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.

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.

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.

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 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.

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.

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.

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.

Enhanced Neural Empathic Responses in Patients with Spino-Bulbar Muscular Atrophy: An Electrophysiological Study.

BACKGROUND: Spino-bulbar muscular atrophy is a rare genetic X-linked disease caused by testosterone insensitivity. An inverse correlation has been described between testosterone levels and empathic responses. The present study explored the profile of neural empathic responding in spino-bulbar muscular atrophy patients. METHODS: Eighteen patients with spino-bulbar muscular atrophy and eighteen healthy male controls were enrolled in the study. Their event-related potentials were recorded during an "Empathy Task" designed to distinguish neural responses linked with experience-sharing (early response) and mentalizing (late response) components of empathy. The task involved the presentation of contextual information (painful vs. neutral sentences) and facial expressions (painful vs. neutral). An explicit dispositional empathy-related questionnaire was also administered to all participants, who were screened via neuropsychological battery tests that did not reveal potential cognitive deficits. Due to electrophysiological artefacts, data from 12 patients and 17 controls were finally included in the analyses. RESULTS: Although patients and controls did not differ in terms of dispositional, explicit empathic self-ratings, notably conservative event-related potentials analyses (i.e., spatio-temporal permutation cluster analyses) showed a significantly greater experience-sharing neural response in patients compared to healthy controls in the Empathy-task when both contextual information and facial expressions were painful. CONCLUSION: The present study contributes to the characterization of the psychological profile of patients with spino-bulbar muscular atrophy, highlighting the peculiarities in enhanced neural responses underlying empathic reactions.

The Meaning of Living in the Time of COVID-19. A Large Sample Narrative Inquiry.

The spread of the COVID-19 pandemic has been a sudden, disruptive event that has strained international and local response capacity and distressed local populations. Different studies have focused on potential psychological distress resulting from the rupture of consolidated habits and routines related to the lockdown measures. Nevertheless, the subjective experience of individuals and the variations in the way of interpreting the lockdown measures remain substantially unexplored. Within the frame of Semiotic Cultural Psychosocial Theory, the study pursued two main goals: first, to explore the symbolic universes (SUs) through which Italian people represented the pandemic crisis and its meaning in their life; and second, to examine how the interpretation of the crisis varies over societal segments with different sociodemographic characteristics and specific life challenges. An online survey was available during the Italian lockdown. Respondents were asked to write a passage about the meaning of living in the time of COVID-19. A total of 1,393 questionnaires (mean = 35.47; standard deviation = 14.92; women: 64.8%; North Italy: 33%; Center Italy: 27%; South Italy: 40%) were collected. The Automated Method for Content Analysis procedure was applied to the collected texts to detect the factorial dimensions underpinning (dis)similarities in the respondents' discourses. Such factors were interpreted as the markers of latent dimensions of meanings defining the SUs active in the sample. A set of χ2 analysis allowed exploring the association between SUs and respondents' characteristics. Four SUs were identified, labeled "Reconsider social priorities," "Reconsider personal priorities," "Live with emergency," and "Surviving a war," characterized by the pertinentization of two extremely basic issues: what the pandemic consists of (health emergency versus turning point) and its extent and impact (daily life vs. world scenario). Significant associations were found between SUs and all the respondents' characteristics considered (sex, age, job status, job situation during lockdown, and place of living). The findings will be discussed in light of the role of the media and institutional scenario and psychosocial conditions in mediating the representation of the pandemic and in favoring or constraining the availability of symbolic resources underpinning people's capability to address the crisis.

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).

Empathy In Neurodegenerative Diseases: A Systematic Review.

INTRODUCTION: Empathy, in its affective and cognitive components, is a crucial interpersonal ability. It is broadly studied in the field of psychopathology, whereas its study in the neurodegenerative diseases is relatively recent. Existing literature, though, focused on a reduced subset of considered diseases, which often found a compromise in empathy abilities. Organized knowledge about a more comprehensive set of diseases is lacking. METHOD: The present PRISMA systematic review was aimed at collecting the current available literature concerning empathic alterations in adult patients affected by neurodegenerative diseases. It considered the different empathy components, evaluated existing patterns, the impact on patients' lives, and treatment considerations. RESULTS: Overall, the 32 retrieved studies describe a spread deterioration of empathic abilities in patients, with each disease displaying its own pattern of empathy functioning. Literature in this field is fragmented and of heterogeneous quality, and further studies are warranted to increase evidence of many preliminary results. DISCUSSION: In conclusion, we highlight the crucial importance of acknowledging empathy deficits in these diseases, showing their repercussion on both patients' and caregivers' quality of life, the establishment of a functional doctor-patient relationship, and the development of efficacious psychological intervention. These clinical approaches can be enriched by the knowledge of the spared abilities of patients affected by neurodegenerative diseases.

Training in psychotherapy: a call for embodied and psychophysiological approaches.

Psychotherapy research studies are increasingly focused on the clinical process, which has allowed for the definition of general models about clinical functioning and the role of the therapist. Embodiment-based research has shown that interpersonal processes, such as synchrony and attunement, are critical for the development of crucial therapist skills and that these mechanisms are mediated by physiological processes. Although the connection between these embodied processes and clinical practice is currently a topic of investigation in psychotherapy research, its implications for clinical training are potentially broad, but they remain unexplored. The present contribution proposes the idea of embodied trainings for psychotherapy trainees, which could support their acquisition of clinical skills through implicit, embodied, and affective learning. We present detailed potential mechanisms, study designs, and psychological variables that could be used to develop such an in vivo training and suggest some possible applications, ranging from biofeedback sessions to experimental settings and roleplaying. Additional research in this field can help bridge the gap between psychotherapy research and psychotherapy training, by overcoming some of the limitations of post-session and external evaluations, by enriching psychotherapy training programs, and by facilitating the implicit and automatic attunement of the attitudes of the students who will become tomorrow's therapists.

Emotion Regulation and Parental Bonding in Families of Adolescents With Internalizing and Externalizing Symptoms.

Parental bonding and emotional regulation, while important to explain difficulties that may arise in child development, have mainly been studied at an individual level. The present study aims to examine alexithymia and parental bonding in families of adolescents with psychiatric disorders through different generations. The sample included a total of 102 adolescent patients with psychiatric disorders and their parents. In order to take a family level approach, a Latent Class Analysis was used to identify the latent relationships among alexithymia (Toronto Alexithymia Scale), perceived parental bonding (Parental Bonding Instrument) and the presence of adolescent internalizing or externalizing psychiatric symptoms (Youth Self-Report). Families of internalizing and externalizing adolescents present different and specific patterns of emotional regulation and parenting. High levels of adolescent alexithymia, along with a neglectful parenting style perceived by the adolescent and the father as well, characterized the families of patients with internalizing symptoms. On the other hand, in the families with externalizing adolescents, it was mainly the mother to remember an affectionless control parental style. These results suggest the existence of an intergenerational transmission of specific parental bonding, which may influence the emotional regulation and therefore the manifestation of psychiatric symptoms.

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

Mutual support groups for family caregivers of people with amyotrophic lateral sclerosis in Italy: A pilot study.

Family caregivers of people with amyotrophic lateral sclerosis (ALS) live stressful lives in which they spend most of their time caring for their loved ones and managing difficult situations, thereby reducing the time spent in taking care of themselves. This situation may last several years. Previous literature has widely highlighted that this situation reduces caregivers' quality of life and increases their psychological distress and risk of health problems, but there is a lack of studies that focus on psychological interventions for these situations. This qualitative study examined a pilot experience of two mutual support groups for family caregivers of people with ALS. The aim was to identify caregivers' needs, the prominent aspects of their experience, and to understand whether and how this intervention strategy might help them. Six partners (four men and two women) and six adult children (five women and one man) participated in the groups, which were conducted in northern Italy. After the support groups finished, participants underwent semi-structured interviews. The authors conducted a content analysis of the transcripts of the interviews and the 20 group sessions. The thematic areas identified were "caregiving," "being the son/daughter of a person with ALS," "being the partner of a person with ALS," "group experience" and "group evaluation." The caregiving experience was profoundly different depending on whether the caregiver was a son/daughter or a partner of a patient with ALS. Moreover, comparison with peers and mutual support helped participants to better cope with ALS and its consequences, to improve their care for their relatives and to overcome typical caregiver isolation. These results suggest the usefulness of involving communities in caregiver support in order to create new networks and activate personal and social resources for well-being.

Rorschach Assessment in Suicide Survivors: Focus on Suicidal Ideation.

Background: The study of Suicidal ideation (SI) in people bereaved through suicide (Suicide Survivors, SSs) could be hampered by the person's willingness to admit it, or by their limited awareness of it. Our main hypothesis is that SI is common in these people, especially if they are parents or children of the victim. For its potential in shedding light on specific unconscious processes, Rorschach test was chosen for our investigation, for the first time in SSs literature. Rorschach suicide ideation and selected variables were further analyzed to better delineate their psychological profile. Method: Rorschach according to Exner's Comprehensive System was administered to 21 people bereaved through suicide presenting as outpatients at SOPROXI Project Service-Padova Mental Health Center- and 23 healthy controls. Beck Depression Inventory (BDI) was routinely administered to SSs and considered in the study. Results: T-tests showed significantly higher mean SI score (S-Con) as it emerged from the Rorschach test S-Con scores in SSs compared to control participants. SI found only weak correlation with the BDI item in which SSs can explicitly state the desire for their death. Within-group analysis revealed higher S-Con mean scores in bereaved children and parents of the victim compared to other kind of kinships. Morbid content (MOR) has been fund as the most characterizing variable in SSs' S-Con in terms of effect size, followed by a low number of responses with an ordinary form (X +%). Human movements (M), Special Scores related to thought slippage (ALOG, FABCOM2, INCOM2, and CONTAM) and poor human representations (PHR) have been shown to be more significantly present in SSs compared controls. Discussion: Psychodynamic interpretations of our results are provided. Clinical practice should consider Rorschach as one of eligible tools of investigation on this field.