Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-06-20T03:13:52.187Z Has data issue: false hasContentIssue false

Levels of emotional awareness during psychotherapy among gynecologic cancer patients

Published online by Cambridge University Press:  08 June 2018

Shannon Myers Virtue*
Affiliation:
Helen F. Graham Cancer Center & Research Institute, Newark, DE
Sharon L. Manne
Affiliation:
Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
Kevin Criswell
Affiliation:
Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
David Kissane
Affiliation:
Monash University, Clayton, VIC, Australia
Carolyn J. Heckman
Affiliation:
Fox Chase Cancer Center, Philadelphia, PA
David Rotter
Affiliation:
Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
*
Author for correspondence: Shannon Myers Virtue, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, 4701 Ogletown-Stanton Road Suite 2200 Newark, DE 19713. E-mail: shannon.virtue@christianacare.org

Abstract

Objective

Emotional awareness is the ability to recognize, describe, and attend to emotions. A known correlate is emotional processing, the ability to orient to and use inner experiences for information. The goal was to examine emotional awareness during therapy among gynecologic cancer patients, identify baseline predictors, and explore the relationship between in-session emotional awareness and processing.

Method

Psychotherapy and baseline data from a randomized controlled trial comparing a supportive counseling (SC) intervention and a cognitive-behavioral coping and communication (CCI) intervention were used. The sample was patients with gynecologic cancers randomized to either therapy (N = 246). Emotion episode transcripts from the first, middle, and sixth of seven in-person sessions were coded for emotional awareness using the Program for Open-Ended Scoring and emotional processing using the Experiencing Scale. Descriptive and regression analyses were conducted.

Result

Participants had moderate in-session emotional awareness. SC participants exhibited higher levels of awareness in the first (p < 0.001) and sixth (p = 0.002) sessions than CCI participants. Awareness was positively correlated with emotional processing in the first and sixth SC sessions (r = 0.25 and 0.24, respectively) and all CCI sessions (r = 0.29–0.31). Baseline negative emotion expression was associated with awareness during the sixth SC session. Baseline cancer-specific distress was associated with awareness during the sixth CCI session.

Significance of results

SC may facilitate emotional awareness. Greater emotional awareness in therapy may facilitate emotional processing, which is an important component of most psychotherapies. Patients who are psychologically distressed may exhibit more awareness than others. Similarly, greater emotional awareness may signal greater patient distress.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barchard, KA et al. (2010) Computer scoring of the Levels of Emotional Awareness Scale. Behavioral Research Methods 42, 586595.Google Scholar
Beutel, ME et al. (2013) Implementing panic-focused psychodynamic psychotherapy into clinical practice. The Canadian Journal of Psychiatry 58, 326334.Google Scholar
Cella, DF et al. (1993) The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology 11, 570579.Google Scholar
Castonguay, LG et al. (1996). Predicting the effect of cognitive therapy for depression: A study of unique and common factors. Journal of Consulting and Clinical Psychology 64, 497504.Google Scholar
Ciere, Y et al. (2017). Distinct trajectories of positive and negative affect after colorectal cancer diagnosis. Health Psychology 36, 521528.Google Scholar
Classen, C et al. (1996) Coping styles associated with psychological adjustment to advanced breast cancer. Health Psychology 15, 434437.Google Scholar
Feldman, G et al. (2009) Change in emotional processing during a dialectical behavior therapy-based skills group for major depressive disorder. Behaviour Research and Therapy 47, 316321.Google Scholar
Frewen, P et al. (2008) Neural correlates of levels of emotional awareness during trauma script-imagery in posttraumatic stress disorder. Psychosomatic Medicine 70, 2731.Google Scholar
Gendlin, ET (1996) Focusing-oriented psychotherapy: A manual of the experiential method. New York: Guilford.Google Scholar
Greenberg, LS (2002). Emotion-focused therapy: Coaching clients to work through their feelings. Washington, D.C.: American Psychological Association.Google Scholar
Greenberg, LS and Korman, L (1993) Assimilating emotion into psychotherapy integration. Journal of Psychotherapy Integration 3, 249265.Google Scholar
Greenberg, LS and Pascual-Leone, A (2006) Emotion in psychotherapy: A practice-friendly research review. Journal of Clinical Psychology 62, 611630.Google Scholar
Greenberg, LS and Safran, JD (1984) Integrating affect and cognition: A perspective on the process of therapeutic change. Cognitive Therapy and Research 8, 559578.Google Scholar
Hayes, SC, Strosahl, KD, and Wilson, KG (1999) Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford.Google Scholar
Horowitz, M, Wilner, N, and Alvarez, W (1979) Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine 41, 209218.Google Scholar
Hunt, MG (1998). The only way out is through: Emotional processing and recovery after a depressing life event. Behaviour Research and Therapy 36, 361384.Google Scholar
Hwang, KH, Cho, O, and Yoo, Y (2016) Symptom clusters of ovarian cancer patients undergoing chemotherapy, and their emotional status and quality of life. European Journal of Oncology Nursing 21, 215222.Google Scholar
King, LA and Emmons, RA (1990) Conflict over emotional expression: Psychological and physical correlates. Journal of Personality and Social Psychology 58, 864877.Google Scholar
Klein, MH, Mathieu, PL, and Gendlin, ET (1969) The Experiencing Scale: A research and training manual. Madison, WI: Wisconsin Psychiatric Institute.Google Scholar
Korman, LM (1998). Changes in clients' emotion episodes in therapy. ProQuest Information & Learning. Available from http://www.collectionscanada.gc.ca/obj/s4/f2/dsk2/tape15/PQDD_0019/NQ27300.pdf.Google Scholar
Kulpa, M et al. (2017) Psychological adaptation to cancer control emotion and cognitive patients with cancer of the genitourinary system. Medycyna Paliatywna/Palliative Medicine 9, 30–4.Google Scholar
Lane, RD and Schwartz, GE (1987) Levels of emotional awareness: A cognitive-developmental theory and its application to psychopathology. The American Journal of Psychiatry 144, 133143.Google Scholar
Leaf, DE and Barchard, KA (2010) Program for Open-Ended Scoring [POES], version 1.4.1. [Unpublished computer program]. Available from Kim Barchard, Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway, Las Vegas, NV 89154-5030, .Google Scholar
Levenson, RW (1994) Human emotion: A functional view. In The nature of emotion: Fundamental questions. Ekman, P and Davidson, RJ, eds., pp. 123126. New York: Oxford University Press.Google Scholar
Manne, SL et al. (2017) Emotional processing during psychotherapy among women newly diagnosed with a gynecological cancer. Palliative & Supportive Care 15, 405416.Google Scholar
Manne, SL et al. (2017) A comparison of two psychological interventions for newly-diagnosed gynecological cancer patients. Gynecologic Oncology 144, 354362.Google Scholar
Manne, SL et al. (2008) Mediators of a coping and communication-enhancing intervention and a supportive counseling intervention among women diagnosed with gynecological cancers. Journal of Consulting and Clinical Psychology 76, 10341045.Google Scholar
Missirlian, TM et al. (2005) Emotional arousal, client perceptual processing, and the working alliance in experiential psychotherapy for depression. Journal of Consulting and Clinical Psychology 73, 861871.Google Scholar
Myers Virtue, S et al. (2015) Emotion episodes during psychotherapy sessions among women newly diagnosed with gynecological cancers. Psycho-Oncology 24, 11891196.Google Scholar
Novick-Kline, P et al. (2005) Level of emotional awareness as a differentiating variable between individuals with and without generalized anxiety disorder. Journal of Anxiety Disorders 19, 557572.Google Scholar
Orlinsky, DE and Howard, KI (1986) Process and outcome in psychotherapy. In Handbook of psychotherapy and behavioral change: An empirical analysis, 3rd ed. Garfield, S and Gergin, A, eds., pp. 311385. New York: John Wiley.Google Scholar
Pos, AE et al. (2003) Emotional processing during experiential treatment of depression. Journal of Consulting and Clinical Psychology 71, 10071016.Google Scholar
Roemer, L and Orsillo, SM (2005) An acceptance-based behavior therapy for generalized anxiety disorder. In Acceptance and mindfulness-based approaches to anxiety: Conceptualization and treatment. Orsillo, SM and Roemer, L (eds.), pp. 213240. Boston, MA: Springer US.Google Scholar
Schag, CA, Ganz, PA, and Heinrich, RL (1991) CAncer Rehabilitation Evaluation System–short form (CARES-SF). A cancer specific rehabilitation and quality of life instrument. Cancer 68, 14061413.Google Scholar
Stanton, AL et al. (2000) Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. Journal of Consulting and Clinical Psychology 68, 875882.Google Scholar
Subic-Wrana, C et al. (2010) Theory of mind and emotional awareness deficits in patients with somatoform disorders. Psychosomatic Medicine 72, 404411.Google Scholar
Watson, JC and Bedard, DL (2006) Clients’ emotional processing in psychotherapy: A comparison between cognitive behavioral and process-experiential therapies. Journal of Consulting and Clinical Psychology 74, 152159.Google Scholar
Watson, D, Clark, LA, and Tellegen, A (1988) Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology 54, 10631070.Google Scholar
Watts, S et al. (2015) Depression and anxiety in ovarian cancer:A systematic review and meta-analysis of prevalence rates. BMJ Open 5:e007618.Google Scholar