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Published in: Journal of Contemporary Psychotherapy 1/2016

01-03-2016 | Original Paper

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

Authors: Ladislav Timulak, James McElvaney

Published in: Journal of Contemporary Psychotherapy | Issue 1/2016

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Abstract

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.
Literature
go back to reference American Psychiatric Association [APA]. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Washington: American Psychiatric Association. American Psychiatric Association [APA]. (2013). Diagnostic and statistical manual of mental disorders (DSM-5) (5th ed.). Washington: American Psychiatric Association.
go back to reference Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77–108). New York: Guilford Press. Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77–108). New York: Guilford Press.
go back to reference Carter, R. M., Wittchen, H.-U., Pfister, H., & Kessler, R. C. (2001). One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depression and Anxiety, 13, 78–88. doi:10.1002/da.1020.PubMedCrossRef Carter, R. M., Wittchen, H.-U., Pfister, H., & Kessler, R. C. (2001). One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depression and Anxiety, 13, 78–88. doi:10.​1002/​da.​1020.PubMedCrossRef
go back to reference Crits-Christoph, P., Connolly Gibbons, M. B., & Crits-Christoph, K. (2004). Supportive-expressive psychodynamic therapy. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 294–319). New York: Guilford Press. Crits-Christoph, P., Connolly Gibbons, M. B., & Crits-Christoph, K. (2004). Supportive-expressive psychodynamic therapy. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 294–319). New York: Guilford Press.
go back to reference Crits-Christoph, P., Gibbons, M. B. C., Narducci, J., Schamberger, M., & Gallop, R. (2005). Interpersonal problems and the outcome of interpersonally oriented psychodynamic treatment of GAD. Psychotherapy: Theory, Research, Practice, Training, 42, 211–224. doi:10.1037/0033-3204.42.2.211.CrossRef Crits-Christoph, P., Gibbons, M. B. C., Narducci, J., Schamberger, M., & Gallop, R. (2005). Interpersonal problems and the outcome of interpersonally oriented psychodynamic treatment of GAD. Psychotherapy: Theory, Research, Practice, Training, 42, 211–224. doi:10.​1037/​0033-3204.​42.​2.​211.CrossRef
go back to reference Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder. New York: Routledge. Dugas, M. J., & Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder. New York: Routledge.
go back to reference Elliott, R., Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2004). Learning emotion-focused therapy: The process-experiential approach to change. Washington: American Psychological Association.CrossRef Elliott, R., Watson, J. C., Goldman, R. N., & Greenberg, L. S. (2004). Learning emotion-focused therapy: The process-experiential approach to change. Washington: American Psychological Association.CrossRef
go back to reference First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured clinical interview for DSM-IV axis-I disorders (SCID-I): Clinician version. Washington: American Psychiatric Press. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1997). Structured clinical interview for DSM-IV axis-I disorders (SCID-I): Clinician version. Washington: American Psychiatric Press.
go back to reference Goldman, R. N., & Greenberg, L. S. (2014). Case formulation in emotion-focused therapy: Co-creating clinical maps for change. Washington: American Psychological Association. Goldman, R. N., & Greenberg, L. S. (2014). Case formulation in emotion-focused therapy: Co-creating clinical maps for change. Washington: American Psychological Association.
go back to reference Goldman, R., Greenberg, L., & Angus, L. (2006). The effects of adding emotion-focused interventions to the therapeutic relationship in the treatment of depression. Psychotherapy Research, 16, 537–549. doi:10.1080/10503300600589456.CrossRef Goldman, R., Greenberg, L., & Angus, L. (2006). The effects of adding emotion-focused interventions to the therapeutic relationship in the treatment of depression. Psychotherapy Research, 16, 537–549. doi:10.​1080/​1050330060058945​6.CrossRef
go back to reference Greenberg, L. S. (2011). Emotion-focused therapy. Washington: American Psychological Association. Greenberg, L. S. (2011). Emotion-focused therapy. Washington: American Psychological Association.
go back to reference Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The moment by moment process. New York: Guilford Press. Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change: The moment by moment process. New York: Guilford Press.
go back to reference Greenberg, L. S., & Watson, J. (1998). Experiential therapy of depression: Differential effects of client-centred relationship conditions and process-experiential interventions. Psychotherapy Research, 8, 210–224. doi:10.1093/ptr/8.2.210.CrossRef Greenberg, L. S., & Watson, J. (1998). Experiential therapy of depression: Differential effects of client-centred relationship conditions and process-experiential interventions. Psychotherapy Research, 8, 210–224. doi:10.​1093/​ptr/​8.​2.​210.CrossRef
go back to reference Greenberg, L. S., & Watson, J. (2006). Emotion-focused therapy for depression. Washington: American Psychological Association.CrossRef Greenberg, L. S., & Watson, J. (2006). Emotion-focused therapy for depression. Washington: American Psychological Association.CrossRef
go back to reference Keogh, D., Timulak, L., & McElvaney, J. (2014, June). Treating generalised anxiety disorder with emotion focused therapy: A case study investigation of emotional change processes. Paper presented at the Annual Meeting of the Society for Psychotherapy Research, Copenhagen, Denmark. Keogh, D., Timulak, L., & McElvaney, J. (2014, June). Treating generalised anxiety disorder with emotion focused therapy: A case study investigation of emotional change processes. Paper presented at the Annual Meeting of the Society for Psychotherapy Research, Copenhagen, Denmark.
go back to reference Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602. doi:10.1001/archpsyc.62.6.593.PubMedCrossRef Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602. doi:10.​1001/​archpsyc.​62.​6.​593.PubMedCrossRef
go back to reference King, M., Sibbald, B., Ward, E., Bower, P., Lloyd, M., Gabbay, M., & Byford, S. (2000). Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care. Health Technology Assessment, 4(19), 1–83. PubMed King, M., Sibbald, B., Ward, E., Bower, P., Lloyd, M., Gabbay, M., & Byford, S. (2000). Randomised controlled trial of non-directive counselling, cognitive-behaviour therapy and usual general practitioner care in the management of depression as well as mixed anxiety and depression in primary care. Health Technology Assessment, 4(19), 1–83. PubMed
go back to reference Mennin, D. S., Fresco, D. M., Ritter, M., & Heimberg, R. G. (2015). An open trial of emotion regulation therapy for generalized anxiety disorder and co-occurring depression. Depression and Anxiety. doi:10.1002/da.22377.PubMed Mennin, D. S., Fresco, D. M., Ritter, M., & Heimberg, R. G. (2015). An open trial of emotion regulation therapy for generalized anxiety disorder and co-occurring depression. Depression and Anxiety. doi:10.​1002/​da.​22377.PubMed
go back to reference National Institute for Health and Clinical Excellence. (2011). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care. London: NICE Clinical Guidelines 113. National Institute for Health and Clinical Excellence. (2011). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care. London: NICE Clinical Guidelines 113.
go back to reference Newman, M. G., Llera, S. J., Erickson, T. M., Przeworski, A., & Castonguay, L. G. (2013). Worry and generalized anxiety disorder: A review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment. Annual Review of Clinical Psychology, 9, 275–297. doi:10.1146/annurev-clinpsy-050212-185544.PubMedCrossRef Newman, M. G., Llera, S. J., Erickson, T. M., Przeworski, A., & Castonguay, L. G. (2013). Worry and generalized anxiety disorder: A review and theoretical synthesis of evidence on nature, etiology, mechanisms, and treatment. Annual Review of Clinical Psychology, 9, 275–297. doi:10.​1146/​annurev-clinpsy-050212-185544.PubMedCrossRef
go back to reference O’Brien, K., Timulak, L., McElvaney, J., & Greenberg, L.S. (2012, June). Emotion-focused case conceptualisation of generalised anxiety disorder. Paper presented at the 43rd Annual Meeting of the International Society for Psychotherapy research, Virginia Beach, USA. O’Brien, K., Timulak, L., McElvaney, J., & Greenberg, L.S. (2012, June). Emotion-focused case conceptualisation of generalised anxiety disorder. Paper presented at the 43rd Annual Meeting of the International Society for Psychotherapy research, Virginia Beach, USA.
go back to reference Paivio, S. C., & Pascual-Leone, A. (2010). Emotion-focused therapy for complex trauma: An integrative approach. Washington: American Psychological Association.CrossRef Paivio, S. C., & Pascual-Leone, A. (2010). Emotion-focused therapy for complex trauma: An integrative approach. Washington: American Psychological Association.CrossRef
go back to reference Pascual-Leone, A. (2009). Emotional processing cycles in experiential therapy: “Two steps forward, one step backward”. Journal of Consulting and Clinical Psychology, 77, 113–126. doi:10.1037/a0014488.PubMedCrossRef Pascual-Leone, A. (2009). Emotional processing cycles in experiential therapy: “Two steps forward, one step backward”. Journal of Consulting and Clinical Psychology, 77, 113–126. doi:10.​1037/​a0014488.PubMedCrossRef
go back to reference Roemer, L., & Orsillo, S. M. (2014). An acceptance-based behavioral therapy for generalized anxiety disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (pp. 206–236). New York: Guilford Press. Roemer, L., & Orsillo, S. M. (2014). An acceptance-based behavioral therapy for generalized anxiety disorder. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (pp. 206–236). New York: Guilford Press.
go back to reference Rowell, L., Murphy, J., Timulak, L., & McElvaney, J. (2014, November). Addressing the worry process in EFT for GAD: Task analysis of the two-chair task. Paper presented at the conference of Psychological Society of Ireland, Kilkenny. Rowell, L., Murphy, J., Timulak, L., & McElvaney, J. (2014, November). Addressing the worry process in EFT for GAD: Task analysis of the two-chair task. Paper presented at the conference of Psychological Society of Ireland, Kilkenny.
go back to reference Shahar, B. (2014). Emotion-focused therapy for the treatment of social anxiety: An overview of the model and a case description. Clinical Psychology & Psychotherapy, 21, 536–547. doi:10.1002/cpp.1853. Shahar, B. (2014). Emotion-focused therapy for the treatment of social anxiety: An overview of the model and a case description. Clinical Psychology & Psychotherapy, 21, 536–547. doi:10.​1002/​cpp.​1853.
go back to reference Timulak, L., McElvaney, J., Martin, E. & Greenberg, L.S. (2014, June). Emotion-focused therapy for GAD: First quantitative and qualitative outcomes. Paper presented at the Annual Meeting of the Society for Psychotherapy Research, Copenhagen, Denmark. Timulak, L., McElvaney, J., Martin, E. & Greenberg, L.S. (2014, June). Emotion-focused therapy for GAD: First quantitative and qualitative outcomes. Paper presented at the Annual Meeting of the Society for Psychotherapy Research, Copenhagen, Denmark.
go back to reference Timulak, L., & Pascual-Leone, A. (2014). New developments for case conceptualization in emotion-focused therapy. Clinical Psychology & Psychotherapy. doi:10.1002/cpp.1922. Timulak, L., & Pascual-Leone, A. (2014). New developments for case conceptualization in emotion-focused therapy. Clinical Psychology & Psychotherapy. doi:10.​1002/​cpp.​1922.
go back to reference Timulak, L. (2015). Transforming emotional pain in psychotherapy: An emotion-focused approach. London: Routledge Timulak, L. (2015). Transforming emotional pain in psychotherapy: An emotion-focused approach. London: Routledge
go back to reference Watson, J.C., & Goldman, R. N. (2012, July). Experiential perspectives on anxiety. Panel presented at the 10th Conference of the World Association for Person-Centered and Experiential Psychotherapy and Counseling. Antwerps, Belgium. Watson, J.C., & Goldman, R. N. (2012, July). Experiential perspectives on anxiety. Panel presented at the 10th Conference of the World Association for Person-Centered and Experiential Psychotherapy and Counseling. Antwerps, Belgium.
go back to reference Watson, J. C., Gordon, L. B., Stermac, L., Kalogerakos, F., & Steckley, P. (2003). Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. Journal of Consulting and Clinical Psychology, 71, 773–781. doi:10.1037/0022-006X.71.4.773.PubMedCrossRef Watson, J. C., Gordon, L. B., Stermac, L., Kalogerakos, F., & Steckley, P. (2003). Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. Journal of Consulting and Clinical Psychology, 71, 773–781. doi:10.​1037/​0022-006X.​71.​4.​773.PubMedCrossRef
go back to reference Wells, A. (2006). The metacognitive model of worry and generalized anxiety disorder. In G. C. L. Davey & A. Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 179–199). Chichester: John Wiley. Wells, A. (2006). The metacognitive model of worry and generalized anxiety disorder. In G. C. L. Davey & A. Wells (Eds.), Worry and its psychological disorders: Theory, assessment and treatment (pp. 179–199). Chichester: John Wiley.
Metadata
Title
Emotion-Focused Therapy for Generalized Anxiety Disorder: An Overview of the Model
Authors
Ladislav Timulak
James McElvaney
Publication date
01-03-2016
Publisher
Springer US
Published in
Journal of Contemporary Psychotherapy / Issue 1/2016
Print ISSN: 0022-0116
Electronic ISSN: 1573-3564
DOI
https://doi.org/10.1007/s10879-015-9310-7

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