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Among psychological therapies for generalized anxiety disorder (GAD), cognitive-behavioral therapy has a dominant position as the most studied therapy. However, some researchers have recommended that to increase treatment options and broaden choice for clients, non-cognitive-behavioral therapy models for GAD should be examined. The present study was an exploratory study, assessing pre-post outcomes and 6-month follow-up of emotion-focused therapy for GAD, supplemented by qualitative posttherapy client accounts of helpful and unhelpful aspects of therapy and changes reported since therapy started. Fourteen clients were assessed on several measures focusing on GAD symptoms, depressive symptoms, and general psychological functioning. Quantitative pre-post and 6-month follow-up data indicated large effect sizes. Qualitative data captured changes in emotional functioning, anxiety, self-acceptance, self-confidence, and self-understanding. Clients reported as helpful both relational aspects of the work and in-depth experiential tasks, although some found the experiential aspect of the work difficult. The findings suggest that there may be value in assessing emotion-focused therapy as a treatment for GAD in a randomized controlled trial. (PsycINFO Database Record

Highlights • First qualitative study on the benefits of iCBT for those who do not meet clinical thresholds • Successful application of cognitive and behavioural strategies reported • Increased insight/awareness and improved self-efficacy reported • The format of online delivery was reported as helpful. • Findings align with previous face-to-face and iCBT treatments.

Background Generalised anxiety disorder (GAD) is an anxiety disorder characterised by excessive anxiety and worry. Worry is seen as a key-defining feature of GAD. Several cognitive-behavioural models of working with worry in GAD exist. More recently, there have been efforts to adapt emotion-focused therapy (EFT) for GAD. This study focused on task analysis, observing therapist and client processes (using qualitative observations as well as observer-used measures) in the clinically developed, two-chair dialogue for worry (an intervention inspired by a similar EFT task of working with self-criticism in depression). Method A task analysis methodological approach was applied to 34 worry dialogues from eight clients. The worry dialogues were qualitatively analysed, focusing on therapist and client processes in the task and also using observer-based measures such as Classification of Affective-Meaning States, Client Emotion Arousal Scale and Client Emotion Productivity Scale. Results A tentative model of worry transformation using the two-chair dialogue for worry is presented. The model consists of marker identification, enactment of the worry, deepening the toll of the worry, articulation of the need towards the worry and the worry softening or the client's standing up to the worry. The results also focus on the progression in the dialogues across the series of dialogues. Implications The model has an immediate practical application as it can inform therapists' actions when working with worry processes in GAD clients. Implications for future research are also discussed.

Generalized anxiety disorder (GAD) is a severely debilitating disorder characterized by high comorbidity and a negative impact on overall well-being. Cognitive-behavioral therapy (CBT) is the most recognized psychological treatment of GAD. Although CBT is well-established, it is also shown that not all clients benefit from it. The goal of this paper is to highlight an emerging model of working with GAD patients from the perspective of emotion-focused therapy. It is comparable to mainstream CBT theories in so far as it proposes that the client is not avoidant of emotional experience or of its processing in general, but rather, that it is specific triggers that the client is afraid of. Contrary to mainstream CBT theories, change is not facilitated through emotional habituation to difficult triggers (or emotions), but rather through the restructuring and transformation of problematic emotion schemes through a sequence of emotional processing steps. These steps include overcoming emotional avoidance, differentiation of, and staying with, core painful feelings (such as loneliness/sadness, shame, and terror/fear), articulation of the unmet needs contained in those feelings and the expression of an emotional response to those feelings/needs, typically compassion and healthy, boundary setting, protective anger. A case illustration is provided.

The classification of generalized anxiety disorder (GAD) is influenced by the tradition of conceptualizing disorders in the context of their clinical presentation and subsequent professional thinking around them. Our qualitative, descriptive-interpretative study uses a theoretical framework drawn from emotion-focused therapy (EFT) as the basis of our interpretation of GAD clients' presentation of their difficulties.The current research consists of an investigation into the GAD presentation based on a multiple case study observational qualitative design. In total, 93 video/audio-taped sessions from 14 clients were used for the analyses. The sessions were analyzed using an EFT case conceptualization framework.The findings capture common themes across the cases covering the EFT framework domains: triggers of emotional pain (e.g., trauma, rejection), problematic self-treatment (e.g., worry, self-criticism, self-interruption), global distress (e.g., anxiety, low mood, somatic symptoms), apprehension/anxiety (fear of triggers and chronic painful emotions), emotional avoidance (e.g., self-distraction), behavioral avoidance (e.g., avoidance of conflict, over-compliance), core painful feelings (e.g., sadness/loneliness, shame, fear), and unmet needs (e.g., to be loved, to be acknowledged, to be protected).Discussion focuses on examining findings in the context of existing psychological models of GAD. The implications for practice as well as limitations of the study are also discussed. Clinical or methodological significance of this article: This is an attempt to provide an in-depth case conceptualization based on the EFT theoretical framework of the clients with GAD that attended EFT. Thus, it should contribute to clinical understanding of the presentation of the clients with GAD. Methodologically, the study uses an original qualitative approach, in which in-session presentations of 14 clients are thoroughly tracked and analyzed within an existing theoretical framework, the domains of which serve as the domains of inquiry.

Aim: The qualitative experience of clients judged by quantitative measures as having ‘good’ or ‘poor’ outcome is not often the focus of outcome research. This exploratory study investigates client experience of psychological therapy in an inner-city primary care centre across two client groups, differentiated on the basis of their outcome scores on quantitative measures. Method: Clients (N=11) were allocated to one of two research groups, (a) good outcome (n=5), or (b) poor outcome (n=6) on the basis of their pre- and post-therapy outcome scores on the Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM). They participated in a face-to-face semi-structured interview. Data were recorded and analysed using a descriptive and interpretive qualitative method. Results: Both groups had broadly similar experiences of their current therapy although some differences in emphasis emerged. Good outcome clients described a greater sense of empowerment in therapy, commenting on a feeling of equality ...

The results of an investigation suggest that, for the various forms of compound loading investigated, i.e.; (1) all other variables except stress level maintained constant; (2) all other variables except temperature maintained constant; and (3) both stress and temperature level varied, fatigue life is predicted with acceptable accuracy by a linear cumulative damage rule. Tests were carried out in the controlled stress mode in rotating bending fatigue machines. Because of the inherent variability of the material, the ability of a linear cumulative damage rule to predict compound-loading fatigue life is assessed over a range of probability of failure levels. The results indicate that there is reasonable probability that the cumulative cycle ratio at failure will be equal to or greater by an acceptable amount than unity.