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Working With Emotions in Cognitive Behavioural Therapy for Depression: A Qualitative Study of Patients' Experiences of Emotional Engagement, Avoidance and Change
Stockholm University, Faculty of Social Sciences, Department of Psychology, Personality, Social and Developmental Psychology.ORCID iD: 0000-0001-7839-7245
Number of Authors: 42026 (English)In: Counselling and Psychotherapy Research, ISSN 1473-3145, E-ISSN 1746-1405, Vol. 26, no 2, article id e70149Article in journal (Refereed) Published
Abstract [en]

Background: Depression is characterised by emotional blunting, avoidance and difficulties in emotional awareness, yet cognitive behavioural therapy (CBT) typically targets thoughts and behaviour more than direct emotional work. Integrating emotion-focused elements within CBT may enhance change processes, but little is known about how depressed patients experience such in-session interventions. Aims: This study explored how primary care patients with depression experienced a behavioural activation (BA) protocol enhanced with emotion-focused components conceptualised as targeted exposure to avoided emotions. Methods: Semi-structured interviews were conducted with eight primary care patients after completing treatment. Data were analysed inductively using reflexive thematic analysis. Results: Three overarching themes captured patients' experiences: moving towards embracing my feelings (gaining understanding, recognising needs, accepting what I feel), dealing with resistance (getting stuck in ambivalence) and feeling secure due to supportive features (firm, empathic guidance; individualised pacing and structured format). Participants described confronting avoided emotions as meaningful yet demanding and emphasised the importance of therapist support and safety. Conclusions: Emotion-focused interventions may strengthen BA by promoting emotional understanding and acceptance, consistent with theories of emotional processing and emotion-focused change. Future research should explore mechanisms and patient–therapist factors supporting emotional engagement in CBT for depression. Findings highlight how structured emotional engagement within CBT may enhance therapeutic change and inform clinical practice in routine care.

Place, publisher, year, edition, pages
2026. Vol. 26, no 2, article id e70149
Keywords [en]
behavioural activation, depression, emotion-focused therapy, emotional processing, primary care, qualitative research
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:su:diva-256103DOI: 10.1002/capr.70149Scopus ID: 2-s2.0-105039505151OAI: oai:DiVA.org:su-256103DiVA, id: diva2:2065352
Available from: 2026-06-03 Created: 2026-06-03 Last updated: 2026-06-03Bibliographically approved

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CiteExportLink to record
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Citation style
  • apa
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  • Other style
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  • de-DE
  • en-GB
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  • asciidoc
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