;Greenberg & Watson, 2006;Greenberg, 2010). Also Kennedy-Moore and Watson (2001) suggested that immersed emotional expression is beneficial as a first step toward change. Specifically, the contact with painful material leads to greater arousal of negative emotional states, and in several situations this will pave the way for a later understanding of the emotional pain as tolerable and acceptable, and for mastering negative feelings. Consequently, people feel encouraged to evaluate the meaning of the experience. Therefore, it can be argued that immersion may be a productive and necessary therapeutic process involving emotional arousal, and by which therapists and patients gain access to very painful experiences in order to allow further therapeutic work. This seems to be the case, for example, in the narrative retelling of traumatic episodes while working with patients with post-traumatic stress disorder (Foa, Zoellen, Feeny, Hembree, & Alvarez-Conrad, 2002;Jaycox, Foa, & Morral, 1998). This suggestion may seem consistent with some forms of therapy. For example, in CBT, therapists encourage clients to describe emotional events aiming to access their cognitive and emotional components, namely dysfunctional thoughts to be restructured (Beck, 2011). In line, EFT argues that clients need to get in touch with their core maladaptive states, in order to become aware of their internal states, and then to process and transform them. As the EFT motto claims, the only way out is through (Pascual-Leone & Greenberg, 2007). Moreover, the encouraging of an immersed perspective is a procedure used when emotions are avoided (typically in clients distant from their emotions) (Elliott et al., 2004). Sometimes, people reflect according to a distanced perspective to avoid the psychological distress caused by painful emotions of negative events (e.g., Foa & Kozak, 1986). This strategy may be dysfunctional, once it complicates access to important information about the experience, hindering the long-term resolution of distress (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996;Kashdan, Barrios, Forsyth, Steger, 2006). In this sense, as immersion may be dysfunctional when leads to rumination and excessive negative affect (e.g., Ayduk & Kross, 2010a;Kross et al., 2012), distancing may also not always be adaptive in therapy when used to avoid the experience. In sum, in spite of the general trend accentuating the benefits of distancing and the negative consequences of immersion, there are also other findings suggesting that in some circumstances these effects can be quite the opposite. Thus, the role of immersion and distancing in psychotherapy needs to be further clarified.
Based on this previous research on emotional arousal and therapeutic models, we developed the following global hypothetical theoretical framework. On the one hand, immersion in negative experiences can lead to increase the arousal of painful emotions. On the other hand, the arousal of painful emotions can lead to increase immersion on negative experiences. However, both processes in the initial phase of therapy promote the contact with emotional experience, developing the awareness of the different facets of experience, which may justify, in some cases, an increase of specific or general clinical symptoms. Then, the change in reflection and in arousal is need. On the one hand, the greater awareness about experience may encourage the client to adopt a distanced perspective, leading to less emotional arousal of painful emotions. On the other hand, the reduction of emotional arousal of painful emotions, i.e., better ability of emo-tional regulation, facilitates the distancing when reflecting on negative experiences. Regardless of the process involved, we hypothesize greater distancing accompanied by less emotional arousal of negative emotions at a later stage of therapy. In a more general vein, one of the first steps of psychotherapy is sharing the content of negative experiences. This will create a high level of negative arousal and immersion while paving the way to the creation of a new awareness of one's own experience -and therefore, promoting distancing in the later stages of therapy. However, this view still needs empirical support.
Furthermore, there are some key issues left unaddressed by previous experimental studies. First, most of these studies did not use clinical samples, and there has been no study focused on psychotherapy and its effects. Second, in these studies participants were assessed only once or over a period of a week or less (e.g., Mischkowski et al., 2012). Thus, it is important to develop longitudinal studies of psychotherapy cases analyzing immersed and distanced perspectives over longer periods of time, in order to test the relationship of these perspectives with emotional arousal and clinical change. Finally, previous studies assessed immersion and distancing using a self-report scale among participants after a reflection task of an experience (e.g., Kross et al., 2012;Mischkowski et al., 2012), or experimental manipulation from instructions provided to participants (e.g., Wang, Lin, Huang, & Yeh, 2012). We still lack an observational measure of distancing and immersion in order to study the therapeutic client's discourse as it unfolds.
In this single case study, we aimed to analyze the development of immersion and distancing throughout a therapeutic process, as well as the relationship of both these perspectives with emotional arousal and depressive symptoms, using an observational measure based on procedures and characteristics of immersion and distancing extracted from previous studies. We selected a good outcome case of CBT, since, in this type of therapy, an observer stance towards personal experiences is promoted by the repeated reality testing of dysfunctional automatic thoughts (Beck, 2011). Therefore, we expected an increase of distancing over time, and a decrease of immersion. However, we had no specific anticipated hypothesis regarding the relative frequency of these two perspectives. In a perhaps simplistic reading of previous experimental studies, immersion can be regarded as a dysfunctional perspective (associated with rumination and high levels of negative affect), and therefore, we may expect a good outcome to be associated with very low frequency by the end of the therapy; on the other hand, therapy sessions may always involve some degree of immersion in problematic states. Therefore, it may be the case that some degree of immersion may always be needed. Thus, from the Simulation Modelling Analysis (SMA; Borckardt & Nash, 2014), as an advanced statistical program that uses a bootstrap sampling method allowing the control of autocorrelation, we will test the following main hypothesis: a) if, generally, immersion is associated with clinical problems, and distancing with overcoming those problems, then we expect to find high levels of immersion at beginning of therapy, and an increase of distancing throughout therapy, as well as a positive relationship between this pattern of evolution and symptomatic improvement; b) However, if immersion may be used in a productive way during therapy, then we expect to find high levels of immersion in different phases of therapy; c) Moreover, if distancing is associated with greater emotional control than immersion, then we expect that arousal of negative emotions to be negatively related with distancing and positively related with immersion.

Client
Laura (pseudonym), a 33 year old woman, married, with one daughter, was unemployed at the time of her participation in the ISMAI Depression Project (Decentering and Change in Psychotherapy) funded by the Portuguese Foundation for Science and Technology (Salgado, 2014). This is a randomized clinical trial that compared CBT and EFT for major depressive disorder (MDD). The following inclusion criteria were set: diagnosis of major depressive disorder, a global assessment of functioning higher than 50, and no medication. Exclusion criteria were: being under another form of treatment for depression; current or previous diagnosis of at least one of the following DSM-IV Axis I disorders: panic, substance abuse, psychosis, bipolar, eating disorder; or one of the following DSM-IV Axis II disorders: borderline, antisocial, or schizotypal personality disorder; or high risk of suicide. All these criteria were assessed by the Structural Clinical Interviews for the DSM-IV-TR I (First, Spitzer, Gibbon, & Williams, 2002) and II (First, Gibbon, Spitzer, Williams & Benjamin, 1997) and the Beck Depression Inventory-II (BDI-II) for the Portuguese population (Coelho, Martins, & Barros, 2002). Laura was diagnosed with moderate MDD and no other disorders, meeting all the inclusion criteria and none of the exclusion criteria of the clinical trial. She was randomly assigned to CBT and attended 16 weekly sessions plus follow-up sessions at 1, 3, 6, 9 and 12 months. As defined by the clinical trial protocol, all sessions were video recorded.
Psychological treatment, as well as the collection and processing of data for research purposes followed principles and standards included in the ethics code (American Psychological Association's -APA -Ethical Principles of Psychologists and Code of Conduct, as well as the Code of Ethics of Portuguese Psychologists). In this sense, after receiving information about the purposes and procedures of the clinical trial, all clients gave their written consent for using their data in scientific publications.
At treatment termination, Laura had recovered and showed reliable and clinically significant change (Comer & Kendall, 2013) according to the cut-off score of 13 points on the Portuguese version of the Beck Depression Inventory-II (BDI-II; Coelho et al., 2002) and the Reliable Change Index of 7.75, calculated from the psychometric information on the BDI-II. More specifically, her pre-therapy BDI-II score was 31, which had dropped to zero by the end of therapy. This score on the BDI-II was maintained across all the available follow-up sessions, namely at 1, 3, 6 and 9 months after concluding therapy.

Therapist
Laura's therapist was female, with 12 years of experience as a psychotherap