Emotion-Focused Therapy for Generalized Anxiety Disorder: An Overview of the Model

Timulák, Ladislav; McElvaney, James

doi:10.1007/s10879-015-9310-7

Cited by 33 publications

(41 citation statements)

References 29 publications

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“…Previous research on ISTDP has also indicated that a high degree of MUCE in treatment (i.e., an “unlocking of the unconscious”) is associated with better outcome in mixed patient samples (Johansson, Town, & Abbass, ; Town, Abbass, & Bernier, ). Because a core feature of GAD seems to be avoidance of negative emotions triggered in interpersonal contexts (Behar, DiMarco, Hekler, Mohlman, & Staples, ; Timulak & McElvaney, ), and some research suggest that emotional experiencing reduces GAD symptoms (e.g., Sugiura & Sugiura, ), activating and processing emotional states within therapy sessions may be particularly important in this population. Thus, for this study, we hypothesize that a higher degree of MUCE in treatment will be associated with greater symptom reduction for GAD patients receiving ISTDP.…”

Section: Introductionmentioning

confidence: 99%

Intensive Short‐Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process‐outcome study

Lilliengren

Town

Kisely

et al. 2017

Clin Psychology and Psychoth

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The objective of this study was to evaluate the clinical- and cost-effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for generalized anxiety disorder (GAD). We further aimed to examine if a key clinical process within the ISTDP framework, termed the level of mobilization of unprocessed complex emotions (MUCE), was related to outcome. The sample consisted of 215 adult patients (60.9% female) with GAD and comorbid conditions treated in a tertiary mental health outpatient setting. The patients were provided an average of 8.3 sessions of ISTDP delivered by 38 therapists. The level of MUCE in treatment was assessed from videotaped sessions by a rater blind to treatment outcome. Year-by-year healthcare costs were derived independently from government databases. Multilevel growth models indicated significant decreases in psychiatric symptoms and interpersonal problems during treatment. These gains were corroborated by reductions in healthcare costs that continued for 4 years post-treatment reaching normal population means. Further, we found that the in-treatment level of MUCE was associated with larger treatment effects, underlining the significance of emotional experiencing and processing in the treatment of GAD. We conclude that ISTDP appears to reduce symptoms and costs associated with GAD and that the ISTDP framework may be useful for understanding key therapeutic processes in this challenging clinical population. Controlled studies of ISTDP for GAD are warranted.

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Section: Introductionmentioning

confidence: 99%

Intensive Short‐Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process‐outcome study

Lilliengren

Town

Kisely

et al. 2017

Clin Psychology and Psychoth

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“…In successful dialogues, the critic (interrupter) softens (shows compassion) and the experiencer self‐asserts him or herself. Several authors have presented clinical vignettes illustrating the use of two‐chair work in addressing anxiety splits (Elliott, ; Greenberg, ) of which worries can be seen as a variation (see for instance example in Greenberg [, p. 129]) or worry process (Timulak & McElvaney, ). These vignettes were based on the therapist's use of clinical judgment in recognising problematic self‐treatment (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…A growing body of research evidence for this approach is emerging (Elliott, Greenberg, Watson, Timulak & Freire, 2013). More recently, researchers have started to develop this form of therapy for anxiety disorders (Elliott, 2013;Shahar, 2014;Timulak & McElvaney, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…The two-chair dialogues for self-criticism (conflict split) and self-interruption served as the basis for the clinical development of two-chair dialogue for worry in the recent treatment development project of EFT for GAD (Timulak & McElvaney, 2016;Timulak et al, 2014). The original tasks (one of which was developed through a similar task analytic research approach, see Greenberg, 1979Greenberg, , 1983Greenberg & Dompierre, 1981;Greenberg & Higgins, 1980) require the client to engage in a two-chair dialogue (see description in Elliott et al, 2004;also Table I), where, in the role of the critic (or interrupter) chair, the client enacts self-criticism (self-interruption) and in the other chair (the experiencer chair) checks for the impact of the critic (interrupter).…”

Section: Introductionmentioning

confidence: 99%

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Developing a model of working with worry in emotion‐focused therapy: A discovery‐phase task analytic study

Murphy

Rowell

McQuaid

et al. 2016

Couns and Psychother Res

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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.

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“…The findings of this research study contribute to a further understanding of the EFT model of case conceptualisation for GAD (Timulak & McElvaney, 2016. While it was acknowledged previously that the worry process prepares for and leads the client to avoid potential core painful feelings (e.g., of shame, loneliness/sadness, fear), it is now clearer that the link to a selfdefining characterological judgement (a problematic self-criticism)…”

Section: Discussionmentioning

confidence: 68%

Relationship between self‐worrying and self‐critical messages in clients with generalised anxiety engaging in emotion‐focused worry dialogues

Toolan

Devereux

Timulák

et al. 2019

Couns and Psychother Res

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Emotion‐focused therapy (EFT) has recently been adapted as a treatment for generalised anxiety disorder (GAD). One intervention used in this adaptation is a worry dialogue, in which the client enacts worry in one chair (“worrier”) and is facilitated to experience the impact of this worry in another chair (“experiencer”). Although not formally studied, anecdotal observations from therapists in the EFT for GAD treatment development study suggested that within worry dialogues there might be a link between client's self‐worrying and self‐critical messages. This study used data from 47 worry dialogues from fourteen study clients who received EFT for GAD. An observation based qualitative analysis of clients' self‐directed messages as present in in‐session worry dialogues was conducted using video/audio recordings of relevant sessions. Results indicate a relationship between self‐worrying and self‐critical messages. A total of 90 paired self‐worry and self‐critic messages across the 47 worry dialogues were logged. Six recurring clusters of themes/relationships were observed: (a) I need to be prepared for future negative events because… I'm weak and a failure; (b) I need to stop worrying… I'm flawed for being a worrier; (c) People will negatively judge me if I engage with them… because I'm not good enough; (d) If I don't worry, there will be negative consequences… and I will be responsible and will be unable to bear it; (e) I worry/ruminate that I cause(d) some damage… because I'm incompetent; and, (f) I must always be prepared against others taking advantage of me… because I'm weak. Given the observed close link between self‐critical and worry processes, it is important that therapists differentiate between these processes and remember to address both in therapy for GAD.

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Emotion-Focused Therapy for Generalized Anxiety Disorder: An Overview of the Model

Cited by 33 publications

References 29 publications

Intensive Short‐Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process‐outcome study

Intensive Short‐Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process‐outcome study

Developing a model of working with worry in emotion‐focused therapy: A discovery‐phase task analytic study

Relationship between self‐worrying and self‐critical messages in clients with generalised anxiety engaging in emotion‐focused worry dialogues

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