Objective
Although resilience is a key topic in clinical theory and research, few studies focused on biobehavioral mechanisms that underpin resilience. Guided by the biobehavioral synchrony frame, we ...examined the dynamic interplay of physiological and behavioral synchrony as marker of risk and resilience in trauma‐exposed youth.
Methods
A unique cohort of war‐exposed versus control children was followed at four time‐points from early childhood to preadolescence and child posttraumatic stress disorder (PTSD) repeatedly assessed. At preadolescence (11–13 years), mother and child were observed in several social and nonsocial tasks while cardiac data collected and measures of respiratory sinus arrhythmia (RSA) and RSA synchrony computed. The social interactive task was microcoded for behavioral synchrony and the second‐by‐second balance of behavioral and physiological synchrony was calculated. War‐exposed preadolescents were divided into those diagnosed with PTSD at any time‐point across childhood versus resilient children.
Results
Group differences in behavioral synchrony, RSA synchrony, and their interplay emerged. PTSD dyads exhibited the tightest autonomic synchrony combined with the lowest behavioral synchrony, whereas resilient dyads displayed the highest behavioral and lowest autonomic synchrony. Hierarchical Linear Model analysis pinpointed two resilience‐promoting mechanisms. First, for resilient and control dyads, moments of behavioral synchrony were coupled with decreased RSA synchrony. Second, only among resilient dyads, moments of behavioral synchrony increased child RSA levels.
Conclusion
Findings specify mechanisms by which biobehavioral synchrony promotes resilience. As children grow, the tightly coupled mother–child physiology must be replaced by loosely coordinated behavioral attunement that buttresses maturation of the child's allostatic self‐regulation. Our findings highlight the need for synchrony‐based interventions to trauma‐exposed mothers.
The measures adopted by governments around the world to control the spread of the COVID‐19 virus (e.g., social distancing) have propelled a rapid transition from face‐to‐face to online therapy. ...Studies on online individual therapy indicate that therapists often have favorable attitudes toward this modality. To date, there is scant work on couples therapists’ attitudes, despite the fact that the provision of online couples’ therapy poses unique challenges (e.g., dealing with escalating conflict remotely). To provide a snapshot, in real time, as to how therapists experience the transition to online therapy, we surveyed 166 Israeli couples’ therapists during April 2020, when lockdown orders prevented therapists from seeing couples face‐to‐face. A few weeks later, when the stay‐at‐home policy was lifted, a subsample (N = 60) of these therapists completed a follow‐up assessment. The results suggest that couples therapists had limited experience using the online modality prior to COVID. The therapists reported experiencing online couples’ therapy as somewhat successful and that their experience of providing therapy during the COVID‐19 crisis had an overall positive impact on their attitudes toward online work. Establishing a strong therapeutic bond with both partners, dealing with escalating conflict, and treatment dropout were identified as the issues of most concern when conducting online couples therapy. The perceived difficulties with online therapy prospectively predicted lower usage of online couples’ therapy, as well as less intention to continue online treatment once the crisis is over.
Resumen
Las medidas adoptadas por los gobiernos de todo el mundo para controlar la propagación del virus de la COVID‐19 (p. ej.: el distanciamiento social) han impulsado una transición rápida de la terapia presencial a la terapia virtual. Los estudios sobre la terapia individual virtual indican que los terapeutas con frecuencia tienen actitudes favorables hacia esta modalidad. Hasta la fecha, los trabajos sobre las actitudes de los terapeutas de pareja son escasos, a pesar del hecho de que la práctica de la terapia de pareja virtual plantea desafíos únicos (p. ej.: manejar la intensificación del conflicto distancia). Para ofrecer un panorama en tiempo real sobre cómo viven los terapeutas la transición a la terapia virtual, encuestamos a 166 terapeutas de pareja israelíes durante abril de 2020, cuando las órdenes de confinamiento impidieron a los terapeutas ver a las parejas en persona. Algunas semanas después, cuando se levantó la orden de quedarse en casa, una submuestra (N=60) de estos terapeutas completó una evaluación de seguimiento. Los resultados sugieren que los terapeutas de pareja tenían poca experiencia en el uso de la modalidad virtual antes de la COVID‐19. Los terapeutas informaron que vivieron la terapia de pareja virtual como bastante favorable y que su experiencia de ofrecer terapia durante la crisis de la COVID‐19 tuvo un efecto general positivo en sus actitudes hacia el trabajo virtual. Los problemas identificados como los de mayor preocupación a la hora de ofrecer terapia de pareja virtual fueron los siguientes: la construcción de un vínculo terapéutico sólido con ambos integrantes de la pareja, el manejo de la intensificación del conflicto y el abandono del tratamiento. Las dificultades percibidas con la terapia virtual predijeron prospectivamente un menor uso de la terapia de pareja virtual, así como menos intenciones de continuar el tratamiento virtual una vez que termine la crisis.
摘要
世界各国政府为控制COVID‐19病毒传播而采取的措施(如保持社交距离)推动了面对面治疗向网络在线治疗的快速转变。对在线个体治疗的研究表明，治疗师通常对这种方式持积极态度。迄今为止，关于伴侣治疗师态度的研究很少，尽管提供在线伴侣治疗会带来独特的挑战(例如，远程处理不断升级的冲突)。为了提供治疗师如何体验向在线治疗过渡的实时概况，我们在2020年4月调查了166名以色列伴侣治疗师，当时封锁令禁止治疗师面对面地与伴侣来访者见面。几周后，当居家政策被取消时，对这些治疗师的子样本(N=60)完成了随访评估。结果表明，伴侣治疗师在COVID ‐ 19之前使用在线模式的经验并不多。治疗师报告称，他们体验的在线伴侣治疗可以算是比较成功，他们在COVID‐19危机期间提供治疗的经历对他们对在线工作的态度产生了总体积极的影响。研究表明在线伴侣治疗时最需要关注的问题有以下几个方面：与伴侣双方建立强有力的医患关系，处理不断升级的冲突，以及治疗中途退出。可预见的在线治疗面临的困难预示着在线伴侣治疗的使用率会降低，一旦危机结束后，继续使用在线治疗的意愿也会降低。
Planning promotes progress toward goal achievement in a wide range of domains. To date, planning has mostly been studied as an individual process. In couples, however, the partner is likely to play ...an important role in planning. This study tested the effects of individual and dyadic planning on goal progress and goal-related actions. Two samples of couples (N = 76 and N = 87) completed daily diaries over a period of 28 and 21 days. The results indicate that individual and dyadic planning fluctuate on a daily basis and support the idea that dyadic planning is predominantly used as a complementary strategy to individual planning. As expected, individual and dyadic planning were positively associated with higher levels of action control and goal progress. In Sample 2, dyadic planning was only associated with goal progress on days in which individuals felt that they were dependent upon their partners’ behaviors to achieve their goals.
Objective
The main goal of this study was to examine the interplay between individuals' attachment insecurity and their perceptions of their partners' COVID‐related behaviors (supportive and negative ...behaviors) in predicting their relationship satisfaction.
Background
Stress is a well‐documented risk factor for relationship satisfaction. COVID‐19 related stressors thus pose a challenge to maintaining relationship satisfaction. Although partners' supportive behaviors can play a central role in mitigating these stressors, enduring individual vulnerabilities, such as attachment insecurity, are likely to moderate the effectiveness of supportive (or negative) behaviors.
Method
In this two‐wave study, conducted at the start of the COVID‐19 pandemic in Israel, 239 participants in cohabiting Israeli couples reported their current relationship satisfaction and perceived partners' supportive and negative behaviors in response to COVID‐related stress. Participants' pre‐COVID reports of relationship satisfaction and attachment orientations were used to assess the extent to which partners' supportive/negative behaviors interacted with attachment orientations to predict relationship satisfaction maintenance during the first lockdown in Israel.
Results
Higher levels of support and lower levels of negative behaviors were associated with greater relationship satisfaction maintenance. Anxiously attached individuals showed greater sensitivity to their partners' support, whereas avoidantly attached individuals manifested lower reactivity to their partners' negative behaviors.
Conclusions
Perceived partners' supportive and negative behaviors can predict relationship satisfaction during stressful times. However, high attachment anxiety and low attachment avoidance may render individuals more sensitive to such behaviors.
Implications
The results suggest that during times of stress, it is essential to target partners with attachment insecurity to strengthen their supportive skills.
The examination of nonverbal synchrony has become a promising line of psychotherapy research. Although several studies have found between‐dyad associations between nonverbal synchrony and ...multidimensional outcomes, the findings remain heterogeneous, and within‐dyad effects remain to be investigated. The present study examines within and between effects of nonverbal synchrony on mastery, resource activation, problem actuation, and motivational clarification (Grawe's general mechanisms of change). Four‐hundred and twenty‐three videotaped sessions of 175 patients were analysed using motion energy analysis (MEA), providing values to quantify nonverbal synchrony in the patient–therapist dyad. Grawe's general mechanisms of change in psychotherapy were rated using the Inventory of Therapeutic Interventions and Skills (ITIS). On average, patient–therapist nonverbal synchrony was greater than chance. Hierarchical linear modelling revealed that nonverbal synchrony was significantly associated with higher mastery and less resource activation on the within‐dyad level. Nonverbal synchrony was not associated with problem actuation or motivational clarification, and in general, no associations were found on the between‐dyad level. The results demonstrate the importance of disentangling within and between effects of nonverbal synchrony and provide initial evidence that nonverbal synchrony is tied to the specific therapeutic strategies observed in psychotherapy sessions.
Shared reality (SR) is the experience of having an inner state believed to be shared by others. Dyadic responsiveness has been suggested to be a critical process in SR construction. The present study ...tested the extent to which SR varies in the daily lives of romantic partners and whether this variability is related to responsiveness processes. We predicted that disclosure of personal events to one’s partner as well as perceived partner enacted responsiveness would be associated with daily levels of SR. We further predicted that these associations would be more pronounced when one has low epistemic certainty with respect to the disclosed event. To test these hypotheses, daily diaries were collected from 76 cohabiting romantic couples for a period of 4 weeks. Participants reported the occurrence of daily personal positive and negative events, indicated whether they had disclosed these events to their partner, and described how their partner had responded. As predicted, the disclosure of positive and negative events, as well as the perceptions of partners’ constructive responses to these disclosures, were positively associated with daily SR. A significant interaction was found between epistemic uncertainty (i.e., low perceived social consensus) and responsiveness processes in the context of negative (but not positive) events; specifically, when participants experienced low certainty, the disclosure of the event and the perceived partner’s constructive response were more strongly associated with SR.
The primary mechanism of change in emotion‐focused couples therapy (EFT‐C) is described as one partner accessing and expressing vulnerability, with the other partner responding affiliatively, with ...compassion, acceptance, validation, and support. These interactions are assumed to restructure the negative, rigid interactional cycle that usually brings couples to therapy and helps build a positive emotional bond. The primary aim of this study was to test whether for this process to occur, partners need to accurately perceive their spouse’s experiences of vulnerability during therapy. Specifically, it examined the factors (i.e., tracking accuracy, assumed‐similarity bias, and directional bias) shaping partners’ perceptions of their spouse’s vulnerability and whether accurate perceptions predict positive session outcomes during EFT‐C. Data from 36 couples who took part in the York Emotional Injury Project were analyzed. Following each session, clients reported their own experience of vulnerability as well as their perceptions of their partners’ vulnerability. Session outcome was defined as the extent to which clients reported resolution. Using a multilevel Truth and Bias model, the results indicated that partners accurately perceived changes in their spouses’ expressions of vulnerability (i.e., significant tracking accuracy). Interestingly, partners’ perceptions were also tied to their own expressions of vulnerability (i.e., significant assumed‐similarity bias) and tended to underestimate the level of their partners’ vulnerability expressions (i.e., significant negative mean‐level bias). Using a multilevel Response Surface Analysis, we found that accuracy regarding partners’ vulnerability was associated with higher levels of resolution.
Resumen
El principal mecanismo de cambio en la terapia de pareja centrada en las emociones (EFT‐C, siglas en inglés) se describe como un integrante de la pareja que accede a la vulnerabilidad y la expresa, y el otro integrante de la pareja que responde afiliativamente; con compasión, aceptación, validación y apoyo. Se supone que estas interacciones reestructuran el ciclo interactivo negativo y rígido que generalmente lleva a las parejas a terapia y ayuda a construir un vínculo emocional positivo. El principal objetivo de este estudio fue evaluar si, para que ocurra este proceso, las parejas necesitan percibir con exactitud las experiencias de vulnerabilidad de su cónyuge durante la terapia. Específicamente, analizó los factores (p. ej.: precisión del seguimiento, sesgo de similitud asumida y sesgo direccional) que determinan las percepciones de las parejas de la vulnerabilidad de su cónyuge y si las percepciones exactas predicen resultados positivos en las sesiones durante la EFT‐C. Se analizaron datos de 36 parejas que participaron en el Proyecto de York sobre Daño Emocional (York Emotional Injury Project). Después de cada sesión, los pacientes informaron su propia experiencia de vulnerabilidad así como sus percepciones de la vulnerabilidad de sus parejas. El resultado de la sesión se definió como el grado en el que los pacientes informaron la resolución. Utilizando un modelo multinivel de verdad y sesgo, los resultados indicaron que las parejas percibieron con exactitud los cambios en las expresiones de vulnerabilidad de sus cónyuges (p. ej.: precisión considerable del seguimiento). De modo interesante, las percepciones de las parejas también estuvieron ligadas a sus propias expresiones de vulnerabilidad (p. ej.: sesgo considerable de similitud asumida) y tendieron a subestimar el nivel de las expresiones de vulnerabilidad de sus parejas (p. ej.: sesgo considerable de nivel medio negativo). Utilizando un análisis superficial de respuesta multinivel, descubrimos que la exactitud con respecto a la vulnerabilidad de las parejas estuvo asociada con niveles más altos de resolución.
摘要
在情感焦点伴侣治疗(EFTC)中主要的改变机制可以具体描述如下：一方更容易表现得脆弱且把脆弱表达出来，而另一方则以亲和的方式回应; 带着怜悯、接纳、给以验证和支持等。这些相互作用被认为重构了原来周而复始的既消极且僵化的相互影响模式，往往是这种周期性的互动方式把伴侣们带到治疗中来，从而帮助其建立积极的情感纽带。本研究的主要目的是为了测试伴侣是否需要在治疗过程中准确地感知到配偶的脆弱经历以促使这种过程的实现。具体来说，它检查了如下因素(例如追踪准确性、假定的相似偏差和方向偏差)塑造伴侣对配偶脆弱性的感知，以及准确的感知是否预测EFT‐C期间的积极会话结果。研究人员分析了参加约克情感伤害项目的36对夫妇的数据。在每次治疗会谈之后，来访者报告了他们自己的脆弱性经历以及他们对其伴侣表现出的脆弱性的看法。疗程结果被定义为来访者自报的解决程度。使用一个多层次的真相和偏见模型得出结果表明，伴侣准确地感知到配偶脆弱性表达的变化（即显著的跟踪准确性）。有趣的是，伴侣的感知也与他们自己的脆弱性表达相关（即显著的假设相似性偏差），并倾向于低估伴侣的脆弱性表达水平（即显著的负平均水平偏差）。通过多层次的反应面分析，我们发现伴侣脆弱性的准确性与较高的解决水平有关。
Although empirically supported treatments for posttraumatic stress disorder (PTSD) exist, many patients fail to complete therapy, are nonresponsive, or remain symptomatic following treatment. This ...paper presents the results of a delayed intervention quasi‐randomized controlled study that evaluated the efficacy of narrative reconstruction as an integrative intervention for PTSD. During narrative reconstruction, the patient and therapist reconstruct an organized, coherent, and detailed written narrative of the patient's traumatic experience. Additionally, narrative reconstruction focuses on arriving at the subjective meaning of the traumatic experience for the patient as related to their personal history. Thus, the therapist asks the patient about associations between the traumatic event and other memories and life events. In the present study, 30 participants with PTSD were randomly assigned to an immediate (n = 17) or delayed (n = 13) 15‐session narrative reconstruction intervention. Participants in the immediate narrative reconstruction group were evaluated using self‐report measures and structured interviews at baseline, posttreatment, and 15‐week follow‐up. Participants in the delayed narrative reconstruction group were evaluated at baseline, postwaitlist/pretreatment, and posttreatment assessments. Data from the pretreatment evaluation showed no significant differences between groups. Mixed linear models showed significant intervention effects for posttraumatic symptom severity, d = 1.17, from pre‐ to posttreatment. Although preliminary, these promising findings suggest that narrative reconstruction may be an effective standalone therapy or an add‐on to current effective treatment strategies.
The primary purported change process in emotion‐focused couples therapy (EFT‐C) occurs as therapists assist one partner to access and reveal vulnerable emotions and needs and promotes a subsequent ...compassionate responding from the other partner. This study aimed to examine the association between therapists' views regarding their interventions during a given session and the degree to which partners reported the session as helpful in resolving their unfinished business. Data from 22 couples who took part in the York Emotional Injury Project and received 10–12 EFT‐C sessions were analyzed using multilevel models. The primary findings revealed that when therapists reported using interventions that promoted acceptance of feelings and needs in a given session, both partners reported higher resolution levels in relation to their partner. Our results suggest that interventions that facilitate responsiveness between partners are particularly important in EFT‐C, and perhaps in couples therapy in general.
Objective: The purpose of the present study was to evaluate the efficacy of emotion-focused therapy (EFT) for adults suffering from social anxiety disorder (SAD). Method: Using a nonconcurrent ...multiple-baseline design, 12 patients (mean age = 26.75 years, SD = 5.15; 7 males) meeting criteria for SAD were treated with up to 28 sessions of EFT. EFT was based on an empathic relationship, 2-chair work for self-criticism, empty-chair work for unresolved feelings, and focusing. Patients were randomized to wait 4, 8, or 12 weeks between the intake and the first therapy session. Intake assessment included the MINI International Neuropsychiatric Interview (MINI; Sheehan et al. 1998), the clinician-administered Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987), and various self-report questionnaires. The LSAS was also administered at the end of the baseline period and at posttreatment. The MINI was administered again at posttreatment. Self-reports were administered throughout the baseline, before each therapy session, and at 6-month and 12-month follow-ups. Results: One patient dropped out prematurely. Of the 11 completers, 7 did not meet criteria for SAD at the end of treatment. Intent-to-treat analysis showed that LSAS scores did not change during baseline, significantly improved during treatment (Cohen's d = −2.37), and remained improved during follow-up. Mixed regression models showed that SAD symptoms and self-criticism did not change during baseline, significantly improved during treatment, and remained improved during follow-up. Self-reassurance improved significantly during the follow-up phase. Conclusion: This study provides initial evidence supporting the efficacy of EFT for SAD.
What is the public health significance of this article?
Social anxiety, a very common disorder, does not always respond to cognitive-behavioral therapy. Although based on a small sample, this study suggests that emotion-focused therapy may be an alternative effective treatment for social anxiety.
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