Emotion-focused Therapy for Depression
EFT has been recognized by Division 12 of the American Psychological Association as an evidence-based treatment for depression (APA residential Task Force on Evidence-Based Practice, 2006; Strunk, n.d.). In addition, in three randomized clinical trials conducted by two research teams, two of these studies found that adding emotion-focused therapy interventions to a person-centered empathic relationship led to better outcome and lower relapse rates than a person-centered empathic relational treatment alone. In addition, EFT was found equivalent to CBT in reducing depressive symptoms and superior in reducing interpersonal problems (Watson et al., 2003). In terms of process-outcome research, EFT has contributed significantly to our understanding of in-session process variables that are related to psychotherapeutic change. EFT process research demonstrates that emotions must be activated in therapy to be processed in awareness. Furthermore, in studies of the change process, better treatment outcome has been predicted by higher in-session emotional arousal during mid-treatment, in addition to subsequently reflecting on and making meaning of aroused emotion (Pos et al., 2017; Warwar & Greenberg, 1999).
From an EFT view of depression, the self has lost a sense of vitality and resilience, mainly by losing contact with primary needs and emotions (Greenberg & Watson, 2006). Problems in the adequate emotional processing of their experiences lead people to become distant from their own inner adaptive resources and needs that would promote healthier functioning. These emotional processing problems leave a person stuck in the same old problematic narratives and result in secondary feelings of hopelessness and helplessness. Additionally, persistent unhealthy depressive emotion schemes stemming from unprocessed past events, activate overwhelming experiences dominated by shame, fear of abandonment, insecurity/helplessness, or sadness/loneliness; when these unprocessed past events are not fully processed, it leaves an individual in a state of depressive hopelessness. These problematic emotion schemes usually develop through early life experiences involving humiliation, rejection, abandonment, loss, helplessness, or powerlessness.
There is general agreement that transforming emotion schemes or schemas is an essential treatment target across all treatments for enduring resolution of depression to occur (Greenberg & Watson, 2006; Teasdale, 1999). In EFT for depression, emotion schemes of shame are common, and they get masked by secondary emotions. Activation of these unhealthy emotion schemes of shame is often accompanied by negative self-cognitions such as “I am defective”, or “I am worthless”. EFT of depression, targets transforming the problematic emotion schemes that are the cause of a person’s depression and underlie interpersonal and cognitive problems (Greenberg & Watson, 2006). Through therapy, healthy emotions are accessed to transform unhealthy emotions and to organize the person for healthy responses. For example, in resolving self-criticism, it is often necessary to access autobiographical childhood memories to activate these emotion schemes of shame and the related problematic developmental histories. Treatment first involves accessing the emotionally based emotion-scheme of a “weak” or “bad” sense of self at the core of a client’s depression. To do this, a client must enter into their core, painful unhealthy state to be able to transform it. It is important to note that in depression, clients often are only aware of secondary reactive feelings of hopelessness or diffuse anxiety, and the therapy work involves empathic exploration to identify the primary emotions.