Narrative-Emotion Process Markers in Cognitive Behavioural Therapy For Generalized Anxiety Disorder: A Process-Outcome Study

According to a narrative-emotion informed approach to psychotherapy, individuals enter psychotherapy when their narratives lack flexibility, emotional coherence and fail to integrate important lived experiences. Effective psychotherapy provides clients with an opportunity to integrate emotionally salient life experiences, as a told story or self narrative that enables new meaning-making and a more adaptive view of self. The Narrative-Emotion Process Coding System Version 2.0 (NEPCS; Angus Narrative-emotion Marker Lab, 2015) is a standardized measure that consists of a set of 10 clinically-derived markers that capture a client's capacity to disclose, emotionally re-experience, and reflect on salient personal stories in videotaped psychotherapy sessions. These 10 markers are classified into three subgroups: Problem (Same Old, Empty, Unstoried Emotion, and Superficial Storytelling), Transition (Reflective, Inchoate, Experiential, and Competing Plotlines Storytelling), and Change Markers (Unexpected Outcome, and Discovery Storytelling). The present study applied the NEPCS Version 2.0 to a sample of clients (N = 6; 36 therapy sessions) engaging in cognitive behavioural therapy (CBT) for generalized anxiety disorder (GAD). The NEPCS Version 2.0 was applied to two early, two middle, and two late-stage videotaped therapy sessions for each of the six clients (three recovered, and three unchanged outcome status), who were drawn from a randomized controlled trial comparing the efficacy of CBT and motivational interviewing integrated with CBT for GAD (Westra, Constantino, & Antony, 2016). Multilevel modeling analyses demonstrated significantly higher proportions of Reflective Storytelling (p < .001), Unexpected Outcome Storytelling (p = .023), as well as the Transition (p = .003), and Change (p = .021) markers subgroups, for recovered versus unchanged CBT clients. Additionally, there was a significant stage effect for individual markers, Competing Plotlines Storytelling (p = .006), Unexpected Outcome Storytelling (p < .001; p = .031; p = .036), No Client Marker (p = .014), and for overall Transition (p = .001; p = .034) and Change (p = .001) markers subgroups. Findings will be discussed in the context of current CBT research literature on GAD as well as research examining NEPCS marker patterns in other diagnostic populations, and treatment modalities.