Emotional processing

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The term 'emotional processing' was used by Rachman (1980, 2001) in reference to how an individual processes stressful events. In fact, there have been a number of related proposals both prior to and subsequent to Rachman's paper which have covered similar ground. For example, in a paper aptly termed "Remembering, Repeating, and Working-through" Freud (1914) first presented the idea of therapy as a working through of repressed material. Although this initial view of working through focused on insight in a more intellectual sense, Freud later recognised that intellectual insight was normally insufficient in itself for change to occur, although it could play an important role in such change. Nevertheless, Freud's famous phrase "Where id was, there ego shall be" (1933, p. 112) captured, as we shall argue, the importance of processing material in relation to the self, especially in which there has been a so-called "primary gain" from avoidance of material that would otherwise cause anxiety or discomfort to the individual.

In Rachman's (1980, 1990, 2001) more specific focus on the emotional processing of stressful or traumatic events, the proposal is that it is inevitable that such unpleasant events will occur to an individual at one time or another, but the consequences of such events are normally processed satisfactorily. Evidence of normal emotional processing is provided, first, by the fact that an emotional disturbance has occurred; second, that the disturbance eventually declines in strength; and, third, that there is a return to routine behaviour. For example, a number of theorists and clinicians have studied the stages that individuals pass through following bereavement (e.g., Bowlby, 1980; Horowitz, 1983; see Chapter 7 for a detailed discussion). There are of course a number of variants on the exact stages and on the labels used for each stage, but Horowitz and Reidbord (1992) summarise this sequence of stages as "outcry", "denial", "intrusion", and, finally, "working through". However, in abnormal grief reactions there is a failure in this normal sequence, which, Rachman has argued, is likely to result from a failure of emotional processing.

Rachman (1980, 1990, 2001) has listed a number of indices by which these failures in emotional processing can be identified. The indices include the presence of direct signs such as obsessions, disturbing dreams, unpleasant intrusive thoughts, inappropriate expressions of emotion (in terms of time and place), behavioural disruptions, pressure of talk, hallucinations (e.g., visual, auditory, and olfactory hallucinations of a loved one following bereavement), and the return of fear after a period of its absence. Additional indirect signs include subjective distress, fatigue, insomnia, anorexia, inability to direct constructive thoughts, preoccupations, restlessness, irritability, and resistance to distraction (see Rachman, 1990, p. 286, Table 2). Rachman also considers factors that may then promote or impede emotional processing (see Rachman, 2001, p. 169, Table 3), but we will not present these in detail.

What we do wish to focus on, however, are some of the proposals that consider the mechanisms by which emotional processing might or might not occur. In other words, what types of emotion models are needed to account for the observation that individuals may fail to process stressful events, while evidence of such failures in emotional processing is still apparent? Can the models that we have considered so far provide an adequate explanation of such phenomena or do these models need to be modified? Rachman (2001) himself has modified his own views over the years such that he now suggests that the term "emotional processing" should be replaced by the term "cognitive-emotional processing" in recognition of the role of high-level cognitive appraisal processes that may impede or facilitate such processing (see Rachman, Gruter-Andrew, & Shafran, 2000, for a relevant empirical study of social anxiety). Such a modification implicitly requires a multi-level model with interaction between the levels, a point that we will return to in Chapter 5 in particular.

One comment that we should make first is about the remnants of Freud's psychic energy model that survive in our metaphors for the repression of traumatic memories. It is now recognised (e.g., Holt, 1967; Power, 1997) that in a more cognitive account of the dynamic unconscious, there is no need for a literal hydraulic energy model in which dammed up energy is transformed into symptoms or things that go bump in the night. Instead, we can consider a cognitive conflict model in which the unwanted material is inhibited because it conflicts with, for example, core self-beliefs, important goals and plans, or important beliefs about significant others. That is, if the material were to be integrated with other relevant material, it would require significant changes to such important beliefs, goals, or plans, which, not surprisingly, the individual may be reluctant to make. The more dramatic or severe the stressful event, then by definition the greater the impact on the individual's beliefs, goals, and plans (e.g., Janoff-Bulman, 1992; see Chapters 6 and 7). For example, the sudden death of a significant other may have a considerable range of effects—thus, in addition to the pain and sadness of the loss, illusory beliefs in the invulnerability of self and others may be shattered; shared goals and plans are no longer viable; and considerable practical hardship may ensue. An individual who had the capacity to deny such a significant loss and its ramifications would not surprisingly cause considerable clinical worry. If we consider the boxing ring as a metaphor for the mind, then as Joe Louis said, "You can run, but you can't hide". In extreme cases of denial or inhibition, the individual may disown particular emotions, especially emotions such as anger or fear that are usually experienced as negative. Such extreme inhibition is the psychological equivalent of disowning one's legs or arms, because such a self would be constructed on a limited range of acceptable basic emotions such as happiness and sadness while excluding other unwanted basic emotions from the self-concept (a theme that will be expanded on in Chapter 5 and the second part of the book).

Does the inhibition or avoidance of painful material "use up energy"? Again, we argue that such energy ideas should not be taken literally, although they have entered common parlance. Instead, in a more cognitive account limited attentional resources may have to be allocated in order to maintain cognitive and behavioural avoidance (see e.g., Dalgleish, Mathews, & Wood, 1999; Dalgleish et al., 2007) given the prospect that the more important the stressful event, the greater the likelihood that both internal and external events will prime the conflict-ridden material. Indeed, in Horowitz's (1983) model the individual is considered to oscillate between periods of overcontrolled avoidance and undercontrolled intrusion (see Chapter 6). No matter which model is true, however, there is now considerable evidence that the inhibition of traumatic memories is associated with, for example, increased autonomic activity, lowered immune functioning, and an increased risk of physical illness (see e.g., Harber & Pennebaker, 1992, for a summary). Horowitz (e.g., 1983) has suggested that traumatic memories may be held in an "active memory" until they have been worked through, although it is unclear why an additional memory system need be implicated when all that is necessary is the possibility that material can be held functionally separate from core beliefs through inhibition.

In contrast, Foa and Kozak (1986) offer an alternative suggestion; drawing on Lang's (e.g., 1969) proposals about fear networks (see Chapter 3), Foa and Kozak argue that fear reduction requires both activation of the appropriate fear structures and the incorporation of information into these structures that is incompatible with the excessive or pathological information. In evidence, they argue that if there is cognitive avoidance or inattention to a feared object or situation, then failures in emotional processing may occur (see Chapter 6). Rachman (1990, 2001) has criticised this proposal on the grounds that fear reduction does not always require fear evocation and because distraction techniques do sometimes work. We return to these issues in more detail in our discussion of trauma in Chapter 6, but suffice it to say that Rachman (1980, 2001) has clearly highlighted an important process in the recovery from emotionally significant adversity, a process that has links with features presented in many other models of the emotional disorders.

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