Changes in symptom intensity and emotion valence during the process of assimilation of a problematic experience: A quantitative study of a good outcome case of cognitive-behavioral therapy

Abstract

The assimilation model describes the change process in psychotherapy. In this study we analyzed the relation of assimilation with changes in symptom intensity, measured session by session, and changes in emotional valence, measured for each emotional episode, in the case of a 33-year-old woman treated for depression with cognitive-behavioral therapy. Results showed the theoretically expected negative relation between assimilation of the client's main concerns and symptom intensity, and the relation between assimilation levels and emotional valence corresponded closely to the assimilation model's theoretical feelings curve. The results show how emotions work as markers of the client's current assimilation level, which could help the therapist adjust the intervention, moment by moment, to the client's needs.

Does assimilation of problematic experiences predict a decrease in symptom intensity?

“…Theoretically (Stiles et al, 2004;Basto et al, 2016), across the range of APES 2 (vague awareness/emergence) to APES 6 (resourcefulness/problem solution), assimilation progress should yield monotonically decreasing scores on symptom intensity inventories, reflecting declining emotional distress (APES 2-4, as the problem is formulated and clarified) followed by increasing pride or elation (APES 4-6, as the problem is understood, worked through, and solved). Most shortterm therapies work primarily within this range of APES levels, leading to our expectation of a negative statistical relation between APES levels and symptom intensity in this study.…”

“…As an example of theme and voice identification, the theme of perfectionism emerged in the case of Laura, a CBT client (drawn from the case study by Basto et al, 2016). This theme involved the highly demanding standards Laura imposed on herself in a variety of intra and interpersonal contexts.…”

“…The assimilation model proposes that therapeutic improvement occurs through the gradual assimilation of experiences that had previously been problematic, distressing, avoided, or warded off (Stiles, , ; Stiles et al, ). Intensive case studies have linked increases in assimilation with decreases in symptom intensity (e.g., Basto, Pinheiro, Stiles, Rijo, & Salgado, ; Caro Gabalda, ) as has one small‐sample study ( N = 8; Detert, Llewelyn, Hardy, Barkham, & Stiles, ). However, more empirical evidence is necessary to consolidate the suggestion that therapeutic change occurs through a process of assimilation of problematic experiences.…”

Fluctuation in the Assimilation of Problematic Experiences: A Case Study of Dynamic Systems Analysis

“…From an assimilation model perspective, the potential therapeutic value of destabilizing may apply only when clients are rigidly denying or avoiding their problematic experiences, that is at APES levels 0 or 1, whereas even in her early sessions, Alice’s problems were at moderate APES levels, between APES 2, (vague awareness/emergence) and APES 3 (problem statement/clarification). Theoretically, the psychological rigidity–the denial and avoidance of problems – reflects the danger of powerful negative affect associated with encountering problems at low APES levels ( Stiles et al, 2004 ; Basto et al, 2017 ). If the beneficial effect of destabilization predicted by dynamic systems approaches applies only to problems that begin at lower levels (below APES 2), it is understandable why the prediction did not work in Alice’s case.…”

“…It requires changes in both voices and a restructuring of the community into a more flexible and functional structure ( Honos-Webb and Stiles, 2002 ). For example, in the case of Laura, a CBT client (drawn from the case study by Basto et al, 2017 ), her community was characterized as perfectionist, dominated by highly demanding voices that required perfection in every situation. Her problematic voice represented her experiences of failure in a variety of different intra- and interpersonal contexts.…”