Cognitive Therapy and Research

, Volume 41, Issue 6, pp 807–828 | Cite as

Systematic Review of In-Session Affect Experience in Cognitive Behavioral Therapy for Depression

  • Katie Aafjes-van Doorn
  • Jacques P. Barber
Review Paper


One way of attempting to improve the efficacy and effectiveness of Cognitive Behavioral Therapy (CBT) for depression is to identify the processes of change that contribute towards its positive outcome. In addition to well-researched cognitive processes, another possible change process is affect experiencing (AE); i.e., a patient’s affective experience in-session. Theorists, clinicians and researchers have emphasized the role of affective traits, tendencies and symptoms in the development, maintenance, and treatment of depression. We make the case that it may be important to also consider patients’ full range of affect experiencing (AE), as a changeable in-session process that may relate to CBT treatment outcome. This systematic review aimed to clarify what is already empirically known regarding in-session AE in CBT for depression and which gaps in empirical research need to be filled by future studies. The reviewed studies on AE in CBT for depression suggest that it is possible to identify and measure AE. In-session experiencing of positive and negative affect (when it includes cognitive processes) relates to and may predict a reduction of symptoms. We encourage researchers to develop and refine multifaceted process measures and analyses to explore when, how and how much AE can be effectively experienced by patients, and how optimal levels of AE may be facilitated by the therapist.


Affect Cognitive behavioral therapy Change process In-session experience Depression 



This review did not use any external funding.

Compliance with Ethical Standards

Conflict of interest

Katie Aafjes-van Doorn and Jacques P. Barber declares that they have no conflict of interest.

Human and Animal Rights

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed Consent

This review did not require any informed consent.


  1. Aafjes-van Doorn, K., Lilliengren, P., Cooper, A., Macdonald, J., & Falkenström, F. (2017). Patients’ affective processes within initial experiential dynamic therapy sessions. Psychotherapy, 54(2), 175–183.  Google Scholar
  2. *Abel, A., Hayes, A. M., Henley, W., & Kuyken, W. (2016). Sudden gains in cognitive–behavior therapy for treatment-resistant depression: Processes of change. Journal of Consulting and Clinical Psychology, 84(8), 726–737. doi: 10.1037/ccp0000101.PubMedCrossRefGoogle Scholar
  3. *Ablon, J. S., & Jones, E. E. (1999). Psychotherapy process in the NIMH treatment of depression collaborative research program. Journal of Consulting and Clinical Psychology, 67(1), 64–75. doi: 10.1037/0022-006X.67.1.64.PubMedCrossRefGoogle Scholar
  4. Adler, J. M., Harmeling, L. H., & Walder-Biesanz, I. (2013). Narrative meaning making is associated with sudden gains in psychotherapy clients’ mental health under routine clinical conditions. Journal of Consulting and Clinical Psychology, 81(5), 839–845. doi: 10.1037/a0033774.
  5. Aldao, A. (2016). Introduction to the special issue: Emotion regulation as a transdiagnostic process. Cognitive Therapy and Research, 40(3), 257–261. doi: 10.1007/s10608-016-9764-2.CrossRefGoogle Scholar
  6. Babl, A., Holtforth, M. G., Heer, S., Lin, M., Stähli, A., Holstein, D., … Ramseyer, F. (2016). Psychotherapy integration under scrutiny: Investigating the impact of integrating emotion-focused components into a CBT-based approach: A study protocol of a randomized controlled trial. BioMedCentral Psychiatry, 16(1), 423–443. doi: 10.1186/s12888-016-1136-7.Google Scholar
  7. Bados, A., Balaguer, G., & Saldaña, C. (2007). The efficacy of cognitive–behavioral therapy and the problem of drop-out. Journal of Clinical Psychology, 63(6), 585–592. doi: 10.1002/jclp.2036.PubMedCrossRefGoogle Scholar
  8. Baker, R., Owens, M., Thomas, S., Whittlesea, A., Abbey, G., Gower, P., … Thomas, P. W. (2012). Does CBT facilitate emotional processing? Behavioural and Cognitive Psychotherapy, 40(1), 19–37. doi: 10.1016/j.jad.2011.08.004.PubMedCrossRefGoogle Scholar
  9. Barber, J. P., & DeRubeis, R. J. (1989). On second thought: Where the action is in cognitive therapy for depression. Cognitive Therapy and Research, 13(5), 441–457. doi: 10.1007/BF01173905.CrossRefGoogle Scholar
  10. Barkham, M., Shapiro, D. A., Hardy, G. E., & Rees, A. (1999). Psychotherapy in two-plus-one sessions: Outcomes of a randomized controlled trial of cognitive–behavioral and psychodynamic–interpersonal therapy for subsyndromal depression. Journal of Consulting and Clinical Psychology, 67(2), 201–211.PubMedCrossRefGoogle Scholar
  11. Barnard, P. J., & Teasdale, J. D. (1991). Interacting cognitive subsystems: A systemic approach to cognitive-affective interaction and change. Cognition & Emotion, 5(1), 1–39. doi: 10.1080/02699939108411021.CrossRefGoogle Scholar
  12. *Basto, I., Pinheiro, P., Stiles, W. B., Rijo, D., & Salgado, J. (2016). Changes in symptom intensity and emotion valence during the process of assimilation of a problematic experience: A quantitative study of a good outcome case of cognitive-behavioral therapy. Psychotherapy Research, 1–13. doi: 10.1080/10503307.2015.1119325.
  13. Beck, A. T. (1979). Cognitive therapy of depression. New York: Guilford Press.Google Scholar
  14. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
  15. Bennett-Levy, J., Westbrook, D., Fennell, M., Cooper, M., Rouf, K., & Hackmann, A. (2004). Behavioural experiments: Historical and conceptual underpinnings. In Oxford guide to behavioural experiments in cognitive therapy (Vol. 2, pp. 1–20). Oxford: Oxford University Press. doi: 10.1093/med:psych/9780198529163.003.0001.CrossRefGoogle Scholar
  16. Berking, M., & Wupperman, P. (2012). Emotion regulation and mental health: Recent findings, current challenges, and future directions. Current Opinion in Psychiatry, 25(2), 128–134. doi: 10.1097/YCO.0b013e3283503669.PubMedCrossRefGoogle Scholar
  17. Bonanno, G. A., Papa, A., Lalande, K., Westphal, M., & Coifman, K. (2004). The importance of being flexible: The ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychological Science, 15(7), 482–487. doi: 10.1111/j.0956-7976.2004.00705.x.PubMedCrossRefGoogle Scholar
  18. Bos, S. C., Macedo, A., Marques, M., Pereira, A. T., Maia, B. R., Soares, M. J., … Azevedo, M. H. (2013). Is positive affect in pregnancy protective of postpartum depression? Revista Brasileira de Psiquiatria, 35(1), 5–12. doi: 10.1016/j.rbp.2011.11.002.PubMedCrossRefGoogle Scholar
  19. Boumparis, N., Karyotaki, E., Kleiboer, A., Hofmann, S. G., & Cuijpers, P. (2017). The effect of psychotherapeutic interventions on positive and negative affect in depression: A systematic review and meta-analysis. Journal of Affective Disorders, 202, 153–162. doi: 10.1016/j.jad.2016.05.019.CrossRefGoogle Scholar
  20. Burum, B. A., & Goldfried, M. R. (2007). The centrality of emotion to psychological change. Clinical Psychology: Science and Practice, 14(4), 407–413. doi: 10.1111/j.1468-2850.2007.00100.x.Google Scholar
  21. Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17–31. doi: 10.1016/j.cpr.2005.07.003.PubMedCrossRefGoogle Scholar
  22. Carryer, J. R., & Greenberg, L. S. (2010). Optimal levels of emotional arousal in experiential therapy of depression. Journal of Consulting and Clinical Psychology, 78(2), 190–199. doi: 10.1037/a0018401.PubMedCrossRefGoogle Scholar
  23. *Castonguay, L. G., Goldfried, M. R., Wiser, S., Raue, P. J., & Hayes, A. M. (1996). Predicting the effect of cognitive therapy for depression: A study of unique and common factors. Journal of Consulting and Clinical Psychology, 64(3), 497–504. doi: 10.1037/0022-006X.64.3.497.PubMedCrossRefGoogle Scholar
  24. Clark, D. A. (2013). Collaborative empiricism: A cognitive response to exposure reluctance and low distress tolerance. Cognitive and Behavioral Practice, 20(4), 445–454. doi: 10.1016/j.cbpra.2012.06.001.CrossRefGoogle Scholar
  25. *Coombs, M. M., Coleman, D., & Jones, E. E. (2002). Working with feelings: The importance of emotion in both cognitive-behavioral and interpersonal therapy in the NIMH Treatment of Depression Collaborative Research Program. Psychotherapy: Theory, Research, Practice, Training, 39(3), 233–244. doi: 10.1037/0033-3204.39.3.233.CrossRefGoogle Scholar
  26. Cooper, M., & Norcross, J. C. (2016). A brief, multidimensional measure of clients’ therapy preferences: The Cooper-Norcross Inventory of Preferences (C-NIP). International Journal of Clinical and Health Psychology, 16(1), 87–98. doi: 10.1016/j.ijchp.2015.08.003.CrossRefGoogle Scholar
  27. Crits-Christoph, P., Gibbons, M. C., & Mukherjee, D. (2013). Psychotherapy process-outcome research. In M.J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th Ed), (pp 298–340). Hoboken, NJ: Wiley.Google Scholar
  28. Cuijpers, P., Cristea, I. A., Weitz, E., Gentili, C., & Berking, M. (2016). The effects of cognitive and behavioural therapies for anxiety disorders on depression: A meta-analysis. Psychological Medicine, 46(16), 3451–3462. doi: 10.1017/S0033291716002348.PubMedCrossRefGoogle Scholar
  29. Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: A meta-analysis. Journal of Affective Disorders, 159, 118–126. doi: 10.1016/j.jad.2014.02.026.PubMedCrossRefGoogle Scholar
  30. David, D., & Szentagotai, A. (2006). Cognitions in cognitive-behavioral psychotherapies; toward an integrative model. Clinical Psychology Review, 26(3), 284–298. doi: 10.1016/j.cpr.2005.09.003.PubMedCrossRefGoogle Scholar
  31. Diener, M. J., Hilsenroth, M. J., & Weinberger, J. (2007). Therapist affect focus and patient outcomes in psychodynamic psychotherapy: A meta-analysis. American Journal of Psychiatry, 164(6), 936–941. doi: 10.1007/BF01172968.PubMedCrossRefGoogle Scholar
  32. Disner, S. G., Beevers, C. G., Haigh E.A.P., & Beck, A. T. (2011). Neural mechanisms of the cognitive model of depression. Nature Reviews Neuroscience, 12, 467–477. doi: 10.1038/nrn3027.PubMedCrossRefGoogle Scholar
  33. Doidge, N. (2007). The brain that changes itself: Stories of personal triumph from the frontiers of brain science. London: Penguin Books.Google Scholar
  34. Driessen, E., & Hollon, S. D. (2010). Cognitive behavioral therapy for mood disorders: Efficacy, moderators and mediators. Psychiatric Clinics of North America, 33(3), 537–555. doi: 10.1016/j.psc.2010.04.005.PubMedPubMedCentralCrossRefGoogle Scholar
  35. Ekman, P. E., & Davidson, R. J. (1994). The nature of emotion: Fundamental questions. Oxford: Oxford University Press.Google Scholar
  36. Elkin, I., Parloff, M. B., Hadley, S. W., & Autry, J. H. (1985). NIMH treatment of Depression Collaborative Research Program: Background and research plan. Archives of General Psychiatry, 42(3), 305–316.PubMedCrossRefGoogle Scholar
  37. Endicott, J., Spitzer, R. L., Fleiss, J. L., & Cohen, J. (1976). The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33(6), 766–771.PubMedCrossRefGoogle Scholar
  38. Engels, A. S., Heller, W., Mohanty, A., Herrington, J. D., Banich, M. T., Webb, A. G., & Miller, G. A. (2007). Specificity of regional brain activity in anxiety types during emotion processing. Psychophysiology, 44(3), 352–363. doi: 10.1111/j.1469-8986.2007.00518.x.PubMedCrossRefGoogle Scholar
  39. Epstein, S. (1994). Integration of the cognitive and the psychodynamic unconscious. American Psychologist, 49(8), 709–724. doi: 10.1037/0003-066X.49.8.709.PubMedCrossRefGoogle Scholar
  40. Fisher, H., Atzil-Slonim, D., Bar-Kalifa, E., Rafaeli, E., & Peri, T. (2016). Emotional experience and alliance contribute to therapeutic change in psychodynamic therapy. Psychotherapy, 53(1), 105–116. doi: 10.1037/pst0000041.PubMedCrossRefGoogle Scholar
  41. Fleury, G., Fortin-Langelier, B., & Ben-Cheikh, I. (2016). The cardiac rhythm of the unconscious in a case of panic disorder. American Journal of Psychotherapy, 70(3), 277–300.PubMedGoogle Scholar
  42. Foa, E. B., Riggs, D. S., Massie, E. D., & Yarczower, M. (1995). The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behavior Therapy, 26(3), 487–499. doi: 10.1016/S0005-7894(05)80096-6.CrossRefGoogle Scholar
  43. Fredrickson, B. L. (2001). The role of positive emotions in positive psychology: the broaden- and -build theory of positive emotions. American. Psychologist, 56, 218–226. doi: 10.1037/0003-066X.56.3.218.PubMedPubMedCentralCrossRefGoogle Scholar
  44. Garrison, A. M., Kahn, J. H., Sauer, E. M., & Florczak, M. A. (2012). Disentangling the effects of depression symptoms and adult attachment on emotional disclosure. Journal of Counseling Psychology, 59(2), 230–239. doi: 10.1037/a0026132.PubMedCrossRefGoogle Scholar
  45. Gay, M. C., Bungener, C., Thomas, S., Vrignaud, P., Thomas, P. W., Baker, R., … Montreuil, M. (2017). Anxiety, emotional processing and depression in people with multiple sclerosis. BMC Neurology, 17(1), 43. doi: 10.1186/s12883-017-0803-8.PubMedPubMedCentralCrossRefGoogle Scholar
  46. Gelso, C. J., & Kanninen, K. M. (2017). Neutrality revisited: On the value of being neutral within an empathic atmosphere. Journal of Psychotherapy Integration. doi: 10.1037/int0000072.Google Scholar
  47. Gilbert, P. (2009). Developing a compassion-focused approach in cognitive behavioural therapy. In G. Simos (Ed.), Cognitive behaviour therapy: A guide for the practising clinician (Vol. 2, pp. 205–220). London: Routledge.Google Scholar
  48. Gillanders, D., & Fleming, P. F. (2006). A test of the interacting cognitive subsystems model using a laboratory analogue of depressive interlock. Clinical Psychology & Psychotherapy, 13(5), 297–305. doi: 10.1002/cpp.499.CrossRefGoogle Scholar
  49. Godfrey, E., Chalder, T., Ridsdale, L., Seed, P., & Ogden, J. (2007). Investigating the active ingredients of cognitive behaviour therapy and counselling for patients with chronic fatigue in primary care: developing a new process measure to assess treatment fidelity and predict outcome. British Journal of Clinical Psychology, 46(3), 253–272. doi: 10.1348/014466506X147420.PubMedCrossRefGoogle Scholar
  50. Goldapple, K., Segal, Z., Garson, C., Lau, M., Bieling, P., Kennedy, S., & Mayberg, H. (2004). Modulation of cortical-limbic pathways in major depression: Treatment-specific effects of cognitive behavior therapy. Archives of General Psychiatry, 61(1), 34–41. doi: 10.1001/archpsyc.61.1.34.PubMedCrossRefGoogle Scholar
  51. Goldfried, M. R. (2013). Evidence-based treatment and cognitive-affective-relational-behavior-therapy. Psychotherapy, 50(3), 376–380. doi: 10.1037/a0032158.PubMedCrossRefGoogle Scholar
  52. Gotlib, I. H., & Joormann, J. (2010). Cognition and depression: current status and future directions. Annual Review of Clinical Psychology, 6, 285–312. doi: 10.1146/annurev.clinpsy.121208.131305.PubMedPubMedCentralCrossRefGoogle Scholar
  53. Greenberg, L. (2008). Emotion and cognition in psychotherapy: The transforming power of affect. Canadian Psychology, 49(1), 49–59. doi: 10.1037/0708-5591.49.1.49.CrossRefGoogle Scholar
  54. Greenberg, L. S. (2007). A guide to conducting a task analysis of psychotherapeutic change. Psychotherapy Research, 17(1), 15–30.CrossRefGoogle Scholar
  55. Greenberger, D., & Padesky, C. A. (1995). Mind over mood: Change how you feel by changing the way you think. New York: The Guilford Press.Google Scholar
  56. Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26. doi: 10.1080/1047840X.2014.940781.CrossRefGoogle Scholar
  57. Grosse Holtforth, M., Hayes, A. M., Sutter, M., Wilm, K., Schmied, E., Laurenceau, J., & Caspar, F. (2012). Fostering cognitive-emotional processing in the treatment of depression: A preliminary investigation in exposure-based cognitive therapy. Psychotherapy and Psychosomatics; Basel, 81(4), 259–260. doi: 10.1159/000336813.CrossRefGoogle Scholar
  58. Hackmann, A., Bennett-Levy, J., & Holmes, E. A. (2011). Oxford guide to imagery in cognitive therapy. Oxford: Oxford University Press. doi: 10.1093/med:psych/9780199234028.001.0001.CrossRefGoogle Scholar
  59. Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry, 23(1), 56–62. doi: 10.1136/jnnp.23.1.56.CrossRefGoogle Scholar
  60. Hart, S. L., Vella, L., & Mohr, D. C. (2008). Relationships among depressive symptoms, benefit-finding, optimism, and positive affect in multiple sclerosis patients after psychotherapy for depression. Health Psychology, 27, 230–238. doi: 10.1037/0278-6133.27.2.230.PubMedPubMedCentralCrossRefGoogle Scholar
  61. Hathaway, S. R., & McKinley, J. C. (1983). Minnesota Multiphasic Personality Inventory: Manual for administration and scoring. Minneapolis: University of Minnesoata Press.Google Scholar
  62. Hauke, G., & Dall’Occhio, M. (2013). Emotional Activation Therapy (EAT): Intense work with different emotions in a cognitive behavioral setting. European Psychotherapy, 11(1), 5–29.Google Scholar
  63. Hayes, A. M. (2015). Facilitating emotional processing in depression: The application of exposure principles. Current Opinion in Psychology, 4, 61–66. doi: 10.1016/j.copsyc.2015.03.032.PubMedPubMedCentralCrossRefGoogle Scholar
  64. Hayes, A. M., & Goldfried, M. R. (1996). Rating scale of therapy change processes. Unpublished Manuscript, University of Miami.Google Scholar
  65. Hayes, A. M., Feldman, G. C., & Goldfried, M. R. (2006). The Change and Growth Experiences Scale: A measure of insight and emotional processing. In L. G. Castonguay & C. Hill (Eds.), Insight in psychotherapy (pp. 231–253). Washington, DC: American Psychological Association.Google Scholar
  66. Hayes, A. M., Beevers, C. G., Feldman, G. C., Laurenceau, J.-P., & Perlman, C. (2005). Avoidance and processing as predictors of symptom change and positive growth in an integrative therapy for depression. International Journal of Behavioral Medicine, 12(2), 111–122. doi: 10.1207/s15327558ijbm1202_9.PubMedCrossRefGoogle Scholar
  67. Hayes, A. M., & Harris, M. S. (2000). The development of an integrative treatment for depression. In S. Johnson, A. M. Hayes, T. Field, N. Schneiderman & P. McCabe (Eds.), Stress, coping, and depression (pp. 291–306). Mahwah, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
  68. *Hayes, A. M., & Strauss, J. L. (1998). Dynamic systems theory as a paradigm for the study of change in psychotherapy: An application to cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 66(6), 939–947. doi: 10.1037/0022-006X.66.6.939.PubMedCrossRefGoogle Scholar
  69. Hayes, A. M., Yasinski, C., Barnes, J. B., & Bockting, C. L. (2015). Network destabilization and transition in depression: New methods for studying the dynamics of therapeutic change. Clinical Psychology Review, 41, 27–39. doi: 10.1016/j.cpr.2015.06.007.PubMedPubMedCentralCrossRefGoogle Scholar
  70. Hayes, S. A., Hope, D. A., & Heimberg, R. G. (2008). The pattern of subjective anxiety during in-session exposures over the course of cognitive-behavioral therapy for clients with social anxiety disorder. Behavior Therapy, 39(3), 286–299. doi: 10.1016/j.beth.2007.09.001.PubMedPubMedCentralCrossRefGoogle Scholar
  71. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change. New York: The Guilford Press.Google Scholar
  72. Hendricks, M. N. (2007). The role of experiencing in psychotherapy: Attending to the “bodily felt sense” of a problem makes any orientation more effective. Journal of Contemporary Psychotherapy, 37(1), 41–46. doi: 10.1007/s10879-006-9033-x.CrossRefGoogle Scholar
  73. Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29(5), 409–416. doi: 10.1002/da.21888.PubMedCrossRefGoogle Scholar
  74. Hollon, S. D., DeRubeis, R. J., Evans, M. D., Wiemer, M. J., Garvey, M. J., Grove, W. M., & Tuason, V. B. (1992). Cognitive therapy, pharmacotherapy and combined cognitive-pharmacotherapy in the treatment of depression. Archives of General Psychiatry, 49, 774–781.PubMedCrossRefGoogle Scholar
  75. Holmes, E. A., & Mathews, A. (2010). Mental imagery in emotion and emotional disorders. Clinical Psychology Review, 30(3), 349–362. doi: 10.1016/j.cpr.2010.01.001.PubMedCrossRefGoogle Scholar
  76. Honkalampi, K., Hintikka, J., Laukkanen, E., & Viinamäki, J. L. H. (2001). Alexithymia and depression: A prospective study of patients with major depressive disorder. Psychosomatics, 42(3), 229–234. doi: 10.1176/appi.psy.42.3.229.PubMedCrossRefGoogle Scholar
  77. Horvath, A. O., & Greenberg, L. (1986). The development of the Working Alliance Inventory: A research handbook. New York: Guildford Press.Google Scholar
  78. Jones, E. E. (2000). Psychotherapy process Q-set (PQS). Therapeutique Action. Northvale, NJ: Jason Aronson Inc.Google Scholar
  79. *Jones, E. E., & Pulos, S. M. (1993). Comparing the process in psychodynamic and cognitive-behavioral therapies. Journal of Consulting and Clinical Psychology, 61(2), 306–316. doi: 10.1037/0022-006X.61.2.306.PubMedCrossRefGoogle Scholar
  80. Kaiser, R. H., Andrews-Hanna, J. R., Spielberg, J. M., Warren, S. L., Sutton, B. P., Miller, G. A., … Banich, M. T. (2015). Distracted and down: Neural mechanisms of affective interference in subclinical depression. Social Cognitive and Affective Neuroscience, 10(5), 654–663. doi: 10.1093/scan/nsu100.PubMedCrossRefGoogle Scholar
  81. Kazantzis, N., Tee, J. M., Dattilio, F. M., & Dobson, K. S. (2013). How to develop collaborative empiricism in cognitive behavior therapy: Conclusions from the C&BP special series. Cognitive and Behavioral Practice, 20(4), 455–460. doi: 10.1016/j.cbpra.2013.03.005.CrossRefGoogle Scholar
  82. Kennedy-Moore, E., & Watson, J. C. (2001). How and when does emotional expression help? Review of General Psychology, 5(3), 187–212. doi: 10.1037/1089-2680.5.3.187.CrossRefGoogle Scholar
  83. Klein, M. (1969). The Experiencing Scale: A research and training manual. Madison: Wisconsin Psychiatric Institute.Google Scholar
  84. Klein, M. H., Coughlan, P. M., & Kiesler, D. J. (1986). The psychotherapeutic process: a research handbook. New York: Guildford Press.Google Scholar
  85. Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. B., Vermeersch, D. A., Clouse, G. C., & Yanchar, S. C. (1996). The reliability and validity of the Outcome Questionnaire. Clinical Psychology & Psychotherapy, 3(4), 249–258. doi: 10.1002/(SICI)1099-0879(199612)3:4<249::AID-CPP106>3.3.CO;2-J.CrossRefGoogle Scholar
  86. Lane, R. D., Ryan, L., Nadel, L., & Greenberg, L. (2015). Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science. Behavioral and Brain Sciences, 38, 1–64. doi: 10.1017/S0140525X14000041.CrossRefGoogle Scholar
  87. Lau, M. A., & Grabovac, A. D. (2009). Mindfulness-based interventions: Effective for depression and anxiety: Evidence supports adjunctive role for the combination of meditative practices and CBT. Current Psychiatry, 8(12), 39–55.Google Scholar
  88. Leahy, R. L. (2015). Emotional schema therapy. New York: The Guilford Press.Google Scholar
  89. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gotzsche, P. C., Ioannidis, J., … Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Annals of Internal Medicine, 151(4), 1–18. doi: 10.7326/0003-4819-151-4-200908180-00136.CrossRefGoogle Scholar
  90. Lindahl, M., & Archer, T. (2013). Depressive expression and anti-depressive protection in adolescence: stress, positive affect, motivation and self-efficacy. Psychology, 4, 495–505. doi: 10.4236/psych.2013.46070.CrossRefGoogle Scholar
  91. Linehan, M. M. (2015). DBT skills training manual. New York: Guilford Publications.Google Scholar
  92. Llewelyn, S., Macdonald, J., & Aafjes-van Doorn, K. (2016). Process–outcome studies. In J. Norcross (Ed.), Handbook of clinical psychology (pp. 451–463). Worcester: American Psychological Association. doi: 10.1037/14773-020.Google Scholar
  93. Lorenzo-Luaces, L., German, R. E., & DeRubeis, R. J. (2015). It’s complicated: The relation between cognitive change procedures, cognitive change, and symptom change in cognitive therapy for depression. Clinical Psychology Review, 41, 3–15. doi: 10.1016/j.cpr.2014.12.003.PubMedCrossRefGoogle Scholar
  94. Lorenzo-Luaces, L., Keefe, J. R., & DeRubeis, R. J. (2016). Cognitive-behavioral therapy: Nature and relation to non-cognitive behavioral therapy. Behavior Therapy, 47(6), 785–803. doi: 10.1016/j.beth.2016.02.012.PubMedCrossRefGoogle Scholar
  95. Mackay, H. C., Barkham, M., & Stiles, W. B. (1998). Staying with the feeling: An anger event in psychodynamic–interpersonal therapy. Journal of Counseling Psychology, 45(3), 279–289.Google Scholar
  96. *Mackay, H. C., Barkham, M., Stiles, W. B., & Goldfried, M. R. (2002). Patterns of client emotion in helpful sessions of cognitive-behavioral and psychodynamic-interpersonal therapy. Journal of Counseling Psychology, 49(3), 376–380. doi: 10.1037/0022-0167.49.3.376.CrossRefGoogle Scholar
  97. McCullough, L., Bhatia, M., Ulvenes, P., Berggraf, L., & Osborn, K. (2011). Learning how to rate video-recorded therapy sessions: A practical guide for trainees and advanced clinicians. Psychotherapy, 48(2), 127–137.Google Scholar
  98. McCullough, L., Kuhn, N., Andrews, S., Kaplan, A., Wolf, J., & Lanza Hurley, C. (2003). Treating affect phobia: A manual for short-term dynamic psychotherapy. New York: The Guilford Press.Google Scholar
  99. Millgram, Y., Joormann, J., Huppert, J. D., & Tamir, M. (2015). Sad as a matter of choice? Emotion-regulation goals in depression. Psychological Science, 26(8), 1216–1228. doi: 10.1177/0956797615583295.PubMedCrossRefGoogle Scholar
  100. Montagno, M., Svatovic, M., & Levenson, H. (2011). Short-term and long-term effects of training in emotionally focused couple therapy: Professional and personal aspects. Journal of Marital and Family Therapy, 37(4), 380–392. doi: 10.1111/j.1752-0606.2011.00250.x.PubMedCrossRefGoogle Scholar
  101. Ogden, P., Minton, K., & Pain, C. (2006). Hierarchical information processing: Cognitive, emotional and sensorimotor dimensions. In P. Ogden, K. Minton & C. Pain (Eds.), Trauma and the body: A sensorimotor approach to psychotherapy (pp. 1–50). New York: Norton & Company.Google Scholar
  102. Panksepp, J. (2007). Neurologizing the psychology of affects: How appraisal-based constructivism and basic emotion theory can coexist. Perspectives on Psychological Science, 2(3), 281–296. doi: 10.1111/j.1745-6916.2007.00045.x.PubMedCrossRefGoogle Scholar
  103. Pascual-Leone, A., & Greenberg, L. S. (2007). Emotional processing in experiential therapy: Why “the only way out is through.” Journal of Consulting and Clinical Psychology, 75(6), 875–887. doi: 10.1037/0022-006X.75.6.875.PubMedCrossRefGoogle Scholar
  104. Porter, R. J., Bourke, C., Carter, J. D., Douglas, K. M., McIntosh, V. V. W., Jordan, J., … Frampton, C. M. A. (2016). No change in neuropsychological dysfunction or emotional processing during treatment of major depression with cognitive–behaviour therapy or schema therapy. Psychological Medicine, 46(2), 393–404. doi: 10.1017/S0033291715001907.PubMedCrossRefGoogle Scholar
  105. Prosser, M., & Watson, J. C. (2007). The relationship of affect regulation to outcome in the treatment of depression. In 22nd annual conference of the Society for the Exploration of Psychotherapy Integration. Lisbon, Portugal.Google Scholar
  106. Ritchey, M., Dolcos, F., Eddington, K. M., Strauman, T. J., & Cabeza, R. (2011). Neural correlates of emotional processing in depression: Changes with cognitive behavioral therapy and predictors of treatment response. Journal of Psychiatric Research, 45(5), 577–587. doi: 10.1016/j.jpsychires.2010.09.007.PubMedCrossRefGoogle Scholar
  107. *Rudkin, A., Llewelyn, S., Hardy, G., Stiles, W. B., & Barkham, M. (2007). Therapist and client processes affecting assimilation and outcome in brief psychotherapy. Psychotherapy Research, 17(5), 613–621. doi: 10.1080/10503300701216298.CrossRefGoogle Scholar
  108. Ryle, A., & Kerr, I. B. (2003). Introducing cognitive analytic therapy: Principles and practice. Chichester: Wiley.Google Scholar
  109. Safran, J. D. (1998). Widening the scope of cognitive therapy: The therapeutic relationship, emotion, and the process of change. Northvale. Lanham, NJ: Jason Aronson Incorporated.Google Scholar
  110. Salgado, J., Meira, L., Santos, A., Cunha, C., Bento, T., Almeida, C., … Pinheiro, P. (2010). Protocolo clínico para investigação: adaptação do manual de terapia cognitivo-comportamental para a depressão. Unpublished manuscript.Google Scholar
  111. Samoilov, A., & Goldfried, M. R. (2000). Role of emotion in cognitive-behavior therapy. Clinical Psychology: Science and Practice, 7(4), 373–385. doi: 10.1093/clipsy.7.4.373.Google Scholar
  112. Sassaroli, S., Brambilla, R., Cislaghi, E., Colombo, R., Centorame, F., Veronese, G., … Ruggiero, G. M. (2015). Emotion-abstraction patterns and cognitive interventions in a single case of standard cognitive-behavioral therapy. Research in Psychotherapy: Psychopathology, Process and Outcome, 17(2), 65–72. doi: 10.4081/ripppo.2014.146.Google Scholar
  113. Schanche, E., Høstmark Nielsen, G., McCullough, L., Valen, J., & Mykletun, A. (2010). Training graduate students as raters in psychotherapy process research: Reliability of ratings with the achievement of therapeutic objectives scale (ATOS). Nordic Psychology, 62(3), 4–20. doi: 10.1027/1901-2276/a000013.CrossRefGoogle Scholar
  114. Schumacher, S., Gaudlitz, K., Plag, J., Miller, R., Kirschbaum, C., Fehm, L., … Ströhle, A. (2014). Who is stressed? A pilot study of salivary cortisol and alpha-amylase concentrations in agoraphobic patients and their novice therapists undergoing in vivo exposure. Psychoneuroendocrinology, 49, 280–289. doi: 10.1016/j.psyneuen.2014.07.016.PubMedCrossRefGoogle Scholar
  115. Schumacher, S., Miller, R., Fehm, L., Kirschbaum, C., Fydrich, T., & Ströhle, A. (2015). Therapists’ and patients’ stress responses during graduated versus flooding in vivo exposure in the treatment of specific phobia: A preliminary observational study. Psychiatry Research, 230(2), 668–675. doi: 10.1016/j.psychres.2015.10.020.PubMedCrossRefGoogle Scholar
  116. Scott, W. D., & Ingram, R. E. (1998). Affective influences in depression: Conceptual issues, cognitive consequences, and multiple mechanisms. In W. F. Flack & J. D. Laird (Eds.), Emotions in psychopathology: Theory and research (pp. 200–215). New York: Oxford University Press.Google Scholar
  117. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2012). Mindfulness-based cognitive therapy for depression. New York: Guilford Press.Google Scholar
  118. Shapiro, D. A., Barkham, M., Rees, A., Hardy, G. E., Reynolds, S., & Startup, M. (1994). Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy. Journal of Consulting and Clinical Psychology, 62(3), 522.Google Scholar
  119. Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin, 86(2), 420–428. doi: 10.1037/0033-2909.86.2.420.PubMedCrossRefGoogle Scholar
  120. Stewart, R. E., & Chambless, D. L. (2007). Does psychotherapy research inform treatment decisions in private practice? Journal of Clinical Psychology, 63(3), 267–281. doi: 10.1002/jclp.20347.PubMedCrossRefGoogle Scholar
  121. Stiles, W. B. (2002). Session Evaluation Questionnaire: Structure and use. Oxford: Miami University.Google Scholar
  122. Stiles, W. B., Elliott, R., Llewelyn, S. P., Firth-Cozens, J. A., Margison, F. R., Shapiro, D. A., & Hardy, G. (1990). Assimilation of problematic experiences by clients in psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 27(3), 411–420.Google Scholar
  123. Stiles, W. B., Morrison, L. A., Haw, S. K., Harper, H., Shapiro, D. A., & Firth-Cozens, J. (1991). Longitudinal study of assimilation in exploratory psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 28(2), 195–206. doi: 10.1037/0033-3204.28.2.195.
  124. *Stringer, J. V., Levitt, H. M., Berman, J. S., & Mathews, S. S. (2010). A study of silent disengagement and distressing emotion in psychotherapy. Psychotherapy Research, 20(5), 495–510. doi: 10.1080/10503301003754515.PubMedCrossRefGoogle Scholar
  125. Strunk, D. R., Adler, A. D., & Hollon, S. D. (2017). Cognitive therapy of depression. In R. J. DeRubeis & D. R. Strunk (Eds.), The Oxford handbook of mood disorders (pp. 411–422). Oxford: Oxford University Press.Google Scholar
  126. Subic-Wrana, C., Greenberg, L. S., Lane, R. D., Michal, M., Wiltink, J., & Beutel, M. E. (2016). Affective change in psychodynamic psychotherapy: Theoretical models and clinical approaches to changing emotions. Zeitschrift Für Psychosomatische Medizin Und Psychotherapie, 62(3), 207–223.PubMedCrossRefGoogle Scholar
  127. Tambs, K., & Moum, T. (1993). How well can a few questionnaire items indicate anxiety and depression? Acta Psychiatrica Scandinavica, 87(5), 364–367.Google Scholar
  128. Teasdale, J. D. (1996). Clinically relevant theory: Integrating clinical insight with cognitive science. In P. M. Salkovskis (Ed.), Frontiers of cognitive therapy (pp. 26–47). New York: The Guilford Press.Google Scholar
  129. Teasdale, J. D. (1999). Emotional processing, three modes of mind and the prevention of relapse in depression. Behaviour Research and Therapy, 37, S53–S77. doi: 10.1016/S0005-7967(99)00050-9.PubMedCrossRefGoogle Scholar
  130. Teasdale, J. D., & Chaskalson, M. (2011). How does mindfulness transform suffering? II: the transformation of dukkha. Contemporary Buddhism, 12(1), 103–124. doi: 10.1080/14639947.2011.564826.CrossRefGoogle Scholar
  131. Thoma, N. C., & McKay, D. (2015). Working with emotion in cognitive-behavioral therapy: Techniques for clinical practice. New York: The Guilford Press.Google Scholar
  132. Town, J. M., Hardy, G. E., McCullough, L., & Stride, C. (2012). Patient affect experiencing following therapist interventions in short-term dynamic psychotherapy. Psychotherapy Research, 22(2), 208–219. doi: 10.1080/10503307.2011.637243.PubMedCrossRefGoogle Scholar
  133. Ulvenes, P. G., Berggraf, L., Wampold, B. E., Hoffart, A., Stiles, T., & McCullough, L. (2014). Orienting patient to affect, sense of self, and the activation of affect over the course of psychotherapy with cluster C patients. Journal of Counseling Psychology, 61(3), 315–324. doi: 10.1037/cou0000028.PubMedCrossRefGoogle Scholar
  134. van Doorn, K., McManus, F., & Yiend, J. (2012). An analysis of matching cognitive-behavior therapy techniques to learning styles. Journal of Behavior Therapy and Experimental Psychiatry, 43(4), 1039–1044. doi: 10.1016/j.jbtep.2012.05.001.PubMedCrossRefGoogle Scholar
  135. Vyskocilova, J., & Prasko, J. (2012). Emotional processing strategies in cognitive behavioral therapy. Activitas Nervosa Superior Rediviva, 54(4), 150–158.Google Scholar
  136. Warwar, S., & Greenberg, L. S. (1999). Client emotional arousal scale–III. Unpublished Manuscript. Toronto: York University.Google Scholar
  137. *Watson, J. C., & Bedard, D. L. (2006). Clients’ emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies. Journal of Consulting and Clinical Psychology, 74(1), 152–159. doi: 10.1037/0022-006X.74.1.152.PubMedCrossRefGoogle Scholar
  138. Watson, J. C., & Prosser, M. (2004). Observer-rated measure of affect regulation (O-MAR). Unpublished manuscript. Toronto: Ontario Institute for Studies in Education of the University of Toronto.Google Scholar
  139. Watson, J. C., Gordon, L. B., Stermac, L., Kalogerakos, F., & Steckley, P. (2003). Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. Journal of Consulting and Clinical Psychology, 71(4), 773. doi: 10.1037/0022-006X.71.4.773.
  140. *Watson, J. C., McMullen, E. J., Prosser, M. C., & Bedard, D. L. (2011). An examination of the relationships among clients’ affect regulation, in-session emotional processing, the working alliance, and outcome. Psychotherapy Research, 21(1), 86–96. doi: 10.1080/10503307.2010.518637.PubMedCrossRefGoogle Scholar
  141. Westbrook, D., & Kirk, J. (2005). The clinical effectiveness of cognitive behaviour therapy: Outcome for a large sample of adults treated in routine practice. Behaviour Research and Therapy, 43(10), 1243–1261. doi: 10.1016/j.brat.2004.09.006.PubMedCrossRefGoogle Scholar
  142. Whelton, W. J. (2004). Emotional processes in psychotherapy: Evidence across therapeutic modalities. Clinical Psychology & Psychotherapy, 11(1), 58–71. doi: 10.1002/cpp.392.CrossRefGoogle Scholar
  143. White, J. (2008). CBT and the challenge of primary care: Developing effective, efficient, equitable, acceptable and accessible services for common mental health problems. Journal of Public Mental Health, 7(1), 32–41. doi: 10.1108/17465729200800006.CrossRefGoogle Scholar
  144. Wiles, N., Thomas, L., Abel, A., Barnes, M., Carroll, F., Ridgway, N., … Metcalfe, C. (2014). The prevalence of treatment-resistant depression in primary care. Health Technology Assessment, No. 18.31. Southampton (UK): NIHR Journals Library. Retrieved from
  145. *Wiser, S. L., & Goldfried, M. R. (1993). Comparative study of emotional experiencing in psychodynamic-interpersonal and cognitive-behavioral therapies. Journal of Consulting and Clinical Psychology, 61(5), 892–895. doi: 10.1037/0022-006X.61.5.892.PubMedCrossRefGoogle Scholar
  146. Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: The Guilford Press. doi: 10.1016/j.jct.2003.07.002.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.The Derner Institute of Advanced Psychological StudiesAdelphi UniversityGarden CityUSA
  2. 2.Yeshiva UniversityNew YorkUSA

Personalised recommendations