Emotions, the Great Captains of Our Lives: Their Role in the Process of Change in Psychotherapy

Emotions, the Great Captains of Our Lives: Their Role in the Process of Change in Psychotherapy

A view of human functioning is presented in which functioning is seen as integrating head and heart, emotion and reason, in a process by which people are constantly making sense of their lived emotional experience to form narratives of told experience. Because much of the processing involved in the generation of emotional experience occurs independently of and prior to conscious thought, therapeutic work on a purely cognitive level of processing is unlikely to produce enduring emotional change. The questions especially relevant to psychotherapy are how we can best facilitate change in emotions rather than only changes in cognition or behavior. A theory of emotional change is presented in which change in emotion is seen as requiring that first emotions be felt and then they both be exposed to new emotional experience and be reflected on to create new meaning. The process of emotional change thus involves both new experience and new understanding. At times, people also need to protect themselves from being overwhelmed by emotions. They need to be helped to tolerate and regulate them so that emotions inform their lives rather than control them. The importance of both emotion awareness and emotion regulation in therapeutic change is thus highlighted. The article ends by reviewing research on the role of emotional processing in therapeutic change and presents six empirically based principles of emotional processing that will help move the field toward psychotherapy integration in a manner that clearly recognizes emotion as a key component of functioning and change.

Emotions are our greatest friends and at times our worst enemies. They are the constant companions of our lives, and they govern much of what we do. As Vincent van Gogh wrote to his brother, "Don't let's forget that the little emotions are the great captains of our lives, and that we obey them without knowing it."

In this article I review the evolving understanding of the role of emotional processing in human functioning and the evidence for emotion's role in therapeutic change and illuminate how this serves as the base for an emotion-focused approach to individual and couple therapy. Emotion-focused therapy for individuals and for couples, which casts emotions as the great captain of our lives, grew out of our early considerations,

over three decades ago, of the role of emotion in therapy and research on the process of therapeutic change. In these early presentations, my colleagues and I emphasized both the preconscious and the adaptive nature of emotion as well as the importance of distinguishing between primary and secondary, and between adaptive and maladaptive, emotion in therapeutic work.

Since then, due in large part to compelling findings in the affective and cognitive neurosciences, emotions have clearly been shown to be an adaptive component of human functioning and not simply secondary to cognition. LeDoux, for example, demonstrated that there are two different paths for producing emotion, the "low" road, when the amygdala senses danger, and the slower "high" road, in which the same information is carried through the thalamus to the neocortex. As LeDoux highlighted, the low road, fundamentally, is highly adaptive because it allows people to respond quickly to important events before complex, time-consuming, reflective processing has taken place. Damasio demonstrated that emotions work through somatic markers that automatically direct our attention toward more advantageous options, simplifying decisions and helping to solve problems, often before we are even conscious that there is a problem. Porges, in his polyvagal theory, linked the autonomic nervous system to social behavior by showing how a subconscious neuroception of interoceptive signals of danger and safety controls important emotional states related to survival.

Until recently, the prevalent commonsense view of emotion, endorsed by many in psychology and psychotherapy, was that emotions were postcognitive; were disruptive to functioning; and were to be controlled, tempered, bypassed, or avoided. Control of emotion, however, is not always wise or adaptive, and overregulation or avoidance of emotion does not ensure health or happiness. Emotion gives important information about our reactions to situations, whereas inhibiting the expression of emotion can lead to impaired immune system function and poorer health. There also is increasing evidence of the importance of emotion knowledge and emotional intelligence in enhancing social competence and healthy development.

The tide has clearly shifted now that it has become clear that emotions are a fundamentally adaptive resource, and there has been a marked shift from a cognitive to an evolutionary view of emotional functioning. As many emotion researchers have pointed out, primary emotional responses have been evolutionarily preserved because they are adaptive and provide an assessment of the degree to which goals or needs have been met in interaction with the environment. They also reset the organism physiologically, behaviorally,

and cognitively to adjust to changing circumstances. They involve a hedonic tone, an action tendency, and a meaning system that influences preferences, organizes people for rapid adaptive action, and informs people of the significance of events to their well-being. Emotional responses are elicited by an automatic process of evaluation of the degree to which needs, values, or goals are being met or not met in interaction with the environment. From birth on, emotion also is a primary signaling system that communicates intentions and regulates interaction. Emotion thus is a primary meaning system, a primary action tendency, and a primary communication system. To access their adaptive benefits, emotions need to be processed rather than avoided or controlled.

In addition to research showing that emotion clearly is precognitive, studies also make clear that emotion interacts with cognition in a variety of important ways. Emotions, however, involve automatic, attentional, and evaluative processes more than computational or propositional forms of cognition. They therefore involve cognition in the broad sense of the term. Emotions, as well, are carriers of personal meanings in that they inform us of what is significant for our well-being. Ultimately, emotion and cognition form complex affective-cognitive structures, which have been termed emotion schemes. These carry our emotional learning and memories and are responsible for the provision of the majority of our emotional experience. In addition, emotion and conscious thought constantly interact, in language, to create narrative meanings. Emotion thus is not cognition free, and ultimately we seldom have emotion without some conscious meaning.

Emotion schematic memory of an emotional episode can be seen as an information network that includes units representing emotional stimuli, somatic or visceral responses, and related semantic (interpretive) knowledge. The memory is activated by input that matches some of its representations, and those elements in the network that are connected are also automatically engaged. As the circuit is associative, any of the units might initiate or subsequently contribute to the activation process. Emotional experiences produced by these structures provide both higher order feelings, such as being on top of the world or down in the dumps, and our sense of things, such as a sense of danger or of attraction. These are a level higher than the original biologically based emotion responses such as anger or sadness. These emotional responses have been informed by experience and benefited from learning. Much automatic adult emotional experience is of this higher order, generated by learned, idiosyncratic schemes that serve to help the individual to anticipate future outcomes and influence decision making. These memory-based emotion schemes are triggered automatically and when activated, cue the amygdala and anterior cingulate, which, in turn, lead to changes in the viscera, skeletal muscles, and endocrine, neuropeptide, and neurotransmitter systems and possibly other motor areas of the brain. These changes, together with the often-implicit meaning represented in the prefrontal cortex, generate human beings' complex, synthesized, and embodied sense of self in the world. This sense then is symbolized in conscious awareness and formed into narrative explanations of self, other, and world.

An example of this second, higher level, more cognitively complex type of emotion would be the pit in one's stomach that one might experience upon unexpectedly encountering an ex-spouse. The trigger is clearly acquired, but the process is still automatic. Regardless of whether the experience can subsequently be fully articulated (i.e., as to exactly what one feels and why one feels the way one does), the experience nonetheless is tacitly generated. Perhaps most important, these memory-based emotion schemes guide appraisals, bias decisions, and serve as blueprints for physiological arousal and action. They act as crucial guides, to which we often need to refer to enhance reason and decision making. These affective/cognitive/motivational/behavioral emotion schemes are thus a crucial focus of therapeutic attention and, when maladaptive, are important targets of therapeutic change.

With the advent of this view of emotion as an adaptive resource and a meaning system, rather than as something that needs to be gotten rid of cathartically, modified, or corrected by reason, the understanding of emotion's role in human relationships and psychotherapy has changed. This "new look" has begun to set a new agenda for psychological research-to determine how we can best facilitate change in emotions, treating emotions as independent variables that exist as such, rather than being secondary to cognition. Key issues for clinicians are how best to promote (a) access to and awareness of emotion and (b) the transformation of emotion.

Four key findings in emotion research help answer these questions. The first is that awareness and symbolization of bodily felt emotional experience have been shown to down-regulate emotional arousal. Second, emotion has for some time been shown to influence memory, thought, and decision making. Third, emotion has been shown to change emotion, and finally, emotion has been shown to change memory during its reconsolidation period. Research also has clearly shown that emotions, in the sense of visceromotor and somatomotor responses associated with bodily sensations, occur out of awareness. For example, emotions can be activated with subliminal stimuli, and the emotional content of the stimuli can influence subsequent behavior, such as consumatory behavior, without the person being aware of such influences on behavior. Thus, a great deal of emotional responding may occur without the person being aware of it. Emotions and motivations, however, do not reside in the unconscious fully formed and waiting to be unveiled when the forces of repression are overcome. Rather, they most commonly exist in an undifferentiated form consisting of sensorimotor schemes that are preideational and preverbal. Implicit emotion, or bodily felt sensations, can be transformed into discrete conscious experiences of specific emotions by putting the felt sensations into words. Through this process an individual can feel specific emotions and "know" what it is that he or she is feeling.

This research suggests a dialectically constructivist view of emotion, in which bodily felt emotions exist palpably, and that reflection on a bodily felt sense produces what we feel, while symbolization in language helps to contain highly aroused emotion. Thus we construct what we feel by attending to a bodily felt sense and symbolizing it in awareness, and our constructions are simultaneously informed and constrained by what we feel in our bodies. In addition, as I will show, we can change what we feel and remember by exposing our activated emotion to opposing emotions, and that new emotional experience leads to the construction of new narratives.

Emotional Change A Dialectical Constructivist Perspective

Human beings actively construct their sense of reality, acting as dynamic self-organizing systems that synthesize many types and levels of information to create their experience. Emotional expression is itself clearly an elaborate cognitive processing task in which data are integrated from many sources in the brain (often in milliseconds), and this occurs, in the main, outside awareness. The conscious narrative flow of evaluations, interpretations, and explanations of experience-the told story of the emotion-is really based on a memory of what occurred and often comes only after the lived experience. The narrative account is significant as a record in memory of experience but often is only peripherally related to the process of generating ongoing emotion.

Multilevel theories that attempt to integrate a variety of different emotion-generation processes have arisen to deal with the complexity of human emotion. Leventhal was the first to suggest that sensorimotor, schematic, and conceptual levels were all involved in generating emotions, and this approach was adapted to explain the role of emotion in therapeutic change. Teasdale subsequently suggested a nine-level model starting out at a sensory level and moving to an implicational tacit level of processing at the top of the hierarchy with a conscious propositional level one level lower, whereas Power and Dalgleish proposed a three-level model similar to Leventhal's with associative, schematic, and propositional levels. In addition, a more dynamic rather than a hierarchical model of emotion construction by synthesis has been proposed by Greenberg and Pascual-Leone to explain how conscious emotional experience is generated.

The type of functioning suggested by these models, in which separate but interacting mental functions are mediated by separate but interacting brain systems, appears to be crucial in understanding a variety of areas of functioning. For example two types of memory, one explicit and more factual, the other procedural and more emotional, have been demonstrated, as well as two kinds of learning, one a more conceptual, logical form of learning, the other a more perceptual and emotionally associative one. These different levels help explain the difference between two ways of knowing-one more conceptual and the other more experiential. More conscious, conceptual forms of processing involve facts and reasoning and are produced by the cortex, whereas more automatic associative forms of processing involve immediate experience and perception and are produced with the aid of the emotional brain. These two systems allow for "knowledge by description" (conceptual knowing) and "knowledge by acquaintance" (experiential knowing). The second is a more tacit, procedural means of generating experience, whereas the first is a more conscious declarative process of explaining experience. Meaning, as has been noted, results from the dialectical synthesis of emotion and reason. Without emotion there is no action, but without conscious organization there is no coherence. Without conscious articulation, the depth, range, and complexity of emotion cannot develop beyond its instinctual origins. Working with emotion involves symbolizing it in awareness and reflecting on it to create new narrative meaning rather than cathartically getting rid of it or habituating to it.

Through language, individuals are able to organize, structure, and ultimately assimilate their emotional experiences and the events that have provoked the emotions, and this has been shown to be helpful in processing traumatic experience. Once emotions are expressed in words, people are able to reflect on what they are feeling, create new meanings, evaluate their own emotional experience, and share their experience with others. There are a number of psychotherapy studies that provide evidence for the importance of reflecting on aroused emotional experience in therapy. The implication of these is that emotional processing is best facilitated by the progressive increase and then fading away of expressed emotional arousal over the course of a session. This process involves helping clients activate emotion in the session in order to reflect on and make meaning of it.