Respiratory sinus arrhythmia predicts perceived therapy process of a group-based acceptance and commitment therapy intervention

Going beyond the DSM in predicting, diagnosing, and treating autism spectrum disorder with covarying alexithymia and OCD: A structural equation model and process-based predictive coding account

Background

There is much overlap among the symptomology of autistic spectrum disorders (ASDs), obsessive compulsive disorders (OCDs), and alexithymia, which all typically involve impaired social interactions, repetitive impulsive behaviors, problems with communication, and mental health.

Aim

This study aimed to identify direct and indirect associations among alexithymia, OCD, cardiac interoception, psychological inflexibility, and self-as-context, with the DV ASD and depression, while controlling for vagal related aging.

Methodology

The data involved electrocardiogram (ECG) heart rate variability (HRV) and questionnaire data. In total, 1,089 participant's data of ECG recordings of healthy resting state HRV were recorded and grouped into age categories. In addition to this, another 224 participants completed an online survey that included the following questionnaires: Yale-Brown Obsessive Compulsive Scale (Y-BOCS); Toronto Alexithymia Scale 20 (TAS-20); Acceptance and Action Questionnaire (AAQII); Depression, Anxiety, and Stress Scale 21 (DAS21); Multi-dimensional Assessment of Interoceptive Awareness Scale (MAIA); and the Self-as-Context Scale (SAC).

Results

Heart rate variability was shown to decrease with age when controlling for BMI and gender. In the two SEMs produced, it was found that OCD and alexithymia were causally associated with autism and depression indirectly through psychological inflexibility, SAC, and ISen interoception.

Conclusion

The results are discussed in relation to the limitations of the DSM with its categorical focus of protocols for syndromes and provide support for more flexible ideographic approaches in diagnosing and treating mental health and autism within the Extended Evolutionary Meta-Model (EEMM). Graph theory approaches are discussed in their capacity to depict the processes of change potentially even at the level of the relational frame.

What the Body Reveals about Lay Knowledge of Psychological Flexibility

The embodied knowledge of psychological flexibility processes was tested by examining the ability of raters to score whole body pictures based on the degree to which they were open, aware, and engaged. Participants’ best and worst physical posture was photographed when asked to think of a difficult psychological matter. Naïve and untrained raters (n = 16) showed excellent reliability while rating the postures of 82 persons from the general population in Reno and Chicago in the USA and recent Iranian immigrants in the Maryland/DC area. Participants showed embodied knowledge of psychological flexibility concepts across all three locations (though significantly less among those recently from Iran). Thus, experience alone appears to teach people that psychological flexibility is helpful, even if they are unable to express this knowledge in words. Implications for psychotherapeutic work is considered.