Heart rate variability and the anxious client: cardiac autonomic and behavioral associations with therapeutic alliance

Heart rate variability predicts outcome of short-term psychotherapy at the workplace

The bio-psycho-social model highlights intra-individual and inter-individual interactions, including psychotherapy. The processing of these interactions within a person takes place, among others, in the central autonomic network (CAN). The CAN's autonomic output to the periphery can be indexed by heart rate variability (HRV), representing individual adaptive capacity. Further, the CAN influences the hypothalamus-pituitary-adrenal axis with its product cortisol. The aim consisted in investigating HRV and cortisol as well as their relation to symptom course in response to short-term psychotherapy. A single-arm, uncontrolled, explorative study was conducted at an outpatient psychotherapeutic consultation in the workplace offered to employees with mental or psychosomatic complaints. Questionnaires included symptoms of depression, irritation and functional impairment. Circadian profile of HRV and salivary cortisol concentrations collected pre and post short-term psychotherapeutic intervention (4-12 sessions) were assessed. Multilevel-linear mixed regressions were calculated. Out of 29 participants (mean age 42; 72% female), 24% were on sick leave from work. Cortisol concentrations were neither affected by intervention nor by symptom course. The proportion of individuals showing a vagally mediated HRV in the range of the lowest quartile assessed for age- and sex-matched healthy controls was reduced at follow-up (pre 34%, post 22%; p = .017). Higher vagally mediated HRV at baseline predicted lower symptom burden at follow-up. Thus, the results support the assumption that HRV reflects the capability of an organism to adapt and recover. Patients with reduced HRV might need additional psychotherapeutic sessions to achieve the same symptom improvements than patients with retained HRV.

Interpersonal Coordination Dynamics in Psychotherapy: A Systematic Review

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.

Heart rate variability monitoring for emotion and disorders of emotion

BACKGROUND

Emotion is composed of cognitive processing, physiological response and behavioral reaction. Heart rate variability (HRV) refers to the fluctuations between consecutive heartbeat cycles, and is considered as a non-invasive method for evaluating cardiac autonomic function. HRV analysis plays an important role in emotional study and detection.

OBJECTIVE

In this paper, the physiological foundation of HRV is briefly described, and then the relevant literature relating to HRV-based emotion studies for the performance of HRV in different emotions, emotion recognition, the evaluation of emotional disorders, HRV biofeedback, as well as HRV-based emotion analysis and management enhanced by wearable devices, are reviewed.

SIGNIFICANCE

It is suggested that HRV is an effective tool for the measurement and regulation of emotional response, with a broad application prospect.

Heart Rate Variability in Individual Psychotherapy: Associations With Alliance and Outcome

Heart rate variability (HRV) can be conceptualized as a marker of an individual's capability to adaptively respond to its environment and has been linked with mental health. Although conceptually and empirically linked to social behavior and thus relevant in the therapeutic setting, HRV is seldom investigated directly within therapy sessions. In the present examination, we aimed at addressing this research gap by assessing patients' and therapists' HRVs both ambulatory within therapy sessions and under resting conditions. Drawing on polyvagal theory, we hypothesized that higher in-session HRV is accompanied with higher therapeutic alliance ratings. Further, we expected baseline HRV to predict symptomatic outcome and to increase over the course of therapy. In a sample of 53 outpatients receiving 25 sessions of cognitive behavioral therapy, we measured HRV, therapeutic alliance and depressive symptoms on four occasions. Multilevel modeling analyses demonstrated that patients with higher in-session high-frequency HRV rated the therapeutic alliance higher. Baseline HRV predicted symptomatic outcome and increased over the course of therapy. Possible explanations involve a link between in-session HRV and in-session behavior and should be investigated in future studies. The results highlight the usefulness of in-session HRV as a promising process variable in psychotherapy research.

The social brain and heart rate variability: Implications for psychotherapy

PURPOSE

Humans evolved within the mammalian line as a highly social species. Indeed, sociality has been a major driver of human social intelligence. From birth, social relationships have emotional and self-regulating properties and operate through different body systems. This paper will explore how heart rate variability (HRV), an index of the vagal regulation of the heart and a central element of the physiological underpinnings of sociality, is related to mental health problems, with important implications for psychotherapy.

METHODS

We conducted a narrative review of the literature on the bi-directional links between prosocial motivations, HRV, and psychophysiological functioning.

RESULTS

HRV is associated not only with the ability to downregulate physiological arousal, but also with a variety of psychological and behavioural variables which are usually the target of psychotherapeutic interventions. A modern neurovisceral integration model can be employed to explain the complex intercorrelation between HRV and psychophysiological functioning. In particular, the link between HRV, the experience of inter- and intrapersonal safeness, and the inhibitory function of the prefrontal cortex will be explored in the context of prosocial motives, such as compassion, that alleviate and help prevent mental health difficulties.

CONCLUSIONS

Our knowledge of the social brain and its physiological underpinnings might influence important elements of a therapeutic intervention, from the initial assessment of patient's difficulties to the evaluation of therapy outcomes.

PRACTITIONER POINTS

Social relationships have emotional and self-regulating properties. The experience of inter- and intrapersonal safeness is connected to prosocial motives, such as compassion, and the inhibitory function of the prefrontal cortex. Social relationships and compassion influence different body systems, such as the vagus nerve. Many forms of psychopathology represent the activation of evolved, defensive strategies especially in contexts where there are few stimuli indicating safeness and social support. Heart rate variability predicts psychotherapy outcome.

Impact of a Simulated Stress Training Program on the Tactical Shooting Performance of SWAT Trainees

PURPOSE

To create a high-stress shooting among the crowd (SAC) program and to examine its effectiveness in reducing SWAT trainees' stress level and their shooting performance in a simulated hostage-rescue situation.

METHOD

After the SAC program was created, it was evaluated using a pretest and posttest experimental design: 98 young male SWAT trainees were randomly divided into experiment and control groups, with the former group trained in hostage rescue, shooting with real persons (high stress), and the latter group trained with "dummy" men (low stress); training for both lasted three days. Their shooting performance was assessed by a tactical shooting test in both high- and low-stress tests in a counterbalanced order, before and after the training, and monitored during the training, as were their stress levels by a set of physical (heart rate [HR] and heart rate recovery time [HRRt]), psychological (salivary cortisol and α-amylase), and self-reported anxiety measures.

RESULTS

The SAC program created needed high-stress for hostage rescue situations as reflected in increased physical, psychological, and anxiety scores and reduced shooting performance. Even with short SAC training, SWAT trainees' capacity in handling high stress and tactical shooting performance were significantly improved. HR, HRRt, and anxiety tests have been found to be effective in monitoring stress and should be a part of future SWAT training.

CONCLUSION

A SAC program involving real people was created, and its effectiveness was confirmed using a pretest and posttest experimental design.

Teaching Counseling Microskills to Audiology Students: Recommendations from Professional Counseling Educators

To provide the highest quality services, audiologists incorporate counseling into their professional practice. This article, written by professional counselors, highlights the distinction between services provided by professional counselors (i.e., psychotherapy) and counseling microskills used by all health and rehabilitation professionals. Effective application of counseling microskills facilitates a strong therapeutic alliance, which research shows contributes to positive therapeutic outcomes. Counseling microskills should be taught early in graduate programs, because they serve as the foundation for the therapeutic alliance and allow for more effective application of other therapeutic interventions. The four most critical counseling microskills for audiologists are active listening, nonverbal communication, silence, and empathy. These skills should be taught using experiential learning activities (i.e., classroom role-play and use of simulated patients) that incorporate practice, repetition, and feedback. Students should be evaluated on their ability to perform counseling microskills using a detailed grading rubric. Instructors should deliver feedback on these skills with care to reduce potential negative reactions. Ultimately, effectively teaching counseling microskills in graduate programs can improve students' ability to facilitate the therapeutic alliance and facilitate better health outcomes for patients.