Changes in Quality of Emotional Processing in Trauma Narratives as a Predictor of Outcome in Emotion Focused Therapy for Complex Trauma

The present study tested a model of change in emotional processes over the course of Emotion Focused Therapy for Trauma (EFTT). The Classification of Affective Meaning States (CAMS; Pascual-Leone & Greenberg, 2005) specifies a sequential shift from maladaptive and unproductive affective processes (i.e. global distress, fear and shame, and rejecting anger), through negative self-evaluation and expressing unmet needs, to productive affective processes (i.e. hurt and grief, self-compassion, assertive anger, and acceptance and agency) that aid in adaptive functioning. This study used the CAMS to examine changes in the quality of emotional processes during trauma narratives in early and late sessions of EFTT. It was expected that a shift from unproductive to productive affective processes over the course of therapy would be associated with resolution of abuse issues and reduction in trauma symptomology at therapy termination. It was also anticipated that the shift in affective processes would follow the sequence as presented in the CAMS. Results indicated a greater frequency of productive affective processes in late narratives; a greater frequency of productive processes was more predictive of treatment outcome compared to unproductive processes; and greater increase in the frequency of productive processes from early to late narratives significantly contributed to good treatment outcome. Findings also revealed a significant interaction between unproductive and productive affective processes in predicting treatment outcome. These findings are consistent with the proposed hypotheses of the present study. Finally, results indicated that clients were significantly more likely to follow the proposed sequence for lower level processes, which supports the hypothesis. However, results did not produce similarly significant results for higher levels. Rather clients expressed higher levels of productive affective processes in late sessions that were not preceded by lower levels of processes in the proposed model. The findings have implications for guiding the therapeutic process in a productive manner that leads to trauma recovery.