Implicit core belief adaptation integrated cognitive behavioural therapy

Abstract

Emotions have been at the forefront of philosophers’ and theoreticians’ curiosities for millennia. A great deal of influential research has described how emotions are defined, generated, and regulated, and many theoretical models have further described the processes underlying the maintenance of psychiatric disorders. Although implicit mechanisms are frequently documented, cognitive behavioural therapy (CBT) practices largely rely on explicit techniques such as cognitive reappraisal. Given the large body of evidence suggesting emotion generation, emotion regulation, and emotional disorders largely operate via implicit mechanisms, the present PhD thesis investigated implicit emotion processing and potential techniques for utilising implicit emotion regulation strategies within brief CBT interventions. This thesis adopted several methodological approaches, including meta-analyses, behavioural studies, and intervention studies. Several novel findings were reported. First, behavioural and fMRI meta-analyses reported maladaptive implicit emotion regulation in mood and anxiety disorder samples compared to healthy controls, further highlighting dysfunctional neural activation in patients within the medial prefrontal cortex. Second, implicit cognitive reappraisal was reported to be effective across symptom measures related to the cognitive model of emotional disorders, particularly at reducing maladaptive core beliefs. Third, the development of a standardised digital single-session cognitive behavioural therapy intervention for a presenting emotional complaint was effective on symptom measures, including GAD-7 scores, negative automatic thoughts, avoidance, and maladaptive core beliefs. Finally, the newly introduced implicit facial stimuli exposure integrated single-session CBT was reported to be increasingly effective on equivalent symptom measures. The findings are discussed within the context of influential theories and models of emotion generation, emotion regulation, emotional disorders, and goal-directed behaviours. From this, the emerging theory of implicit core belief adaptation is presented, which is hypothesised to be the implicit activation of adaptive core beliefs surrounding safety, acceptance, and connection via implicit exposure to facial stimuli. In conclusion, harnessing evolutionary mechanisms in response to facial stimuli may have important implications for adaptive cognitive, emotional, and behavioural responses, further highlighting their importance in both research, and potentially, psychiatric practice.