Summary
The purpose of this study was to examine the therapeutic process and effects of Affect Phobia Therapy (APT), a type of psychotherapy that emphasizes the exploration and restructuring of emotions, in the treatment of a patient diagnosed with cluster C personality disorder. The study used a single-case observational design, examining video recordings of the therapy sessions and using a quantitative observer-rated assessment tool, the Achievement of Therapeutic Objectives Scale (ATOS), as well as qualitative descriptions of the micro-processes and general information about the psychotherapeutic practice. The study aimed to shed light on the mechanisms of change in APT and address the ongoing debate in the field of psychotherapy research about the effective components of psychotherapy and the lack of identified robust mechanisms of change. The study also discusses the importance of affect in psychotherapy and the tension between the widespread belief that emotional exploration is therapeutic and the lack of empirical support for affect-focused therapies showing better outcomes than those that are not affect-focused. The study also discusses the role of insight and mentalization in the therapeutic process and their potential as process variables that can predict positive treatment outcomes.
Psychotherapy research is the study of the effectiveness and mechanisms of change in psychotherapy, which is a type of treatment that aims to help individuals address and resolve emotional, behavioral, and mental health problems. While it is well established that individual psychotherapy is effective, there is still debate about which specific forms of therapy are the most effective and why they work. Meta-analyses of psychotherapy have not consistently shown one type of therapy to be more effective than another, and there have been few robust mechanisms of change identified. Clinical significance refers to a treatment's ability to meet standards of efficacy set by various stakeholders, and is different from statistical significance, which is based on statistical analysis. There is a need for more research on non-responders, or patients who do not benefit from treatment, as well as on identifying predictors of treatment outcomes.
Single-case observational designs, also known as case studies, involve the detailed examination of a single individual or a small group of individuals. These designs are useful for exploring unique features and providing insight into the therapeutic process. They can be a valuable supplement to group-level statistical hypothesis testing, which can overlook unique features and only consider common themes. Single-case designs are often used in psychotherapy research as a complement to randomized controlled trials (RCTs), which have been criticized for their poor statistical power, limited generalizability due to small sample sizes, and lack of causal explanation. Change process research (CPR) is a type of research that aims to understand the mechanisms and processes of therapeutic change, and single-case student research projects can be a useful way to expose students to actual therapeutic practice in a professional training program.
This thesis uses a single-case observational design to examine the therapeutic process of one patient receiving Affect Phobia Therapy (APT). APT is a form of psychotherapy that focuses on the role of affect, or emotions, in psychological difficulties and change. It is based on the work of Silvan Tomkins, who proposed that affect serves as a signal for action and is related to the experience of pleasure or unpleasure. APT aims to help individuals identify and express their emotions, and to develop new ways of coping with difficult affective experiences. The study uses both quantitative measures, in the form of the Achievement of Therapeutic Objectives Scale (ATOS), and qualitative methods, including session transcriptions, to understand the processes and effects of affective restructuring in APT.
Affect, or emotions, are an important aspect of human experience and play a role in driving behavior and forming relationships. They are also believed to be central to psychological difficulties and therapeutic change. There are several forms of psychotherapy that focus on the exploration and expression of emotions, such as Affect Phobia Therapy (APT), mentalization-based treatment (MBT), accelerated experiential dynamic therapy (AEDP), intensive short-term dynamic therapy (ISTDP), short-term dynamic psychotherapy (STDP), and emotion-focused therapy (EFT). Research has suggested that there is a correlation between affect focus in therapy and positive therapeutic outcomes, but clinical trials have not consistently shown that therapies that are specifically focused on affect have better outcomes than those that are not. This has led to the suggestion that affect may be so prevalent in therapy that all therapies work with it, regardless of whether it is a specific focus. Additionally, the therapeutic alliance, or the relationship between the therapist and patient, has been identified as a significant predictor of treatment outcome, regardless of the specific type of therapy being used.
It seems that there is evidence to support the idea that affect-focus, or the exploration and regulation of emotions, can be therapeutic in various forms of psychotherapy. However, there is also research to suggest that affect-focus may not necessarily be a necessary component of successful therapy, and that the therapeutic relationship and alliance may be more important factors in determining treatment outcomes. There is also some debate about whether cognitive or affect-focused approaches are more effective, with some research suggesting that a combination of both may be most beneficial. Additionally, the concept of mentalization, or the ability to reflect on and understand one's own and others' mental states, has been found to be important in the therapeutic process and may be related to affect focus and insight. Overall, it seems that the role of affect and emotion in psychotherapy is complex and multifaceted, and more research is needed to fully understand the relationship between affect focus and therapeutic outcomes.
The thesis examined the relationship between three variables measured by the Affect Temperament and Style Inventory (ATOS) in a psychotherapy context. The study used a single case design to examine the temporal fluctuations and interactions between these variables in the context of Affect Phobia Therapy (APT), which is a form of short-term dynamic psychotherapy. The three variables were F (the frequency of affective activation), D (the depth of affective activation), and SoS (sense of self). The study found that F was significantly correlated with increased SoS, but found no significant relationship between F and D or between D and SoS. The study also found that the therapeutic alliance was strong and that the patient showed significant improvements in symptoms, interpersonal problems, and unhealthy personality functioning over the course of therapy and during the follow-up period. We discuss the findings in light of previous research on affect, insight, and self-representations, and suggest that the focus on affect in APT may have facilitated emotional restructuring and affect consciousness, leading to changes in the patient. We also highlight the importance of the therapeutic alliance and suggest that future research should examine the mechanisms underlying change in psychotherapy more broadly.
The study examined the temporal fluctuations and interactions between three selected variables from the Affect Thermometer Observational Scale (ATOS) in the context of Affect Phobia Therapy (APT). The study used a single-case observational design and analyzed data from 33 sessions of APT for one patient with cluster C personality disorders. TWe found that the patient's F (focus on feelings) significantly increased over the course of therapy and that high D (depth of affect) was predictive of low F, while high F predicted low D. However, the study did not find a significant relationship between D and self-compassion (SoS). The study also found that the patient showed significant improvements in symptoms, interpersonal problems, and unhealthy personality functioning during the course of therapy and the follow-up period. The study discusses the potential mechanisms for clinical change in the context of the APT model and suggests that the focus on feelings in therapy may have facilitated emotional restructuring and improved the patient's ability to regulate emotions. However, the study also acknowledges the limitations of its single-case observational design and the need for further research to confirm the findings and examine the mechanisms of change in psychotherapy.
The thesis found that more focus on feelings (F) in a therapy session was associated with increased self-compassion (SoS) in the subsequent session, while more focus on insight (D) in a session was associated with lower levels of F and SoS in the next session. The study also found that the patient experienced significant clinical change, as indicated by improvements in symptom severity and interpersonal functioning.
The study found that there were small linear trends in the data but no significant correlations between the ATOS variables over the course of therapy. However, the study also found that the therapist demonstrated high expertise in APT and that the patient was well suited for this form of therapy, which may have contributed to the observed significant clinical change (return to normal functioning) in the patient. The study suggests that the long-term effect of repeated process learning with a sustained focus on affects and their associated meaning may have induced essential experiences in the patient's self-understanding (sense of self) and subsequent character change. The study also discusses the importance of affect in psychotherapy and the tension between the widespread belief that emotional exploration is therapeutic and the lack of empirical support for affect-focused therapies showing better outcomes than those that are not affect-focused. The study also discusses the role of insight and mentalization in the therapeutic process and their potential as process variables that can predict positive treatment outcomes. The study concludes by stating that single-case studies can add important knowledge about the mechanisms of change in psychotherapy, but cannot make predictions about psychotherapeutic processes common across patients. The study recommends further research on the relationship between affect, insight, and sense of self, and the underlying processes of change, using larger samples with a focus on micro-processes.
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