The interaction of emotion and reasoning in contemporary talking therapy

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Abstract

There is a great deal of empirical evidence to support the efficacy and effectiveness of cognitive therapeutic approaches such as cognitive behaviour therapy (CBT) and motivational interviewing (MI). In addition to this, research has identified several mechanisms of change thought to underlie these approaches. However, there has been little exploration of the specific cognitive and emotional processes that may underlie change in CBT and MI, or indeed their interactions. This thesis specifically explored the role of reasoning and emotion in relation to MI and CBT.In the first paper, the initial sections provided a narrative review whereby the roles of reasoning and emotion in CBT and MI were critically evaluated in context of existing empirical evidence. Further to this, the literature examining the effects of emotion on deductive reasoning was systematically reviewed. A total of 19 papers were identified and the implications of the studies’ findings discussed in relation to the clinical practice of CBT and MI. The studies varied noticeably in terms of the quality of the methodologies employed. Overall the studies considered, suggested that the effects of emotion on reasoning were complex, and yet to be well understood. However, through extrapolating the findings from the experimental study of cognition and emotion to the clinical practice of CBT and MI, the review demonstrated the potential relevance of such findings, and indicated the need for research exploring the role of reasoning and emotion in these approaches.The second, empirical paper examined the extent to which statements reflecting informal reasoning and the emotional state of the client affected the generation of positive behaviour change statements and positive behaviour change in the context of MI with individuals with psychosis and alcohol use disorders. Participants (n=26) were clients selected from a large randomised controlled trial of integrated MI and CBT for psychosis and substance use. One audio recorded therapy session was selected for each participant. Reasoning and emotion statements were subsequently identified and categorised for each therapy session. It was found that the total number of reasoning statements generated positively predicted the total number of positive behaviour change statements generated. It was also found that negative emotional statements relating to the present, positively predicted the total number of reasoning statements generated. The results suggested that informal reasoning may be a specific cognitive process underpinning the production of behaviour change statements in MI with individuals with psychosis and alcohol use disorders, and provided support for the central role of discrepancy in producing change in MI. The final section provided a critical reflection of the research process. This included a rationale for the development of the literature review and the empirical paper, followed by a critical reflection on the study context and its’ implication to the study methodology. Finally the theoretical and future implications for research in this area were discussed along with the implications to clinical practice.

Keyword(s)

Alcohol misuse; CBT; Emotion; Motivational Interviewing; Psychosis; Reasoning; Substance misuse; Therapy

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