An investigation of emotional expressiveness as one of the proposed mechanisms of change of radically-open dialectical behaviour therapy

Abstract

A systematic review of the literature was conducted to explore Emotional
Expressiveness in Depression, 11 eligible papers were identified. Papers were critically evaluated with the research question in mind: ‘What empirical evidence is there that patients with depression are less emotionally expressive than non-depressed individuals?’ All 11 papers supported the research question that individuals with depression are less emotionally expressive, in comparison to non-depressed individuals. To the best of the author’s knowledge, no previous review has been conducted on emotional expressiveness and depression. The research available to date is in its infancy and several limitations of the studies have been delineated in this review. Thus, conclusions are tentative at best.

The empirical study in this thesis investigated Emotional Expressiveness as one of the Proposed Mechanisms of Change of Radically open-Dialectical Behaviour Therapy (RO-DBT). Depression is considered to be one of the leading causes of disability today, with more than 300 million suffers world-wide (WHO, 2017, 2012). Treatment options for mild to moderate depression have proved to be efficient. However, individuals with more complex trajectories appear to be resistant to both pharmacological and psychological interventions currently available. Thus, many patients present to us clinically with chronic treatment resistant depression. RO-DBT is a transdiagnostic treatment approach that specifically set out to treat patients with complex presentations. It posits that one of the main impairments in these populations is their deficits in emotional expressiveness, which leads to exacerbation of symptoms of depression and functions as a maintenance factor of the disorder.

The main objective of the current study was to explore one of the likely mechanisms of change in RO-DBT, namely, a change in emotional expressiveness as a possible result of the therapy. It was hypothesised that individuals’ observed and self-reported emotional expressiveness would become less maladaptive after receiving RO-DBT. Mental well-being would increase and ambivalence over expressing emotion and observed maladaptive social signalling would decrease, as measured by the PhQ-9, ‘Maladaptive Social Signalling scale’, and the AEQ. 30 participants’ that took part in the original RCT REFRAMED study (14 Male; 16 female, n=30) were eligible according to the inclusion/exclusion criteria for the study. Video-recordings from the RO-DBT session (Pre, Mid, Post) were viewed and rated for emotional expressiveness and scores for the three different time points on the PHQ-9 and AEQ were analysed. A cross-sectional design was utilised and a repeated measures MANOVA yielded a statistically significant result across different time points of therapy (Pre, Mid, Post). Our results provide some support for the efficacy of RODBT therapy, to reduce maladaptive social signalling behaviours, increase mental well-being and ambivalence over expressing emotions. However, there are several limitations of the study and results should therefore be interpreted with caution.

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