British Psychological Society Division of
Clinical Psychology Annual Conference
“Going for gold”
Symposium presented on 3rd December 2015, London
Emotional Processing;
new developments in
medicine, psychology and
psychosomatics
Chair; Professor Roger Baker
Order of presentations
The Emotional Processing Scale; a new pan-diagnostic assessment of
emotional style
Professors Roger Baker & Peter Thomas, Bournemouth University
Emotional processing in patients with psychogenic non-epileptic seizures and
the implications for psychological treatment
Stephanie Howlett, Professor Marcus Reuber & Barbora Novakova, Sheffield
Teaching Hospitals NHS Foundation Trust and Sheffield University
Emotional Processing in Childbirth (EPIC) study; does poor emotional processing
predict the development of postnatal depression
Dr Carol Wilkins & Professor Debra Bick, Bournemouth University & King’s
College London
Chronic pain and emotional processing
Professor Jorge Esteves, British School of Osteopathy, London
The role of emotional processing in cancer survivors with post-traumatic stress
disorder
Dr Gareth Abbey, Dr Simon Thompson & Professor Tamas Hickish,
Bournemouth University
Panel Discussion
The Emotional Processing
Scale; a new pan-diagnostic
assessment of emotional style
In symposium “Emotional Processing; new developments
in medicine, psychology & Psychosomatics”
Roger Baker, Peter Thomas
& Sarah Thomas,
Bournemouth University
December 2015
Emotions are so ephemeral one wonders if psychometrics are possible
emotional processing involves a change in emotional state from a distressed to a
more settled condition so measurement is even more complex
Aims of the emotional processing scale
Measure emotional processing styles and deficits
Predict the role of emotional processing in physical and
psychological disorder
Measure changes in emotion during therapy
Provide a framework to categorize patients for research
or therapy
General research tool to investigate emotions
Assist therapists in formulating patients’ problems
Researchers
Prof Roger Baker
Co-ordinator
Prof Peter Thomas
Statistician
Dr Sarah Thomas
Senior Research Fellow
Dorset Research & Development Support Unit
Matthew Owens
Lara Tosunlar
Ann Henderson
Mariaelisa Santonastaso
Phil Gower, Gareth Abbey, Anna Whittlesea, Sandra May, Claire Nash,
Lisa Gale, Dan Marshall, Eimear Corrigan + honorary staff
Research Publication Officers
Dorset HealthCare NHS Trust
The Emotional Processing Scale is now published
Emotional processing represents a completely new way of thinking f
about psychological distress
In anxiety, depression, eating disorders, alcoholism, brain injury etc EPS
scores are highly significantly elevated in all groups. So far we have not found
any psychological disorder group in which emotional processing is remotely the
same as with healthy normal individuals
Also as Carol Wllkin’s paper and Gareth Abbey’s papers will show, the Emotional
Processing Scale equals or outperforms symptom scales in predicting diagnoses
of depression and post-traumatic stress
Pan-diagnostic
The question is ”Can we regard psychological disorder as categorical or….
…a fundamental dimension underlying all psychopathology
I didn’t think like this when I first started researching
Cognitive
Invalidation and
panic attacks
Suppression of emotional experience
“I feel butterflies in my tummy and
feeling I want to cry. Then I suppress
my feelings. I take a great big breath ,
hold it in, tense myself or put my
mind onto something else – take the
dog out for a walk, do the housework.
I say ‘don’t be so b….. stupid, pull
yourself together”
Control of emotional experience
“Before I wanted everything to be perfect –
nearly every day I was wanting to stay on
this happy level all the time. I didn’t want
to appear out of control to anyone else –
angry,unhappy, I’m not going to let this
bother me – this ‘nothing bothers me’
exterior. Now I’ve come to the regrettable
conclusion that ups and downs are
normal.”
Control of three emotions: Anger, Sadness and
Anxiety
Level of
Control 21
Anger
Strong
control
Sadness
Anxiety
Control
Slight
control
14
Disorder
Panic Group
n = 48
Scottish
Healthy
Controls
English
Healthy
Controls
n = 118
n = 387
Emotional Processing
“A process whereby emotional disturbances are absorbed and
decline to the extent that other experiences and behaviour can
proceed without disruption”
“most people successfully process the overwhelming majority of
the disturbing events that occur in their lives” Rachman 1980
Metaphors conveying emotional processing
• ‘a process where emotional disturbances are absorbed’ (Rachman, 1980).
• ‘the process of transformation is a matter of breaking down the incoming
stimulation’ (Rachman, 1980).
• ‘The majority of people adapt to emotional disturbances and continue, or
resume, their regular behaviour. A significant minority however fail to adapt’
(Rachman, 2004,).
• ‘The new information, which is at once cognitive and affective, has to be
integrated into the evoked information structure for an emotional change to
occur’ (Foa & Kozak, 1986).
• ‘constitutes the essence of recovery or emotional processing’ (Foa et al.,
2006).
• ‘emotional processing occurs only when it is encoded and incorporated into
existing knowledge, that is, when new learning has occurred’ (Foa et al., 2006).
Theories which helped
processing model:
to
shape
the
emotional
• Emotion theory (Bucci, 1997a; Epstein, 1994, 1998; Frijda, 1988;
Leventhal, 1979; Strongman, 1987);
• Cognitive theory (Kelly, 1963; Lazarus & Averill, 1972; Ortony, Clore,
& Collins, 1988; Spielberger, 1972);
• Behaviour therapy (Foa & Kozak, 1986; Marks, 1978,1979;
Rachman, 1980);
• Cognitive therapy (Beck, Emery, & Greenberg, 1985);
• Experiential theory and therapy (Gendlin, 1962, 1996; Rogers,
1961);
• Psychoanalysis (Freud, 1909, 1952);
• Psychosomatics (Seyle, 1956; Traue & Pennebaker, 1993);
• Neuropsychology (Damasio, 1994; LeDoux, 1993, 1998).
Psychological mechanisms integrated within the model
Stressor, Trauma/ “input event”
Memory of input
Cognitive Appraisal of input and of cognitive
appraisal of emotional experience
Emotion Schemas
Family & cultural “emotion rules”
Emotional Experience
Emotional Expression
Emotional Understanding
Emotion Regulation
Initial item selection
Clinical
experience
Schematic
model
Case histories
300 draft items/ideas
152-items
101-items
Literature
Development of Emotional Processing Scale
Version 1
101
questions
Given to
60 healthy people
53 patients visiting
the doctor
37 mental health
patients
n = 150
Analysis of
data
Item Analysis
Distributions
Missing scores
ANOVA
Preliminary
Factor Analysis
Development of Emotional Processing Scale
Version 2
45 questions
Given to
100 students
73 older healthy people
124 cancer patients
16 back pain patients
147 mental health
patients
n = 460
Analysis of
data
Internal and testretest reliability
Item & subscale
correlation
Factor Analysis
ANOVA & t tests
Concurrent
reliability
Sensitivity to
change
Development of Emotional Processing Scale
Version 3
53 questions
Given to
310 healthy people
86 patients visiting the
doctor
114 pain patients
180 mental health
patients
n = 690
Analysis of
data
Internal & testretest reliability
Item & subscale
correlations
Factor Analysis
ANOVA & t tests
Concurrent
reliability
Development of Emotional Processing Scale
FINAL VERSION
25
QUESTIONS
How the questionnaire is rated –
1.
based only on the last week
I smothered my feelings.
0
1
2
3
4
5
6
7
8
9
completely---------------------- disagree--------------------------in between ------------------------- agree------------------------ completely
disagree
agree
2.
Unwanted feelings kept intruding.
0
1
2
3
4
5
6
7
8
9
completely----------------------- disagree-------------------------in between ------------------------- agree------------------------ completely
disagree
agree
3.
When upset or angry it was difficult to control what I said.
0
1
2
3
4
5
6
7
8
9
completely----------------------- disagree-------------------------in between ------------------------- agree------------------------ completely
disagree
agree
Collaboration
There are 85 research collaborators throughout the world
Worldwide EPS-25 Translations
Translations of the EPS-25
To enable worldwide research,
translations into 13 languages
have been completed with our
partners:
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•
•
•
•
•
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•
•
•
•
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Chinese
Danish
Egyptian Arabic
French
French Canadian
Hindi
Italian
Japanese
Marathi
Polish
Portuguese
Spanish
Swedish
In July 2015 the EPS was
published by
3 elements to the EPS
Administrators
Manual
EPS Manual
Explains how to use the scale with 15 worked case
examples depending on different assessment aims;
Identifying targets for intervention; Stephen, a soldier with post traumatic stress
disorder
Measuring changes a group; Evaluation of a new therapy for medically unexplained
symptoms
Personal development; Andrew, a successful GP who always felt there wa something
“missing” emotionally
Assessing risk; Assessing vulnerability in paramedics in an NHS Ambulance trust
Assessing ability to cope with medical procedures; Martin a 25 year old student with
Crohn’s disease facing surgery for an ileostomy
Use of cut-off scores; Investigating the relationship between memory and emotional
processing in students
Norms
Booklet
Mental health
Childhood experiences
Pain
International
Healthy
Other
Total
Addiction
337
Addiction – long term abstinent
26
Eating disorders
76
General psychological difficulties (Depression/anxiety/PTSD) 78
Non-epileptic attack disorder 55
Traumatic Brain Injury
30
Youth offenders
139
Childhood Sexual Abuse
52
Chronic pain
310
Polish sample
521
Indian students
304
Portuguese sample 1156
Egyptian students 216
Japanese sample 830
English-speaking students (USA, Australia, Canada)
547
Lung Cancer
38
Community (UK) 1383
Pregnant women 974
7072
The Scoring
Booklet
The client/patient makes their evaluation on the basis of their emotional
reactions in the last week only
The test administrator tears off a back section
To reveal the profile chart and scoring sheet
They enter the raw scores onto the scoring sheet
And calculate means for each subscale and the total score
This is then transferred to the profile chart
So the user/
client/patient can
see their scores
The scale, profile chart and scoring sheet
Problematic emotional
processing styles
Based on the emotional processing model,
clinical utility and several series of factor
analyses with the different iterations of the
scale.
But finally using Maximum Likelihood Factor
Analysis with Promax Rotation and five fixed
factors in Baker et al (2010), n= 603 and
independently in Baker, Thomas, Thomas,
Santonastaso and Corrigan 2015, n=3054
₪
Mind & Body
Impoverished emotional experience
“Poor emotional intelligence”
“Emotionally unaware”
“Alexithymic”
“mild asbergers”
“somatizer”
“Emotionally illiterate”
e.g. “My
emotions felt blunt/dull”
“I was unable to work out
if I felt ill or emotional”
₪
Mind & Body
Signs of unprocessed emotion
e.g. “Unwanted feelings kept
intruding”
“I repeatedly experienced the
same emotion”
₪
Mind & Body
Avoidance
e.g. “I tried hard to avoid things
that might upset me”
“I tried to only talk about
pleasant things”
₪
Mind & Body
Suppression
e.g. “I bottled up
my emotions”
“I kept quiet about
my feelings”
₪
Mind & Body
Unregulated Emotion
E.g. “When upset
or angry it was
difficult to control
what I said”
“ I reacted too much to
what people said or did”
Our hope is the Emotional Processing Scale
provides a new dimension of assessment
for research and therapy covering both
health and psychopathology
Emotional Processing Websites
Theory
www.emotionalprocessing.org
Assessment
www.emotionalprocessingscale.org
Therapy
www.emotionalprocessingtherapy.org