Last updated on 22nd June 2012
"There's nothing so practical as a good theory". Kurt Lewin
I wrote yesterday about the "triangle of emotions". I am a medical doctor and accredited cognitive behavioural psychotherapist. I was drawn to CBT (cognitive behavioural therapy) because I wanted to help people as effectively as possible. When I started to train more formally in psychotherapy, CBT tended to have many more strongly evidence-based applications than most other psychotherapies. I had mixed feelings about the apparently rather emotionally cool approach of CBT. It somehow, at times, seemed rather "stiff upper lip". It did mostly, however, have better research evidence backing up its effectiveness, and that was enough for me. In the last several years a number of other psychotherapies have begun to get their research acts together. So for example the results of Cuijpers et al's recent meta-analysis of seven major types of psychological treatment for adult depression suggested that " ... there are no large differences in efficacy between the major psychotherapies for mild to moderate depression" and the meta-analysis I quoted yesterday by Leichsenring & Leibing highlights that CBT has no monopoly on effectiveness in treating personality disorders.
However one of CBT's delightful strengths is its self-correcting ability to "follow the data". CBT is evolving and, hopefully, becoming more deeply and broadly effective. One way it is doing this is by exploring the increasingly appreciated relevance of emotional processing. Attempts to make standard CBT more helpful for people suffering from posttraumatic stress disorder (PTSD) resulted in the development of trauma-focused cognitive therapy - now the most strongly evidence-based treatment for PTSD. It then became apparent that emotionally charged intrusive memories are also very common in many other psychological difficulties as well - for example social anxiety disorder, panic disorder, depression, eating disorders, OCD, and so on. For more on this, see the talk I gave on "Trauma memories in anxiety & depression" detailed about half way down the page on "PTSD assessment, images, memories & information". It was then an obvious step to explore emotion processing interventions for intrusive memories in a broader range of clinical problems. See for example the overview in Holmes, Arntz & Smucker's 2007 paper or, more recently, Brewin's 2009 case series of people suffering with depression. At the same time it has become apparent that intrusive memories are not only associated with obvious traumas, but are also present after many more "every day" life events. Processing of difficult memories begins to look like a potentially very widely applicable intervention.
And emotional processing is not just limited to working with difficult memories. Body focusing and particularly two chair dialogue techniques have also proved of real help. See for example Watson et al's 2003 comparison of CBT and emotion focused therapy for depression. Compassionate mind training also frequently uses internal imagery and dialogue to tackle chronic self-criticism. The most impressive example however of using both emotional processing of traumatic memories and also various dialogue methods is probably Arntz and colleagues' schema-focused cognitive therapy's success in treating borderline personality disorder. The McCullough Vaillant adapted "triangle of emotions" I discussed yesterday is another model that makes frequent use of emotion-focused techniques as well as more standard cognitive behavioural approaches. And these emotionally driven, "illogical" mechanisms are found in societies as well as in individuals - see, for example, research on prejudice and stereotype.
The web page "Emotions, feelings & personality" contains quite a few handouts that are relevant to emotion processing work. Inappropriate maladaptive emotional responses are often a useful indicator that this kind of intervention is worth considering.