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In-session emotional expression predicts symptomatic and panic-specific reflective functioning improvements in
John R Keefe1, Zeeshan M Huque1, Robert J DeRubeis1
1Department of Psychology.
Psychotherapy (Chicago, Ill.)
|March 15, 2019
Summary
Higher emotional expression in early panic-focused psychodynamic psychotherapy (PFPP) sessions predicts better outcomes for panic disorder. However, this positive association is diminished in patients with borderline personality traits.
Area of Science:
- Psychotherapy Research
- Clinical Psychology
- Psychodynamic Psychiatry
Background:
- Panic-focused psychodynamic psychotherapy (PFPP) aims to improve panic disorder by exploring conflicted emotions, fostering panic-specific reflective functioning (PSRF).
- In-session emotional expression is a potential marker for engaged affective processing during therapy.
Purpose of the Study:
- To examine if the degree of in-session emotional expression in early PFPP sessions predicts subsequent improvements in panic disorder symptoms and PSRF.
- To investigate whether personality disorder traits moderate the relationship between emotional expression and therapeutic outcomes.
Main Methods:
- 44 patients undergoing a 24-session PFPP protocol were assessed for emotional expression (verbal and nonverbal) by blinded observers in sessions 2, 5, and 10.
- Robust regressions analyzed the association between average emotional expression and subsequent changes in symptoms and PSRF, controlling for early outcomes.
- Moderation analyses explored the impact of personality disorder criteria (obsessive-compulsive, borderline) on this relationship.
Main Results:
- Higher levels of emotional expression across early sessions significantly predicted greater subsequent improvement in both panic disorder symptoms and PSRF.
- Specifically, the expression of grief/sadness was linked to symptomatic improvement.
- Patients with more borderline personality criteria showed a weaker, potentially negative, association between emotional expression and symptom improvement.
Conclusions:
- In-session emotional expression in early PFPP is a promising indicator of positive therapeutic process and predicts future symptom and PSRF gains in panic disorder.
- The beneficial effect of emotional expression on symptom improvement is attenuated in patients with comorbid borderline personality traits.
- These findings highlight the importance of emotional engagement in PFPP and suggest considering personality factors when assessing therapeutic progress.
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