Emotional Change Processes in Resolving Self-Critical Subtypes of Depression During Experiential Treatment
Choi, Bryan Hon Yan
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This mixed-methods study explored emotional processing that predicts long-term outcomes within subtypes of self-critical depression during experiential psychotherapy. First, I validated Kagans (2003) qualitative analysis which identified four subtypes of self-criticism among depressed clients: (1) compare and despair; (2) too sensitive/needy; (3) internalized shoulds/unacceptable feelings; and (4) unworthy/not good enough. I did this by performing a confirmatory reflexive thematic analysis (Braun & Clarke, 2006) on the same original sample (n = 42) Kagan used to establish her self-critical subtypes. Kagans classification system was reliably applied by new coders. I then used Emotion-focused therapy (EFT) theory to hypothesize and extend Kagans self-critical subtypes into higher-order self-critical subtypes. As hypothesized, two higher-order self-critical categories emerged: (1) Socially Inadequate (SI) self-criticism which combined Kagans first three self-critical subtypes, and (2) Core Worthlessness (CW) self-criticism that retained Kagans fourth subtype. Higher-order self-critical subgroups were then examined for differences in working phase emotional processing (WP-EP) occurring within clients in-session emotion episodes. This was performed using proportion analyses and THEME 6.0 sequential pattern analyses (Magnusson, 2000). Measures used were: (1) discrete emotion states and higher-order emotion scheme categories operationalized by the Classification of Affective Meaning States (CAMS; Pascual-Leone & Greenberg, 2005). I also measured (2) the apparent "target" of emotion episodes measured by the Object Valence Scheme (OVS; Choi, 2013). WP-EP differences were found. SI clients expressed more other-positive, and CW clients expressed more fear, shame, and negative self-evaluations. I also examined differences between higher-order self-critical subgroups on 18-month follow up outcomes for clients who provided this data (n = 29). Higher-order self-critical subgroups did not differ on any 18-month post-treatment outcome measure. Finally, depressed versus nondepressed clients at 18-month follow up within each higher-order self-critical subtype were compared for WP-EP differences. Supporting theorized EFT emotional change processes, nondepressed clients in both subgroups expressed greater proportions of, or more sequences involving, primary adaptive emotions and fewer sequences of being stuck in secondary and CAMS-uncodable emotions. Further, nondepressed SI clients expressed specifically more hurt/grief and self-soothing. Nondepressed CW clients also expressed more primary maladaptive emotions and needs. Clinical applications, limitations, and future directions are discussed.