Development of a new observer-rated measure to assess the real relationship in psychotherapy sessions.

OBJECTIVES: Real relationship (RR) refers to a genuine human relationship between client and therapist, that has been found to be positively related to treatment outcome, and to predict unique variance in outcome over and above the working alliance. However, thus far, the measurement of RR has been limited to self-report. We aimed to develop an observer-rated version of the RR measure (RR-O) to assess RR in therapy sessions. METHODS: We adapted items from the self-report measures to an observer rated measure, which was reviewed by RR experts. The final 24-item RR-O was rated in 540 session transcripts from 27 psychoanalytic treatments that already had existing process and outcome scores. RESULTS: The RR-O showed good internal consistency and good interrater reliability. In hierarchical EFA, items clustered into a general RR factor, and client realism, client genuineness, therapist genuineness, and therapist realism group factors. In addition, the RR-O was positively related to another RR measure and to the therapeutic alliance. CONCLUSION: The RR-O shows initial reliability and validity as an observer-rated measure of the RR to be used in post-hoc psychotherapy research. Future research should clarify the relation between RR-O and treatment outcome.

Examining the Associations Between Substance Misuse and Suicide Bereavement.

Focusing on the understudied question of substance misuse among suicide bereaved adults we investigated patterns of binge drinking and non-prescribed drug use among a recently bereaved sample (n = 1,132). Comparing our respondents to the non-bereaved, those in the 2022 National Survey of Drug Use and Health (n = 71,369), we did not find heightened problematical substance misuses among our respondents. With t-tests and multiple regression analyses we examined whether binge drinkers and non-prescribed drug users had heightened levels of grief difficulties, PTSD, self-blaming and depression compared to others not bingeing or using non-prescribed drugs. Results showed binge drinkers had more of all these grieving problems when important confounding variables were also considered. Analysis of the demographic correlates of bingeing showed them dimly aware of their own additional grieving and substance misusing problems. Since 75% indicated being under the care of counseling professionals, this represents an important opportunity for psycho-educational helping.

Implicit relational aspects of the therapeutic relationship in psychoanalytic treatments: an examination of linguistic style entrainment over time.

OBJECTIVE: In an attempt to operationalize an implicit aspect of the therapeutic relationship, this study assesses reciprocal linguistic style entrainment (rLSM) between the patient and therapist. rLSM is defined as the dynamic adjustment of function word usage to synchronize or to be in rhythm with another person as they change over time. METHOD: In this exploratory study, levels of rLSM per talk turn were analyzed for 540 sessions of 27 long-term psychoanalytic treatments in relation to treatment outcomes. RESULTS: Within sessions, rLSM appeared to decrease by the end of sessions and followed a negative linear trajectory, ßlinear = -0.0002, SE < .001, t = -13.04, p < .001. Between sessions, rLSM showed significant variability such that neither a linear, nor a quadratic, nor a cubic trend line fit the session-by-session change over treatment. On average, therapist talk turns had significantly lower rLSM than patient talk turns, while accounting for the nested nature of the data using multilevel models ßSpeakerT = -0.033, SE = 0.009, t = -3.65, p < .001. Levels of rLSM did not relate to treatment outcome. CONCLUSION: Most of the rLSM variance was at the within-patient and within-session level. rLSM was no indicator of psychoanalytic treatment outcomes.

Sexual Assault Victimization in Premature Female Mortalities: Evidence from the National Longitudinal Study of Adolescent to Adult Health.

Previous research has documented many behavioral problems associated with being a female victim of sexual assault, but little attention has been devoted to whether this experience might be related to premature mortalities. We investigated this utilizing the National Longitudinal Study of Adolescent to Adult Health survey, collected from over 10,000 adolescent females in 1995, whose premature deaths (n = 65) were noted in 2007 in National Death Index records. Significant associations were found between females with a substance misuse history and their premature deaths, but not with being a sexual assault victim. The subset of respondents (n = 208) evincing both these characteristics showed significantly higher risks of dying prematurely, as did those females with early histories of drug misuse alone. Yet, adolescent females with histories of drug misuse who also attempted suicide (n = 214) did not show similar elevated risks of dying prematurely compared to others without these experiences. This exploratory evidence points to an affinity between both being a female sexual assault victim and having an early history of misusing drugs, putting such people at heightened risks for dying prematurely, suggesting the potential benefits of counseling and supportive services for those so affected.

Understanding interpersonal guilt: Associations with attachment, altruism, and personality pathology.

The aim of this article is to empirically investigate the relationships among interpersonal guilt, as conceived within control-mastery theory (CMT), and attachment, altruism, and personality pathology in an English-speaking sample. An online sample of 393 participants was recruited to complete the Interpersonal Guilt Rating Scale self-report version-15 (IGRS-15s), together with other empirically validated measures for the assessment of attachment, altruism, and personality pathology. On the basis of previous studies conducted in Italian-speaking samples, we hypothesized that survivor guilt, separation/disloyalty guilt, and omnipotent responsibility guilt would be associated with attachment anxiety and avoidance, altruism, and personality pathology; self-hate was hypothesized to be associated only with attachment anxiety and avoidance and personality pathology. Analyses examined bivariate associations as well as the network of partial correlations among variables. The results largely confirmed hypothesized associations, with self-hate evincing the strongest unique association with personality dysfunction. Findings provide a basis for further research regarding interpersonal guilt and personality and relational functioning, with potential implications for clinical conceptualizations of the role of guilt in psychopathology.

Source of Information on Intentions to Adopt Protective Behaviours During COVID-19 in China.

Introduction: COVID-19 spread across China and other countries in a matter of weeks. Yet, it is uncertain how people have responded to protective behaviours in this pandemic. This study aims to evaluate how trust in different types of information sources influences the intention to adopt protective behaviours. Methods: In total, 122 Chinese completed a survey on Qualtrics in March 2021. Data on demographic information, protective behaviours, trust in formal information, trust in informal information, perceived risk, worry and social desirability were collected. Structural equation modelling (SEM) was used to identify associations between these variables. Results: Trust in formal information was significantly associated with perceived risk (ß = -.18) and significantly and positively associated with worry (ß = .28). Trust in informal information was significantly and positively associated with perceived risk (ß = .57). Subsequently, perceived risk was significantly associated with social distancing (ß = -.17), and worry was significantly and positively associated with mask wearing (ß = .25) and significantly associated with hand washing (ß = -.27). Trust in formal information was significantly and positively associated with hand washing (ß = .26) while trust in informal information was significantly and positively associated with social distancing and hand washing (ß = .26). Perceived risk was significantly and positively associated with worry (ß = .32). Conclusion: People who trust in informal information from social media and interpersonal communication would be more likely to adopt mask wearing and hand washing protective behaviours. People who trust in formal information from government-agency source would have a lower perceived risk of COVID-19 and are less likely to adopt social distancing, but people who trust in formal information have a greater worry about contracting COVID-19 and are more likely to wear masks.

Operationalizing alliance rupture-repair events using control chart methods.

This study aimed to determine how control charts-a form of time-series line graphs-can be implemented in psychotherapy research to indirectly identify probable rupture-repair episodes that are associated with psychotherapy outcome. There is no current standard in psychotherapy research with regard to how to use control charts to identify rupture-repair events. Control charts were generated for each patient (N = 73) using patient-rated Working Alliance Inventory (WAI) scores obtained at the end of every session in a 30-session therapy protocol of either brief relational therapy (BRT) or cognitive behavioural therapy (CBT). Empirically derived cut-off points were used to identify rupture and repair based on each dyad's control chart. Coded rupture-repair episodes were correlated with outcome measures to assess for their relationships. The results of these analyses provide preliminary support for the utility of control charts in psychotherapy research for the indirect identification of probable rupture repair events that are associated with psychotherapy outcome.

The revised suicide crisis inventory (SCI-2): Validation and assessment of prospective suicidal outcomes at one month follow-up.

BACKGROUND AND AIM: The Suicide Crisis Syndrome (SCS) is an evidence-based pre-suicidal cognitive and affective state predictive of short-term suicide risk. The most recent SCS formulation, proposed as a suicide-specific DSM diagnosis, features a feeling of Entrapment accompanied by four additional symptom clusters: Affective Disturbance; Loss of Cognitive Control; Hyperarousal; and Social Withdrawal. The aim of the present study was to revise the Suicide Crisis Inventory (SCI; Barzilay et al., 2020), a self-report measure assessing the presence of the SCS,in accordance with the current SCS formulation, as well as to assess the psychometric properties and clinical utility of its revised version, the Suicide Crisis Inventory-2 (SCI-2). METHODS: The SCI-2, a 61-item self-report questionnaire, was administered to 421 psychiatric inpatients and outpatients at baseline. Prospective suicidal outcomes including suicidal ideation, preparatory acts, and suicidal attempts were assessed after one month. Internal structure and consistency were assessed with confirmatory factor analysis, convergent, discriminant, and current criterion validity. Receiver-operating characteristic (ROC) curves with Area under the Curve (AUC) were used to examine the predictive validity of the SCI-2 to prospective outcomes. Exploratory analyses assessed the predictive validity of the five SCI-2 dimensions. RESULTS: The SCI-2 demonstrated excellent internal consistency (Cronbach's α = 0.971), good convergent, discriminant, and current criterion validity. The SCI-2 significantly predicted all three outcomes, and was the only significant predictor of suicidal attempts with AUC = 0.883. DISCUSSION: The results of this study indicate that the SCI-2 is a valid and reliable tool to assess the presence and intensity of the Suicide Crisis Syndrome and to predict short-term prospective suicidal behaviors and attempts among psychiatric outpatients and inpatients regardless of patients' readiness to disclose suicidal ideation.

Deepening the Group Training Experience: Group Cohesion and Supervision Impact in Alliance-Focused Training.

OBJECTIVE: The aim of the current study is to explore experiences of trainees engaged in alliance-focused training (AFT), a group supervision modality with an explicit focus on awareness of ruptures and implementation of repair strategies. Using Cognitive Behavioral Therapy (CBT) group supervision as a point of comparison, the study examines supervisory alliance, ruptures, group cohesion and safety, and supervision impact. METHOD: Eighty-three trainees (clinical psychology interns, advanced-level psychology externs and psychiatry residents) at a metropolitan medical center in New York City who received supervision in CBT (N = 38) or AFT (N = 45) reported on their group supervision experience. Participants had a mean age of 29.5 (SD = 4.9); 77% were women; 84% of participants identified as White, 7% as Multiethnic, 6% as Hispanic/Latinx, 1% as Black, and 1% as Asian. Participants reported on occurrence of ruptures with their supervisor, supervisory alliance (Working Alliance Inventory-Short), group safety, supervision depth and smoothness (Session Evaluation Questionnaire), and group cohesion (Group Climate Questionnaire). Mixed and general linear models, and correlation analyses were used for analysis. RESULTS: All trainees reported equally low incidence of ruptures with their supervisor alongside high ratings of supervisory alliance. Trainees in AFT reported experiencing less safety, smoothness, and greater intergroup conflict than trainees in CBT supervision; however, they also reported stronger group engagement and a deeper supervision experience. CONCLUSIONS: Results suggest that AFT may provide a rich environment to foster a certain level of discomfort and risk-taking that may facilitate an engaging and meaningful learning experience.

Feasibility and efficacy of a digital CBT intervention for symptoms of Generalized Anxiety Disorder: A randomized multiple-baseline study.

BACKGROUND AND OBJECTIVES: Cognitive behavioral therapy (CBT) is a first-line treatment for anxiety, but it is not widely available as clinical guidelines recommend. We examined the feasibility and efficacy of a novel smartphone-based fully automated digital CBT intervention, 'Daylight™', to improve symptoms of Generalized Anxiety Disorder (GAD). METHODS: In this multiple-baseline design, 21 adults (20 F; mean age 43yrs. range 19-65yrs.) with moderate-to-severe symptoms of GAD were randomized to one of three baseline durations (2-, 4-, or 6-weeks) and then received access to digital CBT. Participants completed daily ratings of anxiety and worry, weekly measures of anxiety, depressive symptoms, and sleep, and measures of anxiety, worry, wellbeing, quality of life, CBT skill acquisition, and work performance at initial assessment prior to baseline randomization, post-intervention, and follow-up. RESULTS: Digital CBT was found to be feasible in terms of engagement, satisfaction, and safety. For preliminary efficacy, improvements were detected in daily and weekly outcomes of anxiety for most participants. Despite individual differences, significant improvements occurred with the introduction of digital CBT and not during baseline. Overall, 70% of participants no longer had clinically significant symptoms of GAD, 61% no longer had significant depressive symptoms, and 40% no longer had significant sleep difficulty at post-intervention. LIMITATIONS: The study sample was recruited using the internet and was mostly female, limiting the generalizability of the findings. CONCLUSIONS: Findings support the feasibility and efficacy of Daylight. Further examination in randomized controlled trials is now warranted.

Guilt, Shame, Empathy, Self-Esteem, and Traumas: New Data for the Validation of the Interpersonal Guilt Rating Scale-15 Self-Report (IGRS-15s).

The aim of this paper is to present further data for the validation of the Interpersonal Guilt Rating Scale-15 self-report (IGRS-15s; Gazzillo et al., 2018). We recruited a sample of 448 subjects, to whom we administered the IGRS-15s together with other empirically validated measures for the assessment of social desirability, shame, self-esteem, empathy, mental health and therapeutic alliance. In line with our hypotheses, the previously established three-factor structure of the IGRS-15s (Survivor guilt, Omnipotence guilt, and Self-hate) was confirmed. Moreover, the internal consistency and test-retest reliability of IGRS-15s were adequate to good. All the IGRS-15s factors were negatively correlated with self-esteem and mental health and positively correlated with shame; Survivor guilt and Omnipotence guilt were positively correlated with empathy; Survivor guilt and Self-hate negatively affected therapeutic alliance; and different traumas had different, theoretically predictable, impacts on the different kinds of guilt. Overall, these data support the reliability and validity of the IGRS-15s.

Differential effects of alliance and techniques on Panic-Specific Reflective Function and misinterpretation of bodily sensations in two treatments for panic.

ABSTRACTObjective: To examine whether working alliance quality and use of techniques predict improvement in Panic-Specific Reflection Function (PSRF), and misinterpretation of bodily sensations in treatments for panic disorder. Method: A sample of 161 patients received either CBT or PFPP (Panic-focused Psychodynamic therapy) within a larger RCT. Data were collected on patient-reported working alliance, misinterpretations, PSRF, observer-coded use of techniques, and interviewer-rated panic severity. Random-Intercept Cross-Lagged Panel Models assessed bi-directional associations, disentangling within- and between-patient effects, and accounting for prior change. Results: Higher alliance predicted subsequent within-patient improvement in PSRF in PFPP, but worsening in CBT. In both treatments, focus on interpersonal relationships predicted PRSF improvement (with stronger effects in CBT), while focus on thoughts and behaviors predicted worsening in PSRF. In CBT only, early focus on affect and moment-to-moment experience predicted reduced misinterpretation, while high focus on thoughts and cognitions predicted subsequent increase in misinterpretation. Conclusion: The quality of the alliance has differential effects on PSRF in distinct treatments. Interpersonal, rather than cognitive or behavioral focus, even when delivered differently within distinct treatments with high adherence, could facilitate improvement in PSRF. Additionally, early focus on affect and moment-to-moment experiences in CBT could reduce misinterpretations.

The Difficult Task of Assessing and Interpreting Treatment Deterioration: An Evidence-Based Case Study.

Objectives: Literature on outcome assessment suggests that 35-40% of patients in randomized control trials terminate treatment with unchanged or higher levels of symptomatology. The goal of the present study was to shed light on this phenomenon and the factors accounting for it using a single case study design that investigates the process and outcome of a treatment conducted within a non-randomized clinical trial comparing a cognitive behavioral and a brief relational treatment. Method: The condition of L., a Caucasian man undergoing cognitive-behavioral therapy in a large metropolitan research program, was classified as deteriorating using the Reliable Change Index for the Inventory of Interpersonal Problems (IIP) and the Symptom Checklist-90 (SCL-90). Therapeutic process and outcome were examined using quantitative and qualitative methods rated by several sources. Results: Analysis showed that the treatment was delivered skillfully, and that despite initial difficulties, a strong alliance eventually developed between the patient and the therapist whose perspectives on the outcome of therapy nevertheless diverged. The patient's satisfaction with treatment was high, and he believed his deterioration was caused by its termination. Discussion: Results suggest that the deterioration was not caused by a negative process or a faulty delivery of the therapy. Several explanations were discussed in the context of the literature.

Are Cheaters Sexual Hypocrites? Sexual Hypocrisy, the Self-Serving Bias, and Personality Style.

This article examines moral hypocrisy and the self-serving bias (SSB) in the sexual infidelity context. We found evidence of self-serving attributions that occur between primary relationship partners following sexual betrayals. Specifically, we found that sexual infidelity perpetrators (a) blamed their primary dyadic partners (i.e., victims) for infidelities significantly more than those victims blamed themselves for such infidelities, (b) blamed the surrounding circumstances for infidelities significantly more than their victims did, and (c) rated the emotional impact of infidelities on their victims as significantly less than victims' ratings of such impact. Moreover, we found that participants with prior experience as both sexual infidelity perpetrators and victims displayed "sexual hypocrisy" by judging others more harshly than themselves for sexually unfaithful behavior. Our findings demonstrate that personality variables associated with sexual infidelity (narcissism, sexual narcissism, avoidant attachment, and primary psychopathy) are also relevant to self-serving attributions in the sexual infidelity context.

The Multitheoretical List of Therapeutic Interventions - 30 items (MULTI-30).

Objective: To develop a brief version of the Multitheoretical List of Therapeutic Interventions (MULTI-60) in order to decrease completion time burden by approximately half, while maintaining content coverage. Study 1 aimed to select 30 items. Study 2 aimed to examine the reliability and internal consistency of the MULTI-30. Study 3 aimed to validate the MULTI-30 and ensure content coverage. Method: In Study 1, the sample included 186 therapist and 255 patient MULTI ratings, and 164 ratings of sessions coded by trained observers. Internal consistency (Chronbach's alpha and McDonald's omega) was calculated and confirmatory factor analysis was conducted. Psychotherapy experts rated content relevance. Study 2 included a sample of 644 patient and 522 therapist ratings, and 793 codings of psychotherapy sessions. In Study 3, the sample included 33 codings of sessions. A series of regression analyses was conducted to examine replication of previously published findings using the MULTI-30. Results: The MULTI-30 was found valid, reliable, and internally consistent across 2564 ratings examined across the three studies presented. Conclusion: The MULTI-30 a brief and reliable process measure. Future studies are required for further validation. Clinical or methodological significance of this article: The MULTI-30, developed and validated in this study, is a valid, reliable, and cost-effective brief measure which could be used to assess patients, therapists, and observers' perceptions of use of interventions from eight major therapeutic approaches. The MULTI-30 could be used to examine the role of use of specific interventions on process and outcome of different treatment modalities. It could also be used as a clinical tool in teaching, training, and supervision.

Panic-Focused Reflective Functioning and Comorbid Borderline Traits as Predictors of Change in Quality of Object Relations in Panic Disorder Treatments.

OBJECTIVE: To investigate whether (a) baseline levels of panic-specific reflection function (PSRF; i.e. patients' capacity to reflect on their panic symptoms) and improvement in this capacity over treatment; (b) baseline borderline personality disorder (BPD) traits and pre-post treatment improvement in BPD traits predict change in patients' quality of object relations. METHOD: A subsample of 102 patients diagnosed with panic disorder from a larger randomized controlled trial received either Cognitive-Behavioral Therapy or Panic-Focused Psychodynamic Psychotherapy. We investigated whether baseline levels and change in both PSRF and BPD traits (as measured by the SCID-II) predicted pre-post change in quality of object relations (QOR), while controlling for pre-post treatment change in panic symptoms assessed by the Panic Disorder Severity Scale. RESULTS: In both treatments, higher baseline levels of PSRF and lower levels of BPD traits, as well as pre-post decrease in BPD traits, predicted improvement in QOR when controlling for symptomatic change. CONCLUSIONS: The findings suggest that reduction in comorbid BPD traits can facilitate improvement in patients' quality of object relations even in brief symptom-focused psychotherapies. Additionally, patients with higher baseline levels of symptom-focused reflective function and lower BPD traits are more likely to demonstrate interpersonal change over the course of psychotherapy for panic disorder. Finally, our study highlights the importance of examining therapeutic change beyond reduction in symptoms, particularly in domains of interpersonal functioning.

The effect of alliance-focused training on a cognitive-behavioral therapy for personality disorders.

OBJECTIVE: To improve success rates in psychotherapy, we developed and evaluated an alliance-focused training (AFT) protocol with regard to patient-therapist interpersonal behavior in a 30-session protocol of cognitive-behavioral therapy (CBT) for outpatients comorbid with Axis I and II conditions. METHOD: Participants included 40 patients treated by 40 therapists in a multiple baseline design in which novice therapists trained to fidelity standards in CBT were introduced to AFT at different time intervals (after either 8 or 16 sessions) during a 30-session CBT protocol. Interpersonal behaviors were assessed with a simplified version of the Structural Analysis of Social Behavior (SASB) on videotaped sessions sampled from the early (between Sessions 6 through 8), mid (Sessions 14 through 16), and late (Sessions 22 through 24) phases of therapy. RESULTS: As predicted, several significant interactions were observed between within-subject interpersonal change and between-groups differences in exposure to AFT. Specifically, there were decreases in patient dependence and in therapist control (including criticism), plus increases in patient expressiveness and in therapist affirmation and expressiveness, all of which could be attributed to AFT. The predictive relationship of several of these variables to session-level and overall treatment outcome was also demonstrated. CONCLUSIONS: This study demonstrates that novice CBT therapists can be trained to improve their interpersonal process with patients who present with comorbid diagnoses, including a personality disorder. (PsycINFO Database Record

Fluctuations in alliance and use of techniques over time: A bidirectional relation between use of "common factors" techniques and the development of the working alliance.

OBJECTIVE: The aim of this study was twofold: (a) Investigate whether therapists are consistent in their use of therapeutic techniques throughout supportive-expressive therapy (SET) and (b) Examine the bi-directional relation between therapists' use of therapeutic techniques and the working alliance over the course of SET. METHOD: Thirty-seven depressed patients were assigned to 16 weeks of SET as part of a larger randomized clinical trial (Barber, Barrett, Gallop, Rynn, & Rickels, ). Working Alliance Inventory-Short Form (WAI-SF) was collected at Weeks 2, 4, and 8. Use of therapeutic interventions was rated by independent observers using the Multitheoretical List of Therapeutic Interventions (MULTI). Intraclass correlation coefficients assessed therapists' consistency in use of techniques. A cross-lagged path analysis estimated the working alliance inventory- Multitheoretical List of Therapeutic Interventions bidirectional relation across time. RESULTS: Therapists were moderately consistent in their use of prescribed techniques (psychodynamic, process-experiential, and person-centred). However, they were inconsistent, or more flexible, in their use of "common factors" techniques (e.g., empathy, active listening, hope, and encouragements). A positive bidirectional relation was found between use of common factors techniques and the working alliance, such that initial high levels of common factors (but not prescribed) techniques predicted higher alliance later on and vice versa. CONCLUSION: Therapists tend to modulate their use of common factors techniques across treatment. Additionally, when a strong working alliance is developed early in treatment, therapists tend to use more common factors later on. Moreover, high use of common factors techniques is predictive of later improvement in the alliance.

Clinical severity as a moderator of outcome in psychodynamic and dialectical behavior therapies for borderline personality disorder.

The aim of the present study was to assess the effect of initial level of psychiatric severity on treatment outcome in psychodynamic therapy and dialectical behavior therapy (DBT) for borderline personality disorder (BPD). It was hypothesized that DBT would lead to better outcome for patients with high psychiatric severity, whereas dynamic treatment would lead to better outcome for patients with lower psychiatric severity. Data from the 5th-year follow-up of the Stockholm City Council's and the Karolinska Institute's Psychotherapy Project were used in the present study. A total of 106 female patients diagnosed with BPD with at least 2 past suicide attempts were randomized into object-relational psychotherapy (ORP; based on transference-focused psychotherapy), DBT, and treatment as usual. Patients' baseline global severity index was used as a moderator. Global Assessment of Functioning (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [American Psychiatric Association, 1994]) was used to examine outcome. There was a significant 3-way interaction of Time × Treatment × Severity. Post hoc analyses suggested that patients with lower levels of severity had significantly better outcomes in object-relational psychotherapy. For patients with higher severity, the 3 treatments resulted in similar outcomes in terms of level of functioning. Outcome of treatment for BPD might differ significantly for patients depending on their initial levels of overall psychiatric severity. If our findings are replicated for patients with low severity and supported for a high-severity sample, psychiatric severity can be used as a low-cost and effective tool to match patients with BPD to optimal treatments. (PsycINFO Database Record

Pathways to Infidelity: The Roles of Self-Serving Bias and Betrayal Trauma.

This study employed a structural equation modeling (SEM) approach to examine the interrelationships between the self-serving bias and various known predictors of sexual infidelity. Specifically, we sought to generate a path model depicting how the following variables jointly predict sexual infidelity perpetration: (1) insecure attachment, (2) pathological narcissism, (3) sexual narcissism, (4) primary psychopathy, (5) self-serving attributions for retaliatory infidelity, and (6) sexual betrayal victimization. We developed a structural model describing various pathways to sexual infidelity perpetration based on these six variables. Three pathways to infidelity were discovered. In the first pathway, anxious and avoidant attachment predicted primary psychopathy, and self-justification for retaliatory infidelity mediated the relationship between primary psychopathy and infidelity perpetration. In the second pathway, anxious attachment predicted sexual narcissism, which predicted self-justification for retaliatory infidelity, which in turn predicted infidelity perpetration. In the third pathway, being a victim of sexual betrayal directly predicted sexual infidelity perpetration. In fact, suffering sexual betrayal was the best predictor of sexual infidelity perpetration. The clinical implications of these findings are discussed.