity within the same path diagram between genders. The result implied that stress management should focus on controlling the degree of rumination rather than self-efficacy in order to efficiently maintain the mental health of Japanese nursing students.
Both common wisdom and findings from multiple areas of research suggest that it is helpful to understand and make meaning out of negative experiences. However, people’s attempts to do so often backfire, leading them to ruminate and feel worse. Here we attempt to shed light on these seemingly contradictory sets of findings by examining the role that self-distancing plays in facilitating adaptive self-reflection. We begin by briefly describing the “self-reflection paradox.” We then define self-distancing, present evidence from multiple levels of analysis that illustrate how this process facilitates adaptive self-reflection, and discuss the basic science and practical implications of this research.
The Structured Clinical Interview for DSM-III-R [Diagnostic and Statistical Manual, Revised] (SCID) is a semistructured interview for making the major Axis I and Axis II diagnoses. It is administered by a clinician or trained mental health professional who is familiar with the DSM-III-R classification and diagnostic criteria (1). The subjects may be either psychiatric or general medical patients or individuals who do not identify themselves as patients, such as subjects in a community survey of mental illness or family members of psychiatric patients. The language and diagnostic coverage make the SCID most appropriate for use with adults (age 18 or over), but with slight modification, it may be used with adolescents. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In
Emotion-Focused Therapy for Depression, Leslie S. Greenberg and Jeanne C. Watson provide a manual for the emotion-focused therapy (EFT) of depression. Their approach is supported by studies in which EFT for depression was compared with cognitive-behavioral therapy and client-centered therapy. The approach has been refined to apply specifically to the treatment of this pervasive and often intractable disorder. The authors discuss the nature of depression and its treatment, examine the role of emotion, present a schematic model of depression and an overview of the course of treatment, and suggest who might benefit. Written with a practical focus rather than the more academic theoretical style of previous books that established the theoretical grounds and scientific viability of working with emotion in psychotherapy, this book aims to introduce practitioners to the idea of using this approach to work with a depressed population. The book covers theory, case formulation, treatment, and research in a way that makes this complex form of therapy accessible to all readers. Particularly valuable are the case examples, which demonstrate the deliberate and skillful use of techniques to leverage emotional awareness and thus bring about change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Designed for undergraduate and first-year graduate students in counseling curricula, this textbook presents a 3-stage model of helping: exploration, insight, and action. Grounded in client-centered, psychoanalytic, and cognitive-behavioral theory, this approach recognizes the critical role of affect, cognition, and behavior in the process of change. Each skill is defined in separate chapters with a discussion of the rationale for each skill's use and the nuances of application in a helping session. Discussion questions and role playing exercises related to personal and professional growth are also included. The book is accompanied by a test booklet that covers all of the chapters in the textbook as well as some overall short answer and essay questions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The response styles theory (Nolen-Hoeksema, 1991) was proposed to explain the insidious relationship between rumination and depression. We review the aspects of the response styles theory that have been well-supported, including evidence that rumination exacerbates depression, enhances negative thinking, impairs problem solving, interferes with instrumental behavior, and erodes social support. Next, we address contradictory and new findings. Specifically, rumination appears to more consistently predict the onset of depression rather than the duration, but rumination interacts with negative cognitive styles to predict the duration of depressive symptoms. Contrary to original predictions, the use of positive distractions has not consistently been correlated with lower levels of depressive symptoms in correlational studies, although dozens of experimental studies show positive distractions relieve depressed mood. Further, evidence now suggests that rumination is associated with psychopathologies in addition to depression, including anxiety, binge eating, binge drinking, and self-harm. We discuss the relationships between rumination and worry and between rumination and other coping or emotion-regulation strategies. Finally, we highlight recent research on the distinction between rumination and more adaptive forms of self-reflection, on basic cognitive deficits or biases in rumination, on its neural and genetic correlates, and on possible interventions to combat rumination.
© 2008 Association for Psychological Science.
Both common intuition and findings from multiple areas of research suggest that when faced with distressing experiences, it is helpful to understand one’s feelings. However, a large body of research also indicates that people’s attempts to make sense of their feelings often backfire, leading them to ruminate and feel worse. In this article, we describe a program of research that focuses on disentangling these seemingly contradictory sets of findings. The research program we describe proposes that psychological distance from the self plays a key role in determining whether people’s attempts to understand their feelings lead to adaptive or maladaptive self-reflection. It suggests that people’s attempts to understand their feelings often fail because they analyze their feelings from a self-immersed perspective rather than a self-distanced perspective. Empirical evidence from multiple levels of analysis is presented to support this prediction. The basic science and clinical implications of these findings are discussed.
One hundred and eighty-one students answered a standardized questionnaire on Post-Traumatic Stress Disorder (PTSD): 25 reported trauma(s) and indicated a pattern of after-effects that matched a PTSD symptom profile, whereas 88 indicated trauma(s) but no PTSD symptom profile. Both groups answered a questionnaire addressing the recollective quality, integration and coherence of the traumatic memory that currently affected them most. Participants with a PTSD symptom profile reported more vivid recollection of emotion and sensory impressions. They reported more observer perspective in the memory (seeing themselves ‘from the outside’), but no more fragmentation. They also agreed more with the statement that the trauma had become part of their identity, and perceived more thematic connections between the trauma and current events in their lives. The two groups showed different patterns of correlations which indicated different coping styles. Overall, the findings suggest that traumas form dysfunctional reference points for the organization of other personal memories in people with PTSD symptoms, leading to fluctuations between vivid intrusions and avoidance. Copyright © 2003 John Wiley & Sons, Ltd.
A structural aspect of personal memories was examined in four studies. In some memories, one has the perspective of an observer, seeing oneself “from the outside.” In other memories, one sees the scene from one's own perspective; the field of view in such memories corresponds to that of the original situation. The existence of “observer” and “field” memories was confirmed in Study 1, using a recall questionnaire. In Study 2, the similarity structure of a specified set of eight to-be-recalled situations was established: the significant dimensions were “emotionality” and “self-awareness.” Study 3 related these dimensions to the observer-field distinction; situations involving a high degree of emotion and selfawareness were most likely to be recalled with an observer perspective. Recall set was varied in Study 4: a focus on feelings (as opposed to objective circumstances) produced relatively more field memories. Studies 3 and 4 also showed that events reported as more recent tend to be recalled in the field mode. Thus a qualitative characteristic of personal memories—the perspective from which they are experienced—is apparently related to characteristics of the original event, to the individual's purpose in recalling that event, and to the reported recall interval.
Recent findings indicate that a critical factor determining whether people's attempts to adaptively analyze negative experiences succeed or fail is the type of self-perspective (self-immersed vs. self-distanced) they adopt while analyzing negative feelings. The present research examined whether these findings generalize to individuals displaying high levels of depression symptoms who are particularly vulnerable to rumination. Findings revealed that the effectiveness of self-distancing for attenuating emotional reactivity increased linearly with depression symptoms. Moreover, mediation analyses revealed that participants tendency to recount vs reconstrue their experience accounted for the regulatory effects of self-distancing on emotional reactivity regardless of depression symptoms.
Recent evidence suggests that reflective (i.e., distanced-why), as compared to ruminative (i.e., immersed-why), processing of negative memories is associated with reductions in negative affect. The present study extended this line of work by examining the effect of these two processing conditions on positive memories among persons with bipolar disorder (BD; n = 27) and a healthy control group (CT; n = 27). After a resting baseline period, participants were instructed to recall a happy autobiographical memory. Using a within-subjects design, participants were asked to process the happy memory in two different experimental conditions (reflective, ruminative) while their experiential, behavioral, and autonomic responses were measured. Consistent with hypotheses, reflective processing was associated with lower self-reported positive affect, positive thoughts, and heart rate compared to ruminative processing for all participants. When current symptoms were controlled for, BD participants reported greater positive affect across both conditions relative to CT participants. Prospective studies are needed to test the extent to which processing of positive emotion contributes to the course of symptoms in bipolar disorder.
Nigro and Neisser (1983) contrasted two ways of remembering personal experiences: the rememberer may 'see' the event from his or her perspective as in normal perception, or 'see' the self engaged in the event as an observer would. Several factors contribute to the determination of perspective, but Nigro and Neisser also reported that many subjects claimed they could change to another perspective at will. We sampled personal memories from several life periods and assessed ability to change the initially reported perspective. Changing was easier for recent or vividly recalled events, harder for older and less vividly recalled events. Memory perspectives may differ in other aspects than their imagery. A second study was conducted to determine whether affective experience is altered when perspectives are changed. The affect experienced decreased when shifting from a field to an observer perspective, but did not change with the converse shift. These studies provide further evidence that remembering is more than retrieval. The information that enters awareness is determined by the information sources in memory and the organisational scheme adopted for recollection.
Cognitive-behavioral theorists (Clark & Wells, 1995: Clark, D. M. & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69-93). New York: Guilford Press; Rapee & Heimberg, 1997: Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741-756.) propose that individuals with social phobia form mental images of themselves as if from an external point of view. Research by Wells and colleagues has shown that, when recalling anxiety-provoking social situations, individuals with social phobia are more likely to take an observer perspective (seeing oneself as if from an external point of view) whereas control subjects are more likely to take a field perspective (as if looking out through one's own eyes). Furthermore, this pattern is specific to social events, as both groups recall non-social events from a field perspective (see Wells, Clark & Ahmad, 1998: Wells, A., Clark, D. M., & Ahmad, S. (1998). How do I look with my minds eye: perspective taking in social phobic imagery. Behaviour Research and Therapy, 36, 631-634; Wells & Papageorigou, 1999: Wells, A. & Papageorgiou, C. (1999). The observer perspective: Biased imagery in social phobia, agoraphobia, and blood/injury phobia. Behaviour Research and Therapy, 37, 653-658). In the current study, individuals with social phobia took more of an observer perspective than non-anxious controls when recalling high anxiety social situations. However, both groups took a predominantly field perspective for memories of medium or low anxiety social situations. As memory perspective has also been shown to be related to causal attributions, we examined this relationship in our sample. Memories of low, medium, and high anxiety social situations were differentially related to attributions for each group. Patients' attributions for their performance became more internal, stable, and global as the anxiety level of the situation increased, while the attributions of control subjects showed the opposite pattern.
Purpose: Depressive disorders (DD) in adolescence are often misdiagnosed and under-recognised. A major clinical problem regards the high rate of co-morbidity with other disorders, namely substance abuse. The aim of this study was to assess the discriminative power of the Beck Depression Inventory II (BDI-II) to characterise specific social-demographic variables related to DD in adolescence.
A Portuguese version of the BDI-II and a social-demographic questionnaire were administered to 775 Portuguese adolescents (312 males, 463 females; mean age: 16.9 years); 83 adolescents performed a clinical interview following DSM-IV criteria.
Mean BDI-II Portuguese version (BDI-II-P) total score was 10.31 (standard deviation: 8.4), with females reporting more depressive symptoms than males (P < 0.001). Low academic achievement, sleep disturbances, and alcohol consumption were consistently associated with depressive symptoms for both genders. Higher tobacco consumption was significantly associated with depressive symptoms in females. Familial factors did not appear to be associated with depressive symptoms in males. However, a higher frequency of siblings, having separated parents as well as a more extreme perception of the mother's educational style were consistently associated with depressive symptoms in females.
The BDI-II-P showed discriminative power to characterise social-demographic variables related to DD especially in adolescent females.
Two experiments examined the psychological operations that enable individuals to process negative emotions and experiences without increasing negative affect. In Study 1, type of self-perspective (self-immersed vs. self-distanced) and type of emotional focus (what vs. why) were experimentally manipulated following the recall of an anger-eliciting interpersonal experience. A why focus on emotions from a self-distanced perspective (distanced-why strategy) was expected to enable "cool," reflective processing of emotions, in which individuals can focus on their experience without reactivating excessive "hot" negative affect. Findings were consistent with this hypothesis. Study 2 replicated these findings and furthermore demonstrated that (a) the degree to which individuals construe their recalled experience in abstract versus concrete terms mediates the effect of the distanced-why strategy and (b) the status of the recalled experience (resolved vs. unresolved) does not moderate the effectiveness of the distanced-why strategy. These findings help disentangle the mechanisms that may allow adaptive working through from those that lead to rumination.
Extending previous work, we conducted two studies concerning the toxic influences of experiential avoidance (EA) as a core mechanism in the development and maintenance of psychological distress, and disruption of pleasant, engaging, and spontaneous activity. Of particular interest was whether EA accounted for relationships between coping and emotion regulation strategies on anxiety-related pathology (Study 1) and psychological distress and hedonic functioning over the course of a 21-day monitoring period (Study 2). In Study 1, EA mediated the effects of maladaptive coping, emotional responses styles, and uncontrollability on anxiety-related distress (e.g., anxiety sensitivity, trait anxiety, suffocation fears, and body sensation fears). In Study 2, EA completely mediated the effects of two emotion regulation strategies (i.e., suppression and reappraisal) on daily negative and positive experiences and was associated with diminished daily positive affective experiences and healthy life appraisals, diminished frequency of positive events and more frequent negative life events, and greater negative affective experiences. The present data show that cognitive reappraisal, a primary process of traditional cognitive-behavior therapy, was much less predictive of the quality of psychological experiences and events in everyday life compared with EA. Further consideration of experiential avoidance as a generalized diathesis and toxic process will be useful in improving our understanding of the etiology, phenomenology, and treatment of anxiety conditions, general human suffering, and disruptions in hedonic capacity.
From a distance: Implications of spontaneous self-distancing for adaptive self-reflection Immersion, distancing and emotional arousal: An intensive case study of a good outcome case of CBT
- Ö Ayduk
- E Kross
- E Barbosa
- M Amendoeira
- T Bento
- S Teixeira
- J Pinto-Gouveia
- J Salgado
Ayduk, Ö., & Kross, E. (2010b). From a distance: Implications of
spontaneous self-distancing for adaptive self-reflection. Journal
of Personality and Social Psychology, 98, 809–829. doi:10.1037/
a0019205
Barbosa, E., Amendoeira, M., Bento, T., Teixeira, S., Pinto-
Gouveia, J., & Salgado, J. (2016). Immersion, distancing and
emotional arousal: An intensive case study of a good outcome case
of CBT. Manuscript submitted for publication.
Methodological issues in studying psychotherapy processes and outcomes
- C E Hill
- M J Lambert
Hill, C. E., & Lambert, M. J. (2004). Methodological issues in
studying psychotherapy processes and outcomes. In M. J.
Lambert (Ed.), Bergin and Garfield's handbook of psychotherapy
and behavior change (5th ed., pp. 84-136). Hoboken, NJ: John
Wiley & Sons.