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Emotion‐focused therapy for symptoms of generalised anxiety in a student population: An exploratory study
Abstract
Anxiety issues continue to retain the highest prevalence rates within student counselling services (SCS) with generalised anxiety a prominent concern. These issues are associated with poor academic achievement, attrition and self‐injurious behaviours. Cognitive behavioural therapy (CBT) is moderately effective in treating generalised anxiety in students. Initial studies of emotion‐focused therapy (EFT) for GAD are indicating successful outcomes for clients though research investigating a brief format within SCS populations is needed.
Aim
The present exploratory study represents an early effort to examine the effectiveness of brief EFT for generalised anxiety symptoms within a university SCS and the clients’ experiences of this type of therapy.
Method
Participants (n = 15) presenting to a SCS with worry and generalised anxiety symptoms received an individual EFT for GAD intervention. Outcomes were assessed using two outcome measures pre‐ and post‐therapy and a semi‐structured post‐therapy interview examined the clients’ experiences of therapy and its outcomes.
Results
Quantitative pre–postdata indicated large effect sizes. Qualitative data described experiences of decreased anxiety, increased self‐understanding, resilience, self‐compassion and assertiveness. Experiential work and the therapeutic relationship were experienced as helpful aspects of therapy though experiential work was difficult. Personal difficulty engaging in therapy and some remaining symptoms were unhelpful aspects.
Conclusion
Findings suggest that brief EFT for generalised anxiety symptoms in students may be an effective SCS intervention and warrants further investigation.
... Broadening treatment choice is not only in line with the service-user-centered ethos embraced by public health service providers such as the service where the here presented study took place, but it also has the potential to positively influence outcomes (Swift et al., 2018). The present study, which builds on initial open trials (O'Connell Kent et al., 2021;Timulak et al., 2017), is a step in the development of an alternate psychological treatment for GAD, namely emotion-focused therapy (EFT) for GAD (Timulak & McElvaney, 2018). ...
... EFT (Greenberg, 2015;Greenberg et al., 1993) is a researchinformed therapy, which focuses on transforming maladaptive emotions through the generation of adaptive emotions. It has been empirically studied, particularly in the context of depression (Goldman et al., 2006;Watson et al., 2003) and complex trauma (Paivio & Nieuwenhuis, 2001), while recent adaptations have also been examined as to their efficacy for anxiety disorders (Shahar et al., 2017) including GAD (O'Connell Kent et al., 2021;Timulak et al., 2017). As GAD is characterized by sufferers' efforts to prepare (by worrying) for emotionally difficult situations and by the avoidance of potentially painful emotions (Behar et al., 2009;Newman & Llera, 2011). ...
... Initial studies conducted in primary care and student counseling settings examined the adaptation of EFT for GAD using an open trial format and showed promising results (O'Connell Kent et al., 2021;Timulak et al., 2017). The present study was intended to contribute to the further assessment of EFT as a viable alternative to an established treatment of GAD (CBT) as provided in a public primary care setting. ...
Generalized anxiety disorder (GAD) is a chronic mental health difficulty typically present in primary care settings. Cognitive-behavioral therapy (CBT) is the psychological intervention with the best evidence for its efficacy for GAD. The development of other psychological interventions can increase client choice. This feasibility trial examined an initial assessment of the efficacy of EFT in comparison to CBT in the treatment of GAD in the context of an Irish public health service. The trial provided information on recruitment, therapist training/adherence, and client retention relevant for a potential noninferiority trial. A randomized controlled trial compared the efficacy of EFT versus CBT for GAD. Both therapies were offered in a 16-20 sessions format. Therapists (n = 8) were trained in both conditions and offered both therapies. Clients were randomly assigned to the two therapies EFT (n = 29) and CBT (n = 29). Outcomes were assessed using several measures, with the Generalized Anxiety Disorder-7 (GAD-7) being the primary outcome. Clients were assessed at baseline, week 16, end of therapy, and at 6-month follow-up. Therapists were able to learn the two models after a short training and showed moderate levels of adherence. Although not statistically significant, the drop out from treatment was 10% for EFT and 27% for CBT. The two therapies showed large pre-post change and similar outcomes across all measures, with these benefits retained at 6-month follow-up. Results suggest that EFT is a potentially promising treatment for GAD. Further investigation is indicated to establish its potential to expand the available psychological therapies for GAD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Additionally, as emotions and narratives interact to form a sense of sense, Emotion Focused Therapy (EFT) was developed to help individuals to develop a more adaptative, empowering meanings and sense of self with clinician support and guidance (Angus & Greenberg, 2011). EFT has been effective for improving outcomes for those with trauma (Paivio & Pascual-Leone, 2010) and generalised anxiety disorder (O'Connell Kent et al., 2021). Studies reporting effects of NT or EFT highlight the potential benefits of exploring narratives, or SDMs which are part of the narrative, to further understand challenges in people's lives, reduce distress, increase the ability to cope with stressful events, and create new narratives to describe their experiences. ...
Background:
Self-defining memories (SDMs) are important for identifying one's purpose in life, achieving goals, and overcoming challenging situations. Individual studies have demonstrated differences in the characteristics of SDMs between clinical and non-clinical populations. This systematic literature review aimed to summarise and compare SDM characteristics among those with mental, substance use, cognitive, neurodevelopmental, and physical health challenges.
Methods:
Peer-reviewed English-language studies were included if they evaluated SDMs in these groups.
Results:
Thirty-five studies (N = 3123) were included. SDM content across all clinical populations tended to focus on illness themes. SDMs were generally less specific and integrated in those with mental health or substance use disorders as compared to non-clinical populations. SDM specificity and integration findings were more mixed in those with cognitive, neurodevelopmental, and physical health challenges.
Conclusions:
Specific differences emerged between groups of individuals which may be related to illness characteristics, recovery trajectory, and individual differences in the ability to understand and process difficult life events.
Research on the positive events in the therapeutic counseling process is usually undertaken from the client’s perspective. However, few studies have investigated the beneficial aspects of the therapeutic counselling process, particularly in creative expressive fields. This preliminary qualitative study aims to evaluate the therapeutic experience of utilizing Creative expressive – Bodily maps of emotions (CE-BME) with young clients in the helpful process. The CE-BME is an art therapy tool that counselling practitioners or therapists have extensively used in Malaysian mental health settings. A qualitative approach known as the grounded theory method was employed in this study through face-to-face and video call interviews with four therapists from the health setting who conducted sessions for children and adolescents using the CE-BME. As a result, six themes of the helpful process were identified: (1) facilitating emotional exploration and processing, (2) engaging relationships with young clients, (3) expanding the client’s self-awareness, (4) helping the direction of intervention, (5) release for clients, and (6) relief for therapists. Furthermore, these findings established the following outcomes regarding the CE-BME tool as a helpful process, thereby boosting researchers’ confidence in applying the main study to more therapists engaged in children’s mental health intervention.
Objective:
Client experience of psychotherapy is an important resource for our understanding of psychotherapy and deserves relevant attention in psychotherapy research. Emotion-focused therapy (EFT) is a relatively new adaptation of a humanistic therapy that has a tradition of giving a voice to the clients in therapy. Despite the number of qualitative studies looking at the experience of clients in EFT, there was no formal qualitative meta-analysis conducted synthesising the existing qualitative research on the clients' experience of EFT METHOD: A sample of 11 primary qualitative studies was selected through a systematic search of the literature. Primary studies were critically appraised, and data (findings) from them extracted and meta-analysed RESULTS: All eleven studies featured experiences of helpful aspects of therapy, with difficult but helpful aspects reported in seven studies and unhelpful aspects reported in six studies. Most studies reported chair and experiential work and intense emotional work in EFT as helpful, with fewer reports and fewer clients finding them difficult but helpful, or unhelpful. The multidimensional nature of the therapist and therapeutic relationship in EFT included emotional connection and support, validation, and understanding, and was commonly experienced as helpful to clients. Other client experiences reported included practical aspects of EFT such as session length, in-session outcomes such as clients' transformative experiences, and internal and external factors which were experienced by clients such as determination or reluctance to commit to therapy CONCLUSIONS: Most clients experience EFT as an intense, challenging, but productive psychotherapy, but it appears a minority of clients experience aspects of EFT as challenging.
Among the variations of anxiety disorders, generalized anxiety disorder is considered to be one of the most problematic. In times of intense social transformation, the issue of mental health of the youth, in particular the prevalence of tendencies to generalized anxiety disorder among young people arises. For this reason, the purpose of the article is to investigate the propensity of young students to excessive experiences and propose a model of understanding and treatment of generalized anxiety disorder. Cognitive-behavioral methodology is used while the study for understanding generalized anxiety disorder, PSWQ experience questionnaire, WWS-II experience value scale, and two survey items. The results of the study show that 18% of the youth surveyed have a high level of anxiety. Such young people can be considered a risk group for generalized anxiety disorder. The results of the study indicate that respondents with a high level of worry are statistically more likely to perceive worries as those helping them to solve problems, motivate them to act and are able to prevent negative results. Such positive beliefs about the experience may reduce the perceived need to seek help from psychologists and psychotherapists. A description of the clinical case is given and the effectiveness of psychotherapeutic interventions is demonstrated. An algorithm for working with clients is proposed, which is based on a modern protocol for the treatment of generalized anxiety disorder. It includes: qualified examination; reassessment of the usefulness of the worry; assistance in a realistic understanding of ambiguous situations as such that are not clearly threatening; rethinking attitudes to situations of uncertainty; use of exposures for the purpose of deeper processing of the stimulus in a nonverbal way; skills of overcoming negative emotions without avoiding them. An attempt to combine the clinical paradigm and the scientific position is made in the article. Nowadays there are very few studies based on cognitive-behavioral methodology in Ukraine.
Objective: Recent years have seen a significant and rapid increase in the provision of tele-therapies. Chairwork methods such as empty-chair dialogues and role-play represent a “common” category of therapeutic interventions which are utilized in many psychotherapeutic approaches. However, guidelines for facilitating chairwork in tele-therapy are currently lacking. The aim of this study was to survey expert providers regarding how chairwork is best provided in internet-delivered psychotherapy.
Method: Forty one experts were recruited from a range of therapeutic backgrounds including cognitive behaviour therapy, compassion focused therapy, emotion focused therapy, psychodrama, schema therapy, and voice dialogue. Participants completed a brief questionnaire survey exploring the delivery of tele-chairwork. Responses were analysed using thematic analysis.
Results: Five themes were identified: (i) divided opinion; (ii) convergence between therapy and home; (iii) disconnection and depth; (iv) practical impediments and benefits; and (v) revising and re-visioning chairwork. Overall, results indicate that chairwork can be successfully incorporated into tele-therapy, but requires adaption and special considerations.
Discussion: Despite challenges, tele-chairwork appears to be a feasible method of psychotherapeutic intervention. Preliminary guidelines for initiating, facilitating, and concluding tele-chairwork are presented, alongside future directions for research.
Increasingly, colleges across the world are contending with rising rates of mental disorders, and in many cases, the demand for services on campus far exceeds the available resources. The present study reports initial results from the first stage of the WHO World Mental Health International College Student project, in which a series of surveys in 19 colleges across eight countries (Australia, Belgium, Germany, Mexico, Northern-Ireland, South-Africa, Spain, United States) were carried out with the aim of estimating prevalence and basic socio-demographic correlates of common mental disorders among first-year college students. Web-based self-report questionnaires administered to incoming first-year students (45.5% pooled response rate) screened for six common lifetime and 12-month DSM-IV mental disorders: major depression, mania/hypomania, generalized anxiety disorder, panic disorder, alcohol use disorder, and substance use disorder. We focus on the 13,984 respondents who were full-time students: 35% of whom screened positive for at least one of the common lifetime disorders assessed and 31% screened positive for at least one 12-month disorder. Syndromes typically had onsets in early-middle adolescence and persisted into the year of the survey. Although relatively modest, the strongest correlates of screening positive were older age, female sex, unmarried-deceased parents, no religious affiliation, non-heterosexual identification and behavior, low secondary school ranking, and extrinsic motivation for college enrollment. The weakness of these associations means that the syndromes considered are widely distributed with respect to these variables in the student population. Although the extent to which cost-effective treatment would reduce these risks is unclear, the high level of need for mental health services implied by these results represents a major challenge to institutions of higher education and governments.
Background: with reports continually demonstrating increased demand and severity of student mental health needs, it is important to gain a fuller understanding of the impact on embedded student counselling services. Aims: to identify (1) service similarities; (2) factors which impact on services; (3) characteristics of service users; and (4) identify the use of therapeutic technology (e.g. online self-help). Methods: an online survey was completed by 113 heads of UK student counselling services across Higher Education (HE), Further Education (FE), and Sixth Form Colleges (SFCs), to capture service data from the academic year 2013/14. Results: students predominantly received high-intensity support (e.g. Counselling) and referrals increased over 3-years. Conclusion: challenges to embedded counselling services and their implications for development are discussed.
This is the first introductory statistics text to use an estimation approach from the start to help readers understand effect sizes, confidence intervals (CIs), and meta-analysis (‘the new statistics’). It is also the first text to explain the new and exciting Open Science practices, which encourage replication and enhance the trustworthiness of research. In addition, the book explains NHST fully so students can understand published research. Numerous real research examples are used throughout. The book uses today’s most effective learning strategies and promotes critical thinking, comprehension, and retention, to deepen users’ understanding of statistics and modern research methods. The free ESCI (Exploratory Software for Confidence Intervals) software makes concepts visually vivid, and provides calculation and graphing facilities. The book can be used with or without ESCI.
A short version of the Counseling Center Assessment of Psychological Symptoms–62 (CCAPS-62) was created via three studies. The final short version (CCAPS-34), which contains 34 items and 7 subscales, demonstrated good discrimination power, support for the proposed factor structure, strong initial convergent validity, and adequate test–retest stability over 1-week and 2-week intervals.
Mental health problems represent a potentially important but relatively unexplored factor in explaining human capital accumulation during college. We conduct the first study, to our knowledge, of how mental health predicts academic success during college in a random longitudinal sample of students. We find that depression is a significant predictor of lower GPA and higher probability of dropping out, particularly among students who also have a positive screen for an anxiety disorder. In within-person estimates using our longitudinal sample, we find again that co-occurring depression and anxiety are associated with lower GPA, and we find that symptoms of eating disorders are also associated with lower GPA. This descriptive study suggests potentially large economic returns from programs to prevent and treat mental health problems among college students, and highlights the policy relevance of evaluating the impact of such programs on academic outcomes using randomized trials.
The study of dynamic and nonlinear change has been a valuable development in psychotherapy process research. However, little advancement has been made in describing how moment-by-moment affective processes contribute to larger units of change. The purpose of this study was to examine observable moment-by-moment sequences in emotional processing as they occurred within productive sessions of experiential therapy. This article further tested A. Pascual-Leone and L. S. Greenberg's (2007) model of emotional processing through a reanalysis of their data sample of 34 sessions in which clients presented with global distress: 17 that ended in poor in-session events and 17 that ended in good in-session events. Current analyses used univariate and bootstrapping statistical methods to examine how dynamic temporal patterns in clients' emotion accumulated moment-by-moment to produce in-session gains in emotional processing. Results show that effective emotional processing was simultaneously associated with steady improvement according to the model as well as increased emotional range. Consequentially, good events were shown to occur in a 2-steps-forward, 1-step-back fashion. Finally, good events were also shown to have progressively shortened emotional collapses, whereas the opposite was true for poor in-session events.
Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28, 487-495.] for weekly assessment of worry was evaluated in a brief treatment study. Cognitive restructuring techniques were taught to 28 nonclinical high-worriers, 14 of whom served as a control group in a lagged waiting-list design. Results showed that the Penn State Worry Questionnaire-Past Week (PSWQ-PW) was highly reliable and substantially valid in the assessment of both (a) weekly status of worry and (b) treatment-related changes in worry: average Cronbach's alpha was 0.91; average convergent correlation with a past-week adaptation of the Worry Domains Questionnaire [Tallis, F., Eysenck, M. W. and Mathews, A. (1992). A questionnaire for the measurement of nonpathological worry. Personality and Individual Differences, 13, 161-168.] was 0.63 and pre-post improvement on PSWQ-PW showed a 0.71 correlation with the Questionnaire of Changes in Experiencing and Behavior [Zielke, M. and Kopf-Mehnert, C. (1978). Veränderungsfragebogen des Erlebens und Verhaltens. Weinheim, Germany: Beltz Test Gesellschaft.]. It is concluded that the PSWQ-PW is a useful instrument for monitoring pathological worry in experimental and applied settings.
Generalized anxiety disorder (GAD) is one of the most common mental disorders; however, there is no brief clinical measure for assessing GAD. The objective of this study was to develop a brief self-report scale to identify probable cases of GAD and evaluate its reliability and validity.
A criterion-standard study was performed in 15 primary care clinics in the United States from November 2004 through June 2005. Of a total of 2740 adult patients completing a study questionnaire, 965 patients had a telephone interview with a mental health professional within 1 week. For criterion and construct validity, GAD self-report scale diagnoses were compared with independent diagnoses made by mental health professionals; functional status measures; disability days; and health care use.
A 7-item anxiety scale (GAD-7) had good reliability, as well as criterion, construct, factorial, and procedural validity. A cut point was identified that optimized sensitivity (89%) and specificity (82%). Increasing scores on the scale were strongly associated with multiple domains of functional impairment (all 6 Medical Outcomes Study Short-Form General Health Survey scales and disability days). Although GAD and depression symptoms frequently co-occurred, factor analysis confirmed them as distinct dimensions. Moreover, GAD and depression symptoms had differing but independent effects on functional impairment and disability. There was good agreement between self-report and interviewer-administered versions of the scale.
The GAD-7 is a valid and efficient tool for screening for GAD and assessing its severity in clinical practice and research.
The aim of this study was to estimate the extent to which anxiety disorders contribute to an increase in suicidal behaviour after controlling for both observed and non-observed sources of confounding.
Data were collected from the Christchurch Health and Development Study (CHDS), a 25-year longitudinal study of over 1000 participants. Measures of anxiety disorders [phobia, generalized anxiety disorder (GAD), panic disorder], major depression (MD), substance use disorders, conduct/antisocial personality disorder, stressful life events, unemployment, and suicidal ideation/attempts for subjects aged 16-18, 18-21 and 21-25 years were used to fit random and fixed effects regression models of the associations between anxiety disorders and suicidal behaviours.
Anxiety disorders were strongly associated with suicidal ideation/attempts. Any single anxiety disorder increased the odds of suicidal ideation by 7.96 times [95% confidence interval (CI) 5.69-11.13] and increased the rate of suicide attempts by 5.85 times (95% CI 3.66-9.32). Control for co-occurring mental disorders, non-observed fixed confounding factors and life stress reduced these associations [suicidal ideation odds ratio (OR) 2.80, 95% CI 1.71-4.58; suicide attempts incidence rate ratio (IRR) 1.90, 95% CI 1.07-3.39]. Rates of suicidal behaviour also increased with the number of anxiety disorders. Estimates of the population attributable risk suggested that anxiety disorders accounted for 7-10% of the suicidality in the cohort.
Anxiety disorders may be a risk factor for suicidality, even after controlling for confounding, with risks increasing with multiple anxiety disorders. Management of anxiety disorders may be an important component in strategies to reduce population rates of suicide.
The authors' purpose in this research was to establish estimates of the prevalence and correlates of nonsuicidal self-injury among university students.
The authors recruited participants (N = 2,843) from a random sample of 5,021 undergraduate and graduate students attending a large midwestern public university.
Using an Internet-based survey, the authors measured the prevalence of self-injury and potential risk factors, including depression, anxiety, eating disorders, suicidal thoughts, and negative health behaviors.
Seven percent of students reported any self-injury over the previous 4 weeks. Factors associated with a significantly higher likelihood (p <.05) of self-injury included cigarette smoking, concurrent depressive and anxiety disorders, and for men, growing up in a family of low socioeconomic status and having symptoms of eating disorders. Only 26% of those who reported self-injury received mental health therapy or medication in the previous year.
Students who harm themselves experience high anxiety and distress, yet are unlikely to seek help.
The paper offers a perspective on some of the methodological issues present in current qualitative psychotherapy research (QPR). The authors are involved in this type of research (for 20 and 40 years, respectively) as researchers, as reviewers of papers submitted to journals publishing QPR, as well as past editors of such journals. The authors reflect at how the overall field of psychotherapy research has had an influence on how QPR is conducted. The authors further discuss a wide range of issues pertaining to QPR that often bring confusion in the community of psychotherapy researchers. These include: brand naming largely overlapping qualitative methods; epistemological confusion arising from the context and application of these methods; issues of data collection and the range of types of qualitative data; the confounding of investigative questions or aims with findings; the issue of interpretative frameworks in data analysis; strategies by which findings are generated; difficulties in assessing the representativeness of findings to the target sample; issues of generalisability of findings; and possibilities for developing cumulative knowledge across studies. The paper specifically focuses on those genres of qualitative research that have a descriptive–interpretative character, typically represented by brand‐name approaches such as empirical phenomenology, hermeneutics, interpretative phenomenological analysis, consensual qualitative research, grounded theory and thematic analysis, etc.
Among psychological therapies for generalized anxiety disorder (GAD), cognitive–behavioral therapy has a dominant position as the most studied therapy. However, some researchers have recommended that to increase treatment options and broaden choice for clients, non-cognitive–behavioral therapy models for GAD should be examined. The present study was an exploratory study, assessing pre–post outcomes and 6-month follow-up of emotion-focused therapy for GAD, supplemented by qualitative posttherapy client accounts of helpful and unhelpful aspects of therapy and changes reported since therapy started. Fourteen clients were assessed on several measures focusing on GAD symptoms, depressive symptoms, and general psychological functioning. Quantitative pre–post and 6-month follow-up data indicated large effect sizes. Qualitative data captured changes in emotional functioning, anxiety, self-acceptance, self-confidence, and self-understanding. Clients reported as helpful both relational aspects of the work and in-depth experiential tasks, although some found the experiential aspect of the work difficult. The findings suggest that there may be value in assessing emotion-focused therapy as a treatment for GAD in a randomized controlled trial.
Recent decades have seen a significant increase in the number of studies exploring client perspectives on, and experiences of, psychotherapy. The present article provides a practice friendly overview of this research, identifying common domains of inquiry, and providing examples of findings relevant to practitioners. Research in this area can be categorized in terms of the client's perspective pertaining to theoretical constructs, studies of client satisfaction, and qualitative studies that are either open-ended or explore specific aspects of client experiences. Examples of this latter category include studies looking at distinct processes (e.g., self-disclosure), particular theoretical constructs (e.g., therapeutic alliance), helpful versus unhelpful aspects of therapy, and significant events. Research suggests that therapist willingness to seek client perspectives, openness to hear what clients have to say, nondefensiveness in the face of negative feedback, and ability to modulate actions accordingly are all likely to contribute to stronger relationships with clients and stronger collaboration, correspondingly contributing to stronger therapeutic outcomes.
Background
Generalised anxiety disorder ( GAD ) is an anxiety disorder characterised by excessive anxiety and worry. Worry is seen as a key‐defining feature of GAD . Several cognitive‐behavioural models of working with worry in GAD exist. More recently, there have been efforts to adapt emotion‐focused therapy ( EFT ) for GAD . This study focused on task analysis, observing therapist and client processes (using qualitative observations as well as observer‐used measures) in the clinically developed, two‐chair dialogue for worry (an intervention inspired by a similar EFT task of working with self‐criticism in depression).
Method
A task analysis methodological approach was applied to 34 worry dialogues from eight clients. The worry dialogues were qualitatively analysed, focusing on therapist and client processes in the task and also using observer‐based measures such as Classification of Affective‐Meaning States, Client Emotion Arousal Scale and Client Emotion Productivity Scale.
Results
A tentative model of worry transformation using the two‐chair dialogue for worry is presented. The model consists of marker identification, enactment of the worry, deepening the toll of the worry, articulation of the need towards the worry and the worry softening or the client's standing up to the worry. The results also focus on the progression in the dialogues across the series of dialogues.
Implications
The model has an immediate practical application as it can inform therapists' actions when working with worry processes in GAD clients. Implications for future research are also discussed.
Background. Although mental disorders are significant predictors of educational attainment throughout the entire educational career, most research on mental disorders among students has focused on the primary and secondary school years.
Methods. The World Health Organization World Mental Health Surveys were used to examine the associations of mental disorders with college entry and attrition by comparing college students (n = 1,572) and nonstudents in the same age range (18-22; n = 4,178), including nonstudents who recently left college without graduating (n = 702) based on surveys in 21 countries (4 low/lower-middle income, 5 upper middle-income, 1 lower-middle or upper-middle at the times of two different surveys, and 11 high income). Lifetime and 12-month prevalence and age-of-onset of DSM-IV anxiety, mood, behavioural and substance disorders were assessed with the Composite International Diagnostic Interview.
Results. One-fifth (20.3%) of college students had 12-month DSM-IV/CIDI disorders. 83.1% of these cases had pre-matriculation onsets. Disorders with pre-matriculation onsets were more important than those with post-matriculation onsets in predicting subsequent college attrition, with substance disorders and, among women, major depression the most important such disorders. Only 16.4% of students with 12-month disorders received any 12-month healthcare treatment for their mental disorders.
Conclusions. Mental disorders are common among college students, have onsets that mostly occur prior to college entry, in the case of pre-matriculation disorders are associated with college attrition, and are typically untreated. Detection and effective treatment of these disorders early in the college career might reduce attrition and improve educational and psychosocial functioning.
Emotion-focused therapy is a research-informed psychological therapy that to date has mainly been studied in the context of depression, trauma and couple distress. The evidence suggests that this therapy has a lasting and transformative effect. Ladislav Timulak presents EFT as a particular therapeutic approach that addresses psychological human suffering, offering a view that puts more emphasis on attending to the distress, rather than avoiding or suppressing it. Focusing on the latest developments in EFT, Transforming Emotional Pain in Psychotherapy presents a theory of human suffering and a model of therapy that addresses that suffering. The model of suffering assumes that the experienced emotional pain is a response to an injury that prevents or violates the fulfilment of the basic human needs of being loved, safe, and acknowledged. This book focuses on a particular way of transforming emotional pain in psychotherapy through: helping the client to tolerate the pain; assisting the client to identify the core of the difficult emotional experiences; identifying the needs connected to the core pain which are unmet or being violated, and responding (with compassion and protective anger) to the underlying needs of the client that transforms the original pain. Transforming Emotional Pain in Psychotherapy provides an account of how emotional pain can be conceptualised and how it can be addressed in therapy. It provides practical tips for therapists working with emotional pain and shows how it can then be made more bearable and transformed allowing the client to be more sensitive to the pain of others, and to seek support when needed. This book will be essential reading for clinical and counselling psychologists, psychotherapists and counsellors in practice and training, as well as for fully qualified professionals undergoing further training in EFT.
Generalized anxiety disorder (GAD) is a severely debilitating disorder characterized by high comorbidity and a negative impact on overall well-being. Cognitive-behavioral therapy (CBT) is the most recognized psychological treatment of GAD. Although CBT is well-established, it is also shown that not all clients benefit from it. The goal of this paper is to highlight an emerging model of working with GAD patients from the perspective of emotion-focused therapy. It is comparable to mainstream CBT theories in so far as it proposes that the client is not avoidant of emotional experience or of its processing in general, but rather, that it is specific triggers that the client is afraid of. Contrary to mainstream CBT theories, change is not facilitated through emotional habituation to difficult triggers (or emotions), but rather through the restructuring and transformation of problematic emotion schemes through a sequence of emotional processing steps. These steps include overcoming emotional avoidance, differentiation of, and staying with, core painful feelings (such as loneliness/sadness, shame, and terror/fear), articulation of the unmet needs contained in those feelings and the expression of an emotional response to those feelings/needs, typically compassion and healthy, boundary setting, protective anger. A case illustration is provided.
Recent years have seen a near-doubling of the number of studies examining the effects
of psychotherapies for Generalized Anxiety Disorders (GAD) in adults. The present
article integrates this new evidence with the older literature through a quantitative metaanalysis.
A total of 41 studies (with 2,132 patients meeting diagnostic criteria for GAD)
were identified through systematic searches in bibliographical databases, and were
included in the meta-analysis. Most studies examined the effects of cognitive behavior
therapy (CBT). The majority of studies used waiting lists as control condition. The
pooled effect of the 38 comparisons (from 28 studies) of psychotherapy versus a control
group was large (g = 0.84; 95% CI: 0.71~0.97) with low to moderate heterogeneity. The
effects based on self-report measures were somewhat lower than those based on
clinician-rated instruments. The effects on depression were also large (g = 0.71; 95%
CI: 0.59~0.82). There were some indications for publication bias. The number of
studies comparing CBT with other psychotherapies (e.g., applied relaxation) or
pharmacotherapy, was too small to draw conclusions about comparative effectiveness or
the long-term effects. There were some indications that CBT was also effective at
follow-up and that CBT was more effective than applied relaxation in the longer term.
Background: The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available.
Objectives: To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data.
Research Design: Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006.
Subjects: Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years.
Measures: The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics.
Results: Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (α = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = -0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater.
Conclusions: Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subject's GAD-7 score with those determined from a general population reference group.
Theoretical conceptualizations of generalized anxiety disorder (GAD) continue to undergo scrutiny and refinement. The current paper critiques five contemporary models of GAD: the Avoidance Model of Worry and GAD [Borkovec, T. D. (1994). The nature, functions, and origins of worry. In: G. Davey & F. Tallis (Eds.), Worrying: perspectives on theory assessment and treatment (pp. 5–33). Sussex, England: Wiley & Sons; Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In: R. Heimberg, C. Turk, & D. Mennin (Eds.), Generalized anxiety disorder: advances in research and practice (pp. 77–108). New York, NY, US: Guilford Press]; the Intolerance of Uncertainty Model [Dugas, M. J., Letarte, H., Rheaume, J., Freeston, M. H., & Ladouceur, R. (1995). Worry and problem solving: evidence of a specific relationship. Cognitive Therapy and Research, 19, 109–120; Freeston, M. H., Rheaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791–802]; the Metacognitive Model [Wells, A. (1995). Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301–320]; the Emotion Dysregulation Model [Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85–90]; and the Acceptance-based Model of GAD [Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive behavioral models. Clinical Psychology: Science and Practice, 9, 54–68]. Evidence in support of each model is critically reviewed, and each model's corresponding evidence-based therapeutic interventions are discussed. Generally speaking, the models share an emphasis on avoidance of internal affective experiences (i.e., thoughts, beliefs, and emotions). The models cluster into three types: cognitive models (i.e., IUM, MCM), emotional/experiential (i.e., EDM, ABM), and an integrated model (AMW). This clustering offers directions for future research and new treatment strategies.
Psychiatric disorders are common during young adulthood and comorbidity is frequent. Individual psychiatric disorders have been shown to be associated with negative economic and educational outcomes, but few studies have addressed the relationship between the total extent of psychiatric disorder and life outcomes.
To examine whether the extent of common psychiatric disorder between ages 18 and 25 is associated with negative economic and educational outcomes at age 30, before and after controlling for confounding factors.
Participants were 987 individuals from the Christchurch Health and Development Study, a longitudinal study of a birth cohort of individuals born in Christchurch, New Zealand, in 1977 and followed to age 30. Linear and logistic regression models were used to examine the associations between psychiatric disorder from age 18 to 25 and workforce participation, income and living standards, and educational achievement at age 30, before and after adjustment for confounding factors.
There were significant associations between the extent of psychiatric disorder reported between ages 18 and 25 and all of the outcome measures (all P<0.05). After adjustment for confounding factors, the associations between psychiatric disorder and workforce participation, income and living standards remained significant (all P<0.05), but the associations between psychiatric disorder and educational achievement were not significant (all P>0.10).
After due allowance had been made for a range of confounding factors, psychiatric disorder between ages 18 and 25 was associated with reduced workforce participation, lower income and lower economic living standards at age 30.
The number of university students with a serious mental illness has risen significantly over the past few years. A systematic review was conducted that addressed emotional and or mental health problems of university students worldwide. In total, 572 articles were identified, of which 11 met inclusion criteria. Issues identified included types of problems experienced by students, how staff dealt with these students, barriers to seeking help, tools that facilitated help-seeking and epidemiological trends in the university student population. Recommendations include (i) providing better links between the university and external mental health providers, and (ii) increasing students’ awareness of existing support services within and external to the university. As it is unrealistic to expect all academic staff to have the expertise required to deal with students with emotional problems, it is also recommended that (iii) policies and personnel with expertise in mental health are available to provide guidance for staff.
This research examined 1) the prevalence of substance use behaviors in college students, 2) gender and academic level as moderators of the associations between mental health problems and substance use, and 3) mental health service use among those with co-occurring frequent binge drinking and mental health problems. As part of the Healthy Minds Study, a probability sample of 2843 college students completed an Internet survey on mental health problems, substance use behaviors, and utilization of mental health care. Response propensity weights were used to adjust for differences between respondents and non-respondents. Major depression, panic disorder, and generalized anxiety disorder were positively associated with cigarette smoking. Frequent binge drinking was negatively associated with major depression and positively associated with generalized anxiety disorder, and these associations were significantly stronger for males than females. Among students with co-occurring frequent binge drinking and mental health problems, 67% perceived a need for mental health services but only 38% received services in the previous year. There may be substantial unmet needs for treatment of mental health problems and substance use among college students.
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.
A handbook of research methods for clinical and health psychology
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to qualitative research. In J. Miles & P. Gilbert (Eds.). A handbook of
research methods for clinical and health psychology (pp. 147-159). New
York, NY: Oxford University Press.
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Timulak, L., Iwakabe, S., & Elliott, R. (2019). Clinical implications of research on emotion-focused therapy. In L. S. Greenberg & R. N.
Goldman (Eds.), Clinical handbook of emotion-focused therapy (pp. 93-109). Washington, DC: American Psychological Association. https://
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The client change interview schedule: Version 5
- R Elliott
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Trinity College Dublin), currently working in HSE Adult Mental Health Services. She also operates a private practice. She has a strong interest in the theory and application of emotion-focused therapy in clinical practice
- O Auth O R B I O G R A Ph I E S Julie
AUTH O R B I O G R A PH I E S
Julie O'Connell Kent is a counselling psychologist (D.Couns.
Psych., Trinity College Dublin), currently working in HSE Adult
Mental Health Services. She also operates a private practice. She
has a strong interest in the theory and application of emotion-focused therapy in clinical practice.
His main research interest is psychotherapy research, particularly the development of emotion-focused therapy. He has written seven books, over 80 peer reviewed papers and various chapters in both his native language, Slovak, and in English
- O'connell Kent
- Jackson A Robinson
- M Rashleigh
- C Timulak
Ladislav Timulak is Associate Professor at Trinity College Dublin,
Ireland. He is Course Director of the Doctorate in Counselling
Psychology. His main research interest is psychotherapy research, particularly the development of emotion-focused therapy. He has written seven books, over 80 peer reviewed papers
and various chapters in both his native language, Slovak, and in
English. His most recent books include Transforming Emotional
Pain in Psychotherapy: An Emotion-Focused Approach
(Routledge, 2015) and Transforming Generalized Anxiety: An
Emotion-Focused Approach (Routledge, 2017). He previously
co-edited Counselling Psychology Quarterly. He maintains a
part-time private practice.
How to cite this article: O'Connell Kent JA, Jackson A,
Robinson M, Rashleigh C, Timulak L. Emotion-focused
therapy for symptoms of generalised anxiety in a student
population: An exploratory study. Couns Psychother Res.
2020;00:1-9. https://doi.org/10.1002/capr.12346