Clients' and therapists' parasympathetic interpersonal and intrapersonal regulation dynamics during psychotherapy for depression.

OBJECTIVE: The literature on affective regulation in psychotherapy has traditionally relied on explicit client self-report measures. However, both clients' and therapists' affect fluctuate moment-to-moment during a session, highlighting the need for more implicit and continuous indices to better understand these dynamics. This study examined parasympathetic interpersonal and intrapersonal regulation dynamics between therapists and clients with Major Depressive Disorder during Supportive-Expressive Therapy. METHOD: Data were collected from 52 dyads across five preselected sessions, using the Respiratory Sinus Arrhythmia (RSA) index. We employed a longitudinal Actor-Partner Interdependence Model, with clients self-reporting their functioning level before and after each session, as the moderator. RESULTS: Therapists' RSA at one time point negatively associated with clients' RSA at the next, and vice-versa, indicating interpersonal regulation. Clients' RSA at one time point was positively associated with their RSA at the next, indicating intrapersonal regulation. However, only interpersonal regulation was significantly moderated by clients' pre-to-post session functioning. Specifically, sessions where clients led positive dyadic RSA associations showed greater improvement in clients' functioning than those led by therapists. CONCLUSION: Physiological interpersonal regulation, measured by RSA, may be a catalyst for change in depression treatment. Therapists who are responsive to clients' arousal levels may help clients improve their functioning.

Machine learning uncovers the most robust self-report predictors of relationship quality across 43 longitudinal couples studies.

Given the powerful implications of relationship quality for health and well-being, a central mission of relationship science is explaining why some romantic relationships thrive more than others. This large-scale project used machine learning (i.e., Random Forests) to 1) quantify the extent to which relationship quality is predictable and 2) identify which constructs reliably predict relationship quality. Across 43 dyadic longitudinal datasets from 29 laboratories, the top relationship-specific predictors of relationship quality were perceived-partner commitment, appreciation, sexual satisfaction, perceived-partner satisfaction, and conflict. The top individual-difference predictors were life satisfaction, negative affect, depression, attachment avoidance, and attachment anxiety. Overall, relationship-specific variables predicted up to 45% of variance at baseline, and up to 18% of variance at the end of each study. Individual differences also performed well (21% and 12%, respectively). Actor-reported variables (i.e., own relationship-specific and individual-difference variables) predicted two to four times more variance than partner-reported variables (i.e., the partner's ratings on those variables). Importantly, individual differences and partner reports had no predictive effects beyond actor-reported relationship-specific variables alone. These findings imply that the sum of all individual differences and partner experiences exert their influence on relationship quality via a person's own relationship-specific experiences, and effects due to moderation by individual differences and moderation by partner-reports may be quite small. Finally, relationship-quality change (i.e., increases or decreases in relationship quality over the course of a study) was largely unpredictable from any combination of self-report variables. This collective effort should guide future models of relationships.

Emotional expression and empathy in an online peer support platform.

Online peer groups are a popular channel for mental health support, but the evidence for their effectiveness is mixed. The present study focused on empathy to better identify which supporters' comments regulated seekers' distress. We also explored how seekers' emotions may shape supporters' empathy. Posts (N = 7,646) published on an online peer support platform ("Emotional first aid [ERAN]") were sourced. Supporters' empathy (empathic concern, personal distress, exploration, and interpretation) and seekers' emotional expressions (soft negative, hard negative, and positive) were coded. We hypothesized that (1) empathic concern, exploration, and interpretation (but not personal distress) would predict better seekers' emotions (lower negative emotions and greater positive ones); (2) support seekers' soft negative and positive emotions would predict supporters' empathic concern and cognitive empathy (i.e., exploration and interpretation); but that (3) hard negative emotions would predict supporters' personal distress. A set of cumulative mixed models revealed that empathic concern predicted more seekers' positive emotions. However, cognitive empathy predicted more negative seekers' emotions. Seekers' soft negative emotions predicted greater expressions of supporters' empathy (of all types). Finally, seekers' positive emotions predicted more supporters' empathic concern and less personal distress, but also predicted less cognitive empathy (i.e., exploration). A secondary analysis found that this pattern of results differed to some extent as a function of the supporters' role as anonymous peers or the professional moderator. These findings suggest that empathy is a key component in online mental support platforms and that it may make online interactions more effective through emotional regulation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The effect of therapists' enactment interventions in promoting vulnerability sharing in emotion focused couple therapy.

OBJECTIVE: The primary purported change process in emotion-focused therapy for couples (EFT-C) involves partners accessing and revealing their underlying vulnerable emotions and responding empathically when their partners disclose their vulnerable emotions. One main intervention to facilitate vulnerability sharing is enactment - guiding partners to interact directly with each other. The objective of the current study was to identify interventions therapists can use to help partners share vulnerability in the context of enactment. The primary hypothesis of this study was that promoting these interventions would lead to more vulnerability expressions during enactments. METHOD: One hundred and five vulnerability enactment events were identified from videod therapy sessions of 33 couples dealing with a significant emotional injury who received 12 sessions of EFT-C. Four therapists' interventions were coded: setting a meaningful systemic context, promoting the revealing partner's emotional engagement, preparing the revealing partner for enactment, and promoting the listening partner's emotional engagement in the enactment. In addition, vulnerability expression was coded. RESULTS: Multilevel regression models showed that two interventions were significantly associated with greater levels of expressed vulnerability: setting a meaningful systemic context, and preparing the revealing partner for enactment. CONCLUSION: These findings suggest that therapists can facilitated vulnerability sharing using specific preparatory interventions.

Facing Change: Using Automated Facial Expression Analysis to Examine Emotional Flexibility in the Treatment of Depression.

OBJECTIVE: Depression involves deficits in emotional flexibility. To date, the varied and dynamic nature of emotional processes during therapy has mostly been measured at discrete time intervals using clients' subjective reports. Because emotions tend to fluctuate and change from moment to moment, the understanding of emotional processes in the treatment of depression depends to a great extent on the existence of sensitive, continuous, and objectively codified measures of emotional expression. In this observational study, we used computerized measures to analyze high-resolution time-series facial expression data as well as self-reports to examine the association between emotional flexibility and depressive symptoms at the client as well as at the session levels. METHOD: Video recordings from 283 therapy sessions of 58 clients who underwent 16 sessions of manualized psychodynamic psychotherapy for depression were analyzed. Data was collected as part of routine practice in a university clinic that provides treatments to the community. Emotional flexibility was measured in each session using an automated facial expression emotion recognition system. The clients' depression level was assessed at the beginning of each session using the Beck Depression Inventory-II (Beck et al., 1996). RESULTS: Higher emotional flexibility was associated with lower depressive symptoms at the treatment as well as at the session levels. CONCLUSION: These findings highlight the centrality of emotional flexibility both as a trait-like as well as a state-like characteristic of depression. The results also demonstrate the usefulness of computerized measures to capture key emotional processes in the treatment of depression at a high scale and specificity.

Capitalisation, motivational effectiveness, and regulatory mode: a daily diary study of romantic partners.

Positive events play an essential role in people's wellbeing. Capitalisation - disclosing such events to others - bolsters such salutary effects. To understand capitalisation-related motivational processes in romantic partners' daily lives, we adopted Higgins' motivational perspective; namely, that people's primary motivation is to feel effective with respect to Value (achieving the desired outcome), Truth (understanding what is true), and Control (managing what happens). We were particularly interested in clarifying how these aspects of effectiveness are reflected in people's daily positive experiences, their partners' responses to their disclosure, and the matching between the two. The role of subject's motivational regulatory mode (assessment vs. locomotion) in these processes was also examined. The results of a diary study of 83 couples showed that assessors (those with motivation to engage in critical evaluation) characterised their positive experiences as high on truth effectiveness but reported greater benefits from partner's responses focusing on control effectiveness. Locomotors (those with motivation to initiate action) were more likely to characterise their positive experiences as high on control effectiveness, but reported greater benefit from partner's responses focusing on value effectiveness. Finally, response mismatching, in particular an "under-focused" response (partner's response effectiveness focus < recipient's event-related motivational effectiveness focus) was rated as less beneficial.

Oxytocin reactivity to the therapeutic encounter as a biomarker of change in the treatment of depression.

Depression affects millions worldwide, thus underscoring the urgent need to optimize health care practices. To better understand the processes involved in psychotherapy gains, studies have emphasized the need to complement subjective reports with objective measures, in particular biological markers. Oxytocin (OT) has been proposed as a potential biomarker in the treatment of depression given its involvement in depression-related psychological and physiological functions and the formation of close relationships. Here, we assessed whether OT reactivity to therapeutic encounters (absolute and/or directional reactivity) is linked to improvements in depressive symptoms from session to session during psychotherapy. A total of 284 saliva samples were collected from 30 adult clients who underwent 16 sessions of manualized psychodynamic psychotherapy for depression in a university setting. Salivary OT was measured before and after five preselected sessions distributed evenly throughout the therapy. The Beck Depression Inventory-II (BDI-II) was administered at the beginning of each session. Multilevel growth models indicated that clients exhibiting greater absolute OT reactivity showed greater improvement in depressive symptoms throughout treatment. Directional reactivity was not associated with depressive symptom change. In addition, clients with higher baseline OT levels displayed less change in depressive symptoms. These findings highlight reactivity of the OT system, in either direction, as an important feature of the treatment response. Consistent with recent models of the neurobiology of resilience, OT reactivity appears to serve as an important biomarker of psychotherapy gain in the treatment of depression. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Couples Therapists' Attitudes Toward Online Therapy During the COVID-19 Crisis.

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.

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.

Attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents.

This pilot open trial examined the efficacy of attachment-based family therapy (ABFT) for Israeli sexual and gender minority (SGM) young adults and their persistently nonaccepting parents. Thirty families received up to 26 weeks of treatment, with parental rejection, parental acceptance, and young adults' attachment avoidance and attachment anxiety assessed at baseline, 8, 16, 24, and 36 weeks (three months post-treatment). Analyses using multilevel growth models revealed that both young adults and their mothers independently reported increases in mothers' acceptance of their young adult's same-sex orientation or noncisgender identity. In addition, young adults reported decreases in both parents' levels of rejection. Also, mothers, but not fathers, reported decreases in their own level of rejection. Finally, young adults reported a decrease in attachment avoidance in their relationships with both mothers and fathers, but not a decrease in attachment anxiety. Importantly, these treatment gains were maintained three months after the end of treatment. Together, these results suggest that ABFT-SGM, a manualized, affirmative, experiential, family-based treatment, may be effective in reducing long-standing parental rejection, promoting parental acceptance, and improving the quality of LGBTQ+ young adults' relationships with their parents. These findings are encouraging in light of the urgent need for efficacious interventions to reduce family generated minority stress and promote safer, more supportive environments for sexual and gender minority people.

Physiological activation and co-activation in an imagery-based treatment for test anxiety.

Objective: The effectiveness of Imagery Rescripting (IR) has been demonstrated in the treatment of various psychological disorders, but the mechanisms underlying it remain unclear. While current investigations predominantly refer to memory processes, physiological processes have received less attention. The main aim of this study is to test whether client physiological activation (i.e., arousal) and client-therapist physiological activation (i.e., synchrony) during IR segments predicted improvement on next-session outcomes and overall treatment response, and to compare these to the role of physiological (co)-activation during traditional cognitive-behavioral (CB) segments. Methods: The results are based on 177 therapy sessions from an imagery-based treatment for test anxiety with 60 clients. Client and therapist electrodermal activity was continuously monitored, next-session outcome was assessed with the Outcome Rating Scale and treatment outcome was assessed using the Test Anxiety Inventory. Results: Hierarchical linear models demonstrated that average physiological synchrony during IR segments (but not during CB ones) was significantly associated with higher well-being at both the session and the overall treatment levels. Clients' physiological arousal in either IR or CB segments was not predictive of either outcome. Conclusion: These results provide initial evidence for the idea that physiological synchrony might be an important underlying mechanism in IR.

Client-therapist congruence in session-helpfulness ratings and its association with therapy outcomes.

Objective: The present study aimed to explore client-therapist congruence in helpfulness evaluations session-by-session and its association with therapy outcomes. As suggested by West and Kenny's truth and bias model, we constructed congruence as both temporal congruence (i.e., the correlation between therapists' and clients' helpfulness judgments over time) and directional discrepancy (i.e., the average difference between therapists' and clients' helpfulness judgments).Method: Seventy-eight clients were treated by 22 experienced therapists within a 12-session course of integrative psychotherapy. At the end of each session, clients and therapists rated their perceptions of session helpfulness and, at the beginning of the next session, clients rated their own psychological functioning.Results: Therapists' and clients' helpfulness judgments were temporally congruent across treatment, and therapists' judgments were lower than those of their clients. Moreover, we found that therapists' negative directional discrepancy, but not temporal congruence, was associated with improvement in clients' psychological functioning as well as with clients' global treatment evaluations.Conclusion: Our results highlight the importance of therapists' vigilant assessment of session helpfulness in a course of brief integrative psychotherapy. As such, they strengthen the importance of further research regarding client-therapist congruence (in different aspects of the therapeutic process) and its association with therapy outcomes.Clinical or methodological significance of this article In this study, we found that therapists' tendency to provide lower session-helpfulness assessments than did their clients was associated with better therapeutic outcomes. These results may highlight the importance of therapists' cautious and humble stance when assessing their perception of session helpfulness across treatment.

Physiological and social synchrony as markers of PTSD and resilience following chronic early trauma.

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.

Narrative Reconstruction as an Intervention for Posttraumatic Stress Disorder: A Pilot Delayed Intervention Quasi-Randomized Controlled Trial.

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.

Accuracy and Bias in Vulnerability Perceptions of Partners Undergoing Emotion-Focused Therapy for Couples.

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.

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.

Within and between associations of nonverbal synchrony in relation to Grawe's general mechanisms of change.

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.

Interpersonal Counseling for College Students: Pilot Feasibility and Acceptability Study.

OBJECTIVE: University counseling centers struggle to meet the growing demand for mental health treatment by students in distress. More acutely distressed students typically receive priority, whereas those with mild to moderate depression often face longer wait times and fewer available therapy sessions. For this reason, interpersonal counseling for college students (IPC-C) was created as a brief manualized psychotherapy, suitable for students with mild to moderate depression, that maintains the core components of interpersonal counseling and integrates components from interpersonal psychotherapy for adolescents and other developmentally appropriate techniques. This article describes a pilot trial of IPC-C. METHODS: IPC-C is delivered in three to six psychotherapy sessions focused on alleviating depressive symptoms and increasing social support. Ten participants from two university counseling centers were recruited to receive IPC-C. The inclusion criterion was a Patient Health Questionnaire-9 (PHQ-9) score of 5-14, indicating mild to moderate depression. Participants completed the PHQ-9 at each session, the College Adjustment Test at baseline and termination, and the IPC Satisfaction Scale at termination. RESULTS: Nine of the 10 participants completed the study, attending an average of five therapy sessions each. Participants agreed that the number of sessions was appropriate and indicated satisfaction with the IPC-C intervention. Participants exhibited significantly reduced depression severity (Cohen's d=2.45) and significantly improved college adjustment (d=0.92). CONCLUSIONS: In this pilot trial, IPC-C was found to be a feasible and acceptable intervention for university-based treatment of young adults with mild to moderate depressive symptoms. IPC-C holds promise as a potentially effective intervention for this population and warrants further study in a randomized trial.

Interpersonal Counseling for College Students: Pilot Feasibility and Acceptability Study.

OBJECTIVE: University counseling centers struggle to meet the growing demand for mental health treatment by students in distress. More acutely distressed students typically receive priority, whereas those with mild to moderate depression often face longer wait times and fewer available therapy sessions. For this reason, interpersonal counseling for college students (IPC-C) was created as a brief manualized psychotherapy, suitable for students with mild to moderate depression, that maintains the core components of interpersonal counseling and integrates components from interpersonal psychotherapy for adolescents and other developmentally appropriate techniques. This article describes a pilot trial of IPC-C. METHODS: IPC-C is delivered in three to six psychotherapy sessions focused on alleviating depressive symptoms and increasing social support. Ten participants from two university counseling centers were recruited to receive IPC-C. The inclusion criterion was a Patient Health Questionnaire-9 (PHQ-9) score of 5-14, indicating mild to moderate depression. Participants completed the PHQ-9 at each session, the College Adjustment Test at baseline and termination, and the IPC Satisfaction Scale at termination. RESULTS: Nine of the 10 participants completed the study, attending an average of five therapy sessions each. Participants agreed that the number of sessions was appropriate and indicated satisfaction with the IPC-C intervention. Participants exhibited significantly reduced depression severity (Cohen's d=2.45) and significantly improved college adjustment (d=0.92). CONCLUSIONS: In this pilot trial, IPC-C was found to be a feasible and acceptable intervention for university-based treatment of young adults with mild to moderate depressive symptoms. IPC-C holds promise as a potentially effective intervention for this population and warrants further study in a randomized trial.

Emotional processing in attachment-based family therapy for suicidal adolescents.

Objective: This study examined proposed sequential pathways through which suicidal adolescents are thought to shift from secondary global distress and rejecting anger to primary adaptive hurt, grief and assertive anger in the context of attachment-based family therapy (ABFT). Method: Participants were 39 suicidal adolescents who had received 16 weeks of ABFT as part of a randomized clinical trial, and who had been assigned to one of three outcome groups (i.e., good responders, slow responders and non-responders). Adolescents' in-session emotions were observationally coded using the Classification of Affective-Meaning States. Results: Across outcome groups, adolescents evidenced shifts from global distress to maladaptive shame, from maladaptive rejecting anger to adaptive assertive anger, and from adaptive assertive anger to adaptive grief/hurt. Adolescents who did not respond to treatment evidenced higher rates of maladaptive global distress. Conclusions: Findings are discussed in the context of ABFT and sequential emotional processing theories.

Intrapersonal and interpersonal emotional networks and their associations with treatment outcome.

In this study, we used multilevel vector autoregressive network analysis to examine clients' intrapersonal and client-therapist interpersonal emotional dynamics from session to session. We expected to find differences in the network structure (i.e., the density) of responders versus nonresponders to treatment. The sample comprised 95 clients treated by 58 therapists in a university clinic. Clients and therapists self-reported their emotions after each session. The functioning level was assessed at the beginning of each session using clients' self-reports. The results indicated that higher intrapersonal density among clients' emotions within the temporal network (associations from session to session) was associated with less improvement in functioning, but higher intrapersonal density among clients' emotions within the contemporaneous network (same-session associations) was not associated with clients' functioning level. Additionally, higher interpersonal density among clients'-therapists' emotions within the contemporaneous network was associated with greater improvement in clients' functioning. These findings highlight the importance of recognizing the dynamic nature of emotions within the client, as well as between the client and the therapist and the contribution of such session-by-session emotional dynamics to the outcome of psychotherapy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Therapists' interventions as a predictor of clients' emotional experience, self-understanding, and treatment outcomes.

Clients' emotional experience (EE) and self-understanding (SU) are two clients' processes thought to play a key role in many therapeutic approaches, especially psychodynamic (PD) psychotherapy. Previous studies exploring client processes and the interventions assumed to promote them have found that both processes and interventions are related to a reduction in symptoms. However, the complex associations between the use of specific interventions, clients' processes and symptomatic outcomes have rarely been investigated. Using data collected on a session-by-session basis, we explored (a) the temporal associations between clients' processes (EE and SU) and treatment outcomes (clients' level of functioning), (b) the associations between therapists' AF and PD interventions and clients' processes, and (c) the direct and indirect associations among therapists' interventions, clients' processes, and clients' functioning. Clients (N = 115) undergoing PD psychotherapy reported their general functioning presession using the Outcome Rating Scale, and their EE and SU postsession using the Emotional Experience Self-Report and Self-Understanding Scale, respectively. Therapists reported their use of interventions postsession using the Multitheoretical List of Interventions. Longitudinal multilevel models indicated that higher EE and SU scores predicted subsequent change in functioning. Moderate (vs. high or low) use of AF interventions predicted an increase in clients' EE. Greater use of PD interventions predicted an increase in clients' SU, which also mediated improvement in functioning. These findings highlight the importance of adjusting therapists' use of interventions to promote clients' therapeutic processes and outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).