Evaluating cognitive behavioral therapy process in frame of the sequential model of emotional processing

Studies has shown the relationship between emotional experience and therapy outcome. The sequence-oriented emotion processing model suggests that in successful therapies, clients go through emotional experiences that are sequenced and differentiated over time. This model, has not yet been tested in cognitive-behavioral therapy (CBT). In this study, the inter-session course of emotional experiences and their relationship with process variables were examined within a case series design. Video recordings of 78 sessions of 4 psychotherapy sessions from a naturalistic setting were divided into one-minute segments. 3,314 minutes were observationally coded with the Classification of Affective Meaning States (CAMS). The time-ordered relationships of the codes obtained from the sessions with the Therapeutic Alliance Scale, Session Evaluation Scale, and Momentary Negative Affective State Rating were examined with Simulation Modeling Analysis. Between-client comparisons were examined with multinomial logistic regression analysis based on multilevel modeling analysis. Results showed that when underlying emotional difficulties and core beliefs were addressed beyond symptomatic relief, inter-session emotion processing progressed in accordance with the sequence-oriented model of emotion processing. In these cases, psychotherapy process measurements and in-session emotional experiences were correlated and the well-being of the clients increased as the therapy progressed. However, when the clients did not deepen on the presenting problems an emotional processing did not emerge, well-being did not increase with the therapy and no significant relationships were found between psychotherapy process measures and in-session experiences. The results obtained from multilevel modeling showed that the sessions are more effective when clients had higher negative affect prior to session and emotional processing had occurred within the session. This first research in which in-session emotional processing in CBT is examined at the micro level and the whole psychotherapy process is examined, indicates that emotional processing is an effective therapeutic mechanism in CBT.