Psychotherapy and Applied Psychology

Emotional Arousal & Meaning Making with Dr. Antonio Pascual-Leone

• Season 3 • Episode 46

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Dr. Antonio Pascual-Leone picks up from last episode to discuss the intricate relationship between emotional arousal and therapeutic processes. He emphasizes the importance of understanding emotional arousal not just as a standalone phenomenon but as a part of a broader context that includes meaning-making and narrative. Then, Dan and Dr. Pascual-Leone dive into the sequential transformation of emotions, highlighting how the order of emotional experiences can significantly impact therapeutic outcomes and ultimately, how the idea that therapy is not merely about resolving issues but fostering emotional growth and resilience.

Dr. Antonio Pascual-Leone is a clinical psychologist and professor of psychology at the University of Windsor, Canada.

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[Music] In the first part of my conversation with our guest, he laid the groundwork for understanding the complexities of emotional dynamics and psychotherapy. In this second part, we transitioned to explore the nuanced processes that underpin emotional transformation. My guest elaborates on how emotional arousal interacts with meaning-making. Why, observed arousal, can be a better predictor of outcomes than self-reported experiences, and how these insights can refine therapeutic practices. We also examined the importance of context and emotional expression, and how therapists can leverage these insights to foster deeper emotional engagement. I'm your host, Dr. Dan Cox, a professor of counseling psychology at the University of British Columbia. Welcome to psychotherapy and applied psychology, where I dive deep with leading researchers to uncover practical insights, pull back the curtain, and hopefully have a little bit of fun along the way. If you're getting something from these discussions, subscribe in your podcast player, watch on YouTube, click like and subscribe. It meaningfully helps us continue making this show. This episode begins with my guest talking about emotional arousal. So without further ado, Dr. Antonio Pesquale-Leone.[Music] It's a really interesting one because arousal is so salient, right? That you get these examples where there's a lot of arousal, emotional arousal, that's what we're talking about, although that could be physiological arousal. Or there's a lot of expression, it's very salient, and then that leads researchers and clients to assume it was the arousal alone that produced the change. In the book, I give an example of a client who I saw who has like this, you know, he was a Mason by trade, worked with his hands, big, burly guy, his dog dies, and for whatever reason he has life context, for whatever reason he falls apart, because his dog died, which was his only companion in life at that time. And I can't see him right away. We have an initial meeting, and then, you know, we schedule something, he comes back, I mean, he's like suicidal. And I'm sure that's why I saw him right away, and then I see him maybe four weeks later, he comes in, he's like, "No, I'm good." And then he says, "What do you mean?" He says, "I solved it, I solved it." So for this is the research part, I'm like, "Tell me everything." Like now I'm really curious. So like, and he tells his story, he says, "Well, you know, how does it start?" He's like, "I was crying a lot, and I decided to go up where I used to hunt with her, the dog, and I drove all night, and I was crying in the car, and the windshield wipers, and I got to her old, hunting ground, since I brought my guns and stuff, but I decided not to hunt. Instead, I just fed the ducks with a loaf of bread that I had, fed the ducks, and the sun came up. And I remember the times we had together with her, the dog. And I decided I'm going to spread her ashes there. That's what I'm going to do. And then I just drove home. And now, you know, he says, "I just cried it all out." Like, it was like just water works, and I cried myself dry. And he says, "Now, now I'm going to throw myself into work and sweat out any more tears that I have, but I think I'm going to be okay." End of scene. So what's the mechanism? Well, clearly, emotional rousal is part of that. There's a lot of water works. And if you have a hydraulic theory of emotion, then that might sort of fit. For him, it clearly fit, right? Like, that's it. I'm just going to sweat the rest of the water, because the water is the problem. But, you know, if you listen closely to the story, there's all sorts of things that are going on there in terms of clarifying what I need in life, taking some time. It's a good buy, creating something that's developing a different kind of relationship with these ducks who we used to jishu-dot. You know, then there's like throwing myself into work, which is now a down-regulation stretch, sort of avoidance of this, and a healthy sort of way to kind of persist, or some sense of direction. So all sorts of, so emotional rousal is often like a black box. It's very salient, and then there's a whole bunch of undeclared processes. So one of the interesting things is, you really have to be looking at what is it amplifying? What is it doing? And if you look carefully at process research, across treatment approaches, you find again and again that a rousal, you predicts outcome, but only certain kinds of a rousal, and always in synergy with meaning making. So it's not just about venting. Venting doesn't work. It's what are you thinking of when you're venting, but that's a different process. Something else that came up, one of the reasons why I'm calling expressive a rousal, is just feeling it. So when you look at parameters of what predicts outcome, clients might fill out an rousal report and say,"I felt a lot very emotional this session," and that will not predict outcome, as well as an observer who watches the video and says,"Oh, they're emotional here." So observed rousal predicts outcome better than subjectively reported rousal. Right? If the therapist can see it happening in session, that's important. That's a better predictor. It suggests there's probably other things going on as well. So, you know, if you had a marker, so part of the book is to say, "What are the markers?" Five processes. Great. When do I use which one? That's pretty important. Downregulation is when things are too intense, right? And that could be a cross-treatment approach, meaning across kind of emotional experiences. One of the errors some therapists make is clients have primary and adaptive emotion. They get upset, they're angry, or they're sad. Don't interrupt primary adaptive emotion. You don't want to down-regulate that. In fact, here we are expressive rousal. That's your target. You want to increase a rousal. Not on everything. You want to increase a rousal on primary adaptive emotion. The story I gave is about grief. People are supposed to cry at funerals. It's good for them. It helps them. That's why we all have a funeral, right? People are supposed to get angry at things, at violations. They're supposed to stand up for themselves. That's healthy. That's good for you, right? There are limits, right? If people are flying off the handle, we'll now we're back to the down-regulation different process. So, you also made a comment about, you know, if I had this client, I might do this, I have that client, I might do that. Yes. Some of these processes are more important depending on the diagnosis, but mostly these are moment by moment processes. So, if you have borderline personality disorder, yeah, there's going to be a lot of times where down-regulation might be what you need to do. But, there also will be times when up-regulation is what you'll need to do. So, let me jump a little bit because I want to juxtapose this with your fifth principle, which is putting feeling into context. Yeah. And so, because you talked about how expression and then facilitates meaning-making. So, help me disentangle sort of this. Yeah, good question. Brushes a rousal thing with the putting feeling into context thing. Yeah. You know, and just so we're down-regulation awareness expressive arousal, there's something about putting, you might have emotions, but putting emotions in a particular sequence will leave that for now. Yeah, and I want to come back to that. Yeah, that's fine. And then there's this narrative meaning-making. So, most of your listeners have studied psychology. You know the optical illusion that has like two circles, and they're the same color, maybe a shade of gray. Right? And I show this in the book, right? I just have to kind of... So, two circles, they're the same color, if you hold them side by side, they're exactly the same color. But the first one will give it a background of white. And the other one will give it a background of black, a very, very dark color. And you know when you look at them, one of them seems much darker than the other one. The gray circles, right? This is an optical illusion. If I fold the pages and hold them side by side, it's exactly the same color. I had some problems publishing the book with this because the copy editor tries to make everything a bit better. And one of the things they did is change the contrast. I'm like, "No, you can't do that. You're that stupid." I think I'm cheating. It has to be the same. It's like, "No, it looks better. I'm like, "That's not the point. Looking better is not the point." The point is, don't make me a liar. The little gray circles have to be the same tone. And they are in the book. So that's good. But so, what's happening here? These are the same... I'm using an analogy. They're the same emotions. Okay? They look and feel the same. Because of the surrounding context of meaning, I'm making a analogy to meaning, rather than the visual context, the field. The feeling means something different. The context imparts meaning to that experience. The experience itself hasn't changed, per se. But... So, here's a really great and quirky example. I had a client who cleaned public toilets. That was part of the side gig this guy was doing. Cleaning public toilets. And he hated it. But he was making extra money. And it was like in a movie. He was making extra money. He's going to pay for the kids' education or contribute. Great. He assured me that the toilets are just as gross as they were before. But he doesn't mind it as much. He's as disgusted as he has been. But he's keeping his eye on the price. And then you realize there's all kinds of suffering that people will endure if they have a higher purpose. The suffering is the same. It just becomes less important. It qualitatively becomes less important. Or maybe even it means something different. I feel good about the fact that I'm suffering because therefore, it depends on your situation and the meaning of the person is making out of it. So, notice that emotional awareness. Downregulation is shrinking it. Emotional awareness is focusing. Right? Focusing the clarity around it. And expressive ralsal expanding it. Right? Here we're not talking about change. Emotional awareness actually works the feeling itself, upregulating, downright the size of it. We're actually working with the emotion. When you work on context, narrative context and reframing. The feeling is the same, at least at the point of departure. It's that you manipulate in a healthy way. Right? The surrounding context of meaning the background. And because the background has changed. The feeling starts to take on a different, it's managed differently. Right? It's less distressing. Like for my client who's cleaning toilets. It's less disorienting. Like for the religious or religious person or person in military who has a sense of higher purpose. I'm doing this for that reason. Why am I enduring this? Oh, I know exactly why I'm enduring this. You know, it's a very different way of working with emotion and activates different parts of the brain. Right? And maybe it becoming obvious that the treatment approaches that leverage that principle of change. Right? It's not all nobody's leveraging only one. Usually they declare treatment approaches will declare which principle they're championing. And then other ones are still in operation. But you know, here when you do cognitive reframe. Or which could be cognitive reframe of the moment or cognitive reframe of the life purpose, which looks a little bit like a third wave therapy now. Acceptance of commitment therapy or a psychodynamic interpretation of. Well, I feel like this because I was brought up like this, but what I really want is that, right? In life. You know, this is a way of thinking about the story or the context. So, narrative works a couple of different ways because we were just talking about expressive arousal. I will point out. And narrative requires you to disinvent, to de-center to some extent. You have to step outside yourself to be like, oh, there's a story here. When I tell the story of me with a beginning and middle of an I'm the author. Right? I'm it's not the lived experience, which is what is it like to be you right now? You can shuttle between them, but those are two different perspectives. When you move to a third person or observer's perspective reliably, it decreases arousal. It reduces arousal. When you take a step back metaphorically or figure it or literally, it reduces arousal. Right? So positive self-talk in the third person. Right? Reduces arousal. This is an interesting example where I've already pointed out these are very different principles are very different ways of working with emotion. They're not all. It's not useful to put them all into a giant umbrella. But also I'm pointing out that they could be antithetical to one another. Right? You can't increase arousal, expressive arousal, and focus on the big picture of narrative because that will dilute the intensity of the experience. So there are different ways of working with emotion. Sometimes they're synergistic and sometimes they're antithetical. They will interfere with one another. Go to the person who's grieving or is angry and it's primary and it's adaptive and we want more of this. The mobilizes the person. We know what they need. We've done the awareness. Now let's feel more of it. We're not just human beings. We're also human doings. Let's do this. Right? Organize the person. So you may have interventions to activate the emotion. If the therapist and therapist sometimes do inadvertently moves to the big picture or the client says it reminds me of and they move to the big picture. The therapist doesn't refocus them on the first person perspective because arousal is from a first person perspective. You will lose what you're trying to do. Right? So like the digression into the narrative will lead to reduce the rousal and you don't actually achieve the increased primary adaptive experience. This is something that when I'm training because I teach a class pretty regularly for like very, very like people like pre graduate school. Yeah, like very and that but like helping skills class and this is one of the things that they struggle with so much is how to stay with the emotion that they always want to go to the story, the context, whatever. And so like that sort of having this sort of depth. Yeah, I just think it's just so it's not what we do in regular life is staying with the emotion and going into the depth of the experience. So it's just something that they just have no. Yeah, so it's always sort of a fun thing, but something it's always frustrating because it's like once you have done it up, you like you get a sense of it. It's like, oh, this is easy, right? Yeah, yeah. For the novice, it's very much not. It's also counter to the social protocol. Exactly. In many cultures and especially in Anglo cultures, you know, you give them space, give them space, you back off, just let them some space. So that's that's like a very. Anglo cultural way of coping with somebody who's getting emotional right it's like you give them space, you might let them change topic, you change topic because that's generous of you. But in therapy, it's like, no, no, it's the state, it's okay. It's a little stay with this. It's okay, not it's okay stop feeling that's okay that we're going to do more of this right. So it's it's very counterintuitive to novice therapists, but you know, even to season therapists and to clients clients don't like high arousal. One of the reasons why, you know, like so here's an interesting therapist ratings of arousal predict outcome. And clients ratings of the rousal don't predict outcome and as well and there's a big difference right part of it is clients. If you ask them was it productive. I mean, I have a funny example where the clients, you know, yeah, it was an emotional session was it what did you feel like was productive. No, she says I use the whole box of Kleenex. I was a mess. Obviously, it wasn't productive. But I think it's a good way to research your comfortable right. I mean, the idea that it's a distressing experience might actually be helpful in some sort of way. Isn't something the person can most people can easily appreciate in that moment. I mean, if I ask her months later, but now we're talking about a lot of other things that have happened, right. So, you know, and many therapists freak out when their client has high arousal, even if it's healthy. You know, I'm not talking super high. I just mean moderately high client tears up some therapists are okay with that. But many therapists get a little nervous. Client starts to sob. Many clients are free therapists are freaking out. And it's terrible because also the client is freaking out. Client sees you freak out. They're like, if he's freaking out, I'm in big trouble. I better shut it down. And of course they do very effectively. It's like when that's like when the flight attendant gets nervous. That's when you know it's your turn to get nervous. Yeah, it's same thing. Therapist gets nervous. Yeah. So, I'm often telling therapists that I train. It's like if your client gets emotional and you don't and you're going to we're going to do this. The first thing you do, they say, yeah, tell them to breathe. I'm like, no, you breathe. Then you tell them to breathe, right. So, this is like the flight. First you put your mask on before you put the mask on. So the client looks at the therapist. You know, and the clients freaking out and they see your nervous. Then they get really nervous. So it's interesting. It's very countertuitive. I even like I researched this. And the other day I was with my kid and he got upset and like, I'm a parent. So now I'm a therapist, but I'm a parent. And instead of being like, yeah, okay. So you feel hurt by what happened at school and the kid and it was mean and whatever. I didn't immediately lean in and be like, let's talk about this feeling and what it means. What did you need really? Like instead, I'm like, well, you know, maybe it was maybe it was a misunderstood. And I was like, what am I doing? Like I was nervous because my kid was crying and suddenly the stakes are much higher, which is, you know, it's hard to be a therapist with your own kid. So, you know, it's it's an aversive experience is scary. It's scary. One of the interesting things about arousal is the uncertainty of where it will go. And yet there's a lot of research saying there's a very clear kind of wave of experience, right? The envelope of distress is not open ended. Right. You know, and some clients get very dysregulated. I'm not saying sit back and watch it happen. I think, I think be more engaged, right? And you can instruct clients to downregulate at times, but they they will. Right. One of the studies I talk about is two very contrasting examples. One where the therapist engages. I mean, the two examples are very similar in content and clients. It's amazing how the researcher found these two examples. But in one of them, the therapist encourages the client to explore this more goes there. What what it mean. And you know, they they have heart rate monitors on the clients and the client freaks out doesn't freak out gets very emotional and then recovers in about five minutes. And it seems like an eternity when you're there, but it's actually five minutes. Right. In the contrasting example, it's very, very similar except there's this arousum for whatever reason the therapist is the same therapist changes to plot and characters. And it's more narrative and goes to well, who was there and what was happening. Why and you know, the why question is is a narrative that's like step outside the experience and just explain it. So anyway. The happens is the clients very obliging their rousal drops, excuse me, from the video their rousal seems to drop their bliaging they like, oh, yeah, sorry, I didn't get off topic and you know, as if the motion was off topic. That's what the therapist just implied clients are very obliging and starts to kind of if you just looked at the video, you're like, oh, okay. But if you look at the heart rate, her heart is is pounding it goes up and instead of recovering in five minutes, it goes up and then it comes, there's this very slow decline. If you go to the video, she looks normal. But the whole time we know her heart is actually pounding we've all felt that right where you freak out and you play like it's normal and you play like it's normal until you feel normal. And probably for that therapist, you know, at that moment, I'm imputing here and making it up, but the therapist probably is sort of going. Yes, nice disaster averted a rousal change topic. God, right? And like it looks like a success. But really all the therapist has done is removed is taking it off the table. So now we can't talk about what's going on with you and your heartbreak because we're talking about something else that's totally a different topic and meanwhile she's feeling heartbroken. You know, so it's an interesting interrupting it doesn't resolve it. I think I really appreciate sort of how your juxtaposing these two things sort of of the the meaning making and sort of that express of a rousal. I think it's helped to clarify from for me what you were, you know, helping me understand that because I think for anybody who's, you know, who is a therapist that that, you know, sort of staying in the emotion versus going to the context and the story like everybody's been there, right? And having to make those decisions. Yeah, absolutely. And like and and and actually I really also appreciate what you're saying though about the if you go to the narrative without like if if it erupts if it comes up and in the clients going into it and then you moved to narrative that yes, that might influence what it looks like from the outside, but the experience of the client. Like that's that's a different story. No pun intended. Sorry, I think it's really insightful. I really appreciate that. So one of the things we oh, sorry, go ahead. No, I was just echoing what you're saying. It's like you need a case formulation that says what does this client need? And then pursue those kinds of processes when they emerge and don't you know, you have to make choices. It doesn't matter what treatment approach you're doing, but you're deciding how to engage with the client at this moment, you know, go back to the awareness. It's like, am I going to use a close ended? Am I going to reflect how they're feeling in a closed ended final answer sort of way or I'm going to be exploring it. I mean, you should be do right now across treatment approaches therapists are using therapists think about what intervention they're doing. Instead of what process am I trying to leverage? The future of therapy is process based. Right? Because the reality is you we know the process predicts the outcome. We agree. We agree. You're the therapist. You get to choose the intervention, but you don't choose the process. Your treatment manual tells you you do, but you actually choose the intervention and your client chooses the process. Yeah. So, you know, this is does a cup means a couple of things for randomized clinical trials and all sorts of stuff, right? Like what was the actual treatment? Do you think, but do you think that as I agree with what you're saying? I sort of the part that you know gives me pause is does the field in general agree with what you're saying? I think I think it's where we're pointing and I think if you think that I think so. I think it's going to take some time. There's some obstacles. But, you know, let's move like look at different approaches, right? I think process research is becoming more and more prominent across treatment approaches. It used to be that's true. The experiential person centered were really into process research and at some point, you know, maybe starting to change now, but at some point is like that would be the approaches that had the most process research. Cognitive behavioral therapy being the approaches that have the most outcome research, but just because you have a good outcome, doesn't mean you know why you have a good outcome. Not people like Hoffman and Hayes, editors of behavioral and cognitive journals, therapy journals, writing papers on process based therapy and saying this is the future we have to be looking at the process because you know smart researchers realize that Oh yeah, exposure works. Right. Oh, hang on. It works better if you use affect labeling. What's really going on here? It's not just exposure all of a sudden, right? And you see this happening again and again, right? So I think it is the future. I think supervisors 30 years from now won't be asking what was your intervention they should will and should be asking what are you trying to what process are you trying to elicit. And you know, it's important to know that because then you could actually move laterally across treatment approaches and be like what other interventions my intervention is not working for that process. That's the process that we need right now. What other interventions maybe from other approaches would facilitate that process. So that's that's an exciting future I think. You know, the fact that you choose the intervention, but don't choose the process. If that if people are having trouble wrapping their head around that. Well, you don't right you don't get decide what happens inside the person. Here's a very funny and very common example. Have you ever had a client say to you that the session was really helpful or the in some aspect of an intervention was helpful. And you don't know what they're talking about. It's like, yeah, I'm great. Now that's wonderful. I'm so happy. So what exactly was useful right this is like a fat finger intervention right where you have had an impact fat finger comes from from the typing right where you accidentally hit the wrong key. And it can have if you were in the financial world that have very big downstream effects right you move the comma a little bit. So this is called a fat finger error. I'm going to talk about fact finger interventions right like there's lots of interventions you do and the client takes it their own way or in a different way. And it's useful for them if it's not useful then it's not useful but it might be useful in a way that you hadn't anticipated that doesn't come from your treatment manual. You know what I mean. And I said, I'm going to work in this fancy kind of a rousal and I said they said that was really useful. I'm like, oh, great. How they say, oh, you know, I went home. I wrote a list of pros and cons and I put out a spreadsheet and I'm like, wow, that's not. That's narrative right that's kind of contacts and trying to come out with a thinking about this is a very different process they engaged in that was elicited for my intervention interventions do lean towards certain processes right obviously but ultimately you don't get to choose the client chooses and your implications for randomized clinical trials and comparing treatments and you know treatment is not a plated service if we're talking about a restaurant. I don't serve you the intervention and that's what you're going to eat. And more of like therapy is a buffet I set the table and then you make use of it you the client but two clients in the same arm of randomized clinical trial might be making use of very different parts of that buffet some persons only eating the salad bar and the other persons only in the past bar and actually they're absorbing let's call it very different treatments per say right. Even though they're in the same arm actually they may one of them maybe observing the same treatment as the other people in the other arm right because you get this randomized clinical trials work really well for medication where I dictate what is the chemical that goes into you the pill but in therapy the client chooses the process so there's kind of a little you know side from the city issue which bill styles brought up is an obvious critique we need randomized clinical trials I'm not saying we don't but you know it's much more fuzzy therapist are responding to clients which means the independent variables dependent on the dependent variable you actually respond to your clients but also you don't get to say what how they use the intervention and they may be using it in very different ways. It's interesting I think. So let's want to make sure we hit on the sequence of emotions because I think that of all five of your principles is probably the one that I sort of struggle with the most into sort of making sense of sure so I guess you know what is sequential transformation when is it important help us understand that yeah. So yeah so you know you could say well isn't it just emotional awareness of an emotion and the rouse of an emotion and you have two emotions so sequential transformation is that you're going to have more than one emotion let's just say two in an ordered sequence first chain then a sort of anger for example. Okay and that sequence will be the fact that occurs in this order will be a change mechanism okay so it's more than the sum is the whole is larger than the parts right it's more than just being aware it's more than just increasing arousal yes that's happening but if you have the same feelings in a different order you don't get the same effect. Ding ding ding one feeling isn't replacing the other feeling it's undoing the previous feeling the sort of anger is undoing the delitious or harmful effects of the shame so to speak. There's some really cool experiments that show that. It is I'm speaking now to your you say it's kind of newer yeah it um I think there's a lot of intuition about this sort of thing being a change process or mechanism from very earlier early on you have stages of grief for example right Kubler so that there's somehow their stages of grief does that hold up no it doesn't hold up but has strong and it hold up empirically I mean but that you know we have a measurement issue and how are you going to calculate that and is it linear or is it dynamic and non linear so this creates complexity and makes these things very hard to measure never mind just measuring emotion in time is hard to measure right it's not a questionnaire it's we have to actually watch it in the video and this happens before that happens so. So but yet stages of grief very very early that's kind of an idea if you look at psychodynamic therapies the idea that this sort of a primary process of defensive sort of emotions then there's deeper processes what does I mean deeper right that inside that there might be more inhibiting effects or or. Activating effects and that you know the punchline here is one emotion could be the antidote to another emotion Fredrickson you know so in throughout the book I told you i'm looking at neuroscience and looking at the phenomenology i'm looking at how we are measuring these things and does it predict outcome can we measure them right these principles but i'm also looking at basic research. Basic research the phenomena that we're talking about the change processes that we're talking about shouldn't only appear in psychotherapy research that would be weird according to me right I mean I don't think what happens in therapy are magically new processes right there'll be learning processes there'll be other sorts of things when you study emotion the kind of processes that emerge in therapy should also have appear in research on the. In research on basic emotion or in a rouse or so and so forth so I also for each principle explore that kinds of research right. For the arouse one we could go to shactor and singer right which is really obvious this is the old study of on where somebody gets you know you put their put into a waiting room they're waiting for something but unbeknownst to them they have gotten an injection some people tell well they know they got an injection. Some people are told this involves deception I don't know if we fly these days but it's done decades a decades ago right one group they're given an injection one group is told it's like a vitamin injection it won't do anything and the other group is told and the other group is told what it is but it's actually an injection of adrenaline and so then they go to the waiting room and there's a confederate in there who's also in the waiting room the person is very irritating. People who get the vitamin injection they become very irritated by the by the confederate and they report having a lot of emotion and the other people who who were told you're getting a adrenaline injection they have that as an explanation and they're not as affected by the shenanigans of the confederate right. So this is where like do you have a reason to explain your arousal has a lot to do with whether arousal will will will capitalize and will will will hijack your experience anyway so there's there's basic research and I was just giving examples and expressive arousal will hear sequences Barbara Fredrickson has done sort of this kind of very simple research really to design where they're activating an emotion and then another emotion in an organ. And she's looking at positive emotions versus negative emotions by positive in this case I hate the language positive negative because what does that mean she's talking about feeling good happy emotions versus negative emotions like anxiety so they induce anxiety with some movies and then you either get a delay or you get to experience something else sadness or what or you get to experience the funny move. The funny movie you watch the funny movie and people laughing at it and basically the cardiovascular what they're interested dependent variables cardiovascular recovery right so how quickly do do people get over their their anxiety and and what she shows is when the positive emotion is elicited after the negative emotion cardiovascular recovery is faster than if you had done nothing like see just how to delay yeah so so it's not that one emotions replacing the other motion it's that there's there's kind of an undoing effect positive emotion undoes negative emotion okay that's compelling but the issue is it turns out it's not just positive it's activating or approach emotions as opposed to withdraw or inhibiting emotions so even though shame is negative experience and anger is a negative experience anger could be the antidote to shame anger is this draw experience they're both negative but one is with draw and the other one's with the approach or vice versa sometimes sadness could be the antidote to unhealthy anger sort of getting back to what the grief example yes well which part of the grief example do you mean well I was thinking about sadness in return like you said that sadness anger or something like that thing about that sadness right is a adaptive way to experience grief or certain types of anger could get in the way of adaptive grieving yeah yeah so actually we did it we did a study on this where we took people who were unfinished business they felt betrayed by another person in their life that's the call we get I can't remember like a hundred people right of course if you've been betrayed by somebody have unfinished business you might you'll usually feel angry and you'll feel sad but some people are more angry and other people are more sad all right so now actually unfinished business betrayal we have two naturally occurring groups some are more angry and some are more sad and what we do is an experiment now where we those two groups we create two interventions so now there's four you see what I mean each one gets either so the angry people either are encouraged to express and experience sadness which isn't what they're feeling right now and then anger or different condition randomized to experience anger before sadness and we do the exact same thing for the people are mostly sad the research question is should I go for anger or you know clients feel a bit of both and the therapist says to me should I go for anger should I go for sadness I'm not an empirical question right it turns out it turns out and doesn't make a difference because if the order didn't make a difference then everybody should have the same outcome but it does make a difference people who feel angry are relieved of their distress or angry distress much more if you facilitate anger first their angry and you encourage them to be angry and then you move to sadness as opposed to if you do it the other way around their angry you say can you look on the other side of the experience sadness maybe it's and then go to anger right both motions but one of them has a good effect on the other one doesn't what happened to the sad group the inverse people in the sad group because you could say also anger is always better before sadness no no no no if the person sad then sadness is better before anger right so in some sense like an old person centered Rogers would give it a thumbs up he would say yeah start where the client is and move from there but here we're doing more than Rogers we're not just moving start with the client is we're actually after we've gone to where the client is there's an agenda to facilitate a different emotion right which presumably is part of their landscape of feeling but isn't high salience right their angry and sad but they're mostly sad we want to work on sadness or the most angry we want to work on anger but it's still in their landscape right so the second emotion undoes the first emotion this is a process that as you said is talked about is newer in some sense emotion focus therapy is talked about it a lot and a lot of the research is there but now this is spread and has been studied in very different treatment approaches including cognitive processing therapy dialectical behavior therapy psychodynamic therapy so this is a problem the thing is we needed a way to measure it and you needed a concept right a way of formulating it it's not just stages like rigidly going through but there's something much more dynamic and if you look at interventions I mean you go to DBT it's not about emotions about behaviors obviously it is about emotion but you know the working with emotion but using behavioral approaches their interventions like opposite action well it's just the opposite behavior of course but you know if you act assertive you start to kind of feel assert so the behavior is like a way of cleverly tugging at an emotional scheme which then gets activated and is indeed the antidote to the shy and sheepish with drawn presenting concern right if you go further back the idea of reciprocal inhibition is I think you know now we're going back back in behavior therapy you see something similar there that doesn't quite add up to inhibition as we understand it in contemporary science right habituation doesn't really explain reciprocal inhibition even though they're using the same word but the sequences this idea of sequences that does so let's I want to take this as we're sort of in sort of the closing stage of this conversation I want to take this sort of big picture so you know we're talking about emotional change and that you know clients typically they're not there to experience solely emotional change in this exact moment right we they're there for some larger personal change so how do you tend to think about the relation between these moment moment to moments sort of emotional changes and how that relates to personal change you know because that's what we're really here for right to help the person if you think if if one thinks of what are you doing when therapy successful right are you just resolving an issue like meaning untying a knot and handing it back to the person and they go about with their life that will be good you know I was just talking about people who feel betrayed and then working through that but you know I'm going to say that when we do that somebody's betrayed and help them work through that that they're not the same person as they were when they came in that they've grown a little bit that they've changed not just changed like the problem is resolved that thing in my life but my infrastructure as a human for working through emotional concerns is more mature is more developed somehow emotional development in kids children is mostly explained by maturational factors by biological factors mostly obviously the way you treat kids and the way you nurture them and grow them up makes a difference but the the lion's share of change in emotional development in a kid is simply because their brain is getting bigger right doesn't mean you have to pick one you do both at the same time but anyway you're getting my idea here by the time this person 16 they have as much engine power as they'll ever have right a little kid of three doesn't feel ambivalent they don't feel more than one thing so emotional awareness is fairly easy for teenager it's very overwhelming because they can they have the engine power they can feel more than one thing at the same time that's very overwhelming and it takes them a number of years to they're not growing an engine power but they're growing in mastery of how to manage this engine power what do I do when I feel ambivalent and so and so forth now we go to the seasoned adult right they don't have more engine power than the 16 year old but they have more experience and more strategies if we want to use that language what I'm saying is I think these five principles are not just little keys for fixing problems undoing locks but they are competencies right you know some people are emotional more emotionally aware than others they are and we can measure it you know it's really cool though some people get better at it so you know alexophobia no words for feelings people who have very low emotional awareness alexophobia is often treated in the literature as a trait it's kind of like not a personality trait but of that type it's somehow it's stable right and it is except the few studies that have looked at alexophobia pre-imposed therapy why would you it's a trait it's not going to change it's like their hair color well actually the few studies that have been experientially oriented therapy so emotion focused therapy also a psychodynamic therapy that's experientially oriented show clients who are alexophemic at the beginning of treatment and many clients are are less alexophemic at the end of treatment it's supposed to be a trait it's not supposed to change it's supposed to have less symptoms they do have less symptoms fewer symptoms but they're also less alexophemic what's going on I mean I think there has been some some mentorship in labeling attending to feeling I was talking about the exploring right this is a real thing and people get better at it if they have very nuanced scaffolding to help them search you say how do you feel about that clients is I don't know and I say we have lots of time take a minute you might not know right now but what if you stay with it and I actually I'm create a task right and we so you know that person at the end of therapy gets better at doing that they get more emotionally aware and that's a competency they take with them for the rest of life they're different people they're more emotionally mature in that one dimension but you actually see it in the different dimensions if we go to narrative some people are really good at telling stories and making a coherent narrative some people are pretty bad at it has a lot to do with how you're socialized by the way early studies showing like even kids if you you know we're talking about adults but even kids is very illustrative if mothers the study was on mothers but we mean caregivers if mothers were instructed on encouraging their kids to tell very rich emotion and socially focused stories as opposed to behaviorally then what did you do two years later those kids in a standardized interview tell much more rich emotional stories and they have higher self esteem compared to their randomized partners they have better sense of self more coherent sense of self and they tell better stories what was the intervention the way the kid was encouraged to tell the story this hasn't been measured in therapy well actually has to some degree there are there are studies that show you know how clients are becoming more coherent or more right over generalized narratives are are is like a trans diagnostic risk factor right and yet you can get people to tell more detail there narratives with encouragement so you know I think to answer your question I try to illustrate it but these aren't little keys for solving local problems you would solve local problems of course but you know these are ways of fostering adult emotional development because you're not going to grow bigger brain right you're not going to have more engine power but you could develop more skill in working with emotion right this is like learning the piano and once you know how to play the piano the musical world is very different so you know the person walks away from therapy having resolved maybe the issue maybe they're less depressed but they're also more resilient for the next time the press genic event happens right I think we are if you're focused on the process then you're focused on cultivating people emotionally that's a wrap on our conversation as I noted at the top of the show be much appreciated if you spread the word to anyone else who you think might enjoy it until next time[Music]

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Dr. Dan Cox

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