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Lohani M, Bryan CJ, Elsey JS, Dutton S, Findley SP, Langenecker SA, West K, Baker JC. Collaboration matters: A randomized controlled trial of patient-clinician collaboration in suicide risk assessment and intervention. J Affect Disord 2024; 360:387-393. [PMID: 38838788 DOI: 10.1016/j.jad.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/17/2024] [Accepted: 06/02/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Clinician collaboration can help high-risk individuals to manage their suicidal crises. However, limited research has directly examined how higher patient-clinician collaboration during assessment and intervention can effectively reduce suicidal ideation. This novel randomized clinical trial compared a high vs. low level of patient-clinician collaboration by pairing commonly used assessment (Structured Interview vs. Narrative Assessment) and intervention approaches (Safety Planning Intervention vs. Crisis Response Planning). We hypothesized that the interventions involving higher (than lower) patient-clinician collaboration during assessment (Narrative Assessment) or intervention (Crisis Response Planning) would lead to larger reductions in suicidal ideation. METHODS Eighty-two participants with a history of suicide ideation and/or attempts were randomly assigned to one of the four interventions varying in patient-clinician collaboration. After attrition, sixty-six participants completed the study. Suicidal ideation via ecological momentary assessment was measured 14 days before and 14 days after treatment. RESULTS Although the severity of suicidal ideation decreased in all groups, the two groups that included highly collaborative assessment had larger pre-post reductions in suicidal ideation (Narrative Assessment+Safety Plan; dwithin = 0.26, and Narrative Assessment+Crisis Response Plan; dwithin = 0.19) than the groups that included a checklist-based assessment (Structured Interview). LIMITATIONS Longer follow-up periods with a larger sample would have provided an understanding of the durability of intervention effects. CONCLUSION Results suggest that the inclusion of higher patient-clinician collaboration techniques during suicide risk assessment can effectively reduce suicidal thoughts. Thus, clinician-led collaborative risk assessment approaches can enhance the effects of safety planning-type interventions among patients with elevated risk for suicide versus checklist-based assessment approaches.
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Affiliation(s)
- Monika Lohani
- Department of Psychology, University of Utah, United States of America.
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University, United States of America
| | - Jamie S Elsey
- Department of Educational Psychology, University of Utah, United States of America
| | - Sam Dutton
- Department of Educational Psychology, University of Utah, United States of America
| | - Samuel P Findley
- Department of Educational Psychology, University of Utah, United States of America
| | - Scott A Langenecker
- Department of Psychiatry and Behavioral Health, The Ohio State University, United States of America
| | - Kristen West
- Department of Educational Psychology, University of Utah, United States of America
| | - Justin C Baker
- Department of Psychiatry and Behavioral Health, The Ohio State University, United States of America
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Levi E, Peysachov G, Admon R, Zilcha-Mano S. Cortisol interdependence during psychotherapy in major depressive disorder. Psychoneuroendocrinology 2024; 163:106983. [PMID: 38367530 DOI: 10.1016/j.psyneuen.2024.106983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/16/2024] [Accepted: 01/30/2024] [Indexed: 02/19/2024]
Abstract
The current study explored cortisol interdependence between patients and therapists during psychotherapy, the possible moderating effect of patient alliance ratings on this interdependence, and the associations between cortisol interdependence and treatment outcome. While cortisol interdependence was explored in other interpersonal contexts, its presence in psychotherapy has remained unexplored. We hypothesized that (a) patients' and therapists' cortisol levels at pre-session will predict their own and their partner's subsequent cortisol levels at post-session, (b) patient ratings of their relationship with their therapists will moderate these partner effects, and (c) cortisol interdependence will be associated with better treatment outcome. Fifty dyads undergoing 16 weeks of psychodynamic treatment for major depressive disorder participated in this study. Patient-therapist salivary cortisol samples were collected at eight time points, alongside a post-session patient-rated alliance questionnaire and a symptom severity interview. For analyses we employed the actor-partner interdependence model. Results revealed that (a) patients' and therapists' cortisol levels before sessions predicted their own post-session cortisol changes. However, significant cortisol interdependence was observed in patients' pre-session cortisol levels predicting therapists' post-session cortisol levels. Furthermore, (b) poorer alliance ratings associated with more pronounced cortisol interdependence, and (c) in dyads where patient pre-session cortisol predicted therapist's post-session cortisol, a better treatment outcome was found. This study found novel evidence of cortisol interdependence in psychotherapy and is partially in line with other studies inspecting cortisol interdependence in adjacent research fields. These findings emphasize the intricate psychophysiological interactions within therapeutic relationships and their associations with treatment outcome.
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Affiliation(s)
- Eyal Levi
- Department of Psychology, University of Haifa, Israel
| | | | - Roee Admon
- Department of Psychology, University of Haifa, Israel; The Integrated Brain and Behavior Research Center (IBBRC), University of Haifa, Israel
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Tal S, Ben-David Sela T, Dolev-Amit T, Hel-Or H, Zilcha-Mano S. Reactivity and stability in facial expressions as an indicator of therapeutic alliance strength. Psychother Res 2024:1-15. [PMID: 38442022 DOI: 10.1080/10503307.2024.2311777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
Objective: Aspects of our emotional state are constantly being broadcast via our facial expressions. Psychotherapeutic theories highlight the importance of emotional dynamics between patients and therapists for an effective therapeutic relationship. Two emotional dynamics suggested by the literature are emotional reactivity (i.e., when one person is reacting to the other) and emotional stability (i.e., when a person has a tendency to remain in a given emotional state). Yet, little is known empirically about the association between these dynamics and the therapeutic alliance. This study investigates the association between the therapeutic alliance and the emotional dynamics of reactivity and stability, as manifested in the facial expressions of patients and therapists within the session. Methods: Ninety-four patients with major depressive disorder underwent short-term treatment for depression (N = 1256 sessions). Results: Both therapist reactivity and stability were associated with the alliance, across all time spans. Patient reactivity was associated with the alliance only in a short time span (1 s). Conclusions: These findings may potentially guide therapists in the field to attenuate not only their emotional reaction to their patients, but also their own unique presence in the therapy room.
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Affiliation(s)
- Shachaf Tal
- Department of Psychology, University of Haifa, Haifa, Israel
| | | | | | - Hagit Hel-Or
- Department of Computer Science, University of Haifa, Haifa, Israel
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Bryan CJ, Bryan AO, Khazem LR, Aase DM, Moreno JL, Ammendola E, Bauder CR, Hiser J, Daruwala SE, Baker JC. Crisis response planning rapidly reduces suicidal ideation among U.S. military veterans receiving massed cognitive processing therapy for PTSD. J Anxiety Disord 2024; 102:102824. [PMID: 38154445 DOI: 10.1016/j.janxdis.2023.102824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
Posttraumatic stress disorder (PTSD) is common among U.S. military veterans and is associated with increased risk of suicidal thoughts and behaviors. Crisis response planning (CRP), a brief safety planning-type intervention, has been shown to rapidly reduce suicidal ideation and suicide attempts in emergency and acute care settings. CRP's effectiveness when combined with trauma-focused therapies remains unknown. In this randomized pragmatic clinical trial with one-year follow-up, 157 U.S. military personnel and veterans were randomly assigned to receive CRP or self-guided safety planning (SP) prior to beginning massed cognitive processing therapy (CPT) for PTSD. Among 51 (32.5 % of sample) participants endorsing suicidal ideation at baseline, reductions in the severity of suicidal ideation were significantly larger and faster in CRP (F(11,672)= 15.8, p < .001). Among 106 participants denying suicidal ideation at baseline, 8.5 % of CRP participants versus 11.9 % of SP participants (OR=0.69, 95 % CI=0.19-2.52) reported new-onset suicidal ideation during any follow-up assessment. PTSD symptoms significantly reduced over time with no differences between groups. Results support the effectiveness of CRP for rapidly reducing suicidal ideation and managing suicide risk during outpatient treatment for PTSD.
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Affiliation(s)
- Craig J Bryan
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA.
| | - AnnaBelle O Bryan
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Lauren R Khazem
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Darrin M Aase
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Jose L Moreno
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Ennio Ammendola
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Christina Rose Bauder
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Jaryd Hiser
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
| | - Samantha E Daruwala
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Health Care System, Canandaigua, NY, USA
| | - Justin C Baker
- The Ohio State University, Department of Psychiatry and Behavioral Health, Columbus, OH, USA
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Steimle L, von Peter S, Frank F. Professional relationships during crisis interventions: A scoping review. PLoS One 2024; 19:e0298726. [PMID: 38394216 PMCID: PMC10890742 DOI: 10.1371/journal.pone.0298726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 01/25/2024] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION A crisis can be described as subjective experience that threatens and overwhelms a person's ability to handle a specific situation. In dealing with crises some people are looking for support from professionals. The "professional relationship" between people experiencing a crisis and professionals plays an important role in the successful management of a crisis which has been widely researched in many contexts. However, regarding outpatient services (e. g. crisis resolution home treatment teams), yet empirical evidence remains limited. OBJECTIVE We aim to explore descriptions of supportive professional relationships during outpatient crisis interventions in empirical literature. Accordingly, a scoping review was conducted to identify types of evidence, map the key concepts, and point out research gaps. METHODS MEDLINE, PsycINFO, CINAHL and Social Science Citation Index were searched for studies reporting empirical data on the professional relationship between people experiencing a crisis (18+) and professionals (e. g. social workers, psychiatrists) during a crisis intervention, defined as a short-term, face-to-face, low threshold, time-limited, outpatient, and voluntary intervention to cope with crises. Studies were excluded if they were published before 2007, in languages other than English and German, and if they couldn't be accessed. Included studies were summarized, compared, and synthesized using qualitative content analyses. RESULTS 3.741 records were identified, of which 8 met the eligibility criteria. Only one study directly focused on the relationship; the others addressed varied aspects. Two studies explored the perspectives of service users, five focused on those of the professionals and one study examined both. The empirical literature was categorized into three main themes: strategies used to develop a supportive professional relationship, factors influencing the relationship and the nature of these relationships. DISCUSSION The results reveal a gap in understanding the nature of supportive professional relationships from the service users' perspective, as well as how professionals construct these relationships.
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Affiliation(s)
- Larissa Steimle
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health and Social Work, Frankfurt University of Applied Sciences, Frankfurt, Germany
| | - Sebastian von Peter
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Fabian Frank
- Department of Social Work, Protestant University of Applied Sciences Freiburg, Freiburg, Germany
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Zilcha-Mano S. Individual-Specific Animated Profiles of Mental Health. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024:17456916231226308. [PMID: 38377015 DOI: 10.1177/17456916231226308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
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.
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Bossé Chartier G, Lam F, Bergmans Y, Lofchy J, Bolton JM, Klonsky ED, Zaheer J, Kealy D. "Psychotherapy in the Pressure Cooker": A Systematic Review of Single Session Psychosocial Interventions in Emergency Departments for Suicide-related Thoughts or Behaviors. J Psychiatr Pract 2023; 29:291-307. [PMID: 37449827 DOI: 10.1097/pra.0000000000000725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES Up to 20% of individuals who die by suicide have visited an emergency department (ED) within 4 weeks of their death. Limited guidance is available regarding the modification of clinical outcomes following a psychosocial intervention in the ED for pediatric and adult populations. METHODS A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted to identify studies focused on single-session psychosocial interventions for pediatric and adult patients experiencing suicide-related thoughts or behaviors (SRTB) in the ED. Two reviewers independently screened articles identified using the key terms suicide/self-harm, emergency department, and interview. Medline, PubMed, Embase, PsycINFO, CINAHL, and CENTRAL were searched from inception to August 2018. RESULTS After screening 3234 abstracts, 29 articles were selected for full-text review and 14 articles, representing 8 distinct studies (N=782), were included. A high level of heterogeneity was present in the included articles, with 7 randomized-controlled trials, 2 nonrandomized-controlled trials, 2 cohort studies, 2 observational studies, and 1 feasibility study. Most of the included studies focused on adolescents (6 articles) or military veterans (7 articles). Strong statistical evidence of ED interventions improving outpatient service linkage was supported (χ2: 81.80, P<0.0001, 7 studies). CONCLUSIONS The findings of this study suggested promising outcomes for patients presenting to the ED with SRTB who receive a single-session psychosocial intervention. All of the studies that measured such outcomes found significantly increased follow-up care in the intervention arm. Further research is needed to strengthen the evidence base, provide better patient representation, and improve our understanding of the mechanisms by which the psychosocial intervention for SRTB in the ED ameliorates patient outcomes (CRD42020156496).
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Affiliation(s)
- Gabrielle Bossé Chartier
- BOSSÉ CHARTIER, LAM, and KEALY: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; BERGMANS and ZAHEER: Department of Psychiatry, University of Toronto, Toronto, ON, Canada; LOFCHY: Adult Acute Care Psychiatry, St. Joseph's Health Centre and University of Toronto, Toronto, ON, Canada; BOLTON: Department of Psychiatry, University of Manitoba, and Shared Health Manitoba Crisis Response Centre, Winnipeg, MB, Canada; KLONSKY: Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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8
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Brockmeyer T, Titzmann M, Zipfel S, Wild B, Resmark G, Teufel M, Giel K, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, Rothermund E, Zeeck A, Herzog W, Friederich HC. The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa. Behav Res Ther 2023; 163:104285. [PMID: 36913844 DOI: 10.1016/j.brat.2023.104285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms 'clarification' (insight), 'mastery' (coping), and 'therapeutic relationship' were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.
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Affiliation(s)
- Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany; Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Marieke Titzmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Beate Wild
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital, Essen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department for Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital and University Hospital Muenster, Muenster, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- Faculty of Social Sciences, TH Köln-University of Applied Sciences, Köln, Germany
| | - Eva Rothermund
- Ulm University Medical Center, Department of Psychosomatic Medicine and Psychotherapy, Ulm, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Herzog
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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Atzil-Slonim D, Soma CS, Zhang X, Paz A, Imel ZE. Facilitating dyadic synchrony in psychotherapy sessions: Systematic review and meta-analysis. Psychother Res 2023:1-20. [PMID: 37001119 DOI: 10.1080/10503307.2023.2191803] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Objective: This paper highlights the facilitation of dyadic synchrony as a core psychotherapist skill that occurs at the non-verbal level and underlies many other therapeutic methods. We define dyadic synchrony, differentiate it from similar constructs, and provide an excerpt illustrating dyadic synchrony in a psychotherapy session. Method: We then present a systematic review of 17 studies that have examined the associations between dyadic synchrony and psychotherapy outcomes. We also conduct a meta-analysis of 8 studies that examined whether there is more synchrony between clients and therapists than would be expected by chance. Results: Weighted box score analysis revealed that the overall association of synchrony and proximal as well as distal outcomes was neutral to mildly positive. The results of the meta-analysis indicated that real client-therapist dyad pairs exhibited synchronized behavioral patterns to a much greater extent than a sample of randomly paired people who did not actually speak. Conclusion: Our discussion revolves around how synchrony can be facilitated in a beneficial way, as well as situations in which it may not be beneficial. We conclude with training implications and therapeutic practices.
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Soma CS, Knox D, Greer T, Gunnerson K, Young A, Narayanan S. It's not what you said, it's how you said it: An analysis of therapist vocal features during psychotherapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023; 23:258-269. [PMID: 36873916 PMCID: PMC9979575 DOI: 10.1002/capr.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 11/07/2022]
Abstract
Psychotherapy is a conversation, whereby, at its foundation, many interventions are derived from the therapist talking. Research suggests that the voice can convey a variety of emotional and social information, and individuals may change their voice based on the context and content of the conversation (e.g., talking to a baby or delivering difficult news to patients with cancer). As such, therapists may adjust aspects of their voice throughout a therapy session depending on if they are beginning a therapy session and checking in with a client, conducting more therapeutic "work," or ending the session. In this study, we modeled three vocal features-pitch, energy, and rate-with linear and quadratic multilevel models to understand how therapists' vocal features change throughout a therapy session. We hypothesized that all three vocal features would be best fit with a quadratic function - starting high and more congruent with a conversational voice, decreasing during the middle portions of therapy where more therapeutic interventions were being administered, and increasing again at the end of the session. Results indicated a quadratic model for all three vocal features was superior in fitting the data, as compared to a linear model, suggesting that therapists begin and end therapy using a different style of voice than in the middle of a session.
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Affiliation(s)
- Christina S Soma
- Department of Educational Psychology, University of Utah, Salt Lake City, (UT) USA
| | - Dillon Knox
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, (CA,) USA
| | - Timothy Greer
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
| | - Keith Gunnerson
- Department of Educational Psychology, University of Utah, Salt Lake City, (UT) USA
| | - Alexander Young
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
| | - Shrikanth Narayanan
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
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11
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Kilshaw RE, Kerig PK, Baucom BRW. Vocally-Encoded Emotional Arousal as a Marker of Callous-Unemotional Traits in a Sample of Justice-Involved Adolescents. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01486-6. [PMID: 36572843 DOI: 10.1007/s10578-022-01486-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/26/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
Callous-unemotional (CU) traits are associated with severe and persistent juvenile offending. CU traits are also associated with dampened emotional arousal, which suggests that fundamental frequency (f0), a measure of vocally-encoded emotional arousal, may serve as an accessible psychophysiological marker of CU traits in youth. This study investigated the associations between f0 range measured during an emotionally evocative task, CU traits, and emotion dysregulation in a mixed-gender sample of 168 justice-involved youth. For boys, after controlling for covariates, wider f0 range-indicating greater emotional arousal-was negatively associated with CU traits and positively associated with emotion dysregulation. For girls, no significant associations with f0 range emerged; however, CU traits were positively associated with emotion dysregulation. Findings suggest that f0 range may serve as a valid indicator of CU traits in JJ-involved boys, and that detained boys and girls with high CU traits are characterized by different profiles of emotion dysregulation.
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Affiliation(s)
- Robyn E Kilshaw
- Department of Psychology, University of Utah, 380 S 1530 E BEH S 502, UT, 84112, Salt Lake City, USA.
| | - Patricia K Kerig
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, USA
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Homan S, Gabi M, Klee N, Bachmann S, Moser AM, Duri' M, Michel S, Bertram AM, Maatz A, Seiler G, Stark E, Kleim B. Linguistic features of suicidal thoughts and behaviors: A systematic review. Clin Psychol Rev 2022; 95:102161. [DOI: 10.1016/j.cpr.2022.102161] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 03/28/2022] [Accepted: 04/27/2022] [Indexed: 12/13/2022]
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13
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Langer SL, Romano JM, Keefe F, Baucom DH, Strauman T, Syrjala KL, Bolger N, Burns J, Bricker JB, Todd M, Baucom BRW, Fischer MS, Ghosh N, Gralow J, Shankaran V, Zafar SY, Westbrook K, Leo K, Ramos K, Weber DM, Porter LS. Couple Communication in Cancer: Protocol for a Multi-Method Examination. Front Psychol 2022; 12:769407. [PMID: 35222142 PMCID: PMC8865086 DOI: 10.3389/fpsyg.2021.769407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/28/2021] [Indexed: 01/18/2023] Open
Abstract
Cancer and its treatment pose challenges that affect not only patients but also their significant others, including intimate partners. Accumulating evidence suggests that couples' ability to communicate effectively plays a major role in the psychological adjustment of both individuals and the quality of their relationship. Two key conceptual models have been proposed to account for how couple communication impacts psychological and relationship adjustment: the social-cognitive processing (SCP) model and the relationship intimacy (RI) model. These models posit different mechanisms and outcomes, and thus have different implications for intervention. The purpose of this project is to test and compare the utility of these models using comprehensive and methodologically rigorous methods. Aims are: (1) to examine the overall fit of the SCP and RI models in explaining patient and partner psychological and relationship adjustment as they occur on a day-to-day basis and over the course of 1 year; (2) to examine the fit of the models for different subgroups (males vs. females, and patients vs. partners); and (3) to examine the utility of various methods of assessing communication by examining the degree to which baseline indices from different measurement strategies predict self-reported adjustment at 1-year follow up. The study employs a longitudinal, multi-method approach to examining communication processes including: standard self-report questionnaires assessing process and outcome variables collected quarterly over the course of 1 year; smartphone-based ecological momentary assessments to sample participant reports in real time; and laboratory-based couple conversations from which we derive observational measures of communicative behavior and affective expression, as well as vocal indices of emotional arousal. Participants are patients with stage II-IV breast, colon, rectal, or lung cancer and their spouses/partners, recruited from two NCI-designated comprehensive cancer centers. Results will be published in scientific journals, presented at scientific conferences, and conveyed to a larger audience through infographics and social media outlets. Findings will inform theory, measurement, and the design and implementation of efficacious interventions aimed at optimizing both patient and partner well-being.
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Affiliation(s)
- Shelby L. Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Joan M. Romano
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Francis Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Donald H. Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Timothy Strauman
- Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Karen L. Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Niall Bolger
- Department of Psychology, Columbia University, New York, NY, United States
| | - John Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Jonathan B. Bricker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Michael Todd
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, United States
| | - Brian R. W. Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT, United States
| | - Melanie S. Fischer
- Institute of Medical Psychology, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Neeta Ghosh
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Julie Gralow
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - Veena Shankaran
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - S. Yousuf Zafar
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Kelly Westbrook
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States
| | - Karena Leo
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Katherine Ramos
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Danielle M. Weber
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura S. Porter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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14
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Scheidt CE, Pfänder S, Ballati A, Schmidt S, Lahmann C. Language and Movement Synchronization in Dyadic Psychotherapeutic Interaction - A Qualitative Review and a Proposal for a Classification. Front Psychol 2021; 12:696448. [PMID: 34744862 PMCID: PMC8569105 DOI: 10.3389/fpsyg.2021.696448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
In individual psychotherapy verbal communication and movement synchronization are closely interrelated. The microanalysis of timing, rhythm and gestalt of movement has established dynamic movement coordination as a systemic property of the dyadic interaction. Movement synchronization supports and enhances the unfolding of linguistic meaning. In order to substantiate the importance of the concept of synchrony for adult psychotherapy we review evidence from developmental psychology and discuss approaches to measure synchrony with particular reference to the naturalistic setting of dyadic psychotherapy. As the concept of synchrony is still ambiguous, and the respective interactional phenomena are ephemeral and fluid, in the current paper we suggest a set of five criteria for the description of synchronization in general terms and eight additional criteria which specifically enable the description of phenomena of movement synchronization. The five general dimensions are: (1) context, (2) modality, (3) resources, (4) entrainment, and (5) time-lag. The eight categories for the description of movement synchrony are: (1) spatial direction, (2) amplitude, (3) sinuosity, (4) duration, (5) event structure, (6) phase, (7) frequency, and (8) content. To understand the process of participatory sense-making and the emergence of meaning in psychotherapy, synchrony research has to cope with the multimodality of the embodied interaction. This requires an integrated perspective of movement and language. A system for the classification of synchrony phenomena may contribute to the linking of variations and patterns of movement with language and linguistic utterances.
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Affiliation(s)
- Carl Eduard Scheidt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany.,Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Stefan Pfänder
- Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs-University Freiburg, Freiburg, Germany.,Romanisches Seminar, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Arianna Ballati
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Albert-Ludwigs-University Freiburg, Freiburg, Germany.,Freiburg Institute for Advanced Studies (FRIAS), Albert-Ludwigs-University Freiburg, Freiburg, Germany
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15
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Cohen AS, Cox CR, Tucker RP, Mitchell KR, Schwartz EK, Le TP, Foltz PW, Holmlund TB, Elvevåg B. Validating Biobehavioral Technologies for Use in Clinical Psychiatry. Front Psychiatry 2021; 12:503323. [PMID: 34177631 PMCID: PMC8225932 DOI: 10.3389/fpsyt.2021.503323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/11/2021] [Indexed: 11/14/2022] Open
Abstract
The last decade has witnessed the development of sophisticated biobehavioral and genetic, ambulatory, and other measures that promise unprecedented insight into psychiatric disorders. As yet, clinical sciences have struggled with implementing these objective measures and they have yet to move beyond "proof of concept." In part, this struggle reflects a traditional, and conceptually flawed, application of traditional psychometrics (i.e., reliability and validity) for evaluating them. This paper focuses on "resolution," concerning the degree to which changes in a signal can be detected and quantified, which is central to measurement evaluation in informatics, engineering, computational and biomedical sciences. We define and discuss resolution in terms of traditional reliability and validity evaluation for psychiatric measures, then highlight its importance in a study using acoustic features to predict self-injurious thoughts/behaviors (SITB). This study involved tracking natural language and self-reported symptoms in 124 psychiatric patients: (a) over 5-14 recording sessions, collected using a smart phone application, and (b) during a clinical interview. Importantly, the scope of these measures varied as a function of time (minutes, weeks) and spatial setting (i.e., smart phone vs. interview). Regarding reliability, acoustic features were temporally unstable until we specified the level of temporal/spatial resolution. Regarding validity, accuracy based on machine learning of acoustic features predicting SITB varied as a function of resolution. High accuracy was achieved (i.e., ~87%), but only when the acoustic and SITB measures were "temporally-matched" in resolution was the model generalizable to new data. Unlocking the potential of biobehavioral technologies for clinical psychiatry will require careful consideration of resolution.
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Affiliation(s)
- Alex S Cohen
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States.,Center for Computation and Technology Louisiana State University, Baton Rouge, LA, United States
| | - Christopher R Cox
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Kyle R Mitchell
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Elana K Schwartz
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Thanh P Le
- Department of Psychology, Louisiana State University, Baton Rouge, LA, United States
| | - Peter W Foltz
- Department of Psychology, University of Colorado, Boulder, CO, United States
| | - Terje B Holmlund
- Department of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway
| | - Brita Elvevåg
- Department of Clinical Medicine, University of Tromsø-The Arctic University of Norway, Tromsø, Norway.,The Norwegian Center for eHealth Research, University Hospital of North Norway, Tromsø, Norway
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16
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Ben David-Sela T, Dolev-Amit T, Eubanks CF, Zilcha-Mano S. Achieving successful resolution of alliance ruptures: for whom and when? Psychother Res 2020; 31:870-881. [PMID: 33357095 DOI: 10.1080/10503307.2020.1862432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Contemporary theories and the empirical literature stress the importance of successful resolution of alliance ruptures for the process and outcome of treatment. Yet, little empirical work has examined what leads to successful resolutions. The aim of the present study was to examine which patients are more likely to achieve successful resolutions of ruptures and under which circumstances. Sixty-five patients completed measures assessing their trait-like pretreatment characteristics (alliance expectations and general attachment orientation), and state-like changes in treatment (working alliance, therapist serving as an attachment figure, and the implementation of common factor techniques). Successful resolutions were coded using observer behavioral coding at four time points. State-like changes, but not trait-like characteristics significantly contributed to successful resolution. Stronger working alliance and the therapist as an attachment figure, and the implementation of common factors techniques were found to contribute to successful resolutions. The current findings emphasize the importance of the process that occurs within treatment, and the therapeutic context in which the resolution process take place for the ability to achieve successful resolutions.
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Affiliation(s)
| | - Tohar Dolev-Amit
- The Department of Psychology, University of Haifa, Haifa, Israel
| | - Catherine F Eubanks
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
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17
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Li X, Kivlighan DM. Examining therapy dynamics and session outcome using differential equations model and multilevel data disaggregation. Psychother Res 2020; 30:604-621. [PMID: 31382841 DOI: 10.1080/10503307.2019.1649730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 07/21/2019] [Indexed: 10/26/2022] Open
Abstract
Objective: This study used Ordinary Differential Equations (ODE) model in a multilevel framework to investigate how the dyadic dynamics between therapist and client in perceiving working alliance (WA) was associated with the clients' session evaluation. Method: Participants were 33 therapists and their 180 clients. Therapists' and clients' WA ratings after each session were entered into the ODE model to estimate four coefficients capturing their consistency of perceptions of WA, and the levels to which one's perception influenced and was influenced by the other's perception. These dynamic coefficients were disaggregated into between-therapist and within-therapist components and entered into the Hierarchical Linear Model to predict client's session evaluation. Results: First, when therapists were generally more stable/consistent in perceiving their WA with all clients, they tended to have higher client evaluations of session quality. Second, when therapists were generally not influential on clients or not receptive to clients' influence, therapists' higher influence or openness to being influenced with a particular client was related to better session outcome. Third, when a therapist was generally highly influential, the more that therapist was influential to a particular client, that client reported worse session outcome. Conclusion: Implications about therapy dynamics and the use of ODE models were discussed.
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Affiliation(s)
- Xu Li
- 1Department of Counseling, Higher Education, and Special Education, College of Education, University of Maryland, College Park, MD, USA
- 2Department of Educational Psychology, University of Wisconsin, Milwaukee, WI, USA
| | - Dennis M Kivlighan
- Department of Counseling, Higher Education, and Special Education, College of Education, University of Maryland, College Park, MD, USA
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18
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Soma CS, Baucom BRW, Xiao B, Butner JE, Hilpert P, Narayanan S, Atkins DC, Imel ZE. Coregulation of therapist and client emotion during psychotherapy. Psychother Res 2020; 30:591-603. [PMID: 32400306 DOI: 10.1080/10503307.2019.1661541] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Close interpersonal relationships are fundamental to emotion regulation. Clinical theory suggests that one role of therapists in psychotherapy is to help clients regulate emotions, however, if and how clients and therapists serve to regulate each other's emotions has not been empirically tested. Emotion coregulation - the bidirectional emotional linkage of two people that promotes emotional stability - is a specific, temporal process that provides a framework for testing the way in which therapists' and clients' emotions may be related on a moment to moment basis in clinically relevant ways. METHOD Utilizing 227 audio recordings from a relationally oriented treatment (Motivational Interviewing), we estimated continuous values of vocally encoded emotional arousal via mean fundamental frequency. We used dynamic systems models to examine emotional coregulation, and tested the hypothesis that each individual's emotional arousal would be significantly associated with fluctuations in the other's emotional state over the course of a psychotherapy session. RESULTS Results indicated that when clients became more emotionally labile over the course of the session, therapists became less so. When changes in therapist arousal increased, the client's tendency to become more aroused during session slowed. Alternatively, when changes in client arousal increased, the therapist's tendency to become less aroused slowed.
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Affiliation(s)
- Christina S Soma
- Department of Educational Psychology, University of Utah, Salt Lake City, UT, USA
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Bo Xiao
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jonathan E Butner
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Peter Hilpert
- School of Psychology, University of Surrey, Guilford, UK
| | - Shrikanth Narayanan
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Zac E Imel
- Department of Educational Psychology, University of Utah, Salt Lake City, UT, USA
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19
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Rozek DC, Bryan CJ. Integrating crisis response planning for suicide prevention into trauma-focused treatments: A military case example. J Clin Psychol 2020; 76:852-864. [PMID: 31926024 PMCID: PMC7138743 DOI: 10.1002/jclp.22920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) and suicidal thoughts and behaviors are common in military members and veterans and produce anxiety for many clinicians. Although there are separate interventions for PTSD and elevated suicide risk, there is not much guidance on how to integrate these approaches. Crisis response planning (CRP) is an evidence-based tool used to prevent suicide attempts that can easily be integrated into trauma-focused therapies for patients with PTSD. METHOD Given the high frequency of suicidal thoughts among patients with PTSD, the current paper discusses how CRP can be integrated into trauma-focused therapy. A clinical case example is provided to demonstrate how the CRP can be integrated into cognitive processing therapy for a suicidal veteran diagnosed with PTSD. RESULTS Using CRP within a cognitive processing therapy treatment program reduced both PTSD and suicidal ideation. CONCLUSIONS Suicide specific treatments can be integrated effectively into trauma-focused treatments.
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Affiliation(s)
- David C. Rozek
- National Center for Veterans Studies, University of Utah, Salt Lake City, UT
- Department of Psychiatry, University of Utah, Salt Lake City, UT
- Department of Psychology, University of Utah, Salt Lake City, UT
- UCF RESTORES, University of Central Florida, Orlando, FL
| | - Craig J. Bryan
- National Center for Veterans Studies, University of Utah, Salt Lake City, UT
- Department of Psychiatry, University of Utah, Salt Lake City, UT
- Department of Psychology, University of Utah, Salt Lake City, UT
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20
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Wiltshire TJ, Philipsen JS, Trasmundi SB, Jensen TW, Steffensen SV. Interpersonal Coordination Dynamics in Psychotherapy: A Systematic Review. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10106-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Abstract
Background
The aim of this study was to gain a better understanding of interpersonal coordination (i.e., covariation over time) in different modalities (e.g., physiology, language) during psychotherapy and their importance for understanding the dynamics of psychotherapeutic interaction and efficacy.
Methods
We conducted a systematic review of all studies examining some form of interpersonal coordination in a psychotherapeutic context.
Results
We first summarize details of the included studies such as gender composition, therapy types, and methods used. The collation of these studies provided evidence that, during psychotherapeutic contexts, interpersonal coordination occurs in physiology, movements, interpersonal displays, and language/vocalizations. Further, it also showed that movement coordination was most frequently associated with psychotherapy outcomes, physiological coordination was most frequently associated with empathy, and coordination in a variety of modalities including language/vocalizations were most frequently associated with therapeutic alliance.
Conclusions
We discuss these results, shortcomings with the current literature, and highlight three crucial questions for future research. Research on interpersonal coordination in psychotherapy has potential to advance the both the research and practice of psychotherapy.
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21
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Weber DM, Fischer MS, Baucom DH, Baucom BRW, Kirby JS, Runfola CD, Matherne CE, Bulik CM. The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder. FAMILY PROCESS 2019; 58:920-935. [PMID: 30229890 DOI: 10.1111/famp.12391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple-based intervention for BED. Vocally encoded emotional arousal was measured during couples' (n = 11) conversations about BED. As predicted, partners' emotional reactivity to patients' emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients' and their own distress. After treatment, partners' arousal was no longer associated with the patients' emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners' emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple-based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.
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Affiliation(s)
- Danielle M Weber
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Melanie S Fischer
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian R W Baucom
- Department of Psychology, University of Utah, University of Utah, Salt Lake City, UT
| | - Jennifer S Kirby
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Cristin D Runfola
- Department of Psychiatry, University of North Carolina at Chapel Hill
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Camden E Matherne
- Department of Psychiatry, University of North Carolina at Chapel Hill
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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