British Psychological Society Division of Clinical Psychology Annual Conference “Going for gold” Symposium presented on 3 rd December 2015, London Emotional Processing; new developments in medicine, psychology and psychosomatics Chair; Professor Roger Baker

Order of presentations The Emotional Processing Scale; a new pan-diagnostic assessment of emotional style Professors Roger Baker & Peter Thomas, Bournemouth University Emotional processing in patients with psychogenic non-epileptic seizures and the implications for psychological treatment Stephanie Howlett, Professor Marcus Reuber & Barbora Novakova, Sheffield Teaching Hospitals NHS Foundation Trust and Sheffield University Emotional Processing in Childbirth (EPIC) study; does poor emotional processing predict the development of postnatal depression Dr Carol Wilkins & Professor Debra Bick, Bournemouth University & King’s College London Chronic pain and emotional processing Professor Jorge Esteves, British School of Osteopathy, London The role of emotional processing in cancer survivors with post-traumatic stress disorder Dr Gareth Abbey, Dr Simon Thompson & Professor Tamas Hickish, Bournemouth University Panel Discussion

Roger Baker, Peter Thomas & Sarah Thomas, Bournemouth University December 2015 In symposium “Emotional Processing; new developments in medicine, psychology & Psychosomatics” The Emotional Processing Scale; a new pan-diagnostic assessment of emotional style

Emotions are so ephemeral one wonders if psychometrics are possible

emotional processing involves a change in emotional state from a distressed to a more settled condition so measurement is even more complex

Aims of the emotional processing scale Measure emotional processing styles and deficits Predict the role of emotional processing in physical and psychological disorder Measure changes in emotion during therapy Provide a framework to categorize patients for research or therapy General research tool to investigate emotions Assist therapists in formulating patients’ problems

Prof Peter Thomas Statistician Prof Roger Baker Co-ordinator Dr Sarah Thomas Senior Research Fellow Researchers Matthew OwensLara TosunlarAnn HendersonMariaelisa Santonastaso Dorset Research & Development Support Unit Dorset HealthCare NHS Trust Phil Gower, Gareth Abbey, Anna Whittlesea, Sandra May, Claire Nash, Lisa Gale, Dan Marshall, Eimear Corrigan + honorary staff Research Publication Officers

The Emotional Processing Scale is now published

Emotional processing represents a completely new way of thinking f about psychological distress

In anxiety, depression, eating disorders, alcoholism, brain injury etc EPS scores are highly significantly elevated in all groups. So far we have not found any psychological disorder group in which emotional processing is remotely the same as with healthy normal individuals

Pan-diagnostic Also as Carol Wllkin’s paper and Gareth Abbey’s papers will show, the Emotional Processing Scale equals or outperforms symptom scales in predicting diagnoses of depression and post-traumatic stress The question is ”Can we regard psychological disorder as categorical or….

…a fundamental dimension underlying all psychopathology

I didn’t think like this when I first started researching Cognitive Invalidation and panic attacks

“I feel butterflies in my tummy and feeling I want to cry. Then I suppress my feelings. I take a great big breath, hold it in, tense myself or put my mind onto something else – take the dog out for a walk, do the housework. I say ‘don’t be so b….. stupid, pull yourself together” Suppression of emotional experience

Control of emotional experience “Before I wanted everything to be perfect – nearly every day I was wanting to stay on this happy level all the time. I didn’t want to appear out of control to anyone else – angry,unhappy, I’m not going to let this bother me – this ‘nothing bothers me’ exterior. Now I’ve come to the regrettable conclusion that ups and downs are normal.”

Control of three emotions: Anger, Sadness and Anxiety Strong control Slight control Control n = 48 n = 118 n = 387

Emotional Processing “most people successfully process the overwhelming majority of the disturbing events that occur in their lives” Rachman 1980 “A process whereby emotional disturbances are absorbed and decline to the extent that other experiences and behaviour can proceed without disruption”

Metaphors conveying emotional processing ‘a process where emotional disturbances are absorbed’ (Rachman, 1980). ‘the process of transformation is a matter of breaking down the incoming stimulation’ (Rachman, 1980). ‘The majority of people adapt to emotional disturbances and continue, or resume, their regular behaviour. A significant minority however fail to adapt’ (Rachman, 2004,). ‘The new information, which is at once cognitive and affective, has to be integrated into the evoked information structure for an emotional change to occur’ (Foa & Kozak, 1986). ‘constitutes the essence of recovery or emotional processing’ (Foa et al., 2006). ‘emotional processing occurs only when it is encoded and incorporated into existing knowledge, that is, when new learning has occurred’ (Foa et al., 2006).

Theories which helped to shape the emotional processing model : Emotion theory (Bucci, 1997a; Epstein, 1994, 1998; Frijda, 1988; Leventhal, 1979; Strongman, 1987); Cognitive theory (Kelly, 1963; Lazarus & Averill, 1972; Ortony, Clore, & Collins, 1988; Spielberger, 1972); Behaviour therapy (Foa & Kozak, 1986; Marks, 1978,1979; Rachman, 1980); Cognitive therapy (Beck, Emery, & Greenberg, 1985); Experiential theory and therapy (Gendlin, 1962, 1996; Rogers, 1961); Psychoanalysis (Freud, 1909, 1952); Psychosomatics (Seyle, 1956; Traue & Pennebaker, 1993); Neuropsychology (Damasio, 1994; LeDoux, 1993, 1998).

Psychological mechanisms integrated within the model Stressor, Trauma/ “input event” Memory of input Cognitive Appraisal of input and of cognitive appraisal of emotional experience Emotion Schemas Family & cultural “emotion rules” Emotional Experience Emotional Expression Emotional Understanding Emotion Regulation

Initial item selection Clinical experience Schematic model Case histories Literature 300 draft items/ideas 152-items 101-items

Development of Emotional Processing Scale Version questions 60 healthy people 53 patients visiting the doctor 37 mental health patients n = 150 Analysis of data Item Analysis Distributions Missing scores ANOVA Preliminary Factor Analysis Given to

Development of Emotional Processing Scale Version 2 45 questions 100 students 73 older healthy people 124 cancer patients 16 back pain patients 147 mental health patients n = 460 Analysis of data Internal and test- retest reliability Item & subscale correlation Factor Analysis ANOVA & t tests Concurrent reliability Sensitivity to change Given to

Development of Emotional Processing Scale Version 3 53 questions 310 healthy people 86 patients visiting the doctor 114 pain patients 180 mental health patients n = 690 Analysis of data Internal & test- retest reliability Item & subscale correlations Factor Analysis ANOVA & t tests Concurrent reliability Given to

Development of Emotional Processing Scale FINAL VERSION 25 QUESTIONS

1.I smothered my feelings completely disagree in between agree completely disagree agree completely disagree in between agree completely disagree agree How the questionnaire is rated – based only on the last week 2. Unwanted feelings kept intruding. 3. When upset or angry it was difficult to control what I said.

Collaboration There are 85 research collaborators throughout the world

Worldwide EPS-25 Translations Translations of the EPS-25 To enable worldwide research, translations into 13 languages have been completed with our partners: Chinese Danish Egyptian Arabic French French Canadian Hindi Italian Japanese Marathi Polish Portuguese Spanish Swedish

In July 2015 the EPS was published by

3 elements to the EPS

Administrators Manual

EPS Manual Explains how to use the scale with 15 worked case examples depending on different assessment aims; Identifying targets for intervention; Stephen, a soldier with post traumatic stress disorder Measuring changes a group; Evaluation of a new therapy for medically unexplained symptoms Personal development; Andrew, a successful GP who always felt there wa something “missing” emotionally Assessing risk; Assessing vulnerability in paramedics in an NHS Ambulance trust Assessing ability to cope with medical procedures; Martin a 25 year old student with Crohn’s disease facing surgery for an ileostomy Use of cut-off scores; Investigating the relationship between memory and emotional processing in students

Norms Booklet

Mental health Addiction 337 Addiction – long term abstinent26 Eating disorders 76 General psychological difficulties (Depression/anxiety/PTSD) 78 Non-epileptic attack disorder55 Traumatic Brain Injury30 Childhood experiences Youth offenders 139 Childhood Sexual Abuse52 Pain Chronic pain 310 International Polish sample 521 Indian students 304 Portuguese sample 1156 Egyptian students 216 Japanese sample 830 English-speaking students (USA, Australia, Canada) 547 Lung Cancer38 Healthy Community (UK) 1383 Other Pregnant women 974 Total 7072

The Scoring Booklet

The client/patient makes their evaluation on the basis of their emotional reactions in the last week only

The test administrator tears off a back section

To reveal the profile chart and scoring sheet

They enter the raw scores onto the scoring sheet

And calculate means for each subscale and the total score

This is then transferred to the profile chart

So the user/ client/patient can see their scores

The scale, profile chart and scoring sheet

Problematic emotional processing styles Based on the emotional processing model, clinical utility and several series of factor analyses with the different iterations of the scale. But finally using Maximum Likelihood Factor Analysis with Promax Rotation and five fixed factors in Baker et al (2010), n= 603 and independently in Baker, Thomas, Thomas, Santonastaso and Corrigan 2015, n=3054

Mind & Body ₪ Impoverished emotional experience “Poor emotional intelligence” “Emotionally unaware” “Alexithymic” “mild asbergers” “somatizer” “Emotionally illiterate”

e.g. “My emotions felt blunt/dull” “I was unable to work out if I felt ill or emotional”

Mind & Body ₪ Signs of unprocessed emotion

e.g. “Unwanted feelings kept intruding” “I repeatedly experienced the same emotion”

Mind & Body ₪ Avoidance

e.g. “I tried hard to avoid things that might upset me” “I tried to only talk about pleasant things”

Mind & Body ₪ Suppression

e.g. “I bottled up my emotions” “I kept quiet about my feelings”

Mind & Body ₪ Unregulated Emotion

E.g. “When upset or angry it was difficult to control what I said” “ I reacted too much to what people said or did”

Our hope is the Emotional Processing Scale provides a new dimension of assessment for research and therapy covering both health and psychopathology

Emotional Processing Websites Theory Assessment Therapy