Paul S. Greenman

Process Research on Emotionally Focused Therapy (EFT) for Couples: Linking Theory to Practice

The focus of this article is on the link among theory, process, and outcome in the practice of Emotionally Focused Therapy (EFT) for couples. We describe the EFT model of change and the EFT perspective on adult love as the reflection of underlying attachment processes. We outline the manner in which theory and research inform EFT interventions. This leads into a detailed review of the literature on the processes of change in EFT. We highlight the client responses and therapist operations that have emerged from process research and their relation to treatment outcomes. We discuss the implications of this body of research for clinical practice and training.

Soothing the Threatened Brain: Leveraging Contact Comfort with Emotionally Focused Therapy

Social relationships are tightly linked to health and well-being. Recent work suggests that social relationships can even serve vital emotion regulation functions by minimizing threat-related neural activity. But relationship distress remains a significant public health problem in North America and elsewhere. A promising approach to helping couples both resolve relationship distress and nurture effective interpersonal functioning is Emotionally Focused Therapy for couples (EFT), a manualized, empirically supported therapy that is strongly focused on repairing adult attachment bonds. We sought to examine a neural index of social emotion regulation as a potential mediator of the effects of EFT. Specifically, we examined the effectiveness of EFT for modifying the social regulation of neural threat responding using an fMRI-based handholding procedure. Results suggest that EFT altered the brains representation of threat cues in the presence of a romantic partner. EFT-related changes during stranger handholding were also observed, but stranger effects were dependent upon self-reported relationship quality. EFT also appeared to increase threat-related brain activity in regions associated with self-regulation during the no-handholding condition. These findings provide a critical window into the regulatory mechanisms of close relationships in general and EFT in particular.

Post-Traumatic Stress Disorder among Cardiac Patients: Prevalence, Risk Factors, and Considerations for Assessment and Treatment

There is increasing awareness of the impact of post-traumatic stress disorder (PTSD) on physical health, particularly cardiovascular disease. We review the literature on the role of trauma in the development of cardiovascular risk factors and disease, aftermath of a cardiac event, and risk for recurrence in cardiac patients. We explore possible mechanisms to explain these relationships, as well as appropriate assessment and treatment strategies for this population. Our main conclusion is that screening and referral for appropriate treatments are important given the high prevalence rates of PTSD in cardiac populations and the associated impact on morbidity and mortality.

Commentary: Of Course It Is All About Attachment!

In the reply to the Bensen et al. article, we suggest that representation of the relationship between attachment and relationship satisfaction, the understanding of relationship specific versus general attachment, and the understanding of EFT presented in the paper are incorrect. We also find the analyses and conclusions of the paper highly questionable. It is however, encouraging to find that the field of couple therapy is recognizing the relevance of attachment theory as a core variable in adult bonding relationships and one that must be taken into account in the creation of change in such relationships.

Sad and Worried Hearts: A Psychological Treatment for Clinically Significant Depression, Anxiety, and Post-traumatic Stress in Patients with Cardiac Disease

People who suffer from depression, post-traumatic stress, or anxiety following cardiac events and treatment are more likely to have further cardiac complications resulting in death than are people who do not. Although there have been advances in psychological techniques to elicit behavior and lifestyle changes in heart patients [1], there is currently a dearth of information on how to address the psychological sequelae of heart disease effectively. The goals of this pilot study were therefore to develop and test a cognitive-behavioral psychological treatment that was specifically tailored to the needs of people with cardiac disease and symptoms of psychological distress. Fifteen men and 12 women between the ages of 35 and 85 who exhibited clinically significant symptoms of depression, anxiety, or post-traumatic stress following a diagnosis of heart disease participated in a maximum of 20 sessions of cognitive-behavioral therapy. By the end of treatment, there were statistically significant reductions in all symptoms of psychological distress, as measured by the Beck Depression Inventory Fast Screen for Medical Patients [2], the Beck Anxiety Inventory [3], the Hospital Anxiety and Depression Scale [4], and the Impact of Event Scale, Revised [5]. We present the treatment protocol in detail and discuss our results in terms of the utility of the integration of psychological services into cardiac care.