CLIENT EMOTION IN COGNITIVE-BEHAVIORAL AND INTERPERSONAL/EMOTIONAL PROCESSING THERAPY FOR GENERALIZED ANXIETY DISORDER

Open Access
Author:
Boswell, James Franklin
Graduate Program:
Psychology
Degree:
Doctor of Philosophy
Document Type:
Dissertation
Date of Defense:
May 12, 2010
Committee Members:
  • Louis Georges Castonguay, Dissertation Advisor
  • Louis Georges Castonguay, Committee Chair
  • Michelle Gayle Newman, Committee Member
  • Kenneth Levy, Committee Member
  • Jeffrey Hayes, Committee Member
Keywords:
  • Psychotherapy research
  • generalized anxiety disorder
  • emotion
  • psychotherapy integration
Abstract:
Contemporary models of generalized anxiety disorder (GAD) posit that worry serves a cognitive avoidance function, and that emotional avoidance may serve as a maintaining factor for worry and related anxiety symptoms. The goals of this study were to (a) investigate emotional experiencing in GAD clients who were treated in an RCT testing the efficacy of augmenting standard CBT with emotion-focused interventions and (b) explore the relationship between client emotional experiencing and session outcome. GAD clients (N = 70) were assigned to one of two treatment conditions: CBT plus interpersonal-emotional processing therapy (I/EP) or CBT plus supportive listening (SL). Psychotherapy sessions representing early, middle, and late phases of treatment were sampled and coded for each treatment segment (CBT, I/EP, SL). Peak emotional arousal for six primary emotions (love, joy, surprise, anger, sadness, fear) was measured from an observer-rated perspective with the Client Emotional Arousal Scale (CEAS), and outcome was assessed with the client version of the Session Progress Scale (SPS). Two sets of double-repeated multilevel ANOVA models were tested. Among the results, significantly higher levels of love, sadness, and anger were observed in the I/EP segment compared to the CBT segments. Significant interactions between phase and treatment were found for sadness and fear, with higher levels occurring in the late phase of treatment in the CBT plus I/EP condition. Clients who experienced more sadness rated those sessions as less helpful, and clients who experienced more joy in the I/EP and CBT segments rated those sessions as more helpful/impactful. These findings are discussed with respect to their conceptual, empirical, and clinical implications.