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Affect Phobia Therapy Research Bibliography

Aafjes-van Doorn, K., Lilliengren, P., Cooper, A., Macdonald, J., & Falkenstrom, F. (in press). Patients’ affective processes in initial EDT sessions. Psychotherapy.

Aafjes-van Doorn, K., Macdonald, J., Stein, M., Cooper, A. M., & Tucker, S. (2014). Experiential Dynamic Therapy: A Preliminary Investigation Into the Effectiveness and Process of the Extended Initial Session. Journal of Clinical Psychology, 70(10), 914-923.

Berggraf, L., Ulvenes, P. G., Hoffart, A., McCullough, L., & Wampold, B. E. (2014). Growth in sense of self and sense of others predicts reduction in interpersonal problems in short-term dynamic but not in cognitive therapy. Psychotherapy Research, 24, 456-469. doi: 10.1080/10503307.2013.840401

Berggraf, L., Ulvenes, P. G., Oktedalen, T., Hoffart, A., Stiles, T., McCullough, L., & Wampold, B. E. (2014). Experience of affects predicting sense of self and others in short-term dynamic and cognitive therapy. Psychotherapy, 51, 246-257.

Berggraf, L., Ulvenes, P. G., Wampold, B. E., Hoffart, A., & McCullough, L. (2012). Properties of the Achievement of Therapeutic Objectives Scale (ATOS): A generalizability theory study. Psychotherapy Research, 22, 327-347. doi:10.1080/10503307.2011.653997

Bhatia, M., Rodriguez, M. G., Fowler, D. M., Godin, J. E., Drapeau, M., & McCullough, L. (2009). Desensitization of conflicted feelings: Using the ATOS to measure early change in a single-case affect phobia therapy treatment. Archives of Psychiatry and Psychotherapy, 11, 31-38.

Cautela, J.R. & McCullough, L (1978) Covert conditioning: A learning theory perspective on imagery, In J.L. Singer& K.S. Pope (Eds.) The power of the human imagination (pp. 227-254). New York: Plenum Press

Dehghani, M., Atef-Vahid, M. K., & Gharaee, B. (2011). Efficacy of short–term anxiety-regulating psychotherapy on love trauma syndrome. Iranian Journal of Psychiatry and Behavioral Sciences, 5(2), 18-25.

Dominic, J., O’Connor, K. (2016) Recasting Psychodynamics into a Behavioral Framework: A Review of the Theory of Psychopathology, Treatment Efficacy, and Process of Change of the Affect Phobia Model. J. Contemp Psychother doi: 10.1007/s10879-016-9324-9

Dornelas, E. A., Ferrand, J., Stepnowski, R., Barbagallo, J., & McCullough, L. (2010). A pilot study of affect-focused psychotherapy for antepartum depression. Journal of Psychotherapy Integration, 20, 364-382. doi:10.1037/a0022035

Etchebarne, I., Garay, C. & Aafjes-van Doorn, K. (in press). Psychotherapy for Personal Growth? A Comparison of South and North American Practices. International Psychology Bulletin.

Frankl, M., Philips, B., Berggraf, L., Ulvenes, P., Johansson, R., Wennberg, P. (2016). Psychometric Properties of the Affect Phobia test. Scandinavian Journal of Psychology, 57(5), 482-488.

Frankl, M, Psychotherapy for Substance Use Disorders - the importance of affects (2017). Linköping University, Department of Behavioural Sciences and learning. Linköping University, Faculty of arts and Sciences.

Frankl, M., (2019) Wanting Too much and too soon. The therapist's clinical perspective. Pragmatic Case Studies in Psychotherapy, volume 15, module 3, Article 1, pp 281-289.

Frankl, M., Wennberg, P., Berggraf, L., Philips, B., (2019) Affect Phobia therapy for mild to moderate alcohol use disorder. Tha cases of "Carey", "*Michelle" and "Mary". Pragmatic case studies in psychotherapy, volume 15, module 3, article 1, pp 214-257.

Johansson, R., Hesslow, T., Ljótsson, B., Jansson, A., Jonsson, L., Färdig, S., Andersson, G. (2017). Internet-based affect-focused psychodynamic therapy for social anxiety disorder: A randomized controlled trial with 2-year follow-up. Psychotherapy, 54(4), 351-360.

Johansen, P.-O., Krebs, T. S., Svartberg, M., Stiles, T. C., & Holen, A. (2011). Change in defense mechanisms during short-term dynamic and cognitive therapy in patients with cluster C personality disorders. Journal of Nervous and Mental Disease, 199, 712-715. doi:10.1097/NMD.0b013e318229d6a7

Johansson, R., Björklund, M., Hornborg, C., Karlsson, S., Hesser, H., Ljótsson, B., … & Andersson, G. (2013). Affect-focused psychodynamic psychotherapy for depression and anxiety through the Internet: A randomized controlled trial. PeerJ, 1, e102. doi: 10.7717/peerj.102

Johansson, R., Frederick, R. J., & Andersson, G. (2013). Using the Internet to provide psychodynamic psychotherapy. Psychodynamic Psychiatry, 41, 385-412.

Julien, D., O’Connor, K. P. (2016). Recasting Psychodynamics into a Behavioral Framework: A Review of the Theory of Psychopathology, Treatment Efficacy, and Process of Change of the Affect Phobia Model. Journal of Contemporary Psychotherapy (online first view. doi 10.1007/s10879-016-9324-9.

Kallestad, H., Valen, J., McCullough, L., Svartberg, M., Hoglend, P., & Stiles, T. C. (2010). The relationship between insight gained during therapy and long-term outcome in short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. Psychotherapy Research, 20, 526-534. doi:10.1080/10503307.2010.492807

Koole, Sander L. & Teacher, Wolfgang (2016), A Review and an Integrative Framework for the Therapeutic Alliance, Frontiers in Psychology, 14 June 2016, doi: 10.3389/fpsyg.2016.00862

Llewelyn, S., & Aafjes-van Doorn, K. (in press). A very short introduction to Clinical Psychology’. ‘Very Short Introduction’ series. UK: Oxford University Press.

Llewelyn, S., Hardy, G. & Aafjes-van Doorn, K. (2015) Chapter 11. Psychologists as researchers. In J. Hall (Ed.) Clinical psychology in Britain: Historical perspectives, UK: British Psychological Society.

Llewelyn, S., Macdonald, J. & Aafjes-van Doorn, K. (2016). Process-Outcome Studies. In (Ed. J. Norcross) Handbook of Clinical Psychology, American Psychological Association.

McCullough, L., & Magill, M. (2009). Affect-focused short-term dynamic therapy. In R. A. Levy & J. S. Ablon (Eds.), Handbook of evidence-based psychodynamic psychotherapy: Bridging the gap between science and practice (pp. 249-277). Totowa, NJ: Humana Press.

McCullough, L., Kuhn, N., Andrews, S., Valen, J., Hatch, D., & Osimo, F. (2003). The Reliability of the Achievement of Therapeutic Objectives Scale: A Research and Teaching Tool for Brief Psychotherapy. Journal of Brief Therapy, 2, 75-90

McCullough, L., Winston, A., Farber, B. A., Porter, F., Pollack, J., Vingiano, W., Trujillo, M. (1991). The relationship of patient-therapist interaction to outcome in brief psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 28(4), 525-533. doi: 10.1037/0033-3204.28.4.525.

McCullough, L. & Winston, A (1991), The Beth Israel Psychotherapy Research Program. In L. Beutler & M. Crago (Eds) Psychotherapy research: An international review of programmatic studies (pp. 15-23). Washington D.C.: American Psychological Association Press

McManus, F., Van Doorn, K., & Yiend, J. (2011). Examining the effects of thought records and behavioral experiments in instigating belief change. Journal of Behavior Therapy and Experimental Psychiatry, 43, 540-547.

Moghadam, M. N., Atef-Vahid, M., Asgharnejad-Farid, A., Shabani, A., & Lavasni, F. (2015). Short-term Dynamic Psychotherapy versus Sertraline in Treatment of Social Phobia. Iranian Journal of Psychiatry and Behavioral Sciences Iran J Psychiatry Behav Sci, 9(2).

Ryum, T., Stiles, T. C., Svartberg, M., & McCullough, L. (2010). The role of transference work, the therapeutic alliance, and their interaction in reducing interpersonal problems among psychotherapy patients with Cluster C personality disorders. Psychotherapy: Theory, research, practice, training, 47, 442-453. doi:10.1037/a0021183

Ryum, T., Store-Valen, J., Svartberg, M., Stiles, T. C., & McCullough, L. (2014). Factor analysis of the Achievement of Therapeutic Objectives Scale (ATOS) in short-term dynamic psychotherapy and cognitive therapy. Psychological Assessment, 26, 925-934. doi: 10.1037/a0036570

Schanche, E., Nielsen, G. H., McCullough, L., Valen, J., & Mykletun, A. (2010). Training graduate students as raters in psychotherapy process research: Reliability of ratings with the Achievement of Therapeutic Objectives Scale (ATOS). Nordic Psychology, 62, 4-20. doi:10.1027/1901- 2276/a000013

Schanche, E., Stiles, T. C., McCullough, L., Svartberg, M., & Nielsen, G. H. (2011). The relationship between activating affects, inhibitory affects, and self-compassion in patients with Cluster C personality disorders. Psychotherapy, 48, 293-303. doi:10.1037/a0022012

Silberschatz, G. & Aafjes-van Doorn, K. (in press). Pathogenic beliefs mediate the relationship between adverse parenting and psychopathology. Journal of Aggression, Maltreatment & Trauma.

Snyder, J. & Aafjes-van Doorn, K. (2016). Utilizing Measure-Based Feedback in Control-Mastery Theory: A Clinical Error. Psychotherapy, (53), 291-296.

Svartberg, M., Stiles, T. C., & Seltzer, M. H. (2004). Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for Cluster C personality disorders. The American Journal of Psychiatry, 161, 810-817. doi:10.1176/appi.ajp.161.5.810

Town, J. M., Hardy, G. E., McCullough, L., & Stride, C. (2012). Patient affect experiencing following therapist interventions in short-term dynamic psychotherapy. Psychotherapy Research, 22, 208- 219. doi:10.1080/10503307.2011.637243

Town, J. M., McCullough, L., & Hardy, G. E. (2012). Therapist interventions in short-term dynamic psychotherapy: Six expert treatments. British Journal of Guidance & Counselling, 40, 31-42. doi:10.1080/03069885.2011.621518

Ulvenes, P. G., Berggraf, L., Hoffart, A., Levy, R. A., Ablon, J., McCullough, L., & Wampold, B. E. (2012). Can two psychotherapy process measures be dependably rated simultaneously? A generalizability study. Journal of Counseling Psychology, 59, 638-644.

Ulvenes, P. G., Berggraf, L., Hoffart, A., Stiles, T. C., Svartberg, M., McCullough, L., & Wampold, B. E. (2012). Different processes for different therapies: Therapist actions, therapeutic bond, and outcome. Psychotherapy, 49, 291-302. doi:10.1037/a0027895

Ulvenes, P. G., Berggraf, L., Wampold, B. E., Hoffart, A., Stiles, T., & McCullough, L. (2014). Orienting patient to affect, sense of self, and the activation of affect over the course of psychotherapy with cluster C patients. Journal of Counseling Psychology, 61, 315-324.

Valen, J., Ryum, T., Svartberg, M., Stiles, T. C., & McCullough, L. (2011). The Achievement of Therapeutic Objectives Scale: Interrater reliability and sensitivity to change in short-term dynamic psychotherapy and cognitive therapy. Psychological Assessment, 23, 848-855. doi:10.1037/a0023649

Van Doorn, K., McManus, F., & Yiend, J. (2012). An analysis of matching cognitive-behavior therapy techniques to learning styles. Journal of Behavior Therapy and Experimental Psychiatry. 43, 1039-1044.

Winston, A, Laikin M, Pollack J, Samstag L, McCullough L, Muran C. Short-Term Psychotherapy of Personality Disorders: 2 year follow-up. American Journal of Psychiatry, 1994, 151(2):190-194.

Treating Affect Phobia: A Manual for Short-Term Dynamic Psychotherapy

by Leigh McCullough, Nat Kuhn, Stuart Andrews, Amelia Kaplan, Jonathan Wolf, Cara Lanza Hurley.

This hands-on manual from Leigh McCullough and associates teaches the nuts and bolts of practicing short-term dynamic psychotherapy, the research-supported model first presented in Changing Character, McCullough’s foundational text.

Reflecting the ongoing evolution of the approach, the manual emphasizes “affect phobia,” or conflict about feelings. It shows how such proven behavioral techniques as systemic desensitization can be applied effectively within a psychodynamic framework, and offers clear guidelines for when and how to intervene.

Demonstrated are procedures for assessing patients, formulating core conflicts, and restructuring defenses, affects, and relationship to the self and others. In an easy-to-use, large-size format, the book features a wealth of case examples and write-in exercises for building key clinical skills. The companion website ( offers useful supplemental resources, including Psychotherapy Assessment Checklist (PAC) forms and instructions.

Changing Character: Short Term Anxiety-Regulating Psychotherapy

by Leigh McCullough Vaillant

The mechanism of emotional change is central to the field of mental health. Emotional change is necessary for healing the long-standing pain of character pathology, yet is the least studied and most misunderstood area in psychotherapy and pharmacotherapy.

Changing Character at its heart is about emotion—how to draw it out, recognize it and make it conscious, follow its lead and, equally important, use cognition to guide, control, and direct our emotional lives.

This treatment manual teaches therapists time-efficient techniques for changing character and helping their patients live mindfully with themselves and others through adaptive responses to conflictual experiences.

Leigh McCullough Vaillant, a nationally recognized expert on short-term dynamic psychotherapy, shows therapists how to identify and remove obstacles in one’s character (ego defenses) that block emotional experience. She then illustrates how the therapist can delve into that experience and harness the tremendous adaptive power provided by emotions.

The result? She shows us how to have emotions without emotions “having” their way with us. Vaillant’s integrative psychodynamic model holds that the source of psychopathology is the impairment of human emotional experience and expression, which includes impairment in drives and beliefs but is seen fundamentally as the impairment of affects.

In this short-term approach, psychotherapists are shown how to combine behavioral, cognitive, and relational theories to make psychodynamic treatment briefer and more effective. Vaillant illustrates how affect bridges the gap between intrapsychic and interpersonal approaches to psychotherapy. Affect, she argues, has the power to make or break relational bonds. Through the regulation of anxieties associated with affects in relation to self and others, therapists can help their patients undergo meaningful character change.

A holistic focus on affects and attachment has not been adequately addressed in either traditional psychodynamic theory or cognitive theory. Clearly and masterfully, Vaillant shows therapists how to integrate the powers of cognition and emotion within a dynamic short-term therapy approach.

Affect Phobia in Practice

By Dr. Quin Dam, written in Dutch

Feelings give energy and color to our lives. They help us make wise  choices, be close to others and set limits. However feelings can also be frightening.  If we are afraid of what we feel we can develop an affect phobia. We retreat, no longer dare to be vulnerable and suffer from stress, anxiety or vague physical complaints.

If clients suffer in this way, they may find it helpful to explore whether or not they have an affect phobia. APT was developed by Dr. Leigh McCullough. APT integrates psychodynamic, cognitive behavioral therapy and experiential techniques to help patients learn how to unlearn an affect phobia. Research shows that people with anxiety, depression avoidant and dependent personality disorders benefit from this form of treatment.

In this book, you’ll find an overview of the model to help you learn how to do a core conflict formulation, restructure a defense, affect restructuring and self and other restructuring. All theoretical concepts are illustrated with insightful patient-therapist dialogues.


By James M. Donovan, Kristin Osborn, & Susan Rice

The universe of dynamic psychotherapy has undergone slow, but ultimately dramatic change, since the 1970s. Now a new psychotherapist has taken up residence in the office. This book tells the story of what we found when we studied that new therapist directly, by watching her work, on videotape or through extended case excerpts. Here we learn that today’s counselor’s thoughts, words and behaviors sharply set her in contrast to her counterparts of just twenty-five years earlier.

The videotape, for the first time, reveals to us the verbatim spoken exchanges, but also the bodily messages: the tones of voice – the facial expressions – the gestures of patient and therapist as they choreograph their interaction. When we begin to examine the therapy participants as embodied speakers, at this moment we find ourselves on the outskirts of mostly untrodden territory. We sense an evolutionary advance perhaps about to take place on the screen, because we can now choose to study all the extra-verbal information, as well as the verbal, in the therapy interchange.

Det här är den första svenska boken om affektfokuserad psykodynamisk terapi. Våra grundaffekter styr vår uppmärksamhet och förbereder oss för handling. De berättar vad som är viktigt och hjälper oss att kommunicera det till andra.

Hur vi hanterar våra affekter beror dock till stor del på vilka relationella erfarenheter vi gjort. En affektfokuserad psykoterapi ger möjligheten att i en nära och förtroendefull relation uppmärksamma och närma sig sina affekter på djupet så att en ominlärning och integration kan ske. För att få mer kontakt med sina genuina känslor och behov behöver patienten få hjälp att se och släppa de försvar som inte är adaptiva, för att kunna ersätta dem med mer balanserade sätt att reglera affekter och ångest. Därför är terapeuten aktiv, fokuserad och så upplevelsenära som möjligt.

Boken ger en god förståelse för såväl teori och forskning, som den praktiska tillämpningen. Författarna tar bland annat upp affektteori och anknytningsteori med koppling till psykoterapi. Med hjälp av många fallvinjetter och dialoger illustreras olika interventioner för arbete med försvar, reglering av ångest och skam samt fördjupning av affekter.

Working with Emotion in Cognitive-Behavioral Therapy: Techniques for Clinical Practice

Edited by Nathan C. Thoma and Dean McKay

Working actively with emotion has been empirically shown to be of central importance in psychotherapy, yet has been underemphasized in much of the writing on cognitive-behavioral therapy (CBT). This state-of-the-art volume brings together leading authorities to describe ways to work with emotion to enrich therapy and achieve more robust outcomes that go beyond symptom reduction. Highlighting experiential techniques that are grounded in evidence, the book demonstrates clinical applications with vivid case material. Coverage includes mindfulness- and acceptance-based strategies, compassion-focused techniques, new variations on exposure-based interventions, the use of imagery to rework underlying schemas, and methods for addressing emotional aspects of the therapeutic relationship.

Using Technology to Enhance Clinical Supervision

Edited by Tony Rousmaniere & Edina Renfro-Michel

This is the first comprehensive research and practice-based guide for understanding and assessing supervision technology and for using it to improve the breadth and depth of services offered to supervisees and clients. Written by supervisors, for supervisors, it examines the technology that is currently available and how and when to use it.

Part I provides a thorough review of the technological, legal, ethical, cultural, accessibility, and security competencies that are the foundation for effectively integrating technology into clinical supervision. Part II presents applications of the most prominent and innovative uses of technology across the major domains in counseling, along with best practices for delivery. Each chapter in this section contains a literature review, concrete examples for use, case examples, and lessons learned.

Länkar till andra EDT (Experientiall Dynamic Therapies) terapiers hemsidor i Sverige: