A Web-Based Physical Activity Promotion Intervention for Inactive Parent-Child Dyads: Protocol for a Randomized Controlled Trial.

BACKGROUND: Low levels of physical activity are associated with numerous adverse health outcomes, yet sedentary lifestyles are common among both children and adults. Physical activity levels tend to decline steeply among children aged between 8 and 12 years, even though children's behavioral patterns are largely governed by familial structures. Similarly, parents' activity levels have been generally reported as lower than those of nonparents of comparable age. For this reason, family-based physical activity promotion interventions are a potentially valuable and relatively underresearched method for mitigating physical activity declines as children develop into adolescents and for increasing physical activity in parents. OBJECTIVE: This study aims to assess the efficacy, feasibility, and acceptability of a novel theory-based web-based physical activity promotion intervention among parent-child dyads in Finland who do not meet physical activity recommendations at baseline. METHODS: Participants (target N=254) will be recruited from the general population using a panel company and advertisements on social media and randomly assigned to either an immediate intervention group or a waitlist control group. The intervention consists of 4 web-based group workshops over the course of 10 weeks, web-based tasks and resources, and a social support chat group. Data on physical activity behavior and constructs from the integrated behavior change model will be collected through self-report surveys assessing physical activity, autonomy support, autonomous motivation, attitude, subjective norm, perceived behavioral control, intention, self-monitoring, habit, and accelerometer measurements at baseline, post intervention, and 3 months post intervention. Exit interviews with participants will assess the feasibility and acceptability of the intervention procedures. RESULTS: This study will reveal whether the intervention changes leisure-time physical activity among intervention participants relative to the control group and will examine the intervention's effects on important theoretical predictors of physical activity. It will also yield data that can be used to refine intervention materials and inform further implementation. Trial recruitment commenced in September 2023, and data collection should be completed by December 2024. CONCLUSIONS: The planned intervention has potential implications for both theory and practice. Practically, the use of an entirely web-based intervention may have scalable future uses for improving physical activity in 2 key populations, while also potentially informing on the value of dyadic, family-based strategies for encouraging an active lifestyle as an alternative to strategies that target either parents or children independently. Further, by assessing change in psychological constructs alongside potential change in behavior, the intervention also allows for important tests of theory regarding which constructs are most linked to favorable behavior change outcomes. TRIAL REGISTRATION: ClinicalTrials.gov NCT06070038; https://clinicaltrials.gov/study/NCT06070038. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55960.

Electrodermal and respiratory synchrony in couple therapy in distinct therapeutic subsystems and reflection periods.

Objective Synchrony in the multi-person context of systemic therapy is a complex and understudied phenomenon. We analyzed respiratory and electrodermal synchronies within a couple therapy system with two therapists to determine whether dyadic subsystems between each client and therapist synchronized differently. We also studied synchrony in reflection periods, in which the therapists discussed the therapy process with clients listening. Finally, we examined the association of synchronies with alliance and outcome.Method: A sample of 22 therapy sessions in which electrodermal activity (EDA) and respiration were recorded were analyzed. Self-report measures of session alliance and outcome were obtained. Synchrony computation was based on windowed cross-correlation using surrogate synchrony and segment-wise shuffling of physiological time series.Results: The results supported the presence of EDA synchrony for the client-therapist and therapist-therapist dyads but not client-client dyads across entire sessions. No significant synchronies were found for respiration behavior. A similar picture was found in reflection periods. Clients' well-being as well as therapists' alliance ratings were significant predictors of client-client EDA synchrony.Conclusion: Our results point to the relational meaning of synchrony and its importance for understanding couple psychotherapy, particularly the reflection periods. Challenges involved in extending synchrony computation to multi-person settings were highlighted.

Associations Between Sympathetic Nervous System Synchrony, Movement Synchrony, and Speech in Couple Therapy.

Background: Research on interpersonal synchrony has mostly focused on a single modality, and hence little is known about the connections between different types of social attunement. In this study, the relationship between sympathetic nervous system synchrony, movement synchrony, and the amount of speech were studied in couple therapy. Methods: Data comprised 12 couple therapy cases (24 clients and 10 therapists working in pairs as co-therapists). Synchrony in electrodermal activity, head and body movement, and the amount of speech and simultaneous speech during the sessions were analyzed in 12 sessions at the start of couple therapy (all 72 dyads) and eight sessions at the end of therapy (48 dyads). Synchrony was calculated from cross-correlations using time lags and compared to segment-shuffled pseudo synchrony. The associations between the synchrony modalities and speech were analyzed using complex modeling (Mplus). Findings: Couple therapy participants' synchrony mostly occurred in-phase (positive synchrony). Anti-phase (negative) synchrony was more common in movement than in sympathetic nervous system activity. Synchrony in sympathetic nervous system activity only correlated with movement synchrony between the client-therapist dyads (r = 0.66 body synchrony, r = 0.59 head synchrony). Movement synchrony and the amount of speech correlated negatively between spouses (r = -0.62 body synchrony, r = -0.47 head synchrony) and co-therapists (r = -0.39 body synchrony, r = -0.28 head synchrony), meaning that the more time the dyad members talked during the session, the less bodily synchrony they exhibited. Conclusion: The different roles and relationships in couple therapy were associated with the extent to which synchrony modalities were linked with each other. In the relationship between clients and therapists, synchrony in arousal levels and movement "walked hand in hand", whereas in the other relationships (spouse or colleague) they were not linked. Generally, more talk time by the therapy participants was associated with anti-phase movement synchrony. If, as suggested, emotions prepare us for motor action, an important finding of this study is that sympathetic nervous system activity can also synchronize with that of others independently of motor action.

Challenges and added value of measuring embodied variables in psychotherapy.

Research on embodied aspects of clinical encounters is growing, but discussion on the premises of including embodied variables in empirical research is scarce. Studies have repeatedly demonstrated that embodied aspects of psychotherapy interaction are vital in developing a therapeutic alliance, and these should be considered to better understand the change process in psychotherapy. However, the field is still debating which methods should be used and which features of the embodied aspects are relevant in the clinical context. The field lacks methodological consistency as well as a theoretical model. In the Relational Mind research project, we have studied the embodied aspects of interaction in the context of couple therapy for almost a decade and have gained experience with the positive and negative aspects of studying embodied variables in quantitative and qualitative studies. We have set out to develop the methodology (or procedures) for studying embodied variables in a multiperson setting, concentrating on interpersonal synchrony of sympathetic nervous system responses and movements, and we have strived to create methods for integrating information from different embodied modalities. In this narrative review, we share our experiences of the challenges and added value of studying embodied aspects in psychotherapy. The research field urgently needs an ongoing discussion of what researchers should take into consideration when studying the embodied aspects of interaction. We urge researchers to collaborate between research groups to jointly decide on the basic parameters of studies on the different embodied modalities of the research so that the individual researcher can become more aware of the impact the methodological choices have on their studies, results, and interpretations. We also see the use of embodied variables as having added value in the clinical work of psychotherapists, since it not only deepens our understanding about what is helpful in psychotherapy but will enable fine-tuning therapy processes to better suit clients who are verbally less fluent.

Nonverbal Synchrony in Couple Therapy Linked to Clients' Well-Being and the Therapeutic Alliance.

Nonverbal synchrony between individuals has a robust relation to the positive aspects of relationships. In psychotherapy, where talking is the cure, nonverbal synchrony has been related to a positive outcome of therapy and to a stronger therapeutic alliance between therapist and client in dyadic settings. Only a few studies have focused on nonverbal synchrony in multi-actor therapy conversations. Here, we studied the synchrony of head and body movements in couple therapy, with four participants present (spouses and two therapists). We analyzed more than 2000min of couple therapy videos from 11 couple therapy cases using Motion Energy Analysis and a Surrogate Synchrony (SUSY), a procedure used earlier in dyadic psychotherapy settings. SUSY was calculated for all six dyads per session, leading to synchrony computations for 66 different dyads. Significant synchrony occurred in all 29 analyzed sessions and between the majority of dyads. Complex models were used to determine the relations between nonverbal synchrony and the clients' well-being and all participants' evaluations of the therapeutic alliance. The clients' well-being was related to body synchronies in the sessions. Differences were found between the clients' and therapists' alliance evaluations: the clients' alliance evaluations were related to synchrony between both dyads of opposite gender, whereas the therapists' alliance evaluations were related to synchrony between dyads of the same gender, but opposite to themselves. With four participants present, our study introduces a new aspect of nonverbal synchrony, since as a dyad synchronizes, the other two participants are observing it. Nonverbal synchrony seems to be as important in couple therapy as in individual psychotherapy, but the presence of multiple participants makes the patterns more complex.

Sympathetic nervous system synchrony: An exploratory study of its relationship with the therapeutic alliance and outcome in couple therapy.

In previous research, we found that sympathetic nervous system synchrony, measured via electrodermal activity (EDA), occurs between participants at the start of couple therapy. The aim now was to test whether this synchrony changes during the therapy process, and how any changes may be related to clients' and therapists' evaluations of the working alliance, and the outcome of therapy. Twelve different couple therapy processes were analyzed (24 clients, plus 10 therapists, working in pairs; hence, 4 persons per session) using EDA concordance indices and questionnaires (Outcome Rating Scale, Session Rating Scale, and Clinical Outcomes in Routine Evaluation-Outcome Measure). EDA synchrony between the couples increased from the beginning to the end of therapy. This seemed to be connected to a positive linear trend in female clients' well-being during the therapy process. There were no statistically significant changes in the EDA synchrony between the cotherapists, or between the clients and the therapists. We found specific changes in the EDA synchrony to be related to changes in the therapeutic alliance, and/or changes in the clients' well-being. Heightened EDA synchrony was frequently related to a better outcome; nevertheless, there was one instance in which decreasing synchrony seemed to be more beneficial. It appears that couple therapy can bring spouses closer together also on a physiological level, which could be especially important for the well-being of women. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Added Value of Studying Embodied Responses in Couple Therapy Research: A Case Study.

This article reports on the added value of embodied responses identified through sympathetic nervous system (SNS) activity in couple therapy research. It focuses on moments of change and the timing of therapeutic interventions or therapeutic moves in a couple therapy session. The data for this single-case study comprise couple therapy process videotapes recorded in a multi-camera setting, and measurements of participants' SNS activity. The voluntary participants were a marital couple in their late thirties and two middle-aged male psychotherapists. The division into topic segments showed how the key issue of seeking help, which was found to comprise three separate components, was repeatedly dealt with in the session. SNS activity showed different degrees of synchronization between the couple, between the therapists, and between the couple and therapists during the dialogue pertaining to these three components. The issue of timing emerged as a complex, even ambivalent, phenomenon. Arousal in the therapists was in line with their therapeutic activity, whereas in the clients it was more anticipatory. The approach used here rendered visible some of the intensity that therapeutic dialogue can generate when dealing with issues of relationship change in the couple context and showed how this intensity can be dialogically regulated in the therapeutic system.

Este artículo informa sobre el valor agregado de las respuestas materializadas reconocidas mediante la actividad del sistema nervioso simpático (SNS) en la investigación sobre la terapia de pareja. Se centra en los momentos de cambio y en la elección del momento oportuno de las intervenciones terapéuticas o en los pasos terapéuticos de una sesión de terapia de pareja. Los datos para este estudio de un solo caso comprenden las cintas de vídeo del proceso de terapia de pareja grabadas en un entorno con varias cámaras y las mediciones de la actividad del SNS de los participantes. Los participantes voluntarios fueron un matrimonio de treintaimuchos y dos psicoterapeutas hombres de mediana edad. La división en segmentos por temas demostró cómo el asunto clave de buscar ayuda, que ahora sabemos que consta de tres componentes individuales, se trató repetidamente en la sesión. La actividad del SNS demostró diferentes grados de sincronización entre la pareja, entre los terapeutas, y entre la pareja y los terapeutas durante el diálogo relativo a estos tres componentes. La cuestión de la elección del momento oportuno surgió como un fenómeno complejo e incluso ambivalente. La agitación en los terapeutas fue acorde con su actividad terapéutica, mientras que en los pacientes fue más anticipatoria. El enfoque utilizado aquí dejó ver algo de la intensidad que puede generar el diálogo terapéutico cuando se tratan cuestiones de cambio en las relaciones en el contexto de la pareja y demostró cómo esta intensidad puede regularse dialógicamente en el sistema terapéutico.

The Relational Mind in Couple Therapy: A Bateson-Inspired View of Human Life as an Embodied Stream.

Research on human intersubjectivity has found that humans participate in a dialogue throughout their life, and that this is manifested not only via language, but also nonverbally, with the entire body. Such an understanding of human life has brought into focus some basic systemic ideas concerning the human relational mind. For Gregory Bateson, the mind works as a system, formed from components that are in continuous interaction with each other. In our Relational Mind research project, we followed twelve couple therapy processes involving two therapists per session, looking at the ways in which the four participants attuned to each other with their bodies, including their autonomic nervous system activity. Using observations from the project, we here describe the ways through which the relational and embodied mind can be realized in a couple therapy setting.

Sympathetic Nervous System Synchrony in Couple Therapy.

The aim of this study was to test whether there is statistically significant sympathetic nervous system (SNS) synchrony between participants in couple therapy. To our knowledge, this is the first study to measure psychophysiological synchrony during therapy in a multiactor setting. The study focuses on electrodermal activity (EDA) in the second couple therapy session from 10 different cases (20 clients, 10 therapists working in pairs). The EDA concordance index was used as a measure of SNS synchrony between dyads, and synchrony was found in 85% of all the dyads. Surprisingly, co-therapists exhibited the highest levels of synchrony, whereas couples exhibited the lowest synchrony. The client-therapist synchrony was lower than that of the co-therapists, but higher than that of the couples. A Video Abstract is available next to the online version of this article on the JMFT web site.

The Embodied Attunement of Therapists and a Couple within Dialogical Psychotherapy: An Introduction to the Relational Mind Research Project.

In dialogical practice, therapists seek to respond to the utterances of clients by including in their own response what the client said. No research so far exists on how, in dialogs, therapists and clients attune themselves to each other with their entire bodies. The research program The Relational Mind is the first to look at dialog in terms of both the outer and the inner dialogs of participants (clients and therapists), observed in parallel with autonomic nervous system (ANS) measurements. In the ANS, the response occurs immediately, even before conscious thought, making it possible to follow how participants in a multiactor dialog synchronize their reactions and attune themselves to each other. The couple therapy case presented in this article demonstrates how attunement is often not a simple "all at the same time" phenomenon, but rather a complex, dyadic or triadic phenomenon which changes over time. In the case presented, there was strong synchrony between one therapist and one client in terms of their arousal level throughout the therapy session. It was also observed that high stress could occur when someone else was talking about something related to the participant, or if that person mirrored the participant's words. Overall, it seems that in evaluating the rhythmic attunement between therapists and clients it is not enough to look at single variables; instead, integrated information from several channels is needed when one is seeking to make sense of the embodiment.