This study examined the effectiveness of brief emotion-focused therapy (EFT) for students presenting with worry and anxiety issues. Nine students received up to 12 sessions of EFT. Quantitative measures found significant reductions in generalized anxiety and worry symptoms. Qualitatively, clients reported increased resilience, self-acceptance, and decreased anxiety. Helpful aspects included the therapeutic relationship and experiential work. While more research is needed, brief EFT showed promise in reducing anxiety symptoms for students.

1. TheUse of Emotion-Focused
Therapy inStudents
Presenting
withWorry andAnxiety Issues
Julie Anne O’Connell Kent
Supervisor: Dr. LadislavTimulak

2. What is this
research
about?
1. Does a course of brief EFT therapy lead to a change in (i) worry
and (ii) generalised anxiety symptoms? [Quantitative]
2. What are clients’ self-reported outcomes from the therapy i.e.
what changes in their lives did the clients notice took place
following therapy? [Qualitative]
3. What were the (i) helpful, (ii) unhelpful and (iii) difficult but
helpful parts of therapy, according to the client? [Qualitative]

3. Study design
Quantitative
Symptom
change
Anxiety
(GAD-7)
Worry
(PSWQ-PW)
Qualitative
Cross-case
analysis
Change
Helpful
Unhelpful
Case studies

4. Literature
overview
 Emotion-focused therapy (EFT)
 Theoretical base: emotion theory, humanism
 Aims of EFT:
 Build awareness of emotion and ability to express the emotion
 Build ability to regulate the emotion
 Build self-soothing/compassion for the self
 Build meaning through reflection, to “make sense” of one’s
experience
 Transformation of emotion, through activation of different,
adaptive emotions
 Effective for treating depression (Greenberg &Watson,
2006), couples counselling (Greenman & Johnson, 2013) and
complex trauma (Paivio et al., 2010)

5. Literature
overview
 Generalised anxiety
 Persistent worry and anxiety
 High comorbidity with depression
 Current treatment options are inadequate (Cuijpers et al., 2014; Hanrahan et al., 2013)
 Generalised anxiety & EFT
 Why?
 Social anxiety & EFT (Shahar, 2014)
 GAD comorbidity with depression
 CBT+emotion-focused components more effective than CBT+supportive listening
(Newman et al., 2011)
 So, how could EFT be developed for use with people with anxiety-related difficulties?
 Recent developments of a model for Generalised Anxiety (O’Brien et al., 2017;
Timulak & McElvaney, 2017)
 Initial research indicates that EFT leads to positive outcomes in GAD (Timulak
et al., 2017)

6. Research
hypotheses
 Our aims:
 (a) to examine the changes observed by clients during a
short-term EFT therapeutic intervention for worry and GAD
symptoms
 (b) to examine the aspects of this therapy that were found to
be helpful, difficult but helpful and unhelpful by the clients
 (c) to investigate whether scores on measures of symptoms
of (i) generalised anxiety and (ii) worry change over the
course of therapy.

7. Research
method
 Open trial of brief EFT in people with generalised anxiety symptoms
 Student counselling service setting
 Participants
 9 clients (7 women, ); age range 19-29 (M = 23)
 Recruited from clients presenting to the counselling service
 Screened for suitability using interview, GAD-7 & CCAPS-34
 Generalised anxiety symptoms as the primary issue
 Exclusion: suicidal ideation, drug/alcohol dependence, and at
interviewer’s discretion
 Information about study provided, informed consent
 Two study therapists
 EFT-trained counselling psychologists; supervised throughout by EFT
trainer

8. Research
method:
Procedure
Recruitment
• During
intake
interview;
GAD-7 & nil
exclusion
criteria
Therapy (up
to 12
sessions)
• GAD-7 &
PSWQ-PW
• Audio
recording
Post
therapy:
Client
interviewed
by
researcher +
debrief
Post
therapy:
Therapists
interviewed
by
researcher

9. Research
method:
Procedure
 Therapy
 EFT for generalized anxiety symptoms
 Up to 12 sessions
 Beginning of each session
 GAD-7
 PSWQ-PW
 Client interviews
 Contacted by researcher following completion of therapy
 Interviewed for approx. 60 minutes-90 minutes
 Client Change Interview Schedule (CCISv5)
 6 agreed to interview, 3 did not (2 non-response, 1 turned down)
 Debrief

10. Research
method:
Procedure
 Interview: CCISv5
 Changes observed
following therapy –
attributions, importance,
necessity of therapy to
these changes, other
influencing factors in
change (e.g. personal
characteristics, life
circumstances)
 Aspects of therapy which
were helpful, unhelpful and
difficult but helpful
 Experience of taking part in
the research, impact of
that on therapy
Changes
experienced
Helpful
aspects of
therapy
Unhelpful
aspects of
therapy
Difficult but
helpful aspects
of therapy

11. Research
method:
Procedure
 Therapist interviews
 Took place after therapy ended
 In relation to each client, therapists were asked to describe their
case conceptualization
 Carried out to contexualise the content of the client interviews for
case studies

12. Results:
Quantitative
Does a course of brief EFT therapy lead to a change in (i) worry and (ii)
generalised anxiety symptoms?
 Only 4+ sessions counted
 Friedman tests carried out to determine whether there were
differences in scores on the outcome measures (GAD-7 & PSWQ-
PW) over the course of therapy

13. Results:
Quantitative
 Statistically significant
reduction in generalised
anxiety and worry symptoms
over the course of therapy
 Large effect sizes found,
though large CI 95% interval,
likely due to low statistical
power

14. Results:
Qualitative
 Descriptive and interpretive research method (Elliott
andTimulak, 2005)
 Experience of change
 Increased resilience (4/6), self-acceptance (4/6) and
self-compassion (4/6)
 Decreased anxiety (4/6), better self-care and
prioritization (3/4)
“I’m feeling much stronger to take
on…whatever challenge may come”
[Ben]
– Increased resilience

15. Results:
Qualitative
 Helpful aspects of therapy:
 Reassuring relationship with therapist (5/6)
 Own determination to engage in therapy (5/6)
 Therapist's interpretation of client’s anxiety &
psychoeducation (5/6)
 Experiential work (4/5)
 Space to talk about difficulties (4/6)
“The chair thing….that really helped big
time” [Laura]
- Experiential work

16. Results:
Qualitative
 Unhelpful aspects of therapy:
 Difficult to answer questions (3/6)
 Some symptoms remaining (2/6)
 Not being open with loved ones (2/6)
 Own difficulty engaging (2/6)
“I think…I was looking for a switch to switch
off the symptoms” [Clodagh]
- Some symptoms remaining

17. Results:
Qualitative
 Difficult but helpful aspects of therapy:
 Depth of painful emotion (3/6)
 Experiential work (3/6)
“…it was a good sadness, or a productive one” [Laura]
- Depth of painful emotions

18. Discussion:
Findings in
context of
literature
 Findings of reduction in worry and generalised anxiety symptoms
consistent with previous research on EFT for generalised anxiety
(Timulak et al., 2017)
 Brief EFT for generalized anxiety may be helpful
 Greater emphasis on self-acceptance, prioritization/self-care
 Similar findings: therapeutic relationship, own determination to
engage, depth of emotions
 New findings
 therapist’s interpretation of client’s anxiety
 support network, not reported inTimulak et al. (2017)
 space reserved to talk about difficulties

19. Discussion:
Limitations
and future
research
 Differs from other similar studies
 Setting – student counselling (homogenous group)
 Short term therapy
 Limitations
 No control or comparison group
 Small sample size – low statistical power, less rich qualitative data
 Continuation of the current study being carried out (Jackson, in
progress)
 Population used – not representative
 Not many outcome measures used (GAD-7 and PSWQ-PW) – future
research measure QoL, depression, physical health?
 No follow up
 Attrition – 3 out of 9 clients dropped out before 4 sessions.

20. Conclusions
 Current study found that scores on measures of worry
and generalized anxiety reduced over the course of
brief EFT therapy
 New lines of enquiry for the changes that are observed,
not simply restricted to a reduction in generalized
anxiety symptoms
 Substantiation of existing literature and new findings
regarding helpful, unhelpful and difficult but helpful
aspects of therapy
 Findings suggest more research is needed, and is
ongoing (Jackson, in progress).

21. Thank you!

22. References
 Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M., & Andersson, G. (2014).
Psychological treatment of generalized anxiety disorder: A meta-analysis. Clinical Psychology
Review, 34(2), 130–140. https://doi.org/10.1016/j.cpr.2014.01.002
 Elliott, R., &Timulak, L. (2005). Descriptive and interpretive approaches to qualitative research.
In J. Miles & P. Gilbert (Eds.), A handbook of research methods for clinical and health psychology
(pp. 147–159.). Oxford, UK: Oxford University Press.
 Greenberg, L., &Watson, J. C. (2006). Emotion-focused therapy for depression. Washington, DC,
US: American Psychological Association.
 Greenman, P. S., & Johnson, S. M. (2013). Process research on Emotionally FocusedTherapy
(EFT) for couples: Linking theory to practice. Family Process, 52(1), 46–61.
https://doi.org/10.1111/famp.12015
 Hanrahan, F., Field, A. P., Jones, F.W., & Davey, G. C. L. (2013). A meta-analysis of cognitive
therapy for worry in generalized anxiety disorder. Clinical Psychology Review, 33(1), 120–132.
https://doi.org/10.1016/j.cpr.2012.10.008
 Newman, M. G., Castonguay, L. G., Borkovec, T. D., Fisher, A. J., Boswell, J. F., Szkodny, L. E., &
Nordberg, S. S. (2011). A randomized controlled trial of cognitive-behavioral therapy for
generalized anxiety disorder with integrated techniques from emotion-focused and
interpersonal therapies. Journal of Consulting and Clinical Psychology, 79(2), 171–181.
http://dx.doi.org/10.1146/annurev-clinpsy-050212-185544

23. References
 O’Brien, K., O’Keeffe, N., Cullen, H., Durcan, A.,Timulak, L., & McElvaney, J.
(2017). Emotion-focused perspective on generalized anxiety disorder: A
qualitative analysis of clients’ in-session presentations. Psychotherapy
Research: Journal of the Society for Psychotherapy Research, 1–17.
https://doi.org/10.1080/10503307.2017.1373206
 Paivio, S. C., Jarry, J. L., Chagigiorgis, H., Hall, I., & Ralston, M. (2010). Efficacy
of two versions of emotion-focused therapy for resolving child abuse trauma.
Psychotherapy Research: Journal of the Society for Psychotherapy Research,
20(3), 353–366. https://doi.org/10.1080/10503300903505274
 Shahar, B. (2014). Emotion-focused therapy for the treatment of social
anxiety: An overview of the model and a case description. Clinical Psychology
& Psychotherapy, 21(6), 536–547. https://doi.org/10.1002/cpp.1853
 Timulak, L., McElvaney, J., Keogh, D., Martin, E., Clare, P., Chepukova, E., &
Greenberg, L. (2017). Emotion-focused therapy for generalized anxiety
disorder: An exploratory study. Psychotherapy, 54(4), 361–366.
https://doi.org/10.1037/pst0000128