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.