Ten good outcome and ten poor outcome psychotherapy cases were compared to investigate whether or not the temporal stability and flexibility of their process variables can predict their outcomes. Each participant was monitored daily using the Therapy Process Questionnaire (TPQ), which has 43 items and seven sub-scales, and responses over time were analyzed in terms of correlation robustness and correlation variability across the TPQ sub-scales. “Correlation robustness” and “correlation variability” are two basic characteristics of any correlation matrix: the first is calculated as the sum of the absolute values of Pearson correlation coefficients, the second as the standard deviation of Pearson correlation coefficients. The results demonstrated that the patients within the poor outcome group had lower values on both variables, suggesting lower stability and flexibility. Furthermore, a higher number of cycles of increase and decrease in correlation robustness and variability of the TPQ sub-scales was observed within good outcome psychotherapies, suggesting that, these cycles can be considered as process-markers of good-outcomes. These results provide support for the validity of these quantitative process-parameters, correlation robustness and variability, in predicting psychotherapeutic outcomes. Moreover, the results lend support to the common clinical experience of alternating periods of flexibility and integration being beneficial to good psychotherapeutic processes.
The rapid development of software applications and the increasing use of the Internet have raised many questions about the impact of this technology on the lives of adolescents, especially on “digital natives.” The advent of social networks (SNs) restructures their relationships in various ways, affecting both adolescents’ development and mental health. The present study aims to investigate uses and dangers of SNs according to a sample of 296 (166 female and 130 male) Italian middle and high schools adolescents (age range 13–18) and build a model of how SNs can turn out to be dangerous. To achieve this, twenty-four audio-recorded focus groups of Italian male and female adolescents were investigated by a Grounded Theory approach, abstracting from the transcripts the main uses and dangers of SNs and proposing a final model for the interpretation of the whole set of categories. The results highlighted two main dangers of SNs: (a) the desperate search for popularity, and (b) the exhibition of violent or offensive behavior facilitated by the sense of protection and anonymity derived from being hidden behind a virtual account. Finally, a psychological model of how SNs can turn out to be dangerous is presented. This study could be useful in developing prevention procedures against the risks of SNs (e.g., cyberbullying, internet addiction) without demonizing the use of social media as such.
The spread of COVID-19 created a state of emergency all over the world and played a big role in the decline of the mental health of citizens. The context of the workplace became an important variable in the impact of the lockdown on individuals. In this study, we deepened the categories of healthcare workers (HWs), virtual workers (VWs), and the elderly, along with their emotional approach to this emergency. A sample of 257 participants (ElderlyN = 62; HWsN = 104; VWsN = 91) completed: a semi-structured interview on their experience during lockdown via telephone; an online survey with a sociodemographic questionnaire; the Difficulties in Emotional Regulation Scale (DERS); and the Post-Traumatic Growth Inventory (PTGI). Linguistic measures of the Referential Process were utilized to code the interviews. An independent ANOVA explored the variability among groups. The results show more affective language in the Elderly (M = 0.0310, SD = 0.0070) and a growth in spirituality (M = 4.16, SD = 3.17). HWs displayed a higher PTGI (M = 56.84, SD = 20.29), while VWs displayed a lower PTGI (M = 50.02, SD = 21.05). Moreover, VWs presented higher scores in Impulse on the DERS (M = 11.67, SD = 5.05) and a more cognitive/abstract narration (Reflection IREF M = 0.0260, SD = 0.0071; Reorganization IWRRL M = 0.5419, SD = 0.0032; Referential Activity IWRAD M = 0.4978, SD = 0.0029). This study aims to take the work context into consideration to create focused interventions.
Abstract: We examine the theoretical implications of empirical studies developed over recent years. These experiments have explored the biosemiotic nature of communication streams from emotional neuroscience and embodied mind perspectives. Information combinatorics analysis enabled a deeper understanding of the coupling and decoupling dynamics of biosemiotics streams. We investigated intraindividual and interpersonal relations as coevolution dynamics of hybrid couplings, synchronizations, and desynchronizations. Cluster analysis and Markov chains produced evidence of chimaera states and phase transitions. A probabilistic and nondeterministic approach clarified the properties of these hybrid dynamics. Thus, multidimensional theoretical models can represent the hybrid nature of human interactions. Keywords: synchronization; semiotics; information; cognitive neuroscience; psychotherapy; conversation; mapping; chimaera states; statistical dynamics; coupling
Background Research into the effects of asthma treatments on the extra-pulmonary symptoms of severe asthma is limited by the absence of a suitable questionnaire. The aim was to create a questionnaire suitable for intervention studies by selecting symptoms that are statistically associated with asthma pathology and therefore may improve when pathology is reduced. Methods Patients attending a specialist asthma clinic completed the 65-item General Symptom Questionnaire (GSQ-65), a questionnaire validated for assessing symptoms of people with multiple medically unexplained symptoms. Lung function (FEV1%) and cumulative oral corticosteroids (OCS) calculated from maintenance dose plus exacerbations were obtained from clinic records. Pathology was represented by the two components of a principal component analysis (PCA) of FEV1% and OCS. LASSO regression was used to select symptoms that had high coefficients with these two principal components and occurred frequently in severe asthma. Results 100 patients provided data. PCA revealed two components, one where FEV1% and OCS were inversely related and another where they were directly related. LASSO regression revealed 39 symptoms with non-zero coefficients on one or more of the two principal components from which 16 symptoms were selected for the GSQ-A on the basis of magnitude of coefficient and frequency. Asthma symptoms measured by asthma control questionnaires were excluded. The GSQ-A correlated 0.33 and − 0.34 (p = 0.001) with the two principal components. Conclusion The GSQ-A assesses the frequency of 16 heterogenous non-respiratory symptoms that are associated with asthma severity using the statistical combination of FEV1% and OCS.
Measuring interpersonal synchrony is a promising approach to assess the complexity of social interaction, which however has been mostly limited to dyads. In this study, we introduce multivariate Surrogate Synchrony (mv-SUSY) to extend the current set of computational methods. Methods: mv-SUSY was applied to eight datasets consisting of 10 time series each, all with n = 9600 observations. Datasets 1 to 5 consist of simulated time series with the following characteristics: white noise (dataset 1), non-stationarity with linear time trends (dataset 2), autocorrelation (dataset 3), oscillation (dataset 4), and multivariate correlation (dataset 5). Datasets 6 to 8 comprise empirical multivariate movement data of two individuals (datasets 6 and 7) and between members of a group discussion (dataset 8.) Results: As hypothesized, findings of mv-SUSY revealed absence of synchrony in datasets 1 to 4 and presence of synchrony in dataset 5. In the empirical datasets, mv-SUSY indicated significant movement synchrony. These results were predominantly replicated by two well-established dyadic synchrony approaches, Surrogate Synchrony (SUSY) and Surrogate Concordance (SUCO). Conclusions: The study applied and evaluated a novel synchrony approach, mv-SUSY. We demonstrated the feasibility and validity of estimating multivariate nonverbal synchrony within and between individuals by mv-SUSY.
Table of Contents -Editorial: The Patient’s Change: Understanding the Complexity of the Dynamics of Change and Its Precursors in Psychotherapy Giulio de Felice, Melissa M. De Smet, Reitske Meganck and Guenter Schiepek -The Role of Entrapment in Crisis-Focused Psychotherapy Delivered in Psychiatric Emergency Settings: A Comparative Study Dana Tzur Bitan, Adi Otmazgin, Mirit Shani Sela and Aviv Segev -Love, Work, and Striving for the Self in Balance: Anaclitic and Introjective Patients’ Experiences of Change in Psychoanalysis Andrzej Werbart, Annelie Bergstedt and Sonja Levander -The Action of Verbal and Non-verbal Communication in the Therapeutic Alliance Construction: A Mixed Methods Approach to Assess the Initial Interactions With Depressed Patients Luca Del Giacco, M. Teresa Anguera and Silvia Salcuni -Roles of Trait Mindfulness in Behavioral Activation Mechanism for Patients With Major Depressive Disorder Koki Takagaki, Masaya Ito, Yoshitake Takebayashi, Shun Nakajima and Masaru Horikoshi -What Differentiates Poor- and Good-Outcome Psychotherapy? A Statistical-Mechanics-Inspired Approach to Psychotherapy Research, Part Two: Network Analyses Giulio de Felice, Alessandro Giuliani, Omar C. G. Gelo, Erhard Mergenthaler, Melissa M. De Smet, Reitske Meganck, Giulia Paoloni, Silvia Andreassi, Guenter K. Schiepek, Andrea Scozzari and Franco F. Orsucci -A Mixed Methods Framework for Psychoanalytic Group Therapy: From Qualitative Records to a Quantitative Approach Using T-Pattern, Lag Sequential, and Polar Coordinate Analyses Eulàlia Arias-Pujol and M. Teresa Anguera -A Phase Transition of the Unconscious: Automated Text Analysis of Dreams in Psychoanalytic Psychotherapy Alessandro Gennaro, Sylvia Kipp, Kathrin Viol, Giulio de Felice, Silvia Andreassi, Wolfgang Aichhorn, Sergio Salvatore and Günter Schiepek -Convergent Validation of Methods for the Identification of Psychotherapeutic Phase Transitions in Time Series of Empirical and Model Systems Günter Schiepek, Helmut Schöller, Giulio de Felice, Sune Vork Steffensen, Marie Skaalum Bloch, Clemens Fartacek, Wolfgang Aichhorn and Kathrin Viol -Long-Term Effects of Home-Based Family Therapy for Non-responding Adolescents With Psychiatric Disorders. A 3-Year Follow-Up Egon Bachler, Benjamin Aas, Herbert Bachler, Kathrin Viol, Helmut Johannes Schöller, Marius Nickel and Günter Schiepek
With the aim of investigating analogies and differences between psychotherapeutic processes, ten good-outcome and ten poor-outcome cases were selected from a sample of patients treated at the University Hospital of Psychiatry, Salzburg, Austria, and the Department of Psycho-Traumatology of the Clinic St. Irmingard, Prien am Chiemsee, Germany. They were monitored daily using the Therapy Process Questionnaire (TPQ), and their evolution over time was analyzed by means of Principal Components Analysis and Linear Discriminant Analysis. The results highlight that poor-outcome patients show a separation between cognitive processes (Principal Component 1) and relational-emotional processes (Principal Component 2) ( r = − 0.25; p = n.s.), while in the good-outcome patients these aspects are well integrated ( r = 0.70; p = 0.02). These results corroborate the validity of the daily monitoring procedure and also indicate the need for greater attention to the relational and emotional aspects of the patients rather than merely to their cognitive functioning and well-being. Key Message In poor-outcome cases, burdensome emotions and interpersonal experiences on the one hand and cognitive/well-being aspects of the mental processing on the other, stay unrelated. Successful therapeutic processing, as in good-outcome cases, requires an integration of cognitive and affective components.
The working alliance (WA) has been widely identified as the key concept for psychotherapy and allied health care services. The WA, measured at different phases of diverse kinds of therapies, has been shown to robustly predict posttreatment outcomes. But the way the clients' conceptualization of the alliance evolves overtime, and the relation between this kind of conceptual change and subsequent symptom improvements, has not been investigated. Dynamic Latent Class Structural Equation Models (DLC-SEM) were applied to data drawn from two randomized clinical trials of cognitive-behavioral therapy for generalized anxiety disorder (N = 57 and 80) to evaluate several potential models of the relation between the conceptual/structural changes in patients' self-reports of the quality of the alliance and subsequent treatment outcomes. Inspection of the DLC-SEM models suggests that, overtime, between 63% and 66% of the better session-level outcome clients switched from three factors (task, goal, bond) to an integrated single factor conceptualization of the therapeutic alliance. The study indicates that the majority of patients evolve their concept of the alliance overtime: The previously distinct alliance elements become integrated into a single factor construct. These findings suggest that if such overtime development is generalizable across diverse patient/treatment populations, future research ought to take these developments into account both methodologically (i.e., how alliance is measured) and in analyzing time-series data (e.g., using DLC-SEM). By modeling the patient's dynamic concept evolution, this initial study shows a potential to empirically explore prior theoretical propositions of the evolutions (or stability) of the alliance overtime. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Objective: The relationship between the therapeutic alliance and outcome has been supported consistently over time. More recently, studies have examined therapist effects in the alliance-outcome relationship and came up with somewhat mixed findings. The purpose of this study was to replicate and extend previous meta-analytic work using a much larger data set, permitting not only the verification of the overall impact of the therapists' contribution but, at the same time, controlling for several potential covariates effecting this relationship. Method: We conducted two- and three-level mixed-effects meta-analyses (k = 152; 827 total effect sizes) to examine the significance of several potential moderators of the alliance-outcome correlation. These moderators included (a) Patient-Therapist Ratio (PTR; Patient N divided by therapist N to test therapist effects), (b) Alliance and Outcome Rater's contribution (patient, therapist, observer, and other), (c) Alliance Measures, (d) Research Design (RCT, Other) and (e) Personality Disorder. Results: The PTR, an index of the therapist's contribution to the alliance, was a significant moderator of the alliance-outcome correlation in both the two- and three-level models. When several potential confounds were simultaneously tested in a three-level multipredictor metaregression, including rater of alliance and outcome, research design, alliance measure, and personality disorder, PTR remained a significant moderator of the alliance-outcome correlation. Conclusion: Replicating and extending previous research, this study supported the significance of therapists' impact in the alliance-outcome relationship. These results remained significant even when, using three-level metaregressions, several potential covariates were simultaneously controlled. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Con saggi di Alessandro Giuliani, Pier Christian Verde e...Vladimir Nabokov Da un punto di vista clinico il lavoro dello psicologo può essere descritto in termini di osservazione del materiale psichico del paziente, ascolto dello stesso attraverso il filtro della mente del clinico, e sua restituzione in seduta. “Osservazione, Ascolto ed Interpretazione” indaga il tema di come si possa divenire buoni lettori del materiale clinico di un paziente individuale o di un gruppo mostrando il posizionamento scientifico necessario a favorire lo sviluppo della relazione terapeutica. Come si osserva il materiale psichico? Qual è l’attitudine necessaria a favorire la scoperta di qualcosa di nuovo? Come lo si interpreta? Il volume risponde a tali annose questioni attraverso un confronto interdisciplinare. Il testo, unico nel suo genere, mostra infatti come si possa divenire buoni lettori di un materiale clinico, di un insieme di dati empirico, di un testo di letteratura. Non dovremmo mai dimenticare infatti che l’“opera d’arte”, indipendentemente dal dominio scientifico a cui appartiene, è sempre la creazione di un mondo nuovo, e non lo si dovrebbe confondere con le cose che si sanno già. L’artista entusiasta tende ad avere un atteggiamento troppo soggettivo, mentre una freddezza di giudizio scientifica attenuerà il calore dell’intuizione. Per trarre piacere da quell’opera d’arte l’aspirante buon lettore dovrà perciò munirsi di passione e pazienza, la passione dell’artista e la pazienza dello scienziato. Buona lettura. [With contributions by Alessandro Giuliani, Pier Christian Verde and...Vladimir Nabokov From a clinical point of view, the work of a psychologist can be described in terms of observation of the patient's psychic material, listening to it through the filter of the clinician's mind, and commenting or interpreting it back to the patient. “Observation, Listening and Interpretation” investigates how we can become good readers of the clinical material of an individual patient or a group, by showing the scientific stance needed to promote the development of the therapeutic relationship. How should we observe the clinical material? What is the attitude needed to encourage the discovery of something new? How should we comment the clinical material? The volume responds to these long-standing questions through an interdisciplinary discussion. The book, one of a kind, in fact shows how we can become good readers of a clinical material; of a set of empirical data; of a literary text. We should never forget that a "masterpiece", regardless of the scientific domain to which it belongs, is always the creation of a new world, and should not be confused with things that are already known. The enthusiastic artist tends to have a too subjective attitude, while the coldness of scientific judgment will attenuate the warmth of intuition. To feel pleasure from that masterpiece, the aspiring good reader will therefore have to equip himself with passion and patience; the passion of the artist and the patience of the scientist. Enjoy the reading.]
Self-organization is a multi-faceted concept, generally indicating the ability of a system to change its dynamics without the need for an instructing external agent. In such a broad sense, very different processes like embryo development (Wennekamp et al. 2013), the onset of self-sustained cyclic chemical processes (Mikhailov and Hess 1996), protein folding (Gerstman and Chapagain 2005), and Bénard rolls (Karsenti 2008) are self-organizing processes. Bénard rolls are probably the simplest (and well-studied) example of self-organization (Karsenti 2008; Prigogine and Nicolis 1967): they are longitudinal cylinders of liquid molecules that form precise and stable dynamic patterns when a fluid is traversed by a flow of energy (e.g. boiling water).
Statistical mechanics investigates how emergent properties of macroscopic systems (such as temperature and pressure) relate to microscopic state fluctuations. The underlying idea is that global statistical descriptors of order and variability can monitor the relevant dynamics of the whole system at hand. Here we test the possibility of extending such an approach to psychotherapy research investigating the possibility of predicting the outcome of psychotherapy on the sole basis of coarse-grained empirical macro-parameters. Four good-outcome and four poor-outcome brief psychotherapies were recorded, and their transcripts coded in terms of standard psychological categories (abstract, positive emotional and negative emotional language pertaining to patient and therapist). Each patient-therapist interaction is considered as a discrete multivariate time series made of subsequent word-blocks of 150-word length, defined in terms of the above categories. “Static analyses” (Principal Component Analysis) highlighted a substantial difference between good-outcome and poor-outcome cases in terms of mutual correlations among those descriptors. In the former, the patient’s use of abstract language correlated with therapist’s emotional negative language, while in the latter it co-varied with therapist’s emotional positive language, thus showing the different judgment of the therapists regarding the same variable (abstract language) in poor and good outcome cases. On the other hand, the “dynamic analyses”, based on five coarse-grained descriptors related to variability, the degree of order and complexity of the series, demonstrated a relevant case-specific effect, pointing to the possibility of deriving a consistent picture of any single psychotherapeutic process. Overall, the results showed that the systemic approach to psychotherapy (an old tenet of psychology) is mature enough to shift from a metaphorical to a fully quantitative status.
Aim: Psychotherapy could be interpreted as a self-organizing process which reveals discontinuous pattern transitions (so-called phase transitions). Whereas this was shown in the conscious process of awake patients by different measures and at different time scales, dreams came very seldom into the focus of investigation. The present work tests the hypothesis that, by dreaming, the patient gets progressively more access to affective-laden (i.e., emotionally charged) unconscious dimensions. Furthermore, the study investigates if, over the course of psychotherapy, a discontinuous phase transition occurs in the patient's capacity to get in contact with those unconscious dimensions. Methods and procedures: A series of 95 dream narratives reported during a psychoanalytic psychotherapy of a female patient (published as the "dreams of Amalie X") was used for analysis. An automated text analysis procedure based on multiple correspondence analysis was applied to the textual corpus of the dreams, highlighting a 10-factor structure. The factors, interpreted as affective-laden unconscious meaning dimensions, were adopted to define a 10-dimensional phase space, in which the ability of a dream to be associated with one or more local factors representing complex affective-laden meanings is measured by the Euclidean distance (ED) from the origin of this hyperspace. The obtained ED time series has been fitted by an autoregressive integrated moving average (ARIMA) model and by non linear methods like dynamic complexity, recurrence plot, and time frequency distribution. Change point analysis was applied to these non linear methods. Results: The results show an increased frequency and intensity of dreams to get access to affective-laden meanings. Non linear methods identified a phase transition-like jump of the ED dynamics onto a higher complexity level of the dreaming process, suggesting a non linear process in the patient's capacity to get in contact with unconscious dimensions. Conclusion: The study corroborates the hypothesis that, by dreaming, the patient gets progressively more access to affective-laden meaning intended as unconscious dimensions. The trajectory of this process has been reproduced by an ARIMA model, and beyond this, non linear methods of time series analysis allowed the identification of a phase transition in the unconscious process of the psychoanalytic therapy under investigation.
To investigate through the prototype methodology as well as the interaction structures methodology which are the factors involved in the psychotherapeutic progress in the treatment of a patient with chronic diseases and somatic symptoms. 62 of the total 120 videotaped sessions were analysed by independent judges using the Psychotherapy Process Q-Set. The interaction structures as well as the extent to which each session conformed to the ideal psychodynamic, cognitive behavioural therapy (CBT) and reflective function prototypes were evaluated through multiple regression analysis, in order to test which factors were able to predict therapeutic progress. The psychotherapeutic process was characterized by moderate adherence to both psychodynamic and CBT prototypes and by greater adherence to the reflective function prototype. The therapeutic progress was better predicted by the adherence to the psychodynamic prototype. Both the psychodynamic technique and the reflective function were prominent factors in this case. Mentalization has been considered a “common factor” among different psychotherapeutic approaches, and our results highlight the importance of considering it along with specific technical aspects. Examining elements of the therapeutic process focusing on the complex interaction among these different aspects can provide helpful new insights into the process factors associated with a favourable outcome.
The present work provides a novel contribution to the psychoanalytic literature on criminal tendencies and is based on an experience of group supervision with the staff of professionals in an Italian Secure Psychiatric Unit. With the support of a single case from that institution, the case of Mary, and two more clinical illustrations, new insights on the criminal act will be presented and discussed according to three main themes: a) the failure of containment; b) the antisocial act as a concrete attempt to represent internal conflicts; c) the violent internal aspect as the place where the patient's psychic vitality resides. The work concludes by showing how the care team, within this kind of institution, can promote the patients' psychic development on each of the following three themes: a) acting as a transformative container; b) being capable of restoring a symbolic and representational dimension to violent and antisocial acts; c) being capable of restoring the aspect of the psychic vitality of violent and antisocial acts to promote the passage towards the differentiation between +psychic vitality and-psychic vitality.
Aim: In many cases, the dynamics of psychotherapeutic change processes is characterized by sudden and critical transitions. In theoretical terms, these transitions may be "phase transitions" of self-organizing nonlinear systems. Meanwhile, a variety of methods is available to identify phase transitions even in short time series. However, it is still an open question if different methods for time series analysis reveal convergent results indicating the moments of critical transitions and related precursors. Methods and Procedures: Seven concepts which are commonly used in nonlinear time series analysis were investigated in terms of their ability to identify changes in psychological time series: Recurrence Plots, Change Point Analysis, Dynamic Complexity, Permutation Entropy, Time Frequency Distributions, Instantaneous Frequency, and Synchronization Pattern Analysis, i.e., the dynamic inter-correlation of the system's variables. Phase transitions were simulated by shifting control parameters in the Hénon map dynamics, in a simulation model of psychotherapy processes (one by an external shift of the control parameter and one created by a simulated control parameter shift), and three sets of empirical time series generated by daily self-ratings of patients during the treatment. Results: The applied methods showed converging results indicating the moments of dynamic transitions within an acceptable tolerance. The convergence of change points was confirmed statistically by a comparison to random surrogates. In the three simulated dynamics with known phase transitions, these could be identified, and in the empirical cases, the methods converged indicating one and the same transition (possibly the phase transitions of the cases). Moreover, changes that did not manifest in a shift of mean or variance could be detected. Conclusion: Changes can occur in many different ways in the psychotherapeutic process. For instance, there can be very slow and small transitions or very high and sudden ones. The results show the validity and stability of different measures indicating pattern transitions and/or early warning signals of those transitions. This has profound implications for real-time monitoring in psychotherapy, especially in cases where a transition is not obvious to the eye. Reliably identifying points of change is mandatory also for research on precursors, which in turn can help improving treatment
There is a renewed interest for complex adaptive system approaches that can account for the inherently complex and dynamic nature of psychopathology. Yet, a theory of psychopathology grounded in the principles of complex adaptive systems is lacking. Here, we present such a theory based on in the notion of adaptive dynamic patterns. We postulate that all observable phenomena of the body and mind are dynamic patterns that emerge from an open complex adaptive system constituted by interdependent biopsychosocial processes located in the individual and its environment, which operate on multiple timescales. Psychopathology is a self-organizing emergent property of a system, meaning that psychopathology arises solely from the interdependencies in the system and is not prescribed by an internal or external ‘blueprint’. While dynamic patterns of psychopathology are highly idiographic in content due to continuous individual-environment transactions, we claim that their change over time can be described by general principles of pattern formation in complex adaptive systems. Our theory thus integrates idiographic and nomothetic science. A discussion of implications for classification, intervention and public health concludes the paper.
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).
Statistical mechanics is the field of physics focusing on the prediction of the behavior of a given system by means of statistical properties of ensembles of its microscopic elements. The authors examined the possibility of applying such an approach to psychotherapy research with the aim of investigating (a) the possibility of predicting good and poor outcomes of psychotherapy on the sole basis of the correlation pattern among their descriptors and (b) the analogies and differences between the processes of good-and poor-outcome cases. This work extends the results reported in a previous paper and is based on higher-order statistics stemming from a complex network approach. Four good-outcome and four poor-outcome brief psychotherapies were recorded, and transcripts of the sessions were coded according to Mergenthaler's Therapeutic Cycle Model (TCM), i.e., in terms of abstract language, positive emotional language, and negative emotional language. The relative frequencies of the three vocabularies in each word-block of 150 words were investigated and compared in order to understand similarities and peculiarities between poor-outcome and good-outcome cases. Network analyses were performed by means of a cluster analysis over the sequence of TCM categories. The network analyses revealed that the linguistic patterns of the four good-outcome and four poor-outcome cases were grounded on a very similar dynamic process substantially dependent on the relative frequency of the states in which the transition started and ended ("random-walk-like behavior", adjusted R 2 = 0.729, p < 0.001). Furthermore, the psychotherapy processes revealed statistically significant changes in the relative occurrence of visited states between the beginning and the end of therapy, thus pointing to the non-stationarity of the analyzed processes. The present study showed not only how to quantitatively describe psychotherapy as a network, but also found out the main principles on which its evolution is based. The mind, from a linguistic perspective, seems to work-through psychotherapy sessions by passing from the most adjacent states and the most occurring ones. This finding can represent a fertile ground to rethink pivotal clinical concepts such as the timing of an interpretation or a comment, the clinical issue to address within a given session, and the general task of a psychotherapist: from someone who delivers a given technique toward a consultant promoting the flexibility of the clinical field and, thus, of the patient's mind.
Silence in psychotherapy has been associated with different, sometimes opposing meanings. This study investigated silence during adolescent identity treatment in adolescent patients with borderline personality pathology. A more active therapeutic approach with less silence is advised in adolescent identity treatment. It was hypothesized that a session with more silence might be negatively perceived by adolescent patients. A total of 382 sessions that involved 21 female patients were analyzed. Silence was automatically detected from audio recordings. Diarization (segmenting an audio according to speaker identity) was performed. The patient's perception of the sessions was measured with the Session Evaluation Questionnaire. The amount of silence in the different speaker-switching patterns was not independent of one other. This finding supports the hypothesis of mutual attunement of patient and therapist concerning the amount of silence in a given session. Sessions with less silence were rated as being both smoother and better. The potential implications for clinical practice are discussed. The investigation of turn-taking and interpersonal temporal dynamics is relevant for psychotherapy research. The topic can be addressed efficiently using automated procedures. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
free copies: https://www.tandfonline.com/eprint/KfafnPTGI8sS4FxsRtJt/full?target=10.1080/10503307.2019.1612114 _______________________________________________________________________Objective: In this proof-of-principle study, a convenience sample of 55 dyadic psychotherapy sessions conducted by one therapist was analyzed. This study aimed at exploring physiological synchrony in naturalistic psychotherapy sessions and the association of such synchrony with self-report ratings. Methods: The electrocardiograms and respiration behavior of both therapist and client were monitored simultaneously. Four clients were included, and session outcome was documented by session reports in two clients. From electrocardiograms, heart rate and heart rate variability were derived in consecutive 15-second intervals throughout sessions. Entire sessions (average duration, 51 min) were assessed for physiological synchrony of therapist’s and client’s respiration, electrocardiogram, heart rate, and heart rate variability. Two methods of synchrony computation were applied to the time series: windowed cross-correlation and correlation of local slopes (concordance). Both methods included surrogate controls using segment-wise shuffling. Results: Significant synchrony of three measures, but not of electrocardiograms, was present in this dataset. In regression models, we found associations between synchronies and alliance ratings, and further self-report variables. Conclusions: Results support the existence of physiological synchrony in this collection of psychotherapy sessions, which speaks for the sympathetic and parasympathetic coupling between this therapist and her clients and its link with ratings of the therapy process. The feasibility of deriving signatures of synchrony of physiological signals with the described methodology was corroborated. The findings now await generalization by further research.
Background: Manual coding of facial emotion expression, e.g. using the Facial Action Coding System (FACS), can be very time consuming. For psychotherapy research the change in emotion expression and microexpressions over time is relevant. Hence, automatic emotion recognition may be a promising tool. Method: We apply a Convolutionary Neural Network (CNN) for emotion recognition to video material from 389 psychotherapy sessions of 23 patients with borderline personality pathology. We cross-validate the findings with human ratings according to the Clients Emotional Arousal Scale (CEAS) and the outcome of psychotherapy. Results: Overall, machine learning ratings show substantial, however, numerically low agreement with human ratings, particularly with overall (non-specific) emotional arousal. Machine learning emotion recognition shows substantial predictive validity for therapy outcome, in particular the display of positive emotions (smiling and happiness). Discussion: Machine learning is a highly promising resource for tracking change in emotional expression over time. The results highlight the differential association of displayed positive and negative feelings to the treatment outcome.
This is the author version manuscript belonging to a chapter in the book 'Selbstorganisation – Ein Paradgima für die Humanwissenschaften'. Olthof, M., Hasselman, F., Wijnants, M., & Lichtwarck-Aschoff A. (2020). Psychological dynamics are complex: a comparison of scaling, variance and dynamic complexity in simulated and observed data. In K. Viol, H. Schöller & W. Aichhorn (Eds.). Selbstorganisation – Ein Paradgima für die Humanwissenschaften [Self-Organization – A Paradigm for the Human Sciences] (pp. 303-316). Springer VS: Wiesbaden.
Objective: We examined individual overall trajectories of change and the occurrence of sudden gains in daily self-rated problem severity, and the relation of these patterns to treatment response. Method: Mood disorder patients (N = 329, mean age = 44, 55% women) completed daily self-ratings about the severity of their complaints as a standard part of treatment, using the Therapy Process Questionnaire (TPQ). Per individual, the best-fitting defined (linear, log-linear, one-step) trajectory was tested for significance: for change over time, and for specificity of the best-fitting trajectory. 203 cases had ICD-10 Symptom Rating (ISR) depression scores post-treatment: a score ≤ 1 identified 114 treatment responders. Relation to response was examined for sudden gains and type of change trajectory. Results: 138 cases (42%) had a significant decrease in problem severity, of which 54 cases (16%) had a defined trajectory: 50 cases with one-step improvement, and 4 with a linear improvement in daily problem severity. Sudden gains occurred in 28% of the total sample, and within 58% of improvement patterns. Specifically, sudden gains occurred in 68% of significant one-step trajectories, and 25% of the linear cases. Sudden gains and non-specific change trajectories were significantly more frequent for treatment responders. Conclusions: At the day-level, patterns of improvement are nonlinear for most patients. Sudden gains occur within various forms of overall change and are associated with treatment response. Clinically relevant improvements in depression occur both gradually and abruptly, and this finding allows for the possibility that the remission process functions according to dynamical systems principles.
We examine the nature of semiotics and its intermingling with physiology in the embodied mind. We consider the balance between order and noise in our knowledge of the natural world. The relational dimension is explored through synchronization dynamics. Synchronization and resonance are representing areas for further investigation in chimaera states. These might also be seen as quantum fields, which are based on four principles: granularity, relationality in space and time, indeterminacy.
Chapter in the book "Self-organization: a paradigm for the human sciences?" by G. Schiepek
Empathy plays a major role in changing a pathological mind's configuration, and the establishment of an empathic link between therapist and patient is a crucial component of a good therapeutic alliance and outcome. Yet, the definition of empathy and its facets is still under debate, limiting the development of objective quantitative measures. Most authors, though, agree that a fundamental immediate resonance, based on mimicry, contagion, and interpersonal regulation, is among the grounding processes of empathy. Following the growing literature on interpersonal physiology, we investigated the hypothesis that this basic empathic process should present appreciable physiological underpinnings. We applied a Principal Component Analysis (PCA) on simultaneous electrodermal activity, and heart rate variability signals from a patient–therapist dyad involved in a 16-sessions psychodynamic therapy. Confirming our expectations, PCA revealed a first ‘shared’ component correlated to both participants’ signals, and two ‘individual’ components separately correlating to the patient's and therapist's signals. A session-by-session regression analysis showed that the shared component predicted therapy outcome (R ² =.28). We further investigated the shared component dynamic via a symbolic Markovian discrete model, and cluster analysis, observing a behaviour that mirrors previously reported properties of a single heart rate dynamic. In conclusion, the PCA extraction of the shared physiological activity is an unsupervised data-driven procedure showing promising properties. Further validation of this novel procedure may lead to a full-fledged objective measure, characterized by simple analysis and interpretation, and a very high temporal resolution, which may offer an objective assessment of fundamental empathy facets, implying exciting practical implications in the study of the clinical process.
Peer Reviewed File. Statistical mechanics investigates how emergent properties of macroscopic systems (such as temperature and pressure) relate to microscopic state fluctuations. The underlying idea is that global statistical descriptors of order and variability can monitor the relevant dynamics of the whole system at hand. Here we test the possibility of extending such an approach to psychotherapy research investigating the possibility of predicting the outcome of psychotherapy on the sole basis of coarse-grained empirical macro-parameters. Four good-outcome and four poor-outcome brief psychotherapies were recorded, and their transcripts coded in terms of standard psychological categories (abstract, positive emotional and negative emotional language pertaining to patient and therapist). Each patient-therapist interaction is considered as a discrete multivariate time series made of subsequent word-blocks of 150-word length, defined in terms of the above categories. Static analysis (Principal Component Analysis) highlighted a substantial difference between good-outcome and poor-outcome cases in terms of mutual correlations among those descriptors. In the former, the patient’s use of abstract language correlated with therapist’s emotional negative language, while in the latter it co-varied with therapist’s emotional positive language, thus showing the different judgment of the therapists regarding the same variable (abstract language) in poor and good outcome cases. On the other hand, the dynamic analysis, based on five coarse-grained descriptors related to variability, degree of order and complexity of the series, demonstrated a relevant case-specific effect, pointing to the possibility of deriving a consistent picture of any single psychotherapeutic process. Overall, the results showed that the systemic approach to psychotherapy (an old tenet of psychology) is mature to shift from a metaphorical to a fully quantitative status.
Neoclassical Economics assumes that economic agents are independent and optimizing. The achievements of Psychoanalysis concerning the development of mind and human interactions, on the contrary, indicate that considering an individual as independent and optimizing is incorrect, as everyone, since birth, is mentally interconnected with other agents. In this research we firstly deal with and criticize the Neoclassical economics concepts of Independence and Optimization; then, on the basis of the psychoanalytic model of the mind, we draw a new definition of Competition.
Whereas sudden gains and losses (large shifts in symptom severity) in patients receiving psychotherapy appear abrupt and hence may seem unexpected, hypotheses from complex-systems theory suggest that sudden gains and losses are actually preceded by certain early-warning signals (EWSs). We tested whether EWSs in patients’ daily self-ratings of the psychotherapeutic process predicted future sudden gains and losses. Data were collected from 328 patients receiving psychotherapy for mood disorders who completed daily self-ratings about their therapeutic process using the Therapy Process Questionnaire (TPQ). Sudden gains and losses were classified from the Problem Intensity scale of the TPQ. The other items of the TPQ were used to compute the EWSs. EWSs predicted an increased probability for sudden gains and losses in a 4-day predictive window. These results show that EWSs can be used for real-time prediction of sudden gains and losses in clinical practice.
Dies ist eine Buchbesprechung. In "Erfolgsgeheimnisse" beschreibt Hermann Haken, um was es bei der Synergetik geht. Die Buchbesprechung eignet sich daher als Kurzabriss dieser bedeutenden Theorie selbstorganisierender Systeme, die auf Psychotherapie angewandt wurde.
This is a book of 180 pages and our contract with the publisher rules out open access distribution of the work. Thus please do not request pdfs from me, but use the library system instead or consider buying the book. Thank you. _____________________________________ ______________________________________________________________________________ The book describes an encompassing modeling approach to psychotherapy, created with the most recent research in the field. Therapeutic interventions are staged within a therapist-client relationship ('alliance'), and become effective by the interplay of deterministic ('causation') and stochastic ('chance') forces. The authors use a Fokker-Planck approach complimented by a structural-mathematical framework from complexity theory. Chapters present statistical tools, which can be applied to analyze the differing time series that depict therapeutic processes. Chapters include examples of how to use these tools within research. The approach adopted in the book – contemporary psychotherapy terminology combined with a systems-theoretical model and algorithms for quantitative psychotherapy research – has the potential to become the new benchmark in psychotherapy. The Process of Psychotherapy is an informative and sophisticated resource for all levels of students, from undergraduate though post-doctoral studies, in the fields of psychology, cognitive psychology, and psychotherapy.
This paper provides a general framework for the use of Theory of Dynamic Systems (TDS) in the field of psychotherapy research. Psychotherapy is inherently dynamic, namely a function of time. Consequently, the improvement of construct validity and clinical relevance of psychotherapy process research require the development of models of investigation allowing dynamic mappings of clinical exchange. Thus, TDS becomes a significant theoretical and methodological reference. The paper focuses two topics. First, the main concepts of TDS are briefly introduced together with a basic typology of approaches developed within this domain. Second, we propose a repertoire of investigation strategies that can be used to capture the dynamic nature of clinical exchange. In this way we intend to highlight the feasibility and utility of strategies of analysis informed by TDS.
Objectives. The paper presents a method of content analysis framed within a semiotic and contextual model of the psychotherapy process as a situated dynamics of sensemaking: the Dynamic Mapping of the Structures of Content in Clinical Settings (DMSC). Design. DMSC is a system of content analysis focused on a generalized level of meaning, concerning basic aspects of the patient's narrative (e.g., if the narrative concerns herself or other than herself). Method. The paper presents the result of the application of DMSC to an intensive single-case analysis (Katja). The method has been applied by judges to the transcripts of sessions and is aimed at identifying patterns of combinations (defined: Patterns of content) of the categories characterizing the patient's narratives (pattern analysis approach) as well as at mapping the transition among these patterns (sequential analysis approach). Results. These results provide evidence of its construct validity. In accordance with the theoretical model grounding the method, we have found that: (a) DMSC provides a meaningful representation of the patient's narratives in terms of Patterns of content; (b) the probability of transition among the Patterns of content have proved to be significantly associated with the clinical quality of the sessions. Conclusion. The DMSC has to be considered an attempt paving the way for further investigations aimed at developing a deeper understanding of the role played by the dynamics of sensemaking in the psychotherapy process.
Objective: While destabilization periods characterized by high variability and turbulence in a patient’s psychological state might seem obstructive for psychotherapy, a complex systems approach to psychopathology predicts that these periods are actually beneficial as they indicate possibilities for reorganization within the patient. The present study tested the hypothesis that destabilization is related to better treatment outcome. Method: 328 patients who received psychotherapy for mood disorders completed daily self-ratings about their psychotherapeutic process. A continuous measure of destabilization was defined as the relative strength of the highest peak in dynamic complexity, a measure for variability and turbulence, in the self-ratings of individual patients. Results: Destabilization was found to be related to better treatment outcome. When improvers and non-improvers were analyzed separately, destabilization was found to be related to better treatment outcome in improvers but not in non-improvers. Conclusions: Destabilization in daily self-ratings of the psychotherapeutic process is associated with better treatment outcome. The identification of destabilization periods in process-monitoring data is clinically relevant. During destabilization, patients are believed to be increasingly sensitive to the effects of therapy. Clinicians could tailor their interventions to these sensitive periods.
Comment le soin centré sur la personne peut-il concilier la dimension humaine et l'efficacité thérapeutique ? La psychothérapie constitue un domaine éminemment confronté à cette question et la méthodologie des études s'y est révélée essentielle pour comprendre comment les interventions complexes sont des facteurs de changement. En ce sens, la recherche sur la psychothé-rapie peut offrir un paradigme susceptible d'inspirer la fondation scientifique des nouveaux modèles de soins. Si l'on considère les éléments communs à ces modèles proposés dans l'introduction de cet ouvrage 1 , la plupart, sinon tous, sont à l'évidence centraux en psychothérapie : importance accor-dée à l'histoire personnelle et aux remaniements existentiels bien au-delà de la maladie, implication de la personne soignée comme acteur décisionnel des soins, attention au clinicien comme personne, impact de la relation soignant-soigné... Ces éléments font désormais partie intégrante de la recherche en psychothérapie : à l'objectivation fine des résultats s'associe la description des principales caractéristiques du processus où sont impliqués le patient, le thérapeute, leur interaction et leurs échanges. Nous tenterons ici de donner un aperçu de cette problématique, dans la perspective d'offrir un point d'appui pour la recherche relative aux nouveaux modèles de soin. Nous reprendrons les premières étapes de l'abord « scientifique » de la recherche en psychothé-rapie, à partir de La médecine psychologique  de Pierre Janet, ouvrage paru en 1923 mais qui reste d'une étonnante actualité (voir § 1). Nous évoquerons ensuite le renouvellement de cette question avec le développement de l'evidence-based medicine (médecine fondée sur les données probantes), ses limites et la réorientation qui lui a été donnée par l'Association américaine de psychologie 2 en se centrant sur la pratique (voir § 2). Nous présenterons enfin une méthodologie qui s'est constituée de façon à prendre en compte la complexité des causes et des interventions qui participent au traitement des troubles psychiques (voir § 3).
La méthodologie de l’évaluation en psychothérapie s’est longtemps limitée aux résultats issus d’essais cliniques comparatifs de groupes. L’objectif, engagé dans les années 2000, de comprendre ce qui cause son efficacité a engagé un renouvellement méthodologique. Son application concrète est peu documentée. La première partie présente, à partir d’une revue de la littérature centrée sur l’introduction de la recherche sur le processus associée aux résultats, comment le paradigme interactionnel multifactoriel de la psychothérapie a stimulé le développement de méthodes adaptées à la complexité et à l’observation en conditions naturelles. La seconde partie introduit autour de cinq axes principaux les questions méthodologiques générales et spécifiques de cette nouvelle orientation : 1. une épistémologie interactionnelle et transactionnelle ; 2. Un recentrage sur les études mixtes intensives de cas ; 3. Une investigation clinique et théorique multifocale des processus et mécanismes de changement ; 4. une forte relation clinicien-chercheur ; 5. une approche statistique innovante. La troisième partie expose l’expérience et les questions soulevées par la mise en œuvre de ce programme dans le cadre d’un réseau de recherche clinique centré sur les pratiques, du recueil des données jusqu’à l’analyse des processus et mécanismes de changement, et les résultats qui en sont issus. La quatrième partie présente une revue détaillée de la littérature. Ce travail devrait favoriser les collaborations avec les disciplines connexes et l’efficience des traitements par une meilleure connaissance des conditions et des mécanismes de changement associée au développement d’une base de données issue d’études de cas.
The literature on psychotherapy research makes use of the so-called "Dodo Bird Verdict" to show that therapeutic change owes more to common factors than to specific techniques. According to the bulk of the empirical literature , common factors explain 30-70% of therapy outcome variance, while specific factors account for between 5% and 15%. This formulation is based on the assumption that common and specific factors are independent of each other. The present study uses a systematic review of the literature to empirically demonstrate that common and specific factors of change are actually correlated. In other words, the prevalent practice in the literature of using correlated common and specific factors as independent predictors in classical ANOVA models is both statistically unsound and conceptually distorted. We offer several alternative proposals for a sensible re-evaluation of the Dodo Bird verdict.
This report at 5 years presents the functioning of the Inserm-FFP Network for research based on psychotherapy practices within the framework of the Autism Pole. It describes his methodology focused on the processes of change and its results from the first 50 intensive studies of cases already finalized concerning children and adolescents from 3 to 15 years.
Summary Throughout history, scientists and philosophers have defined disciplines in different ways. An influential tradition is taking the view that disciplines are tools for dealing with real world problems and scientists are not students of some subject matter, but students of problems. Some disciplines can be flexible and more adaptable to the nature of problems, as for example mathematics. Aristotle argued that also physics, biology and psychology can be considered as flexible to the nature and properties of their matter. However, the last century has seen an explosion of scientific specialisations, sometimes as micro-tools for local problems, sometimes as micro academic domains for university administration. The last decades have seen interdisciplinary emergence as a counter-force of problem focused collaborations. This process has seen highly dynamical landscapes of interdisciplinary collaborations, with different degrees from interaction to fusion between disciplines. We explore in a non-formal way the impact of interdisciplinary knowledge on specialised disciplines. We consider the epistemological and pedagogical implications.
It has repeatedly been shown that interacting persons synchronize their affective, physiological, verbal and nonverbal responses, especially when they are engaged in positive interaction. Nonverbal synchrony (assessed by automated measurement of videotaped movements) is a new concept in psychotherapy research, which has been associated with alliance, self-efficacy and outcome. However, there is a lack of knowledge regarding diagnostic differences in nonverbal synchrony. In this study, we investigated diagnosis and movement quantity as predictors of nonverbal synchrony. The naturalistic analysis sample consisted of 173 videotaped sessions of patients with a depressive disorder (N = 68) or an anxiety disorder (N = 25), who were treated with cognitive behavioral therapy at an outpatient clinic in southwest Germany. Therapy videos were routinely collected and nonverbal synchrony was computed using motion energy analysis (MEA). Using multilevel modeling, we first investigated the influence of diagnosis and time of assessment on patient and therapist movement quantity. Second, we predicted nonverbal synchrony by diagnosis and time of assessment, while controlling for patient movement quantity. We found a lower quantity of movement in depressive than in anxious patients. At the beginning of therapy, nonverbal synchrony was lower in dyads with depressive patients, even when controlling for patient movement quantity. At the end of therapy, patients with depression and anxiety no longer differed as nonverbal synchrony increased in depression and decreased in anxiety during the course of therapy. Nonverbal synchrony provides information beyond psychomotor retardation and is discussed with regard to patients' range of affect and attention focus.
Open access: http://psycnet.apa.org/fulltext/2018-23951-001.pdf Abstract: The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face psychotherapy as well as internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using three-level meta- analysis with random-effects restricted maximum-likelihood estimators. The overall alliance- outcome association for face-to-face psychotherapy was r = .278 (95% CIs [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the ESs, and 2% of the 295 ESs indicated negative correlations. The correlation for internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices. Keywords: therapeutic alliance, psychotherapy relationship, working alliance, meta-analysis, psychotherapy outcome, face-to-face therapy, internet-based therapy