Vulnerabilities in social anxiety: Integrating intra- and interpersonal perspectives.

What are the major vulnerabilities in people with social anxiety? What are the most promising directions for translational research pertaining to this condition? The present paper provides an integrative summary of basic and applied translational research on social anxiety, emphasizing vulnerability factors. It is divided into two subsections: intrapersonal and interpersonal. The intrapersonal section synthesizes research relating to (a) self-representations and self-referential processes; (b) emotions and their regulation; and (c) cognitive biases: attention, interpretation and judgment, and memory. The interpersonal section summarizes findings regarding the systems of (a) approach and avoidance, (b) affiliation and social rank, and their implications for interpersonal impairments. Our review suggests that the science of social anxiety and, more generally, psychopathology may be advanced by examining processes and their underlying content within broad psychological systems. Increased interaction between basic and applied researchers to diversify and elaborate different perspectives on social anxiety is necessary for progress.

Improved CAR-T cell activity associated with increased mitochondrial function primed by galactose.

CD19 CAR-T cells have led to durable remissions in patients with refractory B-cell malignancies; nevertheless, most patients eventually relapse in the long term. Many interventions aimed at improving current products have been reported, with a subset of them focusing on a direct or indirect link to the metabolic state of the CAR-T cells. We assessed clinical products from an ongoing clinical trial utilizing CD19-28z CAR-T cells from patients with acute lymphoblastic leukemia. CAR-T clinical products leading to a complete response had significantly higher mitochondrial function (by oxygen consumption rate) irrespective of mitochondrial content. Next, we replaced the carbon source of the media from glucose to galactose to impact cellular metabolism. Galactose-containing media increased mitochondrial activity in CAR-T cells, and improved in vitro efficacy, without any consistent phenotypic change in memory profile. Finally, CAR-T cells produced in galactose-based glucose-free media resulted in increased mitochondrial activity. Using an in vivo model of Nalm6 injected mice, galactose-primed CAR-T cells significantly improved leukemia-free survival compared to standard glucose-cultured CAR-T cells. Our results prove the significance of mitochondrial metabolism on CAR-T cell efficacy and suggest a translational pathway to improve clinical products.

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.

Therapists' oxytocin response mediates the association between patients' negative emotions and psychotherapy outcomes.

BACKGROUND: Existing literature suggests that patients' experiences of emotions, especially negative emotions, predict outcomes in psychotherapies for major depressive disorder. However, the specific mechanisms underlying this effect remain unclear. Based on studies pointing to the role of oxytocin (OT) in attachment relationships, we proposed and tested a mediation model where the therapists' hormonal responses, as represented by increases in their OT levels, mediates the association between negative emotions and symptomatic change. METHOD: OT saliva samples (pre- and post-session, N = 435) were collected on a fixed schedule over 16 sessions from the therapists of 62 patients receiving psychotherapy for major depression. The Hamilton Rating Scale for Depression was administered to the patients before the sessions, and the patients reported their in-session emotions after the sessions. RESULTS: The findings support the proposed within-person mediation model: (a) higher levels of negative emotions in patients predicted greater increases in therapist OT levels pre- to post-session throughout treatment; (b) greater OT levels in therapists, in turn, predicted reduction in patients' depressive symptoms on the subsequent assessment; and (c) the therapists' OT levels significantly mediated the association between patients' negative emotions and reduction in their depressive symptoms. LIMITATIONS: This design precluded establishing a time sequence between patients' negative emotions and therapists' OT; thus, causality could not be inferred. CONCLUSION: These findings point to a possible biological mechanism underlying the effects of patients' experiences of negative emotions on treatment outcomes. The findings suggest that therapists' OT responses could potentially serve as a biomarker of an effective therapeutic processes.

Emotion-focused skills training for parents with anxious children. A pilot study.

Anxiety disorders are common among children and adolescents. Effective treatments exist, but meta-analyses indicate that 40% of children continue to have significant symptoms posttreatment. Alternative therapeutic interventions are needed. Emotion-focused parental interventions have been found to be effective in targeting children's internalizing difficulties, but no research has examined remission. In this pilot trial, we examined whether Emotion Focused Skills Training (EFST) was associated with remission of diagnosis in children with anxiety. Nine 8-14-year-olds diagnosed with anxiety were recruited at a mental health clinic in Norway. Both parents of each child attended a 2-day EFST program followed by five 1-hour weekly sessions. Pre- and posttreatment diagnosis and severity were evaluated using a multiinformant approach using the Spence Children's Anxiety Scale and the Anxiety Disorders Interview Schedule. After treatment, 33% no longer met criteria for any anxiety diagnosis, 66% obtained remission from their primary anxiety diagnosis, and 89% from at least one.

Multisystem physiological reactivity during help-seeking for attachment needs in school-aged children: differences as a function of attachment.

In this study, we sought to expand on what is currently known regarding autonomic nervous system (ANS) reactivity in middle childhood as a function of attachment. ANS activity includes multiple indices - respiratory sinus arrhythmia (RSA) is an index of parasympathetic nervous system activation (PNS) and electrodermal activity (EDA) is an index of sympathetic nervous system activation (SNS). Children (N = 103) completed Child Attachment Interviews and read vignettes describing situations aimed to activate attachment needs (NEED; e.g., getting hurt, which can elicit need for comfort or assistance) and help-seeking (HS; when children experience need and seek comfort from attachment figures), while SNS and PNS reactivity were monitored. Attachment was not associated with children's SNS or PNS reactivity during NEED, but attachment was associated with physiological reactivity during HS: Dismissing attachment was associated with greater SNS activation (higher EDA) and preoccupied attachment with PNS deactivation (lower RSA, greater vagal withdrawal) during HS.

The multifaceted role of empathy in the transmission of postpartum depressive symptoms between parents.

Postpartum depression is a common challenge faced by mothers and fathers and can be transmitted between them. Despite the well-documented adverse effects of postpartum depressive symptoms (PPDS) on parents and children, not much is known about risk factors pertaining to the transmission of PPDS between parents. Guided by The Social Functions of Emotions theory, the current study tested the moderating effects of different forms of empathy, including perspective-taking, empathic concern, and personal distress on the transmission of PPDS between parents. Pairs of first-time Israeli parents (N = 105) completed self-report questionnaires assessing emotional (personal distress and empathic concern) and cognitive (perspective-taking) empathy during the third trimester and PPDS at three and six months postpartum. The results showed that in both parents, greater PPDS at 6 months were predicted by one's own greater personal distress. Also, lower perspective-taking and greater empathic concern of fathers predicted their own PPDS. Furthermore, the associations of PPDS at 3 months with PPDS at 6 months between parents occurred when fathers reported lower levels of personal distress and when mothers reported greater perspective-taking. Also, when mothers were lower in perspective-taking, greater PPDS at 3 months in fathers predicted lower levels of PPDS in mothers at 6 months. The study reflects the multifaceted role of empathy in the development of PPDS in new parents and highlights the potentially adverse effects of emotional and cognitive empathy on the development of PPDS in parents.

Effectiveness of emotion focused skills training for parents: study protocol for a randomized controlled trial in specialist mental health care.

BACKGROUND: Emotion-Focused Skills Training (EFST) is a newly developed manualized skill training program for parents to strengthen emotional bonds between parents and children and improve mental health outcomes in children. Results from several preliminary trials indicate that EFST can be quite effective, but more rigorous methods are needed to affirm the evidence of the program. The primary objective of this study is to compare the effectiveness of EFST to treatment as usual (TAU) in a Norwegian outpatient clinic for child and adolescent mental health. Additionally, the study will examine the basic theoretical assumption underlying EFST that increased parental emotional functioning predicts a decline in children's mental health symptoms.  METHOD : 120 patients will be randomly assigned to either EFST or TAU. The main outcome measure is the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia, present and lifetime version (K-SADS-PL) scored by trained assessors administered at pretreatment and repeated after 3 months. The secondary outcome measure is the DSM-IV version of the Strength and Difficulties Questionnaire (SDQ) administered at pretreatment as well as 3, 6, and 12 months after the intervention. To examine the efficacy question, effect sizes and reliable change for each of the treatment arms will be assessed as well as symptom differences between the conditions. To examine the second aim of the study, we will examine (1) how parents relate to emotions in their children assessed by the Emotion-Related Parenting Styles (ERPS), (2) the parents' emotion regulation capacity assessed by the Difficulties in Emotion Regulation Scale, short-form (DERS-SF), and (3) parents' sense of self-efficacy and the strength of their relationship with the child will be assessed by the relationship with child scale (RWC) of the systemic inventory of change. DISCUSSION: This study will provide insights into the effectiveness of EFST in improving children's mental health and the mechanisms of change responsible for the program's effectiveness. Impotently, this study may provide information regarding whether children's mental health issues can be alleviated through therapeutic work provided to the parents alone. TRIAL REGISTRATION: Clinical trials.gov Identifier: NCT04885036 . First Posted on May 13, 2021. TRIAL STATUS: In recruitment.

Potential processes of change in MDMA-Assisted therapy for social anxiety disorder: Enhanced memory reconsolidation, self-transcendence, and therapeutic relationships.

OBJECTIVE: Researchers have suggested that psychotherapy may be enhanced by the addition of 3,4-methylenedioxymethamphetamine (MDMA), particularly in the treatment of disorders wherein interpersonal dysfunction is central, such as social anxiety disorder. We review literature pertaining to three potential processes of change that may be instigated during sessions involving MDMA administration in the treatment of social anxiety disorder. DESIGN: This is a narrative review that integrates research on the etiology and maintenance of social anxiety disorder and mechanisms of action of MDMA to examine how MDMA may enhance psychotherapy outcomes. RESULTS: We first outline how MDMA may enhance memory reconsolidation in social anxiety disorder. We then discuss how MDMA may induce experiences of self-transcendence and self-transcendent emotions such as compassion, love, and awe; and how these experiences may be therapeutic in the context of social anxiety disorder. We subsequently discuss the possibility that MDMA may enhance the strength and effectiveness of the therapeutic relationship which is a robust predictor of outcomes across many disorders as well as a potential key ingredient in treating disorders where shame and social disconnection are central factors. CONCLUSION: We discuss how processes of change may extend beyond the MDMA dosing sessions themselves.

The relationship between therapist interventions and couples' emotional injury resolution in emotion focused couples therapy.

The primary purported change process in emotion-focused couples therapy (EFT-C) occurs as therapists assist one partner to access and reveal vulnerable emotions and needs and promotes a subsequent compassionate responding from the other partner. This study aimed to examine the association between therapists' views regarding their interventions during a given session and the degree to which partners reported the session as helpful in resolving their unfinished business. Data from 22 couples who took part in the York Emotional Injury Project and received 10-12 EFT-C sessions were analyzed using multilevel models. The primary findings revealed that when therapists reported using interventions that promoted acceptance of feelings and needs in a given session, both partners reported higher resolution levels in relation to their partner. Our results suggest that interventions that facilitate responsiveness between partners are particularly important in EFT-C, and perhaps in couples therapy in general.

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.

Cohort data on divorce among first, second and higher order marriages in Norway 1981 until 2013.

This article present prospective data on all Norwegian two sex-marriages that was formed from 1981 to 2013, all together more than 770 000 marriages, with yearly follow up for until 32 years. Four different categories of marriages and remarriages were investigated: First time for both spouses, first time for one and second time for the other, second time for both, and third time or more for at least one in the couple. The data stems from a special order from Statistics Norway and marriages formed within one calendar year are combined to cohorts where each couple were checked for each successive year if the same two individuals were still married to each other. The data holds the original population for each of the 33 cohorts and number of divorced couples for each year of follow up.

Investigating patient-specific mechanisms of change in SET vs. EFT for depression: study protocol for a mechanistic randomized controlled trial.

BACKGROUND: Major depressive disorder (MDD) is the leading cause of disability worldwide and one of the most heterogeneous mental health disorders. Although there are effective treatments for MDD, about 50% of patients do not respond to treatment. One of the greatest challenges in improving current treatments is identifying the mechanisms responsible for therapeutic change in MDD. The proposed study aims to identify patient-specific mechanisms of change in two treatments for MDD by investigating whether subpopulations of patients differ in the mechanisms of change that operate when receiving a given treatment. Based on theories of targeting weakness and building on strength, we will examine whether the mechanism of change operating when a treatment is provided depends on whether the treatment targets the patient's strength or weakness. METHOD: To test our hypothesis that two treatments, supportive-expressive treatment (SET) and emotion-focused treatment (EFT), differ in their mechanisms of change and to explore whether focusing on the patient's strength or weakness will result in better treatment outcome, we conduct a mechanistic randomized controlled trial. One hundred and twenty-four individuals diagnosed with MDD are randomized to 16 sessions of either SET or EFT. The two treatments are theorized to differ in their main mechanism of change: SET places emphasis on insight as its main mechanism of change, and EFT places emphasis on emotional processing. Both can serve as strength- or weakness-focused treatments, based on the patient's baseline levels of insight and emotional processing. The primary outcome is the Hamilton Rating Scale for Depression. Additional measures include self-report measures and clinical interviews, hormonal, motion, acoustic, physiological, and neuroimaging assessments, performance on cognitive tasks, and narrative material (collected from the sessions and interviews). DISCUSSION: The RCT will expand our understanding of mechanisms of change in psychotherapy, from one-size-fits-all to patient-specific mechanisms of change. By informing therapists about which of the two approaches is most effective with patients based on their baseline characteristics, the RCT will contribute to progress toward personalized treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT04576182 submitted on October 1st 2020. FUNDING: The Israel Science Foundation. Trial status: Recruitment is ongoing.

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.

New Developments in Emotion-Focused Therapy for Social Anxiety Disorder.

Social anxiety disorder (SAD) is a highly complex, chronic, disabling and costly anxiety disorder. Although cognitive-behavioral therapy (CBT) is effective for many patients, many others do not respond to CBT or remain considerably symptomatic at the end of treatment. Pharmacological effects are also modest. More empirically-supported treatment options are needed in order to increase patient access to effective treatment. Emotion-focused therapy (EFT) shows great promise in treating SAD effectively and is particularly suitable for treating SAD because pervasive emotional avoidance, difficulties with emotional differentiation, and high levels of self-criticism, which are central psychopathological processes in SAD, are also primary therapeutic targets in EFT. EFT is based on the assumption that the most efficient way to change a maladaptive emotion is not through reason or skill learning, but through the activation of other, more adaptive emotions. EFT aims to access shame-based emotional memories that underlie SAD, and transform them by exposing them to new adaptive emotional experiences, such as empowering assertive anger, grief, and self-compassion. In this paper, the core features of EFT for SAD are presented, as well as the EFT view of dysfunction in SAD and EFT change processes. Research findings regarding the effectiveness of EFT for SAD are presented together with initial findings regarding mechanisms of change occurring during treatment.

Exploring the process of change in emotion-focused therapy for social anxiety.

Objective: This study examined purported change mechanisms in emotion-focused therapy for social anxiety disorder. Methods: The sample included nine clients who had participated in a multiple-baseline case study trial examining the efficacy of emotion-focused therapy for social anxiety disorder (SAD). Multilevel analyses were conducted to examine the trajectories of emotions over the course of treatment, and whether primary adaptive emotions in a given session predicted levels of SAD symptoms, self-criticism, and self-reassurance over the course of the following week. Results: Findings showed a significant decrease in shame, and a marginally significant increase in assertive anger, over the course of treatment. Adaptive sadness/grief in a given session predicted less fear of negative evaluation over the course of the following week. Shame in a given session predicted higher levels of inadequate-self over the course of the following week. Finally, shame, and to a lesser degree assertive anger, in a given session predicted reassurance of self over the course of the following week. Neither assertive anger nor adaptive sadness/grief in a given session predicted levels of self-criticism over the course of the following week. Conclusions: These findings lend partial preliminary support for the therapeutic role of evoking and processing adaptive sadness/grief and assertive anger in the treatment of SAD.

The Factor Structure of the Forms of Self-Criticising/Attacking & Self-Reassuring Scale in Thirteen Distinct Populations.

There is considerable evidence that self-criticism plays a major role in the vulnerability to and recovery from psychopathology. Methods to measure this process, and its change over time, are therefore important for research in psychopathology and well-being. This study examined the factor structure of a widely used measure, the Forms of Self-Criticising/Attacking & Self-Reassuring Scale in thirteen nonclinical samples (N = 7510) from twelve different countries: Australia (N = 319), Canada (N = 383), Switzerland (N = 230), Israel (N = 476), Italy (N = 389), Japan (N = 264), the Netherlands (N = 360), Portugal (N = 764), Slovakia (N = 1326), Taiwan (N = 417), the United Kingdom 1 (N = 1570), the United Kingdom 2 (N = 883), and USA (N = 331). This study used more advanced analyses than prior reports: a bifactor item-response theory model, a two-tier item-response theory model, and a non-parametric item-response theory (Mokken) scale analysis. Although the original three-factor solution for the FSCRS (distinguishing between Inadequate-Self, Hated-Self, and Reassured-Self) had an acceptable fit, two-tier models, with two general factors (Self-criticism and Self-reassurance) demonstrated the best fit across all samples. This study provides preliminary evidence suggesting that this two-factor structure can be used in a range of nonclinical contexts across countries and cultures. Inadequate-Self and Hated-Self might not by distinct factors in nonclinical samples. Future work may benefit from distinguishing between self-correction versus shame-based self-criticism.

The Development of the Working Alliance and Its Ability to Predict Outcome in Emotion-Focused Therapy for Social Anxiety Disorder.

The study focuses on the alliance of 12 patients receiving emotion-focused therapy for social anxiety. Anxiety symptoms and patient perception of the working alliance were examined weekly. The first eight sessions of each patient were coded for within- and between-sessions alliance levels (1008 segments were coded). At the sample level, the alliance shows linear development over time but high variability between individuals. More than half the patients showed alliance development consistent with the rupture-resolution pattern. Without accounting for the temporal relationship between alliance and symptoms, alliance significantly predicted symptoms across treatment. When we accounted for the temporal relationship between alliance and symptoms, we found that symptoms can predict alliance but alliance cannot predict symptoms. We obtained the same findings using patient-rated and coded alliance.

Attachment-based family therapy and individual emotion-focused therapy for unresolved anger: Qualitative analysis of treatment outcomes and change processes.

Twenty-six clients who received 10 sessions of either attachment-based family therapy (ABFT) or individual emotion-focused therapy (EFT) for unresolved anger toward a parent were interviewed 6 months after completing treatment. Interviews were analyzed using the consensual qualitative research approach. Clients in both conditions reported improved relationships with parents, gaining a new perspective of their parent, increased compassion toward parent, less reactivity to anger, feeling cleaned-out, and acquiring new coping strategies. Whereas ABFT clients more often reported improved relationships with parents, EFT clients more often reported feeling cleaned-out. Clients in both groups attributed change to productive emotional processing. Also, clients in both groups attributed change to saying difficult things that had never been said before directly to parents, though more so in ABFT. Whereas ABFT clients noted the importance of their parents participating in treatment and mutual vulnerability, EFT clients noted the importance of remembering previously avoided memories and feelings, and getting their anger of their chest. While some EFT clients reported that therapy had a negative impact on their relationship with their parents and increased their anger, some ABFT clients reported that the positive impact of therapy during the active phase of treatment did not last, though there were no meaningful between-groups differences regarding these negative treatment outcomes and processes. Results are discussed in the context of previous quantitative findings from the same sample, and in the context of prior research on experiential and emotion-focused therapies. Implications for future research are noted. (PsycINFO Database Record