Ole André Solbakken
Affect integration, defined as the functional integration of affect in cognition, motivation and behavior, is commonly presumed to be a central feature of healthy psychological functioning. Conversely, the relative absence of such integration is recognized to be characteristic of a wide range of psychological disturbances. The construct domain of affect integration inherently reflects both capacity for accessing and utilizing the adaptive properties of affects for personal adjustment and the more general capability of tolerating and regulating affective activation. Problems in affect integration are thus expected to play a key role in the development of not only a variety of psychopathological symptoms, but also in the establishment and maintenance of recurring maladaptive relationship- and personality patterns. The present thesis is a systematic investigation into the processes of affect integration and their role in psychopathology and psychotherapy from theoretical and empirical points of view.
Affect integration was operationalized through the affect consciousness construct (AC) as the individual’s capacity to consciously perceive, tolerate, reflect upon and express the experiences of basic affective activation. The thesis examines and clarifies the conceptual and theoretical underpinnings of the AC-construct, investigates its construct validity, and explores its predictive utility for understanding response to open-ended psychotherapy.
In the first paper the processes of affect integration and their operationalization through the AC-construct are discussed and analyzed from a theoretical vantage point. A framework for understanding these processes is described and clarified, and the underlying theoretical assumptions of that framework are explicated. The article reviews what arguably appears to be the prevailing understanding of these processes in clinical psychology as conceptualized by the mentalization model. Points of overlap are discussed, along with important areas of divergence, indicating ways in which a more complex and exhaustive understanding of integration of affect, cognition and behavior can be attained. The importance of a precise and nuanced understanding of affects, affect integration and affect regulatory processes is underscored.
In paper two the construct validity of affect integration as operationalized through the AC-construct and corresponding assessment procedures is investigated. The reliability of AC-scores was examined through generalizability analyses and examination of inter-rater agreement. Internal structure was examined through first order semi-confirmatory factor analyses. Issues of external validity were addressed through analyses of relationships with various external criteria of psychopathology from both self- and observer rated perspectives. The reliability of AC-scores was found to be adequate across raters and when internal consistency or generalizability is considered. The internal structure of AC-scores conformed well to the theoretical model upon which they rest, with discrete affects emerging as separate factors. Correlations with external criteria indicated sound and predictable relationships both on global and specific levels of AC. Furthermore, scores for the integration of discrete affects were distinctly associated with different and predictable patterns of interpersonal problems demonstrating convergent and discriminant validity.
Paper three investigates the relationship between baseline levels of affect integration and the magnitude of change during open-ended psychotherapy and follow-up. Problems with affect integration, like other indicators of functional severity, have been found to negatively affect response to treatment. However, studies have generally been on short-term treatments. In structured forms of open-ended and long-term psychotherapy this effect appears to be a paradoxical state of affairs. The present study tests whether the deleterious effect of severity as indicated by baseline levels of AC may be reversed in open-ended psychotherapy.
The results indicated that patients with more severe problems in affect integration before treatment show larger improvements in symptoms, interpersonal problems and personality functioning than higher functioning peers. This tendency persists when examining the predictive effects of integration of specific affects on changes in interpersonal relatedness. Finally, it was indicated that increasing problems with specific affects are predictive of distinct patterns of change in different interpersonal problem domains.