Emotional Processing and Therapy Result in Long-term Psychotherapies: A Process-Outcome Study

Third party funding: Heidehofstiftung Foundation

2013 to 2018 / Project Head: Prof. Dr. Dr. Dorothea Huber


Project Description

In the context of psychotherapy research, emotional processes or the emotional experience respectively are gaining increasing importance as process parameters in ongoing therapies. The relationship between emotional processes in therapy and the therapy success has proven to be a robust finding in process-outcome research (cf. Orlinsky et al., 2004), and especially the construct of the emotional processing plays a significant role here. Emotional processing describes an intra-psychic process which adds a cognitive component to the psychobiological components of the emotion in order that a mental phenomenon arises from an originally purely physical one (Lecours et al., 2007). On an overlapping methodological level, the emotional processing conceived in this way has proven to be a reliable predictor for the success of the therapy with humanistic methods, with behavioural therapy and with psychoanalytically-based methods (Goldman et al., 2005; Castonguay et al., 1996; Silberschatz & Curtis, 1993, among others). These findings are mainly related to short-term treatments, with the result that there has been a research gap to date in the investigation of emotional processing in long-term treatments.

Problems and Hypotheses

The overall problem or issue in the study is: "Which role does emotional processing play in long-term therapies with respect to the success of the therapy and its stability?"

By means of a two-step approach, the following research questions should be pursued:

  • In a first hypotheses-based step, the hypotheses are examined as to whether the degree of the emotional processing is positively correlated in the mid phase of the therapy with the success of the therapy and its stability.
  • In a second explorative step, it should be investigated above and beyond this whether the emotional processing is to be considered as a mediator of the success of the therapy.

The determination of a mediator presupposes differential outcome effects which have been verified in the Munich Psychotherapy Study (MPS) for the three methods approved in the applicable guidelines (cf. Huber et al. 2012a; Huber et al. 2012b; Huber et al. 2013). The investigation is to occur on the basis of Munich Psychotherapy Study (MPS) database.

Work Schedule

In order to answer the research questions posed above, the process parameter of the emotional processing is set in relation to the outcome measured post 1- and 3-year catamneses over the measurement times. As this phase of the research should be concerned with the correlations of the therapy processes and the in lege artis concluded therapies and the long-term outcome, we are selecting a completer sample as the data basis. From the total of 100 patients in the intend-to-treat random sample, 85 have finished their therapy in a regular manner. Following an assessment of the recording quality of the hours in the mid phase, 13 cases (6 AP, 3 DP, 4 CBT) had to be excluded. The remaining 72 patients are to be screened as to whether they have two sessions of the mid phase which reach or exceed the lower operationalised cut-off value of the hours rating scale for change relevance. The number of therapies found in this way should be the same per therapy form and not exceed an n = 20:

1. Analytical psychotherapy (AP): 20 patients with two to three sessions per week lying down;
2. Depth psychology-based psychotherapy (DP): 20 patients with one session per week, in a sitting position;
3. Cognitive behavioural therapy (CBT): 20 patients with one session per week.


The degree of the emotional processing in the mid phase should be recorded with the Experiencing Scale (EXP; German version Dahlhoff & Bommert, 1978; Klein et al., 1986a; Klein et al., 1986b) which measures the emotional and cognitive participation of the patient in a therapeutic dialogue on a seven-stage scale. In order to apply the EXP scale, hourly segments are selected in a targeted manner from over the course of the therapy. Initially hours are selected from the mid therapy phase, operationalised as the mid third of the therapy. It is assumed with this therapy phase that it represents the genuine "working phase" of the therapy. Two therapy sessions are then selected from this phase on the basis of the so-called hours rating scale, from which it is to be expected theoretically that they are suitable for answering our problem ("significant events approach", Elliott, 2010).

Change relevant hours can be identified in the Munich Psychotherapy Study with the help of the hours rating scale, on which the therapist conducted an evaluation of the hours on a Likert scale immediately after the end of the hours. The change relevance is operationalised a) for the AP and DP as one hour in which the "transference processing" variable was scored on a 4-step Likert scale, with 4 = much, and the "hours evaluation" variance on a 5-stage Likert scale, with +1 or +2 (= "a good hour"), and b) for the KCBT as one hour in which the "recognisable cognitive restructuring" or "recognisable behavioural change" variables were scored, with 4 = much, and the "hours evaluation" variance on a 5-stage Likert scale, with +1 or +2 (= "a good hour").

Statistical Analysis

In order to test the first problem, a total of six multiple regression analyses are planned. Mediation analyses are envisaged for the second exploratory problem.

Practical Relevance and Outlook

"We know well that therapy works, i.e. is responsible for change, but have little knowledge of why or how it works" (Kazdin, 2007, page 2). In this way, Kazdin is pointing out the necessity of a process-outcome approach in which, through an understanding of the therapeutic processes, strategies can in turn be optimised which initiate the therapeutic change process. Thus the process-outcome approach is to be regarded as a central component of quality assurance and the optimising of psychotherapeutic treatments. In this research context, this study should contribute to findings about the effectiveness and the effective mechanisms of different forms of therapy with depressive patients.

Project Head

Prof. Dr. Dr. Dorothea Huber
International Psychonalytic University
Stromstraße 3b
10555 Berlin
dorothea.huber(at)ipu-berlin.de

Project Team

Dr. Günther Klug
Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie / /Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy
TU Munich University
Langerstrasse 3
81675 München

Dr. Dipl. Psych. Carolina Seybert
Research Assistant
International Psychoanalytic University Berlin
Stromstr. 3b
Tel.: +49 30 300 117-767
Fax.: +49 30 300 117-769
10555 Berlin
Email: carolina.seybert(at)ipu-berlin.de

Dr. Dipl. Psych. Melanie Ratzek
Research Assistant
International Psychoanalytic University Berlin
Stromstr. 3b
10555 Berlin
Telefon: +49 30 300 117-767
Telefax: +49 30 300 117-769
Email: melanie.ratzek(at)ipu-berlin.de

Prof. Dr. Johannes Zimmermann
Psychologische Hochschule Berlin (PHB)
Am Köllnischen Park 2
10179 Berlin

Literature

  • Castonguay, L. G., Goldfried, M. R., Wiser, S., Raue, P. J., and Hayes, A. M. (1996). Predicting the effect of cognitive therapy for depression: study of unique and common factors. Journal of Consulting and Clinical Psychology, 64, 497-504.
  • Dahlhoff, H. D., & Bommert, H. (1978). Forschungs- und Trainingsmanual zur deutschen Fassung der Experiencing-Skala [Research- and trainings-manual for the German version of the Experiencing Scales]. In H. Bommert & H. D. Dahlhoff (Eds.), Das Selbsterleben (Experiencing) in der Psychotherapie [Experiencing in psychotherapy] (pp. 63-125). München, Wien, Baltimore: Urban & Schwarzenberg.
  • Elliott, R. (2010). Psychotherapy change process research: realizing the promise. Psychotherapy Research, 20, 123-135.
  • Goldman, R. N., Greenberg, L. S., & Pos, A. E. (2005). Depth of emotional experience and outcome. Psychotherapy Research, 15, 248-260.
  • Huber, D., Henrich, G., Clarkin, J., & Klug, G. (2013). Psychoanalytic versus psychodynamic therapy for depression – A three-year follow-up study. Psychiatry, 76(2), 132-149.
  • Huber, D., Henrich, G., Gastner, J., & Klug, G. (2012a). Must all have prices? The Munich Psychotherapy Study. In J. S. Ablon, R. Levy & H. Kaechele (Eds.), Evidence Based Psychodynamic Psychotherapy (pp. 51-69). New York: Humana Press.
  • Huber, D., Zimmermann, J., Henrich, G., & Klug, G. (2012b). Comparison of cognitivebehaviour therapy with psychoanalytic and psychodynamic therapy for depressed patients – a three-year follow-up study. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 58, 299-316.
  • Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1-27.
  • Klein, M. H., Mathieu-Coughlan, P., & Kiesler, D. J. (1986). The Experiencing Scales. In L. S. Greenberg & W. Pinsof (Eds.), The psychotherapeutic process: a research handbook (pp. 21-71). New York, London: The Guilford Press.
  • Klein, M. H., Mathieu, P., Gendlin, E., & Kiesler, D. J. (1986). The Experiencing Scales: a research and training manual (Vol. 1). Madison: University of Wisconsin, Extension Bureau of Audio visual instruction (copyrighted 1970).
  • Lecours, S., Sanlian, N., & Bouchard, M.-A. (2007). Assessing verbal elaboration of affect in clinical interviews. Bulletin of the Menninger Clinic, 71, 227-247.
  • Orlinsky, D. E., Ronnestad, M. H., & Willutzki, U. (2004). Fifty years of psychotherapy process-outcome research: continuity and change. In M. Lambert (Ed.), Handbook of Psychotherapy Research and Behavior Change (pp. 307-389). New York: Wiley.
  • Silberschatz, G., & Curtis, H. (1993). Measuring the therapist's impact on the patient's therapeutic progress. Journal of Consulting and Clinical Psychology, 61, 403-411.