1. Person-Centred and Experiential Therapies for Depression and Anxiety Ladislav Timulak Trinity College Dublin

2. Person-Centred and Experiential Therapies Have a great tradition starting with Rogers and now primarily through the emotion-focused therapy researchers Nevertheless somewhat ambivalent with regard the mainstream classification of psychological disorders Recognising human suffering in ‘classifiable’ psychopathological symptoms But also seeing that optimal human state involves also vulnerability (which for instance is an invitation to human connection) and perhaps conflictual resolve

3. Depression Most studied person-centred/experiential therapies: Person-centred Therapy (NICE, 2009 recognised 1 RCT; King et al., 2000) Emotion-Focused Therapy (NICE, 2009 recognised 3 RCTs; Greenberg & Watson, 1998; Goldman et al., 2006; Watson et al., 2003)

4. Elliott et al., 2013 cover 27 studies (34 client samples) of humanistic-experiential therapies for depression not all RCTs and include various therapies (incl. person-centered, emotion-focused, Gestalt, Focused Expressive, attachment-based family therapy, groups versions of some of those therapies, etc.) Equivalent to compared treatments (mainly CBTs) Process-guiding treatments appearing more effective

5. Humanistic Psychological Therapies competences framework (Roth, Hill, & Pilling, 2009) In the context IAPT and the roll out of CBT Identifying basic competences common to humanistic therapies Identifying specific competences not shared by all humanistic therapies

6. Counselling for Depression competences framework In the context of Humanistic Psychological Therapies competences Using person-centred (PCT) and a selection of emotion- focused (EFT) competences (adapted by Hill, 2014) Formulated in a book format (Sanders & Hill, 2014) Now being tested in PRaCTICED trial (Barkham et al.) IAPT providing training (curriculum developed by Hill, 2011) British Association for Counselling & Psychotherapy (BACP) collaborates with several universities that provide the CfD training (they are listed on BACP website)

7. Some features of CfD Knowledge of depression Time-limited work (6-10 sessions; up to 20 if required) Goals, assessment and review of progress Basic person-centred stance Accessing and expressing emotions Reflecting on them and making sense Tasks: clearing a space, systematic evocative unfolding, promotion of emotion regulation, work with conflicting parts of the self and unfinished business issues.

8. Anxiety Elliott et al. (2013) overview and meta-analysis suggested (of mainly supportive and PCT therapies): – Uncontrolled pre-post studies (19 studies, 20 samples) suggesting large effects – Controlled studies (n=4) medium effects – Comparative studies (n=19), mainly against CBT showing small to medium negative effect, that shrunk to small when controlled for allegiance Majority studies used variations of supportive therapy rather than genuine PCT Most studies for GAD

9. Anxiety The studies that would test person-centred or experiential therapy developed as a treatment for some anxiety disorders where almost entirely missing Recent years: development of genuine experiential treatments informed by knowledge about anxiety disorders and their treatment

10. Anxiety Projects Emotion-Focused Therapy (EFT) and PCT for Social Anxiety (Elliott, Glasgow) EFT for Social Anxiety (Shahar, Israel) EFT for Generalised Anxiety Disorder (Watson, Toronto) EFT for Generalised Anxiety Disorder (Timulak, Dublin)

11. First outcomes

12. Elliott, 2012; Elliott & Rodgers, 2012 Partially randomised comparison of EFT (n=21) and PCT (n=29) for social anxiety The effects sizes on the principal measure Social Phobia Inventory (SPIN): – EFT (d=1.75) – PCT (d=1.01)

13. Shahar (2014) EFT for Social Anxiety (multiple baseline case studies – delayed start, n=12) Effect size on the principal measure, Cohen’s d=1.24

14. Timulak et al., 2014 – EFT for GAD study A treatment development study An open trial n=14 A comparative RCT with CBT in preparation The first results presented at SPR

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16. Benchmarking using the principal measure (GAD-7) Clarke et al. (2009) of two UK ‘IAPT demonstration sites’ offering CBT related therapy to people with anxiety and depression (not only GAD) the Timulak et al.’s study Cohen’s d=2.48; while Clarke et al.’s data for one site indicate a pre-post Cohen’s d=1.36 (N=1647; pre mean 13.9, post mean 6.8;), and for the other site Cohen’s d=1.35 (N=221; pre mean 13.7, post mean 6.8;). 16

17. Titov and colleagues’ (2011) RCT studying transdiagnostic internet treatment for anxiety and depression reported data on the GAD-7 for the treatment (anxiety) group indicated a pre-post Cohen’s d=0.76 (N=19; pre mean 11.68, post mean 7.63;), Our study d=2.48 17

18. Second principal measure benchmark GADSS When compared to Craske and colleagues’ (2011) internet-based study of Disorder-Specific Impact of Coordinated Anxiety Learning and Management Treatment for Anxiety Disorders in Primary Care, The Timulak et al. study reported a pre-post difference on the GADSS of d =2.43, While Craske and colleagues report data which indicated a base-line to 6-month difference, in the intervention group, d=0.44 (base-line 13.36, 6-month 8.85;), 18

19. Stanley and colleagues (2009) CBT for older adults in primary care, data indicated a pre- post difference on the GADSS for the CBT group of d=0.77 (N=115; pre mean 11.4, post mean 8.9), The Timulak et al. study d =2.43, 19

20. Common features of the EFTs for anxiety (apart from Empathic relationship and experiential tasks) Anxiety is seen as a secondary emotion that leads to avoidance The clients are avoiding underlying core painful emotions such as shame in social anxiety Avoidance is overcome by working on the self-interrupting, self-scaring or self-worrying process – (awareness and compassion and boundary setting experiences are used to mobilise resolve to overcome the avoidance) Core painful emotions (e.g. shame, loneliness, primary fear) are accessed in treatment and made more tolerable Unmet needs are articulated (e.g., acceptance in case the underlying shame) Painful maladaptive emotions are transformed by the generation of adaptive emotions such as – compassion and healthy protective anger

21. Conclusion Exciting developments in Person- centred/experiential therapies for anxiety disorders The first attempts at developments of genuine person-centred/experiential well underway with promising first data Genuine person-centred/emotion-focused theoretical framework for working with anxiety is being developed – although there is some overlap with dominant CBT theories (e.g., overcoming avoidance), the PCT/EFT models distinctively different