Nonverbal synchrony in psychotherapy: Coordinated body movement reflects relationship quality and outcome.

Objective: The authors quantified nonverbal synchrony—the coordination of patient's and therapist's movement—in a random sample of same-sex psychotherapy dyads. The authors contrasted nonverbal synchrony in these dyads with a control condition and assessed its association with session-level and overall psychotherapy outcome. Method: Using an automated objective video analysis algorithm (Motion Energy Analysis; MEA), the authors calculated nonverbal synchrony in (n = 104) videotaped psychotherapy sessions from 70 Caucasian patients (37 women, 33 men, mean age = 36.5 years, SD = 10.2) treated at an outpatient psychotherapy clinic. The sample was randomly drawn from an archive (N = 301) of routinely videotaped psychotherapies. Patients and their therapists assessed session impact with self-report postsession questionnaires. A battery of pre- and postsymptomatology questionnaires measured therapy effectiveness. Results: The authors found that nonverbal synchrony is higher in genuine interactions contrasted with pseudointeractions (a control condition generated by a specifically designed shuffling procedure). Furthermore, nonverbal synchrony is associated with session-level process as well as therapy outcome: It is increased in sessions rated by patients as manifesting high relationship quality and in patients experiencing high self-efficacy. Higher nonverbal synchrony characterized psychotherapies with higher symptom reduction. Conclusions: The results suggest that nonverbal synchrony embodies the patients' self-reported quality of the relationship and further variables of therapy process. This hitherto overlooked facet of therapeutic relationships might prove useful as an indicator of therapy progress and outcome. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Outcome of cognitive–behavioral therapy for depression: Relation to hemispheric dominance for verbal processing.

Unmedicated depressed outpatients were tested on dichotic syllable and complex tone tests prior to receiving 16 weekly sessions of cognitive therapy (n?=?31 ) or 6–12 weeks of placebo treatment (n?=?45). Cognitive-therapy responders had twice the right-ear (left hemisphere) advantage for syllables when compared with nonresponders but did not differ from nonresponders on the nonverbal task. The larger right-ear advantage in cognitive-therapy responders was due to better right-ear accuracy; they did not differ from nonresponders in left-ear accuracy. No differences in perceptual asymmetry or accuracy were found between placebo responders and nonresponders. Right-ear accuracy for syllables was the best predictor of response to cognitive therapy in a logistic regression analysis. The findings suggest that greater left-hemisphere advantage for verbal processing is associated with more favorable outcome of cognitive therapy for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers.

Clinically depressed family caregivers (N?=?66) of frail, elderly relatives were randomly assigned to 20 sessions of either cognitive-behavioral (CB) or brief psychodynamic (PD) individual psychotherapy. At posttreatment, 71% of the caregivers were no longer clinically depressed according to Research Diagnostic Criteria (RDC), with no differences found between the 2 outpatient treatments. The results suggested therapy specificity; there was an interaction between treatment modality and length of caregiving on symptom-oriented measures. Clients who had been caregivers for a shorter period showed improvement in the PD condition, whereas those who had been caregivers for at least 44 mo improved with CB therapy. These findings suggest that patient-specific variables should be considered when choosing treatment for clinically depressed family caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex differences in sustained attention across the adult life span.

We used a life span sample of 18- to 91-year-old men (n?=?176) and women (n?=?108) to investigate sex differences and the effect of age on sex differences in performance and arousal during a 62-min no-memory-demand sensory vigilance task (Mackworth's Clock-Test). We observed sex differences in target response time and on measures of autonomic arousal; women were slower and less aroused than men. A review of the literature, in conjunction with the results of this study, led to our concluding that women are slower to respond to targets than men and that women may tend to detect fewer targets than men only when they are young (18–29 years old). Sex differences in arousal levels were consistent with an arousal explanation of sex differences in response time. However, detection accuracy and false alarm rates were not consistent with sex differences in arousal levels. Sex differences in the time course of vigilance performance were inconsistent. Age did not significantly moderate the sex differences in vigilance decrement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Specificity and stability of self-referent encoding in clinical depression.

The self-referent encoding task was to investigate the specificity and stability of the self-schema in depression. Results of a comparison between depressed psychiatric (n?=?24), nondepressed psychiatric control (n?=?15), and nonpsychiatric control (n?=?14) patients revealed that the self-referent encoding task is specific to depression and that the use of content-specific adjectives in the task is important for the results obtained. A subset of the depressed group (n?=?9) who completed the task at a second occasion while still depressed showed results very similar to those obtained at the first testing occasion. A subset of depressed subjects (n?=?14) who completed the task on remission of their depression, however, evidenced a pattern of results quite dissimilar to those obtained while they were depressed. The pattern of results showed considerable shift in these subjects' self-referent encoding, and their results approximated those obtained by the two control groups. These results are discussed with reference to (a) the concept of the self-schema and its relevance for depression and (b) the self-referent encoding task as a means of assessing the self-schema. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A national survey of group psychotherapy services in correctional facilities.

Facilitating group psychotherapy in correctional settings presents dilemmas and concerns that are unmatched in other environments, often leaving clinicians grasping for therapeutic advantages. This article provides information regarding national practices of group psychotherapy services for male inmates in state correctional facilities (n?=?79) as reported by correctional mental health providers (n?=?162). The general findings of this study will be of interest to group psychotherapy providers employed in correctional facilities; however, of particular importance for doctoral-level psychologists is their potential role in fulfilling a need for the active development and evaluation of group psychotherapy programs in correctional settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relative endurance of unipolar depression treatment effects: Longitudinal follow-up.

This study represents a 2.25-year follow-up to a treatment study reported earlier (P. D. McLean & A. R. Hakstian, [see PA, Vol 63:1360]) in which 121 unipolar depressed outpatients were treated by either (a) nondirective psychotherapy, (b) behavior therapy, (c) pharmacotherapy, or (d) relaxation therapy. A nondepressed, normal control group was evaluated on the same 28 measures and 6 intervals for contrast purposes. Behavior therapy patients alone were significantly improved in the areas of mood, personal productivity, and social activity, relative to treatment control patients over the follow-up period. Also, twice as many behavior therapy patients (i.e., 64%) fell within one standard deviation of the normal, nondepressed control group distribution on depressed mood, compared with nondirective psychotherapy and pharmacotherapy patients, when scores were aggregated across the 6 assessment points. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.

This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients (n?=?145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapist orientation and expectations for liked and disliked patients.

Two fictional intake summaries were presented to either psychodynamically (n?=?32) or cognitive-behaviorally oriented (n?=?22) psychotherapists. Therapists rated the personality attributes of and expectations for the course of therapy with these potential patients. Therapists were less inclined to treat hypothetical patients whom they did not like, even though they believed these individuals to be in greater need of psychotherapy. When imagining themselves working with less liked patients, therapists expected to feel less confident of their skills and were more concerned that such patients would engage in countertherapeutic activities. Cognitive-behavioral therapists were somewhat more likely to differentiate between liked and less liked patients in their expectations for the course of therapy than were psychodynamic therapists. Implications for the provision of psychotherapy services are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bipolar disorder and family communication: Effects of a psychoeducational treatment program.

Family psychoeducational programs are efficacious adjuncts to pharmacotherapy for patients with schizophrenic and bipolar disorders, but little is known about what these programs change about families. The authors assessed changes in face-to-face interactional behavior over 1 year among families of bipolar patients who received a 9-month family-focused psychoeducational therapy (FFT; n?=?22) or crisis management with naturalistic follow-up (CMNF, n?=?22), both administered with maintenance pharmacotherapy. Members of families who received FFT showed more positive nonverbal interactional behavior during a 1-year posttreatment problem-solving assessment than families who received CMNF, although no corresponding decreases were seen in negative interactional behaviors. The positive effect of family treatment on patients' symptom trajectories over 1 year was partially mediated by increases in patients' positive nonverbal interactional behaviors during this same interval. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is homophobia associated with homosexual arousal?

The authors investigated the role of homosexual arousal in exclusively heterosexual men who admitted negative affect toward homosexual individuals. Participants consisted of a group of homophobic men (n?=?35 ) and a group of nonhomophobic men (n?=?29); they were assigned to groups on the basis of their scores on the Index of Homophobia (W. W. Hudson & W. A. Ricketts, 1980). The men were exposed to sexually explicit erotic stimuli consisting of heterosexual, male homosexual, and lesbian videotapes, and changes in penile circumference were monitored. They also completed an Aggression Questionnaire (A. H. Buss & M. Perry, 1992). Both groups exhibited increases in penile circumference to the heterosexual and female homosexual videos. Only the homophobic men showed an increase in penile erection to male homosexual stimuli. The groups did not differ in aggression. Homophobia is apparently associated with homosexual arousal that the homophobic individual is either unaware of or denies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adolescent psychopathology: II. Psychosocial risk factors for depression.

In a prospective study of adolescent depression, adolescents (N?=?1,508) were assessed at Time 1 and after 1 yr (Time 2) on psychosocial variables hypothesized to be associated with depression. Most psychosocial variables were associated with current (n?=?45) depression. Formerly depressed adolescents (n?=?217) continued to differ from never depressed controls on many of the psychosocial variables. Many of the depression-related measures also acted as risk factors for future depression (n?=?112), especially past depression, current other mental disorders, past suicide attempt, internalizing behavior problems, and physical symptoms. Young women were more likely to be, to become, and to have been depressed. Controlling for the psychosocial variables eliminated the gender difference for current and future but not for past depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Naltrexone, relapse prevention, and supportive therapy with alcoholics: An analysis of patient treatment matching.

Alcohol-dependent patients (N?=?97 ) were randomly assigned to receive either naltrexone or placebo and either relapse prevention therapy or supportive therapy. The present report explored the hypothesis that patients could be matched to the above treatments on the basis of specific pretreatment characteristics. Treatment matching variables explored included craving, alcohol dependence severity, and cognitive measures of learning and memory. Results of linear regression analyses tentatively suggest that patients experiencing higher levels of craving and poorer cognitive functioning may derive the greatest benefit from naltrexone versus placebo. For psychotherapy, lower levels of verbal learning were associated with poorer drinking outcomes for relapse prevention therapy but not for supportive therapy. Conversely, higher levels of verbal learning were associated with better outcomes for relapse prevention therapy but not for supportive therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sustained attention in adulthood: A unique, large-sample, longitudinal and multicohort analysis using the Mackworth Clock-Test.

A cross-sectional sample of men (n?=?177) tested in 1962–1964, and men (n?=?188) and women (n?=?113) tested in 1980–1984, and a longitudinal sample (n?=?53) of men tested in 1962–1964 and 1980–1984, were used to investigate age differences and 18-year age changes on a 62-min sensory vigilance task that made virtually no demand on memory, the Mackworth Clock-Test. Age differences and changes in the vigilance decrement were also examined. No age differences or changes were obtained for detection accuracy. Target response time showed significant age-related 18-year longitudinal changes and one significant cross-sectional age difference; the overall age effect was of a U-shaped function with a minimum at middle age. Age differences and changes were obtained in a measure of arousal: skin potential response latency; the overall age effect was also consistent with a U-shaped function. There was little consistent evidence of a differential effect of age on the vigilance decrement. Outcomes contradictory to Surwillo and Quilter (1964) and Quilter, Giambra, and Benson (1983) are reconciled through additional statistical analyses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social climate comparison of mutual help and psychotherapy groups.

Mutual help groups for the mentally ill (n?=?33) were significantly different from psychotherapy groups (n?=?25) on 9 of 10 perceived social climate dimensions from the 90-item Group Environment Scale. The mutual help members perceived that their groups had more active leaders, greater group cohesion, more structure and task-orientation, and fostered more independence. The members of psychotherapy groups perceived that their groups encouraged more expression of negative and other feelings and showed more flexibility in changing the group's activities. The present findings could be used to improve cooperation and referrals between mutual help groups and the mental health community. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diminished response to pleasant stimuli by depressed women.

This study examined the self-report and facial expressions of emotional response to pictorial stimuli and the incidental learning of pleasant and unpleasant words by depressed (n?=?20) and nondepressed (n?=?20) women. Depression was associated with reports of diminished emotional response and reduced frequency and intensity of facial expressions only to pleasant stimuli. The 2 groups did not differ in response to hedonically unpleasant stimuli, even those specifically relevant to the emotion of sadness. In a similar vein, depressed and nondepressed participants showed differences in incidental recall for only pleasant self-referential terms. There was no difference in recall of unpleasant words. These findings suggest the importance of hedonic deficits on psychological processes in clinical depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Religion and spirituality.

We define religion and spirituality and discuss five scenarios in which they will probably emerge in psychotherapy. We review empirical research on religion and spirituality as they pertain to psychotherapy outcomes and relationships. Most research has been unsophisticated relative to the general status of psychotherapy research. Nonetheless, therapists are urged to assess for religion. and spirituality and, if possible, intervene in religiously and spiritually sensitive ways. Nine empirical studies of religiously accommodative Christian (n = 6) and Muslim (n = 3) psychotherapy have provided limited support for its efficacy, especially with depressed clients. Highly religious clients appear to desire therapy that respects (if not integrates) their religion, but research is unclear about the degree to which they can benefit from secular therapies, especially when they request religious therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of DSM-IV cluster B personality disorder symptoms on the termination and continuation of psychotherapy.

This study investigates the relationship between therapy attendance with DSM-IV criteria for the cluster B personality disorders (antisocial [ANPD]; borderline [BPD]; histrionic [HPD]; and narcissistic [NPD]). Ninety patients who were found to meet DSM-IV criteria for an Axis II disorder (cluster A personality disorders?=?10; ANPD?=?20, BPD?=?25, HPD?=?5, NPD?=?14; cluster C personality disorders?=?16). Total number of DSM-IV criteria for BPD (r?=?.33, p?=?.001) and ANPD (r?=?–.22, p?=?.04) were significantly related to the number of psychotherapy sessions attended by a patient. Stepwise regression indicated that the 5 individual criteria BPD-1, NPD-4, BPD-8, HPD-8, and ANPD-7 (in order of entry into the regression equation) were independent and nonredundant predictors that explained 31% of variance found in the number of psychotherapy sessions attended by patients. The presence or absence of 3 of these individual criteria provided a good balance of positive predictive power (.78–.95) and overall correct classification rate (.53–.69) for therapy continuation. Clinical and research implications of personality characteristics are discussed in relation to the termination and continuation of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-behavioral therapy of panic disorder with secondary major depression: A preliminary investigation.

Controlled studies indicate that cognitive-behavioral therapy eliminates panic attacks in greater than 80% of patients who suffer from panic disorder. However, because most of the screening procedures used in those studies called for excluding patients who were depressed, a question arises as to the extent to which these results apply to patients who are clinically depressed in addition to having panic attacks. An attempt was made in the present study to determine whether or not panic patients who are clinically depressed could be treated as successfully as those who are not clinically depressed. Two multiple baseline A-A–1-A-B across-Ss designs were used, 1 to test 8 panic Ss with major depression and the 2nd to test 7 panic Ss without major depression. In baseline (A), Ss monitored their panic attacks daily. During the A–1 phase, a program of information on panic attacks presented as psychotherapy was instituted to assess the effects of nonspecific factors, followed by a 2nd baseline phase (A). Cognitive-behavioral therapy (B) was then introduced. Results showed that cognitive-behavioral therapy was significantly superior to information-based therapy in the reduction of panic attacks. No significant differences were found between depressed and nondepressed patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early process and dropping out from short-term group therapy for complicated grief.

Early group process variables were investigated as predictors of dropping out for patients who participated in short-term group psychotherapy for complicated grief. Constructs assessed included affect, cohesion, group climate, and therapeutic alliance. Using logistic regression analyses, the authors investigated differences between dropouts and remainers at Sessions 1 and 4. Results indicated that after the lst therapy session, imminent dropouts reported experiencing less positive feelings than remainers. In addition, therapists' ratings of cohesion to the patients were significantly lower for the dropouts than for remainers. Clinical implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)