Minding my brain: Fourteen neuroscience-based principles to enhance psychotherapy responsiveness

Assessing the patient's affective perception of their psychotherapist: validation of the in-Session Patient Affective Reactions Questionnaire

Background

Psychotherapists need effective tools to monitor changes in the patient's affective perception of the therapist and the therapeutic relationship during sessions to tailor therapeutic interventions and improve treatment outcomes. This study aims to evaluate the factor structure, reliability, and validity of the in-Session Patient Affective Reactions Questionnaire (SPARQ), a concise self-report measure designed for practical application in real-world psychotherapy settings.

Methods

Validation data was gathered from (N = 700) adult patients in individual psychotherapy. These patients completed the SPARQ in conjunction with additional measures capturing sociodemographic details, characteristics of therapeutic interventions, individual personality traits, mental health symptom severity, elements of the therapeutic relationship, and session outcomes. This comprehensive approach was employed to assess the construct and criterion-related validity of the SPARQ.

Results

The SPARQ has a two-factor structure: Positive Affect (k = 4, ω total = .87) and Negative Affect (k = 4, ω total = .75). Bifactor confirmatory factor analysis (CFA) yielded the following fit indices: X2[df] = 2.53, CFI = .99; TLI = .98; RMSEA = .05; and SRMR = .02. Multi-group CFAs demonstrated measurement invariance (i) across patients who attended psychotherapy sessions in person versus in remote mode, and (ii) across patients with and without psychiatric diagnoses confirmed metric invariance. Furthermore, the SPARQ showed meaningful correlations with concurrently administered measures.

Discussion

The SPARQ proves to be a valuable instrument in clinical, training, and research contexts, adept at capturing patients' session-level affective responses towards their therapist and perceptions of the therapeutic alliance. Comprehensive descriptive statistics and a range of score precision indices have been reported, intended to serve as benchmarks for future research.

Enhancing Psychotherapy Outcomes by Encouraging Patients to Regularly Self-Monitor, Reflect on, and Share Their Affective Responses Toward Their Therapist: Protocol for a Randomized Controlled Trial

BACKGROUND

The quality of the therapeutic relationship is pivotal in determining psychotherapy outcomes. However, facilitating patients' self-awareness, reflection on, and sharing of their affective responses toward their therapist remains underexplored as a potential tool for enhancing this relationship and subsequent treatment outcomes.

OBJECTIVE

The primary objective of this study is to examine whether and how the patients' regular self-monitoring and self-reflection (fostered by the systematic compilation of a brief postsession battery) on their affective reactions toward the psychotherapist impact the quality of the therapeutic relationship and treatment outcomes in individual psychotherapy. Secondary objectives are to (1) explore whether and how the characteristics of the patient, the therapist, and the process moderate the effect of regular self-monitoring on the therapeutic relationship and outcomes; (2) examine the relationships between the affective response of the patient, the alliance, and the result of the therapy session outcome; and (3) explore how the affective responses of the patient unfold or change throughout the course of the therapy.

METHODS

We conducted a 1:1 randomized controlled trial of adults in individual psychotherapy versus individual psychotherapy plus self-monitoring. Participants will be enrolled through the web-based recruitment platforms "ResearchMatch" and "Research for Me," and data will be collected through web-based surveys. Participants in the control group will receive only their regular individual psychotherapy (treatment as usual) and will not complete postsession questionnaires. Participants in the intervention group will continue their regular individual psychotherapy sessions and complete the "in-Session Patient Affective Reactions Questionnaire" and the "Rift In-Session Questionnaire" following each therapy session in the 10 weeks of the trial. Additionally, after completion of the postsession battery, they will receive general written feedback encouraging them to discuss their feelings and reflections with their therapist. Participants in both groups will complete a comprehensive psychological assessment at baseline, midtrial (week 5), and end-of-trial (week 10). The primary outcome measure of the trial is the "Clinical Outcomes in Routine Evaluation-Outcome Measure," while the secondary outcomes are the "Real Relationship Inventory-Client-Short Form," the "Working Alliance Inventory-Short Revised," and the number of scheduled therapy sessions that the patient has missed or canceled.

RESULTS

The trial was approved by the institutional review board of the University of North Carolina at Chapel Hill. Recruitment started in September 2023. A total of 475 individuals completed the baseline assessment. Data collection was completed in February 2024. The results are expected to be published in the autumn of 2024.

CONCLUSIONS

This study could reveal key information on how regular self-monitoring and introspection can influence both the therapeutic relationship and treatment outcomes. Findings have the potential to shape interventions, enhance the efficacy of psychotherapeutic sessions, and possibly offer a cost-effective strategy for improving patients' well-being.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06038747; https://classic.clinicaltrials.gov/ct2/show/NCT06038747.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55369.

Introducing a Neuroscience-Based Assessment Instrument: Development and Psychometric Study of the Neural Networks Symptomatology Inventory

Background: Neuroscience research methods contribute to the understanding of the underlying neural impairments associated with psychopathology. Previous research suggested that impairments in Default Mode Network, Fronto-Parietal Executive Network, Amygdaloid-Hippocampal Memory Network, and Attentional Salience Network are present in different psychopathological symptoms. However, a self-report measure based on this evidence is lacking. Aims: Therefore, the present study describes the development and preliminary psychometric study of the Neural Network Symptomatology Inventory (NNSI). Method: Two different samples were recruited (sample 1: N = 214, Mage = 21.0, SD = 7.10; sample 2: N = 194, Mage = 21.5, SD = 8.41) and responded to self-report instruments in a cross-sectional design. Standard methodologies to scale development and psychometric study were applied: Item development, Exploratory (EFA), Confirmatory Factor Analysis (CFA), and Pearson correlations. Results: EFA and CFA suggested a 4-factor model with adequate goodness-of-fit indices (χ2(449) = 808,9841, TLI = .89, CFI = .92, RMSEA = .048 (.042-.053). All NNSI subscales correlated positively with psychopathological domains and correlated negatively with psychological well-being. Conclusions: This preliminary study suggests that NNSI may be a valid instrument to assess symptomatology associated with complex neural network impairments. Nevertheless, further research is required to deepen and improve NNSI psychometric characteristics.

Development and Initial Validation of the in-Session Patient Affective Reactions Questionnaire (SPARQ) and the Rift In-Session Questionnaire (RISQ)

This article discusses the development and preliminary validation of a self-report inventory of the patient's perception of, and affective reaction to, their therapist during a psychotherapy session. First, we wrote a pool of 131 items, reviewed them based on subject matter experts' review, and then collected validation data from a clinical sample of adult patients in individual therapy (N = 701). We used exploratory factor analysis and item response theory graded response models to select items, confirmatory factor analysis (CFA) to test the factor structure, and k-fold cross-validation to verify model robustness. Multi-group CFA examined measurement invariance across patients with different diagnoses (unipolar depression, bipolar disorder, and neither of these). Three factors produced short scales retaining the strongest items. The in-Session Patient Affective Reactions Questionnaire (SPARQ) has a two-factor structure, yielding a four-item Negative affect scale and a four-item Positive affect scale. The Relationship In-Session Questionnaire (RISQ) is composed of four items from the third factor with dichotomized responses. Both scales showed excellent psychometric properties and evidence of metric invariance across the three diagnostic groups: unipolar depression, bipolar disorder, and neither of these. The SPARQ and the RISQ scale can be used in clinical or research settings, with particular value for capturing the patient's perspectives about their therapist and session-level emotional processes.

Exploring relationships between executive functions and maladaptive cyclical patterns in a transdiagnostic sample

Executive functions are described as a set of neurocognitive processes underlying human mental processing, while maladaptive cyclical patterns are the dysfunctional psychological elements associated with psychological distress and symptomatology that tend to be recurrent. Both psychological constructs tend to be studied by different scientific fields and with different methods which limits a coherent theoretical integration. Therefore, the present study aims to explore the relationships between executive functions and maladaptive cyclical patterns. A sample was gathered (N = 96, Mage = 20.78, SD = 4.63), and completed several self-report questionnaires along with several neuropsychological tests for the assessment of executive functions. Results showed that behavioral inhibition correlated negatively with maladaptive cyclical patterns while cognitive inflexibility correlated positively. Regression analysis showed that behavioral inhibition, psychological inflexibility, and recurring states of mind predicted emotional processing difficulties. These results emphasize previous assumptions that a difference between self-report questionnaires and behavioral tasks may limit the integrated study of psychological and neurocognitive processes.

Neuroscience-based psychotherapy: A position paper

In the recent years, discoveries in neuroscience have greatly impacted upon the need to modify therapeutic practice starting from the evidence showing some cerebral mechanisms capable of coping with mental health crisis and traumatic events of the individual's life history by redesigning the narrative plot and the person's sense of the Self. The emerging dialogue between neuroscience and psychotherapy is increasingly intense and modern psychotherapy cannot ignore the heritage deriving from studies about neuropsychological modification of memory traces, neurobiology of attachment theory, cognitive mechanisms involved in psychopathology, neurophysiology of human empathy, neuroimaging evidence about psychotherapeutic treatment, and somatoform disorders connecting the brain and the body. In the present article, we critically examined sectorial literature and claimed that psychotherapy has to referred to a neuroscience-based approach in order to adopt the most tailored interventions for specific groups of patients or therapy settings. We also provided recommendations for care implementation in clinical practice and illustrated challenges of future research.