Date of Award


Publication Type

Doctoral Thesis

Degree Name




First Advisor

Paivio, Sandra (Psychology)


Psychology, Clinical.




The present study had two objectives. The first was to examine the contributions of emotional engagement with trauma material to outcome in two versions of EFTT, each employing a different reexperiencing procedure. These procedures are the IC and empathic exploration (EE) of trauma memories with the therapist. The second objective was to investigate the relative predictive validity of different measurement perspectives of emotional engagement to outcome in the two versions of EFTT. Clients were randomly assigned to therapy condition. Alliance quality was measured with client self-reports on the Working Alliance Inventory (WAI; Horvath & Greenberg, 1989). Emotional engagement was measured through observer-ratings of videotaped sessions employing the IC and EE procedure using the Levels of Engagement Scale (LES; Paivio et al., 2001) and client self-reports using the Post Session Questionnaire (PSQ; Paivio, Jarry, Chagigiorgis, Hall, & Ralston, in press). Emotional distress was measured with client self-reported subjective units of distress (SUDS) during IC and EE work. Treatment outcome was measured through 7 self-report questionnaires. In terms of similarities between IC and EE, clients reported moderate levels of engagement, from both observer-rated (LES) and self-reported (PSQ) measurement perspectives, which remained stable over the course of both treatment conditions. Furthermore, client self-reported emotional engagement during IC and EE both contributed to treatment outcome as did alliance quality. Finally, there were no significant associations between complex measures of engagement (LES and PSQ) and simple distress (SUDS) and frequency of participation in IC and EE was not significantly associated with client change. In terms of differences between IC and EE, there was a steady decline in distress (SUDS) during IC from early to late sessions (although not statistically significant), whereas distress peaked during middle therapy sessions containing the EE procedure and then significantly declined. There was an association between observer-ratings (LES) and self-reports (PSQ) of engagement only in the IC. Finally, in the IC condition, alliance quality and self-reported emotional engagement during IC contributed to resolution of abuse issues, only, whereas in the EE condition, alliance quality and clients levels of distress contributed to multiple dimensions of change.