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The goal of this study was to test the efficacy of training community-based psychotherapists who were part of a practice research network to be more attuned to their patients' experiences of the therapeutic relationship. We were particularly interested in the effect of therapist training on the congruence of alliance ratings with their patients. Forty psychotherapists who treated 117 patients were randomly assigned to receive either no training or training, whose learning objectives were to help therapists to develop and maintain a therapeutic alliance. The training included workshops and ongoing consultations to help the clinician to strengthen the therapeutic relationship with the use of mentalizing, attachment theory, countertransference management, and metacommunication. Therapeutic alliance and well-being outcomes were measured at each of six consecutive early psychotherapy sessions. We used the truth and bias model and response surface analysis within a multilevel modeling context to test hypotheses. There was a significantly faster rate of alliance growth in the training versus the no training condition when the alliance was rated by therapists, but not when rated by patients. Trained therapists experienced greater temporal congruence in alliance ratings with their patients compared to untrained therapists. Patient well-being outcomes improved in a session when trained therapists and their patients agreed in their positive alliance ratings in a previous session. This association not significant among untrained therapists. Training therapists in key interpersonally focused skills may lead them to be better attuned to their patients' experiences of the therapeutic relationship. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Emotionally Focused Couple Therapy (EFT), an attachment-based couple therapy, views emotion as being central to the process of therapeutic change. As affect arousal of emotion is a somatic reaction, the purpose of this study was to focus on therapists’ interventions classified as noting and commenting on clients’ somatic cue of emotional experience, such as their facial expression or posture, in relation to depth of emotional experiencing demonstrated by clients in EFT couple therapy sessions. The sample included 13 therapists, each treating one couple during a single EFT training demonstration session. We coded therapists’ interventions (i.e., commenting on one partner’s somatic cue of emotion). Immediately prior to and following such therapist interventions, we rated the partner’s depth of emotional experiencing. The results of multilevel modeling demonstrated a significant linear increase in terms of depth of partner’s experiencing throughout the session. Furthermore, partners demonstrated a significant immediate increase in the depth of experiencing following somatically focused interventions. These findings suggest that interventions focusing on somatic experience of emotion may facilitate deeper experiencing for clients in EFT sessions. peerReviewed

ObjectiveThis study aims to longitudinally investigate the effects of individual's factors on subsequent burn-out/psychological distress in a sample of mental health practitioners, testing if higher attachment anxiety and avoidance and lower reflective functioning (i.e., certainty and uncertainty of mental states) and well-being at baseline may lead to a greater psychological distress and burn-out 1 year later. MethodsThe sample consisted of 40 experienced psychotherapists (females: 72.5%; mean age: 47.40 +/- 9.48 years) who completed a battery of questionnaires at baseline and 1 year later. Statistical analyses were conducted with Bayesian multiple linear regressions. ResultsGreater attachment anxiety and certainty about mental states and lower individual's well-being at baseline predicted greater burn-out 1 year later. Similarly, greater attachment anxiety and lower individual's well-being at baseline predicted psychological distress at 1 year follow-up. Of note, uncertainty of mental states and avoidant attachment were not associated with outcomes. ConclusionThese findings suggest that the levels of burn-out and psychological distress among psychotherapists may be alleviated with interventions targeting attachment insecurity, specific aspects of reflective functioning (i.e., certainty about mental states) and well-being.

Defensive functioning (i.e., unconscious process used to manage real or perceived threats) may play a role in the development of various psychopathologies. It is typically assessed via observer rating measures, however, human coding of defensive functioning is resource-intensive and time-consuming. The purpose of this study was to develop a machine learning approach to automate coding of defense mechanisms from interview transcripts.Participants included a clinical sample of women with binge-eating disorder (The models were capable of distinguishing defenses (ROC-AUC .82-.90) but were not proficient enough to warrant replacing human coders (PR-AUC .28-.60). Follow-up analysis was performed to assess other practical uses of these models.Our machine learning models could be used to assist coders. Future research should conduct a deployment study to determine if human coding of defense mechanisms can be expedited using machine learning models.

Emotionally Focused Couple Therapy, an experiential modality, views emotion central to therapeutic change. In this exploratory study, we examined therapists' repetition of somatically focused interventions (therapist verbalizing somatic cues, such as facial expressions) and their impact on clients' emotional experiencing in-session. We also assessed difference for withdrawing versus pursuing partners. The sample included 13 EFT therapists who worked with one couple each for a single session. From transcripts we coded therapists' repetition of somatically focused interventions and clients' depth of experiencing pre-and post-intervention. Multilevel modeling demonstrated that a higher number of repetitions of somatically focused interventions predicted greater increase in depth of experiencing, unlike length of time spent repeating interventions. Somatically focused interventions resulted in greater increase in depth of experiencing for withdrawing as compared to pursuing partners. The results of this exploratory study suggest that such interventions may be a specific technique of EFT therapists that enhances emotional experiencing especially among withdrawing partners. peerReviewed

Previous research provides support for the role of psychosocial variables in the progression of hypertension. However, few studies have rigorously tested the longitudinal interplay between blood pressure and depressive symptoms, quality of life, and well-being. Fewer still disaggregate the effects of changes of these psychological variables within patients over time from the effects of differences between patients on essential hypertension.A total of 185 patients with hypertension and metabolic syndrome (130 males, 70.3%; mean age 54 ± 10.93 years) volunteered for this multicentre study. We analyzed the longitudinal associations between office or daytime ambulatory blood pressure with depressive symptoms, well-being, and quality of life, measured at the same three time points (baseline and 36- and 48-week follow-up), through multilevel models and controlling for several sociodemographic and clinical factors.Within-person increases in depressive symptoms were significant, positive time-varying covariates of both office and daytime blood pressure, even after controlling for several potential confounders (e.g., age, sex, changes over time in risk factors for metabolic syndrome). Within-person increases in well-being and mental health components of quality of life had similar negative associations with the level of blood pressure over time. Between-person differences in these variables tended not to predict blood pressure.Our findings provide a deeper insight on the relationship between variability of psychological variables within individuals and their levels of blood pressure. The findings support the need for health services to implement evidence-based psychological interventions that can foster a better management of the hypertensive disease. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

High rates of cigarette smoking is the leading contributor to the increasing risk of cardiovascular disease (CVD) among people living with HIV (PLH). Relapse rates among PLH who quit smoking are high among those receiving standard care, which may be due to several unique social and psychological challenges PLH face when they attempt to quit smoking. The purpose of the current study was to examine change in relevant psychological factors in a subgroup of participants (n = 14) who remained smoke-free at 6-months follow-up in an HIV-tailored smoking cessation counselling program (N = 50). We examined self-reported depressive symptoms, attachment style and self-efficacy across 5 time points (baseline, quite date, 4, 12 and 24 weeks). At study baseline, mean depression scores fell above the clinical cut off of 16 (M = 16.31; SD = 13.53) on the Centre for Epidemiological Studies - Depression (CES-D) scale and fell below the clinical cut off at 24 weeks post quit date (M = 13.36; SD = 10.62). Results of multi-level modeling indicated a significant linear reduction in depressive symptoms and a significant linear improvement in self-efficacy to refrain from smoking across study visits. These results suggest that positive change in mood and self-efficacy may be helpful for PLH who remain smoke-free during a quit attempt.

Objective: The therapeutic alliance has been studied in group interventions, but its relationship to patient outcome is still controversial. This study systematically reviewed the association of both the member-leader and member-group alliance with patient outcomes, and assessed the effects of several theoretically informed moderators. Method: A three-level meta-analysis was conducted on 57 studies to disentangle within- and between-study variability in the alliance-outcome association. Results: The overall effect size of the unconditional model was r = -.259 (95% CI: -.302, -.214; p < .001), whereas the correlation between alliance and outcome based on the three-level meta-analytic model was r = -.215 (95% CI: -.252, -.178; p < .001) indicating a medium effect. Meta-regressions of moderators showed that the alliance-outcome correlation was higher when patients reported on their alliance with the group/other members compared with when they rated the alliance with the leader. Outcome type, rating perspective, theoretical orientation, treatment length, and year of publication were significant moderators of the relationship between alliance and outcome. Conclusions: The current meta-analysis highlighted that the therapeutic alliance, especially with other group members, is a significant predictor of outcomes in group therapies even after controlling for several moderators and adopting more conservative statistical modeling.What is the public health significance of this article? Prior research has established that member-leader alliance is a predictor of outcome in group psychotherapy with a small effect. This meta-analysis provides a comprehensive analysis of the complex role of the alliance in group therapy, suggesting that the alliance with other group members or the group as a whole has a significantly larger association with outcome. This study provides support for the importance of the group context on the alliance-outcome relationship.

Objective Even though the early alliance has been shown to robustly predict posttreatment outcomes, the question whether alliance leads to symptom reduction or symptom reduction leads to a better alliance remains unresolved. To better understand the relation between alliance and symptoms early in therapy, we meta-analyzed the lagged session-by-session within-patient effects of alliance and symptoms from Sessions 1 to 7. Method We applied a 2-stage individual participant data meta-analytic approach. Based on the data sets of 17 primary studies from 9 countries that comprised 5,350 participants, we first calculated standardized session-by-session within-patient coefficients. Second, we meta-analyzed these coefficients by using random-effects models to calculate omnibus effects across the studies. Results In line with previous meta-analyses, we found that early alliance predicted posttreatment outcome. We identified significant reciprocal within-patient effects between alliance and symptoms within the first 7 sessions. Cross-level interactions indicated that higher alliances and lower symptoms positively impacted the relation between alliance and symptoms in the subsequent session. Conclusion The findings provide empirical evidence that in the early phase of therapy, symptoms and alliance were reciprocally related to one other, often resulting in a positive upward spiral of higher alliance/lower symptoms that predicted higher alliances/lower symptoms in the subsequent sessions. Two-stage individual participant data meta-analyses have the potential to move the field forward by generating and interlinking well-replicable process-based knowledge. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

In this article, Canadian psychotherapy researchers and teachers review the state of psychodynamic therapy (PDT) in Canada. We review the ways in which PDT has been implemented, developed and resea...

We used an actor–partner interdependence model (APIM) to study the association between the individual group member and other group therapy members’ defensive functioning on an individual group member’s treatment outcome. We hypothesized that (a) more adaptive individual defensive functioning at pretreatment will be significantly related to better treatment outcomes (i.e., lower binge eating and interpersonal distress) at 6 months post-treatment; and (b) more adaptive other group members’ defensive functioning at pretreatment will be significantly related to better treatment outcomes at 6 months post-treatment. Participants (N = 136) were individuals with BED enrolled in group psychodynamic-interpersonal psychotherapy (GPIP). Participants completed attachment interviews and were assessed on interpersonal distress and days binged at pre-treatment and 6 months post-treatment. The interview audio recordings were transcribed and used to code defensive functioning. We found that individual overall defensive functioning (ODF) scores at pretreatment were not significantly associated with binge-eating frequency or interpersonal distress at 6 months post treatment. Other group members’ mean ODF scores at pretreatment were significantly associated with individual interpersonal distress at 6 months post-treatment. However, the other group members’ mean ODF scores were not significantly associated with individual binge-eating outcomes at 6 months post treatment. Defensive functioning of other members of a therapy group may be particularly important for improving interpersonal functioning in individuals with BED.

Excessive use of technology has become a worldwide problem due to its high prevalence, fast growth rate, and undesirable consequences. However, little is known about underlying psychological mechanisms that maintain excessive use of technology. We investigated the mediating role of self-esteem, novelty seeking, and persistence on the relationship between attachment dimensions and technology addiction among young adults. Data were collected from 727 young adults (females, N = 478; 66.3 percent), aged 23.44 ± 3.02 years. Participants completed self-report measures of secure and insecure attachment dimensions, personality, and temperament characteristics (i.e., self-esteem, novelty seeking, and persistence), technology addiction and frequency of technology use (i.e., own technology use, perceived use by peers and parents). The mediation model was tested through a path analysis. The effects of attachment insecurity on technology addiction were partially mediated by the levels of persistence and self-esteem, whereas the effects of attachment security on technology addiction were fully mediated. The effects remained robust even after controlling for the frequency of technology use. The model was gender and age invariant, suggesting that the mediation worked in a similar way for both men and women and across ages. Findings suggest that attachment dimensions exert not only a direct but also an indirect effect on technology addiction through self-esteem and persistence. Such findings may help to develop psychosocial interventions that are sensitive to young adults' attachment, personality, and temperament characteristics.

Background: In 2020, due to the COVID-19 pandemic, most group therapists moved their practice to online platforms. Surveys of psychotherapists indicate that many intend to maintain at least part of their practices online after the pandemic. This survey-based study is an attempt to identify therapist experiences with doing group therapy online, and to examine factors that are associated with therapist-rated outcomes. Method: We surveyed 307 group therapists about their ratings of the ease or difficulty in conducting group therapy online versus in-person, and indicators of patient outcomes in online groups. A confirmatory factor analysis resulted in a good fitting three latent factor solution: group therapeutic process factor (therapist ratings of ease to foster therapeutic alliance, group cohesion, and patient self-disclosure), group therapist factor (therapist presence, empathy, and focus in online therapy), and group therapeutic challenges factors in online work (related to the difficulty of working through conflict, managing avoidance, observing nonverbal communication, and discomfort during the online session). An online group therapy outcome factor was the dependent variable modeled as a latent factor of therapists' perception of patient outcomes and their own satisfaction with online groups. In a structural equation model, higher levels of the group therapeutic processes and group therapist factors, and lower group challenges were associated with higher online group therapy outcomes. Discussion: The present study suggests that online groups operate based on many of the same factors that have been supported in in-person group treatment. These factors were associated with the therapist's perceptions of online group effectiveness. However, difficulties in managing relationships in the online session may represent a barrier to enacting group therapeutic factors. Postpandemic research on conducting online group therapy and managing online therapeutic relationships may lessen perceived drawbacks to its use.

PURPOSE/OBJECTIVE The onset of chronic illness or disability (CID) can be conceptualized as a threat that activates the attachment system. Moreover, the waxing-and-waning nature of CID-related symptoms and management of acute and chronic illness stressors means that the attachment system may be repeatedly activated. Contending with repeated threats to health (i.e., security) can complicate psychosocial adjustment to CID and can negatively impact health-related quality of life (HRQoL). Adjustment to CID requires intrapersonal resources, such as adaptive coping and self-efficacy. In spite of attachment theory's relevance to conceptualizing adaptation to CID, no models of psychosocial adaptation to CID account for individual differences in coping behaviors and health self-efficacy through an attachment lens. This limits future theory-driven research. Thus, the present study proposes and tests an integrated model of psychosocial adaptation to CID using an attachment framework. Research Method/Design: Participants in this study included adults referred for psychological services at a tertiary care physical rehabilitation center between 2016 and 2020. Ninety adults completed measures of attachment anxiety and attachment avoidance, coping, health self-efficacy, and HRQoL at one time point. RESULTS Path analysis indicated that the proposed model fits the data well. Higher attachment avoidance was significantly related to lower HRQoL, as mediated by higher avoidant coping and lower health self-efficacy. CONCLUSIONS/IMPLICATIONS Results suggest that individuals high on attachment avoidance may require additional support to move toward psychosocial adaptation. Further research examining the role of attachment insecurity dimensions in adaptation to CID is warranted and should include longitudinal designs to replicate these findings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective Self-esteem is a core aspect of eating disorder symptomatology. This study aims to examine whether method effects associated with negatively worded items of the Rosenberg Self-Esteem Scale (RSES) may interact the negative self-evaluations experienced by patients with obesity and binge eating disorder (BED). We also examined whether negatively worded items were associated with psychological distress and eating symptoms. Method Five hundred thirty three female outpatients (mean age: 42.59) with BED (n = 160) or obesity without BED (n = 373) completed the RSES and measures of interpersonal problems, psychological distress, and eating symptoms. Results Patients with BED responded more strongly to the negatively worded items of the RSES than those with obesity. The RSES negatively worded item factor was negatively associated with higher interpersonal problems, psychological distress, and binge eating. Conclusions Patients with BED may be more responsive to negatively phrased items on the RSES consistent with their negative self-evaluations and self-perceptions.

In general, arousal of emotions is often felt and expressed as a somatic experience in the body. In Emotionally Focused Couple Therapy (EFT), the deepening of emotional experiencing enables therapeutic change. This research explores the experiences of eight experienced EFT trainer therapists regarding their somatic experiences in their work with couples. Using interpretative phenomenological analysis of transcribed in-depth interviews, this research data yielded three core themes that captured therapists' experiences of using their own and couples' somatic experiences in therapy: (1) the importance and relevance of somatic experiences, (2) therapists' use of their own somatic experiences, and (3) working with clients' somatic experiences. The findings suggest that therapists do focus on their own and couples' somatic experiences in their work with couples, and that EFT therapists could benefit from a map to guide therapists how to focus on felt, somatic experiences as a way of maintaining an emphasis on emotional experience. peerReviewed

Abstract. The aim of the study was to explore the effects of situational stress and anxiety in a group of healthy elderly, both in terms of psychophysiological correlates and cognitive performance. Eighteen participants ( Mage = 70 ± 6.3; range 60–85) were assessed for anxiety and were instructed to perform a computerized math task, under both a stressful and a control condition, while near-infrared spectroscopy (NIRS) signal and electrocardiography (ECG) were recorded. NIRS results evidenced an increased activation of right PFC during the entire procedure, even if effect sizes between left and right channels were larger during the experimental condition. The amount of right activation during the stressful condition was positively correlated with anxiety. Response times (RTs) were slower in more anxious than in less anxious individuals, both during the control and stressful conditions. Accuracy was lower in more anxious than in less anxious individuals, only during the stressful condition. Moreover, heart rate (HR) was not modulated by situational stress, nor by anxiety. Overall, the present study suggests that in healthy elderly, anxiety level has a significant impact on cerebral responses, and both on the amount of cognitive resources and the quality of performance in stressful situations.

Prominent models of eating disorders tend to focus on cognitive and behavioral features, but tend not to consider important developmental issues related to affect regulation, interpersonal style, self concept, and mentalization-all of which are well conceptualized within attachment theory. Higher levels of attachment insecurity across diagnoses are related to greater eating disorder symptoms. Low parental care and early trauma may lead to attachment insecurity that then might lead to greater eating disorder symptoms. The association between insecure attachment and eating disorder severity is likely mediated by affect dysregulation and perfectionism. Recent research using the Adult Attachment Interview highlights the importance of reflective functioning in predicting treatment response and therapeutic processes, and on the utility of therapies that increase mentalization.

Emotionally focused couple therapy (EFT) is an empirically validated attachment based approach to couple therapy. From an EFT perspective, sexual functioning is viewed within the context of an atta...

Background The genetics of binge-eating disorder (BED) is an emerging topic, with dopaminergic genes being implicated in its etiology due to the role that dopamine (DA) plays in food reward sensitivity and self-regulation of eating behavior. However, no study to date has examined if DA genes influence response to behavioral treatment of BED. Objective The primary objective of this study was to examine the ability of DA-associated polymorphisms to predict BED treatment response measured using binge frequency over 12 months. As secondary objectives, this study examined cross-sectional relationships between these polymorphisms and anthropometrics in women living with and without BED and obesity. Methods Women aged 18–64 years old were genotyped for the DA-related SNPs DRD2/ANKK1 Taq1A (rs1800497) and COMT (rs4680), as well as the DA-related uVNTRs DAT-1 (SLC6A3) and MAO-A. A multi-locus DA composite score was formed from these 4 polymorphisms using genotypes known to have a functional impact resulting in modified DA signaling. Binge frequency (Eating Disorder Examination – Interview) and body composition (Tanita BC-418) were assessed in a pre-post analysis to examine genetic predictors of treatment response in women living with obesity and BED. Secondary data analysis was conducted on a cross-sectional comparison of three groups of women enrolled in trial group treatment for BED: women living with obesity and BED (n = 72), obesity without BED (n = 27), and normal-weight without BED (n = 45). Results There were no significant genotype × time interactions related to anthropometrics or binge frequency for any individual DA genotypes, or to the composite score reflecting DA availability. At baseline, there were no significant between-group differences in frequencies of DA-related alleles, nor were there associations between genotypes and anthropometrics. Conclusions Our study found no evidence to suggest that the DRD2/ANKK1 Taq1A, COMT, MAO-A, or DAT-1 polymorphisms are associated with response to behavioral intervention for BED as measured by changes in binge frequency. Future studies should examine a greater variety of dopaminergic polymorphisms, other candidate genes that target other neurotransmitter systems, as well as examine their impact on both behavioral and pharmacological-based treatment for BED.

Objective: Subjective well-being is a crucial variable for mental health practitioners. This study examines the influence of therapists’ attachment dimensions and self-reported reflective functioning on their perceived well-being. Further, it examines if reflective functioning mediates the association between attachment insecurity and well-being. Method: A total of 416 experienced psychotherapists were enrolled in this cross-sectional study, and completed self-report measures of attachment insecurity, reflective functioning, and well-being. We tested the hypothesized mediation model with path analysis that examined indirect effects. Results: Both attachment anxiety and avoidance dimensions had a significant negative association with perceived well-being with small to medium effects. “Certainty” in reflective functioning had a small positive effect on therapist well-being. Reflective functioning mediated the association between insecure attachment dimensions and well-being, suggesting that therapist's lower ability to mentalize may partially account for the effects of higher attachment insecurity on lower well-being. Conclusion: The well-being of psychotherapists with greater insecure attachment may deserve special attention, and therapists’ mentalizing capacities may be targeted by researchers and trainers as a core ability to be cultivated in order to preserve therapists’ professional and personal resources.

Background Research that explores stigma in Cystic Fibrosis (CF) is limited. Productive cough, repeated lung infections, and periods of serious illness requiring hospitalizations are among common symptoms of CF. These symptoms may cause a negative perception by others. We developed a CF-specific Stigma Scale and tested its psychometric properties. Methods We conducted a focus group with 11 participants including adult patients with CF (n = 5) and their informal caregivers (n = 6). The thematic content of the focus group was analyzed to find key themes. We developed a CF-specific Stigma Scale and assessed its psychometric properties in a 3-month prospective cohort study of adult CF outpatients (n = 45). Results Stigma emerged as consistent concern for people living and caring for those with CF, affecting both patients’ lives and health through the focus group. Using the newly developed CF Stigma scale, the mean baseline score was 16.6 (SD = 4.5, Range = 10-25). The CF Stigma Scale demonstrated robust psychometric properties: 1) Internal consistency: α = 0.79; 2) Mean inter-item correlation: 0.30 with good test-retest reliability; 3) Convergent validity: Positive associations with depression, severity of CF symptoms and anxiety; negative associations with validated quality of life scores were observed. Conclusions Stigma is measurable and significantly impacts the lives of CF patients. Further research should investigate the role of stigma in patients living with CF.

Previous studies have emphasized the effect of insecurity attachment on youth's Internet and smartphone addiction. In this study, we examine the mediating role of alexithymia, impulsivity, and general psychological distress in the relationship between insecure attachment dimensions and technology addiction. Data were collected from 539 adolescents and young adults, mostly women (N = 378; 70.1 percent), aged 19.76 ± 1.99 years. Participants completed self-report measures of attachment insecurity, psychological risk factors (i.e., impulsivity, psychological distress, and alexithymia), and technology addiction (i.e., problematic Internet use, smartphone, and Internet addiction). The gender-related (i.e., multi-group) mediation model was tested through a path analysis with both observed and latent variables. Attachment anxiety had no direct effect on technology addiction, whereas attachment avoidance had a small negative direct effect, but only among women. Insecure attachment dimensions were significantly associated with psychological risk factors, whereas the latter had a significant, direct association with technology addiction. Psychological risk factors significantly mediated the association between insecure attachment dimensions and technology addiction. Finally, the tested model was gender-invariant. Findings suggest that insecure attachment dimensions have an indirect effect on the development of technology addiction mediated almost entirely by higher levels of psychological risk factors. Such findings might have relevant implications to inform any treatment plan for young adults who are overinvolved with technology activities and so to deliver patient-tailored interventions.