1. Unifying Theory of Change Across Theoretical Orientations
The Affect Phobia
as a
Unifying Theory of Change
Across Theoretical Orientations
Leigh McCullough, Lene Berggraf, and Pål Ulvenes
Modum Bad Research Institute Norway
McCullough, Berggraf & Ulvenes SEPI 2010

2. Modum Bad Research Institute Vikersund, Norway
McCullough, Berggraf & Ulvenes SEPI 2010

3. Traditional Freudian Conflict Model
Learned and seen as
necessary to control primitive impulses
EGO
Super EGO
Rigid
Defensive
Barrier ID
Beastial impulses need to be controlled Dual-Drive Theory (sex and aggression)
McCullough, Berggraf & Ulvenes SEPI 2010

4. An Updated Version of Freud’s Conflict Model The UNIVERSAL PRINCIPLE OF PSYCHODYNAMIC PSYCHOTHERAPY
Learned from civilization
Sometimes helpful and sometimes hurtful
DEFENSES
ANXIETY - INHIBITION
Ideally, flexible cognitive controls that
guide feelings
ADAPTIVE
ACTIVATING FEELINGS
Biologically endowed feelings. Natural and adaptive responses
That need guidance, but not restriction (Tomkins)
McCullough, Berggraf & Ulvenes SEPI 2010

5. Dollard and Miller (1950) Stampfl and Levis (1967)
Feather and Rhoads (1972)
( Psychodynamic Behavior Therapy)
Paul Wachtel (1977)
(Behaviorism and Psychodynamics)
All believed that
Anxiety is aroused by the experience of a
specific drive or impulse.
Desensitization by exposure & prevention of avoidance
could be applied to help the patient reduce the anxiety.
McCullough, Berggraf & Ulvenes SEPI 2010

6. Dollard and Miller pointed out that Freud had observed that
anxiety can be steadily weakened by extinction (1924; Vol 1, pp 241, ).
That Freud already in 1924 observed that ….
McCullough, Berggraf & Ulvenes SEPI 2010

7. Desensitization in STDP
DEFENSES-COPING
Thoughts, feelings, behaviors
INHIBITORY AFFECTS
Anxiety, guilt, shame, pain
RESPONSE PREVENTION
ACTIVATING AFFECTS
When we opearationalize these constructs, the three main components that we observe are 1) Defenses or Coping, 2) Inhibitory Affects and 3) Activating Affects
EXPOSURE
Sadness, Anger, Closeness, Positive Self Feeling, Interest, Joy
McCullough, Berggraf & Ulvenes SEPI 2010

8. Comparing Dynamic & Learning Theories
TREATMENT
MODELS
ACTIVATION-
APPROACH
COMPONENT:
approach, action, excitation, or mobilization.
INHIBITION-
AVOIDANT
COMPONENT
avoidance, withdrawal
Signal danger
PROTECTIVE/
COPING
Responses that cope, protect, hide, cover up, defend (adaptive & maladaptive)
MAIN TREATMENT GOAL
Balance of
Opposing Motivational Forces
Psychodynamic Theory*
Updated Id:
Full range of activating affects & drives
Superego:
Normative rules to manage Id & Ego conflicts
Ego:
Coping Skills &
Defense Mechanisms
Resolution of Conflict
between the three psychic structures
Learning & Behavioral Theory**
Affect responses
That become
Associated with
aversive stimuli
Inhibitory affects & conditioned associations
Conditioned Avoidant or
Protective responses
To balance approach & avoidance:
Desensitization
Here are the three components put in a table. The Learning theory components we can see as operational definitions of the psychodyamic constructs. Leigh and collegues have been working to develop this over many years.
McCullough, Berggraf & Ulvenes SEPI 2010

9. Short Term Psychodynamic Models of Psychotherapy
TREATMENT
ACTIVATION
APPROACH
COMPONENT:
INHIBITION -
AVOIDANT
COMPONENT
PROTECTIVE/
COPING
MAIN GOAL OF
Short Term Dynamic Psychotherapy
McCullough
(and IEDTA)
Exposure to
Activating Affects
Regulation of Inhibitory Affects
Build capacity to recognize and alter defensive/
maladaptive patterns
Build Affective Capacity : by
Desensitization
McCullough, Berggraf & Ulvenes SEPI 2010

10. TO WHAT EXTENT DO THESE 3 COMPONENTS: OCCUR IN OTHER FORMS OF THERAPY?
ACTIVATION
INHIBITION
COPING RESPONSES
OCCUR IN OTHER FORMS OF THERAPY?
McCullough, Berggraf & Ulvenes SEPI 2010

11. these many forms of therapy, We want to emphasize,
As we present
these many forms of therapy,
We want to emphasize,
that we are NOT attempting to reduce
all forms of therapy to
three simple components.
Each therapy model has beautiful and distinct
contributions to make!
We are just identifying some common factors that we belive contribute to change
McCullough, Berggraf & Ulvenes SEPI 2010

12. Psychodynamic Models of Psychotherapy
TREATMENT
ACTIVATION
APPROACH
COMPONENT:
INHIBITION -
AVOIDANT
COMPONENT
PROTECTIVE/
COPING
MAIN GOAL OF
MENTALISATION
Bateman,
Fonagy
Understand and reflect upon patients feelings and modes of responding
Understand, regulate & reflect upon anxieties leading to modes of responding
Understand modes of responding
(e.g., psychic
equivalence) covering healthy feeling
For the Patient to Understand others
and
to feel understood
TRANSFERENCE
FOCUSED THERAPY
Kernberg.
Clarkin
Unconscious conflicted aggressive feelings and unintegrated & polarized feelings toward self and others
Understand reasons
(fears & anxieties) preventing affective resolution
Focus On
Defenses
E.g,
Splitting
Integrate polarized affect states, and split off self/other representations
I will give a brief overview of two forms of psychodynamic psychotherapy, and our 3 components of Activation, Inhibition and Coping Mechanisms as we would code them. We fully acknowledge that the developers of these models, do not conceptualize their treatment in our terminolgy. We are just looking at other models through our lenses and seeing if we pick up similar mechanisms. We do not have time to go into detail with each treatment we present. So now we will look more closely at Mentalisation Based Treatment.
McCullough, Berggraf & Ulvenes SEPI 2010

13. Defenses: MBT does not use the term "defense.’
MBT helps the patient distinguish how the reflective process
underlying uncertainty can regulate affect instead of immediately going into modes such as
‘psychic equivalence’ and "assuming"
or letting the affects "decide" what transpired in reality.
These modes, (e.g., psychic equivalence and pretend mode),
underlie concepts such as pseudomentalising, hypermentalising and different forms of acting out.
Can these be seen as "defenses" or
maladaptive coping patterns?
McCullough, Berggraf & Ulvenes SEPI 2010

14. Anxiety/ Inhibition: MBT strives to regulate anxiety;
MBT is more anxiety regulating and works to diffuse anxiety more than STDP.
(due to the focus on Borderline patients)
(STDP also uses greater anxiety regulation with more severely ill patients.)
McCullough, Berggraf & Ulvenes SEPI 2010

15. (We would label this process, ‘Insight’).
Exposure to Activating Affects: MBT does not emphasize specific affect states per se, and does not use exposure.
MBT focuses more on the reasoning process (the modes) behind the affect. It works to regulate and change affects by helping the patient gain a more nuanced perspective on how situations in close relationships have been poorly mentalized (or reflected upon).
(We would label this process, ‘Insight’).
The MBT therapist uses open questions to pursue affects and affective/interpersonal problems.
MBT does not label affective states for patients with BPD as they see this as a form of "planting" an idea instead of intervening in ways to expand the patients perspective and push the patients to reflect for themselves.
McCullough, Berggraf & Ulvenes SEPI 2010
McCullough, Berggraf & Ulvenes SEPI 2010

16. Affect Regulation, Mentalization, & Development of the Self.
An Example of a patient ’Emma’
From the book by
Fonagy, P., Gergely, G., Jurist, E. and Target, M.
Affect Regulation, Mentalization,
& Development of the Self.
Other Press, New York
Pages
McCullough, Berggraf & Ulvenes SEPI 2010

17. Could this be an Affect Phobia about Anger?
The patient, Emma, has a dream (p ).
A number of horses had broken out of their stables.
They were blind and threatened to trample all over her.
The therapist replied that Emma was terrified in case her anger might break out of the stables she created for it and make everyone in the ‘analytic hospital’ violent and mad.
(Later) Th: ’It is so painful for you to see the manifestations of violence that being blind was almost preferable.’
Could this be an Affect Phobia about Anger?
McCullough, Berggraf & Ulvenes SEPI 2010

18. Again, could this be an Affect Phobia?
The therapist replied that
Emma was terrified (INHIBITION)
in case somehow her anger (ACTIVATION)
might break out of the
stables she created for it (COPING-DEFENSES)
and make everyone in the ‘analytic hospital’ violent and mad.
(Later) Th: ‘It is so painful (INHIBITION)
for you to see the manifestations of violence (ACTIVATION)
that being blind (COPING – DEFENSES)
was almost preferable.’
Again, could this be an Affect Phobia?
What do you think? Does there seem to be some overlap here?
McCullough, Berggraf & Ulvenes SEPI 2010

19. Psychodynamic-Relational Models of Psychotherapy
TREATMENT
ACTIVATION
APPROACH
COMPONENT:
INHIBITION -
AVOIDANT
COMPONENT
PROTECTIVE/
COPING
MAIN GOAL OF
INTEGRATIVE
RELATIONAL
PSYCHO-
DYNAMICS
Paul Wachtel
Exposure to experiences that were previously avoided & kept out of awareness due to fear, guilt and shame
Anxiety
Guilt
Shame
That
Block experience
Vicious
Cycles
that are
Consistently
Repeated
Over the
lifetime
To resolve these conflicts
and vicious cycles in relationships
McCullough, Berggraf & Ulvenes SEPI 2010

20. From Wachtel, Cyclical Psychodynamics, p. 181.
The patient John was a man who had not passed his
professional licensing exam.
Wachtel used gentle confrontation to uncover John’s
Defensive, dismissive response to the exam. (COPING)
And then used systematic desensitization to
Reduce his anxiety about the exam (INHIBITION)
But Wachtel also helped John see the
dynamic underpinnings of the defenses; his
disavowed wish for status and success (ACTIVATION)
that was learned from his parents
McCullough, Berggraf & Ulvenes SEPI 2010

21. Barlow’s UNIFIED TREATMENT (Cognitive Therapy)
ACTIVATION
APPROACH
COMPONENT:
INHIBITION -
AVOIDANT
COMPONENT
COPING/
PROTECTIVE
MAIN GOAL OF
UNIFIED
David Barlow
Facilitates
Expression of
Action Tendencies
& related feelings
Response
prevention
of emotional avoidance
Identify & alter Maladaptive Cognitive Appraisals:
Facilitate action tendencies by
altering cognitive
appraisals, &
prevent avoidance
McCullough, Berggraf & Ulvenes SEPI 2010

22. Cognitive Models of Psychotherapy
TREATMENT
ACTIVATION
APPROACH
COMPONENT:
INHIBITION -
AVOIDANT
COMPONENT
COPING/
PROTECTIVE
MAIN GOAL OF
CBT
Edna Foa
David Clark,
Aron Beck
Adrian Wells
Jeffrey Young
Experimental
tests that trigger the avoided response & allow for potential disconfirm-atory experiences
Maladaptive emotional responses that prevent adaptive responding
Maladaptive responses that block the testing of discomfirm-
atory experiences
To confirm
the validity and utility of the more constructive & adaptive response
McCullough, Berggraf & Ulvenes SEPI 2010

23. In Young’s Schema Focused Therapy,.
In Young’s Schema Focused Therapy,
Schemas are maladaptive patterns that therapists need to ‘break and change.’ (COPING COMPONENTS?)
By identifying ‘avoidant strategies’ (INHIBITION?)
Schema Therapy focuses and streamlines therapy.
Young’s goals show strong similarity to
the Affect Phobia conceptualization, and
Barlow’s Unified Treatment model;
to help patients see the ‘avoidant strategies,’
give them up, and replace them with
a more constructive schema (ACTIVATION?).
McCullough, Berggraf & Ulvenes SEPI 2010

24. McCullough, Berggraf & Ulvenes SEPI 2010
Young gives an example of ‘Daniel’ who has fears of closeness to women .
The therapist encourages him to imagine asking a woman to dance. (EXPOSURE).
His anxiety increases at the thought, (INHIBITION) but the therapist holds him in the imagery (EXPOSURE) until he can feel relaxed and at ease imagining this scene. (DESENSITIZATION)
Homework assignments are given to continue the work outside the session. (MORE EXPOSURE) (pp ).
Although Young does not use the terms ‘exposure’ and ‘desensitization,’ can you see these mechanisms in operation?
McCullough, Berggraf & Ulvenes SEPI 2010

25. Behavioral Models of Psychotherapy
TREATMENT
ACTIVATION
APPROACH
COMPONENT:
INHIBITION
AVOIDANT
COMPONENT
COPING-PROTECTIVE
MAIN GOAL OF
CONSISTENCY
THEORY
Klaus Grawe
Approach
Motivation
&
Approach Goals
Avoidance Motivation
Avoidance Goals
Balance approach & avoidance motivation,
so goals are consistent
DIALECTICAL BEHAVIOR THERAPY
Marsha Linehan
Mindfulness to manage feelings.
Focus on
self care & compassion
Identifies and reduces guilt, anxiety & shame
Identifies maladaptive responses and adaptive alternatives
Building coping skills, self control,
and self worth
McCullough, Berggraf & Ulvenes SEPI 2010

26. Focus on Specific Affects and their functions Primary Adaptive &
Experiential Models
TREATMENT
MODEL
ACTIVATION
APPROACH
COMPONENT:
INHIBITION -
AVOIDANT
COMPONENT
COPING-
PROTECTIVE
COMPON’T
MAIN GOAL OF
Emotion-Focused
Therapy
Les Greenberg
Focus on Specific Affects
and their functions
Primary Adaptive &
Maladaptive Affects
(Not Activation & Inhibition Categories)
Instru-mental
and
Strategic Affects
Attain capacity to use emotions adaptively as motivators
of action
Les Greenberg does not separate affects into Activation and Inhibition components because he sees all affects as activating some form of action. Leigh spoke with Les at length last year about this and regrets she cannot be here to discuss it further with him. In retrospect, she feels he was right in htis regard. In the past year, we have stopped categorizing affects as solely activating or inhibiting, and instead evaluate affects in terms of their functions. That is, whether anger or grief, or shame is being used in an activating or inhibiting way. All affects can be used in any of the three modes above. But again, when one looks at specific examples, they all start looking remarkably similar. Here is an example from Greenberg’s emotion focused manual:
McCullough, Berggraf & Ulvenes SEPI 2010

27. The labels may differ, but can you see the similar components?
Greenberg does not conceptualize Activating and Inhibitory affects in the same way we do, but the FUNCTIONS can be observed in his examples;
‘Primary emotions need to be accessed for their
adaptive information and capacity to organize action. Whereas maladaptive emotions need to be
regulated and transformed. (2004, p.7);
i.e, ‘Her anger undid her fear and the therapist supported the client’s newfound sense of power.” (Ibid, p. 14).
The labels may differ, but can you see
the similar components?
Anger and the newfound sense of power would be the ACTIVATING COMPONENTS and her fear would be the INHIBITORY COMPONENT.
McCullough, Berggraf & Ulvenes SEPI 2010

28. We have looked at these components across therapy models.
Now we will examine some data
in support of our premises.
McCullough, Berggraf & Ulvenes SEPI 2010

29. The Affective Capacity Ratio
And
Frequency of Affect
Between CT and STDP
McCullough, Berggraf & Ulvenes SEPI 2010

30. Videotapes from a Clinical Trial of Psychotherapy
Svartberg, Stiles & Seltzer, Am.J. Psychiatry, 2004.
Compared STDP with CT
Patients with Axis II Cluster C Dx
(N=50), 40 sessions, all videotaped
The videotaped sessions 6 and 36, permit analysis
of change processes
The data we will first examine comes from process coding of the clinical trial by Svartberg
McCullough, Berggraf & Ulvenes SEPI 2010

31. STDP CT Improvement in both groups Is related to:
METHOD: ANALYSIS OF VIDEOTAPES OF THE
SVARTBERG, ET AL., 2004, RCT , AXIS II CLUSTER C PD
STDP
SIMILAR
OUTCOMES CT
SIMILAR
PROCESSES
Improvement in both groups
Is related to:
DESENSITIZATION OF CONFLICTED AFFECTS
McCullough, Berggraf & Ulvenes SEPI 2010

32. McCullough, Berggraf & Ulvenes SEPI 2010
ATOS: The Achievement of Therapeutic Objectives Scale (McCullough et al.)
The ATOS scale evaluates how therapy impacts a patient during each session
Like the assessment of blood levels for the amount of medication absorbed,
...the ATOS ratings of patient behavior shows to what degree specific therapeutic objectives are absorbed or achieved
McCullough, Berggraf & Ulvenes SEPI 2010

33. ATOS Scale - Common Factors
Measuring theAchievement of Therapeutic Objectives across
STDP and CBT
INSIGHT
MOTIVATION
EXPOSURE TO ACTIVATING FEELING
DECREASE OF INHIBITORY FEELINGS
NEW LEARNING
CHANGE IN SENSE OF SELF & OTHERS
Today we are just going to focus on three of the subscales, Insight (into the Coping or defensive responses), and Activating and Inhibitory Affects.
McCullough, Berggraf & Ulvenes SEPI 2010

34. ATOS METHODS Each session is divided into five 10-minute segments
For each segment the core affective conflict is identified
Then the achievement of each objective is rated 1-100
McCullough, Berggraf & Ulvenes SEPI 2010

35. BRIEF EXCERPTS FROM THE ACTIVATING AFFECT SCALE
51-60 Moderate affective arousal. Moderate duration. Moderate holding back, e.g. tearing up, moderate anger, some tenderness. Moderate relief.
41-50 Low-moderate affective arousal. Mild feeling with much holding back shown in face, vocal tone or body, e.g. briefly tears up, raises voice a little in anger, or says a few tender words for short duration, speaks openly. Mild relief.
31-40 Low affective arousal. Low, quickly passing experience of feeling shown in face, vocal tone or body; e.g. clenching fist, choking up, grimaces, sighs, slight sadness/anger/care for self but quickly stopped. A little relief.
21-30 Slight affective arousal. Minimal or barely visible/audible signs of feeling of short duration shown in face, vocal tone or body.
11-20 No affective arousal, BUT bland verbal report of feeling. Almost no expression on face. Flat/dull/bland tone of voice, stiff or barely moving body. No relief
McCullough, Berggraf & Ulvenes SEPI 2010

36. BRIEF EXCERPTS FROM THE INHIBITORY AFFECT SCALE
Much inhibitory affects. Much shakiness, hesitation, sighing, guardedness or vigilance in tone of voice or non-verbal behavior. Much tightness, tension, rigidity. Voice tone has much hesitant, trembling, inaudible. Much uneasiness.
High moderate inhibitory affect. More than moderate shakiness, hesitation, sighing or guardedness or vigilance. More than moderately tight, tense, rigid. Tone of voice more than moderately hesitant, trembling, or difficult to hear. More than moderate uneasiness.
Moderate inhibitory affects. Moderate shakiness, hesitation, sighing or guardedness or vigilance. Moderately tight, tense, rigid. Tone of voice moderately hesitant, trembling or moderately difficult to hear. Moderate uneasiness.
Low-moderate inhibition. Low (less than) moderate shakiness, hesitation, sighing or guardedness or vigilance. Less than moderate tightness, tension, or rigidity. Tone of voice less than moderately hesitant, trembling or somewhat difficult to hear. Less than moderate uneasiness.
31-40 Low inhibition. Low degree of shakiness, hesitance, sighing, guardedness, or vigilance. Tone of voice shows only a low level of hesitance, trembling and is fairly audible. Low level of uneasiness.
McCullough, Berggraf & Ulvenes SEPI 2010

37. Frequency of Affect Focus in STDP & CBT
The Predominant Affect Focus in each 10 minute segment of a session
Svartberg, Stiles, & Seltzer, Am J. Psychiatry (2004)
AFFECT
Total Frequency
Short-term Dynamic Psychotherapy
Cognitive therapy
Anger/Assertion
323
143
180
Positive feelings about Self
251
137
114
Closeness/Tenderness
160 87 73
Grief
113 62 51
Interest/Excitement 8 4
Sexual feelings 1
Joy
Total N
856
433
423
These results amazed us all. We never expected to find the same frequency of affects in these two very different therapies!
McCullough, Berggraf & Ulvenes SEPI 2010

38. THE AFFECTIVE CAPACITY RATIO
LEVEL OF ADAPTIVE AFFECT EXPRESSION (Sorrow, anger, closeness, self compassion)
AFFECTIVE
CAPACITY
_________________________________ =
LEVEL OF INHIBITORY AFFECT
(Anxiety, guilt, shame, pain)
Again, we are going to look at the ratios of these affects, early and late. We have been trying to find a clinical meaningful way of expressing how the affect function categories relate to one another, and what we have come up with is the affective capacity ratio by dividing the level of activating feeling by the level of inhibitory affect.
McCullough, Berggraf & Ulvenes SEPI 2010

39. CHANGE IN AFFECT PHOBIA ABOUT ANGER
Ratio = Intensity of Anger / Intensity of Inhibition
Frequency
Mean Ratio Activation/Inhibition
Early in therapy (Session 6)
126
0.60 / 1.0
Late in therapy
Session 36 (of 40) 94
0.96 / 1.0
Total
220
Late; it is close to 1 over 1
McCullough, Berggraf & Ulvenes SEPI 2010

40. CHANGE IN PHOBIA ABOUT GRIEF/SADNESS
Ratio = Intensity of Grief / Intensity of Inhibition
Frequency
Mean Ratio Activation/Inhibition
Early in therapy (Session 6) 45
0.70 / 1.0
Late in therapy
Session 36 (of 40) 32
1.25 / 1.0
Total 77
Grief is more frequent early in therapy, than late.
The ratio of Activation/Inhibition is raised from 0.7 early in therapy to 1.25 late in therapy, which suggests that desensitization is occurring.
McCullough, Berggraf & Ulvenes SEPI 2010

41. There were not strong differences between STDP and CBT In the ratio of
ACTIVATION to INHIBITION
Early to late in treatment
McCullough, Berggraf & Ulvenes SEPI 2010

42. McCullough, Berggraf & Ulvenes SEPI 2010
BUT….
IS THE CHANGE IN
AFFECT RATIO
ASSOCIATED WITH
OUTCOME??
McCullough, Berggraf & Ulvenes SEPI 2010

43. AFFECT EXPRESSIVE CAPACITY
How Activating and Inhibitory Affects
Lead to
AFFECT EXPRESSIVE CAPACITY
In three different patient populations treatments
Pål Ulvenes
Leigh McCullough, Lene Berggraf, Tore Stiles, Martin Svartberg
Modum Bad Research Institute and
NTNU Trondheim, Norway
McCullough, Berggraf & Ulvenes SEPI 2010

44. Svartberg, Stiles & Selzer, 2004
RCT with 50 Patients with Cluster C PD
Cognitive and Short-Term Dynamic Therapy
ATOS ratings
Observer Ratings
Rated sessions 6 and 36
Affective Capacity
Early and Late in Treatment
STUDY
RATIO EARLY
RATIO LATE
TOP 25%
TOP 10%
Svartberg RCT, 2004
N=50
.6/1
1/1
1.7/1
1.8/1
McCullough, Berggraf & Ulvenes SEPI 2010

45. Affective Capacity Early and Late in Treatment. 1/1 1.5/5 1.8/1 2.7/1
Thornes et al, 2008 Naturalistic study
52 patients
Cognitive and Short Term Dynamic Therapy Blend
Inpatient Treatment
Frequent diagnoses: depression/ dysthymia, Cluster B and C PD
Core Conflict Ratings
Self Rapport
Session 2 and 19 used
Affective Capacity
Early and Late in Treatment.
STUDY
RATIO EARLY
RATIO LATE
TOP 25%
TOP 10%
Thornes Nat. Study
1/1
1.5/5
1.8/1
2.7/1
McCullough, Berggraf & Ulvenes SEPI 2010

46. Gude, Hoffart and Monsen 2001
45 Patients
Schema Focused Therapy
Inpatient Treatment
Social phobia
Self Rapport
First and Last Sessions used
Affect Phobia Ratio
Early and Late in Treatment.
STUDY
RATIO EARLY
RATIO LATE
TOP 25%
TOP 10%
Gude et al. RCT
1.1/1
2.4/1
3.7/1
3.8/1
McCullough, Berggraf & Ulvenes SEPI 2010

47. Affect Phobia Ratio
(level of Activation over level of Inhibition)
Early and Late in Treatment.
STUDY
RATIO EARLY
RATIO LATE
TOP 25%
TOP 10%
Svartberg RCT, 2004
N=50
.6/1
1/1
1.7/1
1.8/1
Thornes Naturalistic Study, 2008
N=52?
1.5/5
2.7/1
Hoffart RCT, 2006
N=45
1.1/1
2.4/1
3.7/1
3.8/1
McCullough, Berggraf & Ulvenes SEPI 2010

48. AFFECTIVE CAPACITY RATIO
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on SCL
Controlling for Admission level, and Alliance
Svartberg et al. 2004
Beta R2
R2Change
SCL-90 admission
.280
.078
.78
Alliance session 4
-.437
.301
.222***
Affective Capacity Ratio
-.259
.361
.062**
McCullough, Berggraf & Ulvenes SEPI 2010

49. AFFECTIVE CAPACITY RATIO
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on IIP
Controlling for Admission level, and Alliance
Svartberg et al. 2004
Beta R2
R2Change
IIP admission
.200
.040
Alliance
-.503
-.293
.253***
Affective Capacity Ratio
-.337
-.395
.102**
McCullough, Berggraf & Ulvenes SEPI 2010

50. AFFECTIVE CAPACITY RATIO
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on MCMI
Controlling for Admission level, and Alliance
Svartberg et al. 2004
Beta R2
R2Change
MCMI admission
.577
.333
.333***
Alliance
-.293
.417
.084**
Affective Capacity Ratio
-.314
.506
.089***
McCullough, Berggraf & Ulvenes SEPI 2010

51. AFFECTIVE CAPACITY RATIO
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on Main Problem (SR)
Controlling for Admission level, and Alliance
Thornes et al. 2008
Beta R2
R2Change
Main Problem at admission
.520
.270
.270**
Affective capacity ratio
-.323
.367
.097
McCullough, Berggraf & Ulvenes SEPI 2010

52. AFFECTIVE CAPACITY RATIO
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on IIP
Controlling for Admission level, and Alliance
Gude, Hoffart and Monsen, 2001
Beta R2
R2Change
IIP at admission
.661
.438
.438***
Affective capacity ratio
-.285
.514
.076**
Alliance
-.229
.559
.045
McCullough, Berggraf & Ulvenes SEPI 2010

53. AFFECTIVE CAPACITY RATIO
Hierarchical Linear Regression of
AFFECTIVE CAPACITY RATIO
AT TWO YEAR OUTCOME on STAY
Controlling for Admission level, and Alliance
Gude, Monsen and Hoffart, 2001
Beta R2
R2Change
STAY at admission
.535
.286
.286***
Affective capacity ratio
-.507
.523
.237***
Alliance
-.063
.526
.003
McCullough, Berggraf & Ulvenes SEPI 2010

54. McCullough, Berggraf & Ulvenes SEPI 2010
D I S C U S S I O N
McCullough, Berggraf & Ulvenes SEPI 2010