Physiological synchronization and innovative moments in psychotherapy: A single-case study of micro-process.

OBJECTIVE: Interpersonal synchronization is increasingly studied as a biomarker of empathy, therapeutic alliance, and treatment outcome. However, most studies average data over sessions, leaving associations between synchrony and actual interactions largely unexplored. We aim to showcase a novel approach examining synchronization during specific micro-processes: Innovative Moments (IM) as markers of exceptions to clients' problematic patterns of meaning. METHODS: Electrodermal activity was recorded over 15 sessions of a psychodynamic psychotherapy single case. Moment-to-moment patient-therapist synchrony was calculated using the Adaptive Matching Interpolated Correlations (AMICo) algorithm. The Innovative Moments Coding System was utilized to identify IMs within session transcripts with precise timing. Monte-Carlo permutation tests were conducted to examine the association between physiological synchrony and IM Levels of increasing complexity (Levels 1-3). RESULTS: Higher-than-random synchronization emerged during Level 3 IMs (p = 0.046; d = 0.21) but not in lower Levels. Post-hoc qualitative analyses linked high synchrony to sub-processes of Level 3 IMs, such as positive contrasts and attributions for change. CONCLUSION: Our findings show it is possible to link moment-by-moment physiological co-regulation to theoretically identified meaning-making processes. While generalization of these observations is undue, this work demonstrates a robust and promising application of a multimodal approach to investigating psychotherapy, providing insights into both the clinical case and the theoretical model adopted.

Affective Saturation Index: A Lexical Measure of Affect.

Affect plays a major role in the individual's daily life, driving the sensemaking of experience, psychopathological conditions, social representations of phenomena, and ways of coping with others. The characteristics of affect have been traditionally investigated through physiological, self-report, and behavioral measures. The present article proposes a text-based measure to detect affect intensity: the Affective Saturation Index (ASI). The ASI rationale and the conceptualization of affect are overviewed, and an initial validation study on the ASI's convergent and concurrent validity is presented. Forty individuals completed a non-clinical semi-structured interview. For each interview transcript, the ASI was esteemed and compared to the individual's physiological index of propensity to affective arousal (measured by heart rate variability (HRV)); transcript semantic complexity (measured through the Semantic Entropy Index (SEI)); and lexical syntactic complexity (measured through the Flesch-Vacca Index (FVI)). ANOVAs and bi-variate correlations estimated the size of the relationships between indexes and sample characteristics (age, gender), then a set of multiple linear regressions tested the ASI's association with HRV, the SEI, and the FVI. Results support the ASI construct and criteria validity. The ASI proved able to detect affective saturation in interview transcripts (SEI and FVI, adjusted R2 = 0.428 and adjusted R2 = 0.241, respectively) and the way the text's affective saturation reflected the intensity of the individual's affective state (HRV, adjusted R2 = 0.428). In conclusion, although the specificity of the sample (psychology students) limits the findings' generalizability, the ASI provides the chance to use written texts to measure affect in accordance with a dynamic approach, independent of the spatio-temporal setting in which they were produced. In doing so, the ASI provides a way to empower the empirical analysis of fields such as psychotherapy and social group dynamics.

Physiological synchronization in the clinical process: A research primer.

Physiological synchronization is the study of how individuals in interaction coregulate their physiology. The topic has sparked increasing interest in counseling and psychotherapy research, where it has been found to be associated with the therapeutic alliance, clinicians' empathy and patients' outcome. Physiological synchronization allows researcher to investigate subtle but fundamental aspects of the clinical process through objective measures. In this article, we aim to offer a guide to researchers and clinicians to explore this growing field of study. We begin by reviewing the existing literature of physiological synchronization in clinical relationships, and then we provide practical guidelines for research. We discuss the various aspects involved in synchronization studies: study design, selection of physiological signals, data analytic approaches, and interpretation of results. To better illustrate how to implement these types of design, we provide a running example describing the data collection and analysis of a single-case study. In the example we discuss both how to conduct a longitudinal nomothetic analysis, as well as a moment-to-moment idiographic exploration of the clinical content. In this latter analysis, in particular, we show how physiological synchronization can be used in combination with 2 transcripts analysis tools, the Patient Attachment Coding System, and the Therapist Attunement Scales to reach a deeper understanding of the ongoing processes. We conclude by arguing that research in counseling and psychotherapy has much to gain from and contribute to the overall development of our understanding of physiological synchronization in human interaction. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Attachment-security prime effect on skin-conductance synchronization in psychotherapists: An empirical study.

Physiological synchronization (PS) is a phenomenon of simultaneous activity between two persons' physiological signals. It has been associated with empathy, shared affectivity, and efficacious therapeutic relationships. The aim of the present study was to explore the possible connections between PS and the attachment system, seeking preliminary evidence of this link by means of an experimental manipulation of the sense of attachment security in psychotherapists according to a protocol by Mikulincer and Shaver (2001), which has been proven to elicit empathetic behavior. We compared the synchronization of skin-conductance signals in brief psychological interviews between 18 psychodynamic therapists and 18 healthy volunteers. A sense of attachment-security priming was administered to half of the therapists, whereas the other half received a positive-affect control prime. Lag analysis was performed to investigate the "leading" or "following" attitudes of the participants in the two conditions. Mixed-model regressions and evidence-ratio model comparisons were used to investigate the effects of the manipulation on PS. Therapist attachment anxiety and avoidance traits were considered covariates. The attachment-security prime showed a significant effect on PS lag dynamics, but not on overall PS amount. Lag analysis showed that the therapists in the attachment-security condition were significantly more prone to assume a leading attitude in the physiological coupling than the therapists in the control condition. Therapist attachment anxiety and avoidance had no apparent effect. Our result paves the way for further exploration of the clinical relationship from a physiological standpoint. (PsycINFO Database Record

Illness trajectories in patients with amyotrophic lateral sclerosis: How illness progression is related to life narratives and interpersonal relationships.

AIMS AND OBJECTIVES: To identify illness trajectories in amyotrophic lateral sclerosis by analysing personal, social and functional dimensions related to amyotrophic lateral sclerosis progression. BACKGROUND: Previous studies have considered some psychological distinct variables that may moderate illness progression, but no research has combined an extensive qualitative understanding of amyotrophic lateral sclerosis patients' psychological characteristics and illness progression. DESIGN: A mixed-methods approach was used to combine quantitative and qualitative measures. Illness progression was assessed through a longitudinal design. METHODS: Eighteen patients with amyotrophic lateral sclerosis attending a Neurology Department in northern Italy participated in the study. Semi-structured interviews to explore personal experience, and dependency grids to assess the distribution of dependency; ALSFRS-R and neuropsychological screening were, respectively, used to measure physical and cognitive impairment. To assess the progression of the disease, ALSFRS-R was re-administered after 8 months and mortality rate was considered. Data were analysed using the grounded theory approach. RESULTS: Illness progression changed according to the perception of the disease, the trust placed in medical care, self-construction and the distribution of dependency. Based on these categories, cases that had similar experiences were grouped, and four illness trajectories were identified: aggressiveness, threat, constriction and guilt. CONCLUSION: The findings suggest that it is possible to identify different illness trajectories in amyotrophic lateral sclerosis. RELEVANCE TO CLINICAL PRACTICE: Personalised intervention strategies may be construed based on the different trajectories identified.

Meaning making after a near-death experience: The relevance of intrapsychic and interpersonal dynamics.

This study aims to investigate the processes used by individuals to integrate a near-death experience (NDE) and to discuss the use of a meaning-making component to help people who have had such experiences. A psychotherapist interviewed six individuals who reported having had a NDE. Transcripts of the interviews were coded using an interpretative phenomenological analysis. The authors identified intrapsychic and interpersonal dynamics implicated in the individuals' meaning-making processes, and the problems encountered during their integration of the experience. Meaning-based approaches are a feasible theoretical framework for shedding light on the NDE and providing support for people who have lived through them.

Female gender doubles executive dysfunction risk in ALS: a case-control study in 165 patients.

BACKGROUND: Cognitive impairment, mainly characterised by executive dysfunction, occurs in about half of cases in amyotrophic lateral sclerosis (ALS). There is evidence that gender influences some clinical features of the disease, but its influence on the cognitive spectrum is unknown. Our objective was to investigate the impact of gender on cognitive profiles of patients with ALS. METHODS: A retrospective study based on an exhaustive neuropsychological battery was performed in a group of 165 (70 females, 95 males) sporadic, non-demented patients with ALS compared with 134 healthy control participants. This assessment primarily focused on executive, memory and language functions. RESULTS: 47 (29%) patients revealed impairment in executive function and 30 (18%) patients revealed cognitive non-executive impairment. Independent from mood tone and clinical variables, a significantly greater executive impairment was determined in female patients than in male patients and control participants. The relative risk for ALS females having impairment in executive function compared with male patients was 2.6 (95% CI 1.6 to 4.4; p=0.0003). ALS females scored lower in Phonemic Fluency, Trial Making, and Wisconsin Card Sorting test. CONCLUSIONS: Results highlight a significant vulnerability of ALS female patients to develop cognitive dysfunctions peculiar to the disease, independently of bulbar onset. The explicative hypotheses of the data are focused on two interpretative lines not mutually exclusive: the role of gonadal hormones and gender-related brain asymmetry pre-existing to the disease. These findings, never reported before in the literature, can have important implications for models of ALS pathogenesis and for future clinical trial designs.

Reciprocal empathy and working alliance in terminal oncological illness: the crucial role of patients' attachment style.

Security of attachment is described as an inner resource that may also facilitate the adaptation of individuals during critical life adversity, even when facing end-stage illness and death. This study assessed the relation between attachment styles, patient-caregiver reciprocal empathy, and patient-physician working alliance, in the terminal phase of an oncological disease. We hypothesized that the attachment security of patients, as measured by the Relationship Questionnaire (RQ), is related to the reciprocal empathy with the caregiver, as measured by the Perception of Partner Empathy (PPE) questionnaire, and to the working alliance with the physician, as measured by the Working Alliance Inventory-Short Form (WAI-S). Thirty-seven end-stage cancer patients, their caregivers, and physicians participated in the study. The PPE and WAI-S were administered twice: immediately after the hospice recovery and a week later. Results showed a significant improvement in patient-caregiver empathy and in patient-physician alliance after a week at the hospice. Findings indicated that the patients' attachment style influenced their perception of reciprocal empathy with the caregiver and the working alliance with the physician. Patients with a secure attachment had a greater capacity to show empathic closeness with their caregivers and enjoyed a better working alliance with their physicians. Caregivers' attachment security, otherwise, did not show the same influence on empathy and alliance. Findings support the hypothesis that patients' attachment security plays a crucial role in the relation with their own caregiver and with the physician, even at the terminal phase. Theoretical and clinical implications of these findings are explored in the discussion.

Role of narcissism in parental alienation phenomenon. A narrative review.

Parental Alienation Syndrome (PAS) is a term addressed to describe negative, psychopathological feelings, thinking and behaviours, including hostility and fear, exhibited by children who have been alienated from one parent by the other parent. Despite its relevance in the clinical psychology field, theoretical and empirical contributions to understanding and deepening the many facets of this concept are still few. In particular, literature aimed at disentangling the alienating parent's psychological characteristics is scarce and fragmented. Our contribution encompasses a narrative review of scientific literature since the term PAS was coined in 1987 by Gardner, to delineate narcissistic proneness in alienating parents. Namely, considering the narcissistic drift the western society is going toward, we hypothesised that narcissism has a pivotal role in parents' alienating behaviours against the alienated ones. Firstly, the elements that emerged from our literature search confirmed our theoretical hypothesis, in terms of the likely role of narcissism/narcissistic marked traits in alienating parents. In the second section, we contextualised the phenomenon in a psychodynamic/psychoanalytic theoretical framework. Finally, based on previous findings/considerations, the developmental trajectories of children with PAS have been traced. An improved theoretical knowledge of this phenomenon, also in terms of the psychopathology associated with its genesis, means to refine the diagnostic and treatment tools to prevent it.

Somatic underpinnings of perceived empathy: the importance of psychotherapy training.

This study investigated the somatic underpinning of empathy using an interpersonal physiology approach. Thirty-nine dyads were formed by a "pseudo-patient" and a "listener" (a therapist, a psychologist, or a non-therapist). Dyadic physiological concordance in electrodermal responses and listeners' empathy were evaluated during simulations of clinical sessions. A significant positive correlation between empathy as perceived by pseudo-patients and physiological concordance was found, providing empirical evidence of a somatic underpinning of empathy. Moreover, therapists showed higher levels of physiological concordance and empathy, confirming the importance of psychotherapy training in managing clinical interactions.

Parkinson-like features in ALS with predominant upper motor neuron involvement.

Owing to the frequent observation of poverty of movements, facial hypomimia and balance impairment, amyotrophic lateral sclerosis (ALS) variant with predominance of upper motor neuron involvement (UMN-ALS) is prone to be diagnosed with Parkinsonism. A clinical assessment, including the velocity-dependent stretch response test to differentiate between pyramidal and extrapyramidal stiffness; the Unified Parkinson's Disease Rating Scale and the Berg Balance Scale to assess degree of bradykinesia and postural instability; and (123)I-FP-CIT scintigraphy evaluation to investigate the nigrostriatal circuit involvement, were carried out to characterize Parkinson-like features in UMN-ALS patients. Sixteen UMN-ALS patients were included in the study. The velocity-dependent stretch response indicated spasticity in all the muscles tested. The degree of stiffness was found to be related to bradykinesia and postural instability. Eleven patients (70%) showed a reduction in striatal (123)I-FP-CIT uptake found to be related to disease duration and patients' ages but not to scores of the functional scales. Slowness of movements and postural instability noted in our patients could be mostly attributed to spasticity. The lack of any correlation between UPDRS or BBS scores and the degree of nigrostriatal impairment on DaTSCAN seems to disprove nigrostriatal circuit involvement in these extrapyramidal-like features.

Neurological complications in hyperemesis gravidarum.

Hyperemesis gravidarum can impair correct absorption of an adequate amount of thiamine and can cause electrolyte imbalance. This study investigated the neurological complications in a pregnant woman with hyperemesis gravidarum. A 29-year-old pregnant woman was admitted for hyperemesis gravidarum. Besides undernutrition, a neurological examination disclosed weakness with hyporeflexia, ophthalmoparesis, multidirectional nystagmus and optic disks swelling; the patient became rapidly comatose. Brain MRI showed symmetric signal hyperintensity and swelling of periaqueductal area, hypothalamus and mammillary bodies, medial and posterior portions of the thalamus and columns of fornix, consistent with Wernicke encephalopathy (WE). Neurophysiological studies revealed an axonal sensory-motor polyneuropathy, likely due to thiamine deficiency or critical illness polyneuropathy. Sodium and potassium supplementation and parenteral thiamine were administered with improvement of consciousness state in a few days. WE evolved in Korsakoff syndrome. A repeat MRI showed a marked improvement of WE-related alterations and a new hyperintense lesion in the pons, suggestive of central pontine myelinolysis. No sign or symptom due to involvement of the pons was present.

Emotion Regulation in Psychodynamic and Cognitive-Behavioural Therapy: An Integrative Perspective.

Objective: Psychotherapy fragmentation constitutes a significant barrier to progress. In the present article, we argue that emotion regulation processes operate across psychotherapy approaches, serving as an overarching meta-factor of therapeutic change. Method: Two major therapeutic approaches-psychodynamic and cognitive-behavioural-were examined through the lens of emotion regulation theory. In particular, key constructs within each approach were analyzed in terms of relevant emotion regulation processes. Results: Emotion regulation processes are an overarching meta-factor relevant to a wide range of therapeutic constructs (e.g., defence mechanisms, internal working models, coping strategies, ruptures/reparations of alliance). Different clinical traditions emphasize different aspects of emotion regulation, mainly in terms of implicit vs explicit emotion regulation processes. Conclusions: An integrative emotion regulation perspective contributes to our understanding of the core change mechanisms of psychotherapy, with significant implications both for research and clinical practice.

Self-Oriented Empathy and Personality Organisation Level: Insights from a Psychiatric Sample.

Objective: Empathy functioning is among the criteria to delineate psychiatric diagnosis. However, the self-oriented empathy dimension is almost neglected in the existing literature. On the basis of previous fragmented contributions, we hypothesised that an individual's level of personality organisation is explained by this facet of empathy more than the other components of empathy, both transversally and independently from the specific psychiatric diagnosis. Method: Fifty-nine psychiatric inpatients were evaluated with clinical interviews inspired by the Structured Clinical Interview for DSM-5, completed the Symptom Checklist-90-Revised, and Interpersonal Reactivity Index (IRI). A panel of experts established each patient's psychiatric diagnosis and the level of personality organisation according to DSM-5 and PDM-2. Thirty-two patients were considered functioning at a psychotic level, 27 at a borderline level, and none at a neurotic level. Multinomial models were compared with the corrected AIC to determine if self-oriented empathy, among all IRI subscales, was the best-fitting model for explaining the levels of personality organisation. A further analogue series of models was used to investigate the best IRI subscale to explain each patient's psychiatric diagnosis. Results: The first series of models revealed self-oriented empathy (IRI personal distress subscale) as the best empathic dimension to explain levels of personality organisation. The second series revealed that none of the four IRI subscales explained psychiatric diagnoses. Conclusions: The consistency of our findings with evolutionary concepts pertaining to both traditional psychodynamic models and contemporary models of psychopathology, such as the p factor theory, was illustrated. Despite the many limitations of our consecutive sampling jeopardising the findings' generalisability, the insight of self-oriented empathy as the best predictor of the level of personality organisation, irrespective of psychiatric diagnosis, has several implications from both research and clinical/diagnostic perspectives.

The harmonium model and its unified system view of psychopathology: a validation study by means of a convolutional neural network.

The harmonium model (HM) is a recent conceptualization of the unifying view of psychopathology, namely the idea of a general mechanism underpinning all mental disorders (the p factor). According to HM, psychopathology consists of a low dimensional Phase Space of Meaning (PSM), where each dimension of meaning maps a component of the environmental variability. Accordingly, the lower thenumber of independent dimensions in the PSM, and hence its intrinsic complexity, the more limited the way of interpreting the environment. The current simulation study, based on a Convolutional Neural Network (CNN) framework, aims at validating the HM low-dimensionality hypothesis. CNN-based classifiers were employed to simulate normotypical and pathological cognitive processes. Results revealed that normotypical and pathological CNNs were different in terms of both classification performance and layer activation patterns. Using Principal Component Analysis to characterize the PSM associated with the two algorithms, we found that the performance of the normotypical CNN relies on a larger and more evenly distributed number of components, compared with the pathological one. This finding might be indicative of the fact that psychopathology can be modelled as a low-dimensional, poorly modulable PSM, which means the environment is detected through few components of meaning, preventing complex information patterns from being taken into account.

The Role of Affective Sensemaking in the Constitution of Experience. The Affective Pertinentization Model (APER).

The paper outlines a model of the basic cognitive process of the constitution of experience - the Affective Pertinentization Model (APER). The constitution of experience is intended as the basic cognitive process underpinning the meaning-maker's experience of mental representations as self-contained, stable, substantive entities standing for something in the external reality. Framed within the general family of theories highlighting the embodiment of cognition, the APER model claims that affects are the basic mechanism at the basis of the constitution of human experience. The first part of the paper outlines the APER model; the second part reviews some preliminary evidence supporting it.

Empathy-based supportive treatment in amyotrophic lateral sclerosis: A pragmatic study.

Scarce literature has been dedicated to the psychological treatment of amyotrophic lateral sclerosis (ALS). However, there have been some encouraging findings, such as in hypnosis-based studies, which revealed patient improvements in anxiety, depression and quality of life (QoL). We replicated such a design of a pragmatic study on empathy-based supportive counseling treatment in four weekly domiciliary sessions. Twenty-one people with ALS (pALS) consecutively attending the Motor Neuron Disease Center of Padova University were recruited to the study; in total, 21 pALS who did not undergo any kind of psychological treatment served as the control group. In the treatment group, depression, anxiety and QoL (measured respectively with the HADS-D, HADS-A and ALSSQOL-R) were assessed at pre- and post-treatment levels and at 3- and 6-month follow-ups. Statistical mixed-model regression analyses revealed that in the treated group, perceived conditions of anxiety, depression and QoL were significantly stable compared to worsening in the control patients. Interestingly, there were improvements in the QoL domains "Interaction", "Emotion" and "Physical" at the 6-month follow-up. Overall, even if not directly comparable, our current results on support-based counseling, though interesting, seem not to reach the efficacy of a hypnosis-based study in which the observed dimensions were significantly improved with respect to the baseline. The implications of our results from a psychodynamic perspective are highlighted.

The phase space of meaning model of psychopathology: A computer simulation modelling study.

INTRODUCTION: The hypothesis of a general psychopathology factor that underpins all common forms of mental disorders has been gaining momentum in contemporary clinical research and is known as the p factor hypothesis. Recently, a semiotic, embodied, and psychoanalytic conceptualisation of the p factor has been proposed called the Harmonium Model, which provides a computational account of such a construct. This research tested the core tenet of the Harmonium model, which is the idea that psychopathology can be conceptualised as due to poorly-modulable cognitive processes, and modelled the concept of Phase Space of Meaning (PSM) at the computational level. METHOD: Two studies were performed, both based on a simulation design implementing a deep learning model, simulating a cognitive process: a classification task. The level of performance of the task was considered the simulated equivalent to the normality-psychopathology continuum, the dimensionality of the neural network's internal computational dynamics being the simulated equivalent of the PSM's dimensionality. RESULTS: The neural networks' level of performance was shown to be associated with the characteristics of the internal computational dynamics, assumed to be the simulated equivalent of poorly-modulable cognitive processes. DISCUSSION: Findings supported the hypothesis. They showed that the neural network's low performance was a matter of the combination of predicted characteristics of the neural networks' internal computational dynamics. Implications, limitations, and further research directions are discussed.

Natural history of upper motor neuron-dominant ALS.

A new amyotrophic lateral sclerosis (ALS) category named 'UMN-dominant ALS' and defined as 'due predominantly to UMN signs but with minor electromyogram (EMG) denervation or LMN signs on examination' has been proposed. The clinical and laboratory features of 20 patients with UMN-dominant ALS are described here, their disease course is analysed longitudinally according to their disability progression, and all these parameters are compared with those of typical ALS patients. Ten women and 10 men diagnosed with UMN-dominant ALS were evaluated. Their mean age at disease onset was 58.6 years. At the most recent evaluation, after a mean disease duration of 7.7 years, all patients progressed to a tetrapyramidal syndrome with pseudobulbar features of varying degree. No patient had respiratory problems. Cognitive impairment was observed in eight patients. The differences in disease progression between the UMN-dominant ALS and typical ALS patients proved significant (p <0.02) both with regard to the total ALSFRS-R score at six months and to each single region subscore at 12 months. Our findings suggest that there is both a different pattern of disability and longer survival in UMN-dominant ALS compared to classic ALS patients.

TDP-43 in skeletal muscle of patients affected with amyotrophic lateral sclerosis.

TAR DNA binding protein (TDP-43) is the pathologic substrate of neuronal and glial aggregates in amyotrophic lateral sclerosis (ALS). Pathologic TDP-43 is hyperphosphorylated and cleaved to generate abnormal protein species that accumulate in the cytoplasm. To assess the hypothesis of TDP-43 pathology as a systemic disorder in ALS we analysed the immunohistochemical and biochemical profile of TDP-43 in muscle biopsies of 30 ALS patients and 30 controls. In all ALS muscle biopsies we observed that TDP-43 was constantly present in an intranuclear localization and TDP-43 Western blotting showed only a 43-KDa band as controls. Our results suggest that TDP-43 pathology is probably confined to the central nervous system in ALS.