Emosjonsfokusert behandling av depresjon: effekten av en spesifikk intervensjon rettet mot destruktiv selvkritikk.

Common mental health difficulties is a huge and expensive societal problem that implies great suffering for those affected. More than half of the population in the world will be affected by common mental health difficulties during their life time. There are several psychotherapeutic methods that is proven helpful for those suffering from mental health difficulties. Still, there is an everlasting need to improve and develop more efficient psychotherapeutic methods. In order to improve these psychotherapeutic interventions, we need to better understand the processes that play out during psychotherapy. There is increasing consensus around the fact that emotions play a central part in the development and alleviation of common mental health difficulties. One psychotherapeutic approach that focuses explicitly on emotions is Emotion-Focused Therapy (EFT). In EFT one assumes that emotions are fundamentally adaptive processes that help us to survive and thrive in our environment. Mental health difficulties is assumed to arise when our emotions are no longer allowed to function as inner compasses that help us to take care of our basic needs. All though EFT has proven to be effective in alleviating common mental health difficulties, there is a need for more research on how change happens. This way, even more efficient techniques can be developed. In this study, we have investigated a specific technique drawn from EFT. This techniques is called a two-chair dialogue. The goal with the two-chair dialogue is to work with emotional processes that cause and fuel destructive self-criticism. The assumption was that working with these emotional processes, destructive self-criticism and thus common mental health difficulties, would be alleviated. For this research project we aspired to investigate 3 areas; 1) the effect the two-chair dialogue has on common mental health difficulties and self-criticism, 2) see if the two-chair dialogue impacts emotional processes that underlie self-criticism, and 3) investigate the participants experience of working with their emotions in this intervention. The overarching goal was to better understand emotional processes in psychotherapeutic change. For the first research question, results suggest that adding the two-chair dialogue intervention is associated with a more substantial decrease in depression- and anxiety-related symptoms, in comparison to the baseline phase. Destructive self-criticism exhibited reduction throughout the treatment. However, this was not significant greater for the phase which included the two-chair dialogue intervention. For the second research question, results suggest that the phase containing the two-chair dialogue intervention is associated with significantly more high-arousal episodes than the baseline phase. Experiencing increases throughout the entire treatment, but not significantly more in the phase including the two-chair dialogue, suggesting that both phases are associated with enhanced emotional processing. For the third research question, the qualitative enquiries indicated three main themes. The first theme, termed as "Talking to a chair: An obstacle to overcome", refers to the clients? experiences with regard to the intervention as awkward and sometimes difficult to engage in. The second theme, "Heavy, intense, horrendous, and nice" captures the experiences of the intervention as being emotionally intense, physically and mentally draining, painful, but at the same time helpful. The third theme, titled as "Realization: What am I doing to myself?" captures the clients? reports pertaining to the attainment of a better understanding of the way in which they treat themselves.

Formålet med prosjektet er todelt. Det første er å utvikle en større forståelse for mekanismene i depresjon, nærmere bestemt å studere hvordan selv-kritiske og skambaserte mønstre leder til depresjon og hvordan det kan behandles mer effektivt. Den andre delen av formålet er å bedre forstå hvilke mekanismer i emosjonsfokusert terapi som er virkningsfulle i det å behandle depresjon, nærmere bestemt å se om spesifikke intervensjoner i emosjonsfokusert terapi kan være særlig virkningsfulle i å endre på selv- kritiske og skambaserte mønstre hos de som utvikler depresjon. Depersjon er hovedårsaken til uføretrygding og WHO antar at innen 2020 vil depresjon være det største helseproblemet på verdensbasis. Det er konsensus i forskningsmiljøet og blant offentlige myndigheter at det er et økende behov for bedre behandlingsmetoder. Emosjonsfokusert terapi har gjennom flere studier vist seg som en effektiv måte å behandle depresjon, men det er stadig behov for å vite mer om de spesifikke endringsmekanismene. Emosjo nsfokusert terapi er en form for psykoterapi som legger til grunn at psykisk lidelse oppstår når emosjoner ikke lenger fungerer som de skal. Dette prosjektet søker å utvide kunnskapen om depresjon og videreutvikle intervensjoner som viser lovende resulta tere i behandling av depresjon. Den største forventede forskningsmessige utfordringen er at dersom en ønsker å si noe om spesifikke endringsmekanismer, så må disse mekanismene isoleres. Dette er en generell utfordring i psykoterapiforskning, ettersom det er mange variabler som er vanskelig å kontrollere. Prosjektresultatene vil øke og spisse kompetansen innad i bedriften på denne terapiformen og gjøre bedriften til en premissleverandør av kunnskap om terapiformen. En større forståelse av endringsmekani smene vil dessuten kunne benyttes for å utvikle programmer for personlig utvikling, lavterskeltilbud for behandling av psykiske lidelser, og skape høyere kvalitet på opplæringstilbudet i denne terapiformen.