Working with feelings: The importance of emotion in both cognitive-behavioral and interpersonal therapy in the NIMH treatment of depression collaborative research program

This study explores the in-session expression of patient emotion and therapist stance toward affects in treatments conducted as part of the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP) and the relationship of these processes to treatment outcome. Therapy transcripts of 128 cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) treatment sessions were rated with. the Psychotherapy Process Q-Set (PQS) to identify therapists' overall stance toward patient emotion and to characterize other aspects of the therapy process. There were no significant differences in the amount of patient Painful Affect in CBT and IPT sessions. Factor analysis of the PQS ratings of treatment sessions revealed three primary factors. Factor 1, labeled Collaborative Emotional Exploration, whether present in CBT or IPT, was significantly related to positive outcome, whereas Factor 2, labeled Educative/Directive Process, was not. Factor 3, termed Patient Inhibition, was higher in IPT and associated with positive outcome. Patients with high levels of painful emotion tended to have poorer outcomes in these brief treatments. In addition, as patients' painful emotion increased, therapists found it more difficult to apply modality-specific interventions.