Emotion cascade: Harnessing emotional sequences to enhance chair work interventions and reduce self-criticism

This study examines if experiencing the sequence of primary maladaptive emotions followed by primary adaptive emotions in-session predicts therapeutic change and whether this sequence mediates the impact of therapist emotional reflections on outcomes at post-treatment and follow-up.

Nineteen participants with high self-criticism underwent 10-12 sessions of emotion-focused therapy (EFT). Therapist responses focusing on emotions, thoughts, and actions were coded for two sessions (sessions 6-12) during the initial 10 minutes prior to chair work. Clients' emotional states were coded using the Classification of Affective Meaning States (CAMS) during the subsequent chair work. Self-criticism and depression were measured at pre-treatment, post-treatment, and 3-month follow-up.

Primary maladaptive emotions and the transformational sequence (primary maladaptive followed by adaptive emotion) predicted reductions in self-criticism at post-treatment, with the transformational sequence also predicting improvements at follow-up. The impact of therapist focus on emotions on depression and self-criticism at post-treatment and follow-up was mediated by the transformational sequence.

The transformational sequence predicts therapeutic outcomes and mediates the impact of therapist responses focused on the client's emotion and therapeutic results. Implications for therapist training are discussed.