Narrative - Emotion processing in Motivational Interviewing and Cognitive Behavioural Therapy for Generalized Anxiety Disorder

Constructing adaptive narratives in therapy involves processing and symbolizing (i.e., storying) emotional experience. The Narrative-Emotion Process Coding System (NEPCS) is a tool for coding in-session client behaviors that indicate 10 underlying narrative-emotion processes: Same Old Story, Empty Story, Unstoried Emotion, Superficial Story, Reflexive Story, Inchoate Story, Experiential Story, Competing Plotlines, Unexpected Outcome, and Discovery Story. The NEPCS was applied to videotaped therapy sessions of three recovered and three unchanged clients who underwent cognitive behavioral therapy (CBT) and motivational interviewing (MI) for Generalized Anxiety Disorder (GAD). Multilevel modeling analyses demonstrated a significant effect of outcome for Reflexive Story, Competing Plotlines, and Unexpected Outcome, and a significant outcome x stage effect for Discovery Story. Findings are discussed in the context of ambivalence about worry and emotion avoidance as key features of GAD. Limitations and future research directions, including avenues for further elucidation of mechanisms of MI for GAD, are also discussed.