Therapists' oxytocin response mediates the association between patients' negative emotions and psychotherapy outcomes

Reduction of oxytocin plasma levels in borderline personality disorder and normalization induced by psychotherapies

BACKGROUND

Borderline personality disorder (BPD) is a severe mental disorder characterized by emotional dysregulation, impulsive behaviors, and difficulties in interpersonal relationships. Despite the poor understanding of the underlying biological processes, the oxytocin (OXT) system may be involved in and mediate some of BPD's symptomatic and behavioral aspects. To clarify OXT's role in BPD, we assessed its plasma levels and modulations induced by psychotherapies in patients.

METHODS

Fifty BPD patients and 28 healthy controls (HC) participated in the study; patients were randomly assigned to two psychotherapeutic treatments: metacognitive interpersonal therapy and structured clinical management. Clinical and psychometric measures were assessed, and plasma was collected at baseline (T0) and in patients after 6 (T6) and 12 (T12) months of treatment. OXT was quantified by a radioimmunoassay technique.

RESULTS

BPD patients showed lower plasma OXT at T0 than HC (p = 0.002), and a correlation was observed (r = -0.36, p = 0.017) between low OXT concentrations and high Attachment Style Questionnaire - Italian Version-Preoccupation with Relationships subscale scores. OXT changed significantly over time in patients (p = 0.049) with an increase particularly evident from baseline to T6 (p = 0.022), without significant difference between treatment groups. OXT changes (T0 - T12) inversely correlated with symptom improvement as changes in the Zanarini Rating Scale for borderline personality disorder (r = 0.387, p = 0.006) and the Difficulties in Emotion Regulation Scale (r = 0.387, p = 0.005) scores during treatment.

CONCLUSIONS

OXT alteration in BPD patients and the regularizing effect of long-term psychotherapies support an involvement of the OXT system in the disease and in treatment impact. More research is needed to fully understand the underlying causal mechanisms linking OXT with pathogenesis and psychotherapy outcomes.

Oxytocin as a physiological correlate of dyadic music therapy relationships - a randomized crossover pilot study

Rationale

Music therapy has been in practice for years. However, the mechanism of action of music or music therapy is not well understood. It is only recently that the neuroendocrinological basis of therapeutic relationships has become the subject of growing research interest. The aim of this pilot study (Clinical Trial No: DRKS00035174) is to investigate whether oxytocin is usable and feasible as a biomarker of attachment to demonstrate the development of therapeutic alliance between therapist and patient in a dyadic music therapy setting.

Methods

In a single-measure crossover design, children aged 6-12 years from a special school for social and emotional disorders, were randomly with either music therapy followed by a waiting list control group that performed silent work, or vice versa. The respective interventions were conducted on the school premises on different days over a period of 1 month. The primary outcome was salivary oxytocin, with tests performed immediately before and after each 30-min intervention.

Results

Thirty-two children were included in the study, resulting in n = 16 children per allocation sequence. During the implementation of the study, difficulties were encountered with protocol adherence both in terms of the duration of the music therapy and the implementation of the silent work in the control group. There were no dropouts, however, only 28 children were included in the final data analysis as two participants in each group were excluded due to large fluctuations in oxytocin levels. Between-group comparison and within-group comparisons showed no significant changes in oxytocin levels. However, the music therapist showed a significant increase in oxytocin levels in the before after measurement. No side effects or adverse events were reported during the trial.

Conclusion

The findings indicated a responsiveness of oxytocin to musical stimulation. Although feasibility of oxytocin measurement was clearly demonstrated, evaluation of the results is difficult against the background of many remaining questions regarding individual and contextual factors influencing the oxytocinergic system. Moreover, the clinical significance of changes in oxytocin levels remains a topic for further research to better understand the role of oxytocin in the attachment formation between therapist and patient in music therapy.

Alliance processes in eating disorders with childhood maltreatment sequelae: Preliminary implications

BACKGROUND

Effective eating disorder (ED) treatments are drastically needed for patients with experiences of sustained and prolonged emotional, physical and sexual childhood maltreatment (CM) that often results in post-traumatic sequelae such as severe, complex posttraumatic stress disorder (cPTSD). EDs with comorbid cPTSD (cPTSD-ED) have protracted treatment courses and poorer prognoses.

AIM

To summarise the knowledge base on cPTSD-ED with specific emphasis on disturbances in self-organisation (DSO) in relation to therapeutic alliance (TA) processes.

METHOD

Expert opinions based on current relevant literature are critically examined.

RESULTS

Preliminary insights on change and alliance processes suggest that neglecting to address emotional-relational processes in the conceptualisation and treatment of cPTSD-ED impedes treatment progress.

CONCLUSION

We hypothesise that the DSO construct inherent in cPTSD-ED calls for a focus on TA processes in addition to traditional ED treatment elements such as nutritional rehabilitation and behaviour change, and regardless of ED treatment provided. More process research on a larger scale is urgently called for.

Between- and within-person effects of affective experiences on coping in CBT: Direct effects and interplay with therapeutic alliance and resource activation

OBJECTIVE

The role of affective experiences (AE) in cognitive-behavioral therapy (CBT) has rarely been investigated. We examined between- and within-person effects of AE on coping in CBT for family caregivers and interactions with therapeutic alliance and resource activation.

METHODS

67 family caregivers rated AE, therapeutic alliance, resource activation, and coping after each of 12 sessions of telephone-based CBT. We examined direct session-to-session effects of AE on coping in structural equation modeling and interactions of AE with therapeutic alliance and resource activation in multilevel models.

RESULTS

AE did not directly predict coping. Instead, within-person effects of AE interacted with simultaneous within-person emotional bond. Given strong emotional bond, AE positively predicted coping, whereas given weak emotional bond, AE negatively predicted coping. Further, cross-level interactions of between-person AE and within-person agreement on collaboration and resource activation indicated that these positively predicted coping only in dyads with high between-person AE.

CONCLUSION

AE may enhance coping when complemented with strong emotional bond. Further, within-person effects of agreement on collaboration and resource activation seem to rely on a certain degree of between-person AE. Results are discussed in relation to current findings on emotional processing in CBT.

Needs, Modes, and Stances: Three Cardinal Questions for Psychotherapy Practice and Training

Background

Advances in motivational science (Dweck, 2017), personality dynamics (Lazarus & Rafaeli, 2023), and process-based psychotherapy (Hofmann & Hayes, 2019) converge into a pragmatic, integrative, and transtheoretical model of practice and training.

Method

The model comprises three elements: a formulation centered on clients' psychological needs which provides guidance regarding the goals and processes most profitable to pursue; a recognition that such pursuit frequently requires contending with a multiplicity of clients' internal self-states (i.e., modes); and an enumeration of pragmatic therapeutic stances likely to help address clients' need-related goals in light of their modes.

Results

We distill these elements into three cardinal questions: What needs does this client have that are not currently met, and what are the most profitable ways of remedying that frustration? What mode or modes does this client manifest - both generally and at this very moment? and What stance should I adopt in response to the client's current mode? We suggest that clinicians should be trained to continually pose these questions and seek to answer them collaboratively with their clients.

Conclusion

This model - illustrated here using schema therapy terms - offers a process-based approach which serves as a theoretically integrative starting point but is general enough to provide an assimilative integration roadmap for therapists anchored in most primary orientations. Integrative or assimilative therapists trained to attend to needs, modes, and stances are likely to be (and be perceived as) particularly responsive, and thus, to enact "common factor" practices known to be conducive to therapeutic alliance and gains.

Individual-Specific Animated Profiles of Mental Health

How important is the timing of the pretreatment evaluation? If we consider mental health to be a relatively fixed condition, the specific timing (e.g., day, hour) of the evaluation is immaterial and often determined on the basis of technical considerations. Indeed, the fundamental assumption underlying the vast majority of psychotherapy research and practice is that mental health is a state that can be captured in a one-dimensional snapshot. If this fundamental assumption, underlying 80 years of empirical research and practice, is incorrect, it may help explain why for decades psychotherapy failed to rise above the 50% efficacy rate in the treatment of mental-health disorders, especially depression, a heterogeneous disorder and the leading cause of disability worldwide. Based on recent studies suggesting within-individual dynamics, this article proposes that mental health and its underlying therapeutic mechanisms have underlying intrinsic dynamics that manifest across dimensions. Computational psychotherapy is needed to develop individual-specific pretreatment animated profiles of mental health. Such individual-specific animated profiles are expected to improve the ability to select the optimal treatment for each patient, devise adequate treatment plans, and adjust them on the basis of ongoing evaluations of mental-health dynamics, creating a new understanding of therapeutic change as a transition toward a more adaptive animated profile.