Emotion cascade: Harnessing emotional sequences to enhance chair work interventions and reduce self-criticism

Abstract

Objective: This study examines if experiencing the sequence of primary maladaptive emotions followed by primary adaptiveemotions in-session predicts therapeutic change and whether this sequence mediates the impact of therapist emotionalreflections on outcomes at post-treatment and follow-up.Method: Nineteen participants with high self-criticism underwent 10–12 sessions of emotion-focused therapy (EFT).Therapist responses focusing on emotions, thoughts, and actions were coded for two sessions (sessions 6–12) during theinitial 10 minutes prior to chair work. Clients’ emotional states were coded using the Classification of Affective MeaningStates (CAMS) during the subsequent chair work. Self-criticism and depression were measured at pre-treatment, post-treatment, and 3-month follow-up.Results: Primary maladaptive emotions and the transformational sequence (primary maladaptive followed by adaptiveemotion) predicted reductions in self-criticism at post-treatment, with the transformational sequence also predictingimprovements at follow-up. The impact of therapist focus on emotions on depression and self-criticism at post-treatmentand follow-up was mediated by the transformational sequence.Conclusion: The transformational sequence predicts therapeutic outcomes and mediates the impact of therapist responsesfocused on the client’s emotion and therapeutic results. Implications for therapist training are discussed.