Emotional processing of trauma narratives is a predictor of outcome in emotion-focused therapy for complex trauma.

Abstract

This study tested a model of emotional processes over the course of emotion-focused therapy for trauma. The model of emotional processing (Pascual-Leone & Greenberg, 2007) proposes a sequential order of shifting from "early expressions of distress" to "primary adaptive emotion" that aid in adaptive functioning. Thirty-eight participants were taken from a randomized clinical trial to examine in-session process from video recordings of treatment. The sample had an average age (M ϭ 44.3 years) and the majority was female (55.3%) and of European descent (89.5%). The Classification of Affective Meaning States was used to examine changes in emotional processes during trauma narratives in both early and late sessions. Processes were related to treatment outcome as measured by the Impact of Event Scale and the Resolution Scale. Sessions later in treatment showed a higher frequency of primary adaptive emotions compared with early sessions (p Ͻ .001, r ϭ .76). Primary adaptive emotions were also more frequent in good-outcome cases (p ϭ .017). Using emotional processes as predictors correctly classified 67% of poor-outcome cases and 80% of good-outcome cases. Increases in primary adaptive emotions from early to late treatment sessions more than doubled the odds (2.2) of having a good treatment outcome. The order of emotion was concordant with the sequential model in early sessions and partially concordant in late sessions. Findings have implications for guiding therapeutic process in a productive manner that leads to trauma recovery. Changes in discrete emotions were related to good treatment outcome. Clinical Impact StatementQuestion: In what way do client emotions change over the course of emotion-focused therapy for trauma? Findings: Increasing adaptive emotions and minimizing expressions of distress facilitates trauma recovery. Meaning: This will help clinicians guide the therapeutic process toward positive treatment outcomes. Next Steps: It would be beneficial for future research to focus on factors that facilitate change in emotional processes over the course of treatment.

Depth of experiencing and therapeutic alliance: What predicts outcome for whom in emotion‐focused therapy for trauma?

“…The IIP has achieved test–retest liabilities ranging from .89 to .98, and an internal consistency reliability of .94 with other outcome measures. We chose the IIP as our outcome measure because the treatment focus was complex relational trauma and a large outcome effect had already been observed on the IIP in two studies that used original data set (i.e., Khayyat‐Abuiaita, Paivio, Pascual‐Leone, & Harrington, 2019; Paivio et␣al., 2010). It followed that using this measure increased the likelihood of a large effect explained by the process variables under investigation in the current study.…”

Survivor narratives of the Oklahoma City bombing: The story over time

“…Narratives have been successfully used in psychotherapy to improve depression, anxiety and PTSD (Cepeda et al., 2008; Deblinger et al., 2011; Graf et al., 2008; Lely et al, 2019; Mauritz et al., 2020; Morkved et al., 2014), and the findings of this study suggest that they may also have potential in the healing process for disaster trauma. Positive narratives, in particular, have been found to be associated with improved outcomes in narrative therapeutic interventions (Khayyat‐Abuaita et al., 2019; Tuval‐Mashiach et al., 2004; Westerman et al., 2017), suggesting that integration of positive elements into disaster narratives may help protect individuals against pathological reactions to trauma.…”

How clients “change emotion with emotion”: Sequences in emotional processing and their clinical implications.

“…A study of EFT for social anxiety disorder (Haberman et al, 2015) coded emotion over the course of treatment and concluded that as successful treatment progressed, maladaptive shame was essentially being resolved by way of increasing primary adaptive emotions. Khayyat-Abuaita's (2015) study of complex trauma also demonstrated the dynamic shifting of emotional processes from the beginning to the end of therapy. By comparing early and late in-session stories about trauma, she was able to show that the amount of primary adaptive emotion clients experienced increased from a total of 8 seconds per session at the beginning of therapy to a total of 4 minutes per session at the end of therapy.…”