Physiological activation and co-activation in an imagery-based treatment for test anxiety

Emotion dynamics of clients with test anxiety before and after an imagery-based treatment

BACKGROUND AND OBJECTIVES

Imagery-based techniques have become a promising means in the treatment of test anxiety (TA). Although previous studies have demonstrated the effectiveness of imagery-based treatment, not all clients seem to benefit from it. The present study compares clients' pre- as well as post-treatment emotion dynamics between responders and non-responders. Furthermore, it examines treatment-related changes in emotion dynamics in both subgroups.

METHODS

The results are based on 44 clients suffering from TA who underwent a six-session imagery-based treatment and include Ecological Momentary Assessment (EMA). Emotions were assessed with the Profile of Mood States four times a day over the course of two weeks before and after the treatment. Temporal networks were computed to index emotion dynamics.

RESULTS

Pre-treatment emotion dynamics differed between responders and non-responders. Similarly, post-treatment emotion dynamics differed as well between both groups. Some changes were also observed between pre-treatment and post-treatment networks: for responders, fatigue no longer predicted anger, and depression predicted itself; for non-responders, calmness predicted fatigue, anger, depression, contentment, and anxiety. In addition, fatigue no longer predicted itself and anxiety predicted vigor.

LIMITATIONS

The investigation is marked by several limitations: a liberal inclusion threshold of at least a 50% response to EMA prompts, and a relatively homogenous sample.

CONCLUSION

These results provide first evidence for the idea that emotion dynamics may be associated with response to treatment for TA. Furthermore, effective imagery-based treatments may be tied to changes within these dynamics.

[Digitization and Machine Learning in Psychotherapy Research and Clinical Practice - Potentials and Problems]

Im Zuge des weltweiten Anstieges der Bedeutung von psychischen Störungen 1, werden frühzeitige Interventionen und wirksame psychotherapeutische Behandlungen für ein funktionierendes Gesundheitssystem immer wichtiger. Der aktuelle Stand der Psychotherapieforschung zeigt jedoch, dass nicht alle Patient:innen gleichermaßen von Psychotherapie profitieren, sondern dass die meisten Patient:innen (70–80%) zwar deutliche Verbesserung zeigen, während andere nur geringe oder keine Fortschritte erzielen oder sogar Verschlechterungen erfahren 2. Dies impliziert eine stärkere Berücksichtigung von individuellen Unterschieden von Patient:innen und deren Therapieverlauf in der Psychotherapieforschung, sowie eine stärkere Refokussierung auf ungünstige Therapieverläufe und Abkehr von der Frage nach durchschnittlichen Unterschieden zwischen den verschiedenen Therapieverfahren oder Therapieschulen.

Facilitating dyadic synchrony in psychotherapy sessions: Systematic review and meta-analysis

Objective: This paper highlights the facilitation of dyadic synchrony as a core psychotherapist skill that occurs at the non-verbal level and underlies many other therapeutic methods. We define dyadic synchrony, differentiate it from similar constructs, and provide an excerpt illustrating dyadic synchrony in a psychotherapy session. Method: We then present a systematic review of 17 studies that have examined the associations between dyadic synchrony and psychotherapy outcomes. We also conduct a meta-analysis of 8 studies that examined whether there is more synchrony between clients and therapists than would be expected by chance. Results: Weighted box score analysis revealed that the overall association of synchrony and proximal as well as distal outcomes was neutral to mildly positive. The results of the meta-analysis indicated that real client-therapist dyad pairs exhibited synchronized behavioral patterns to a much greater extent than a sample of randomly paired people who did not actually speak. Conclusion: Our discussion revolves around how synchrony can be facilitated in a beneficial way, as well as situations in which it may not be beneficial. We conclude with training implications and therapeutic practices.

Movement-based patient-therapist attunement in psychological therapy and its association with early change

Objective

Attunement is a novel measure of nonverbal synchrony reflecting the duration of the present moment shared by two interaction partners. This study examined its association with early change in outpatient psychotherapy.

Methods

Automated video analysis based on motion energy analysis (MEA) and cross-correlation of the movement time-series of patient and therapist was conducted to calculate movement synchrony for N = 161 outpatients. Movement-based attunement was defined as the range of connected time lags with significant synchrony. Latent change classes in the HSCL-11 were identified with growth mixture modeling (GMM) and predicted by pre-treatment covariates and attunement using multilevel multinomial regression.

Results

GMM identified four latent classes: high impairment, no change (Class 1); high impairment, early response (Class 2); moderate impairment (Class 3); and low impairment (Class 4). Class 2 showed the strongest attunement, the largest early response, and the best outcome. Stronger attunement was associated with a higher likelihood of membership in Class 2 (b = 0.313, p = .007), Class 3 (b = 0.251, p = .033), and Class 4 (b = 0.275, p = .043) compared to Class 1. For highly impaired patients, the probability of no early change (Class 1) decreased and the probability of early response (Class 2) increased as a function of attunement.

Conclusions

Among patients with high impairment, stronger patient-therapist attunement was associated with early response, which predicted a better treatment outcome. Video-based assessment of attunement might provide new information for therapists not available from self-report questionnaires and support therapists in their clinical decision-making.

Validation and application of the Non-Verbal Behavior Analyzer: An automated tool to assess non-verbal emotional expressions in psychotherapy

BACKGROUND

Emotions play a key role in psychotherapy. However, a problem with examining emotional states via self-report questionnaires is that the assessment usually takes place after the actual emotion has been experienced which might lead to biases and continuous human ratings are time and cost intensive. Using the AI-based software package Non-Verbal Behavior Analyzer (NOVA), video-based emotion recognition of arousal and valence can be applied in naturalistic psychotherapeutic settings. In this study, four emotion recognition models (ERM) each based on specific feature sets (facial: OpenFace, OpenFace-Aureg; body: OpenPose-Activation, OpenPose-Energy) were developed and compared in their ability to predict arousal and valence scores correlated to PANAS emotion scores and processes of change (interpersonal experience, coping experience, affective experience) as well as symptoms (depression and anxiety in HSCL-11).

MATERIALS AND METHODS

A total of 183 patient therapy videos were divided into a training sample (55 patients), a test sample (50 patients), and a holdout sample (78 patients). The best ERM was selected for further analyses. Then, ERM based arousal and valence scores were correlated with patient and therapist estimates of emotions and processes of change. Furthermore, using regression models arousal and valence were examined as predictors of symptom severity in depression and anxiety.

RESULTS

The ERM based on OpenFace produced the best agreement to the human coder rating. Arousal and valence correlated significantly with therapists' ratings of sadness, shame, anxiety, and relaxation, but not with the patient ratings of their own emotions. Furthermore, a significant negative correlation indicates that negative valence was associated with higher affective experience. Negative valence was found to significantly predict higher anxiety but not depression scores.

CONCLUSION

This study shows that emotion recognition with NOVA can be used to generate ERMs associated with patient emotions, affective experiences and symptoms. Nevertheless, limitations were obvious. It seems necessary to improve the ERMs using larger databases of sessions and the validity of ERMs needs to be further investigated in different samples and different applications. Furthermore, future research should take ERMs to identify emotional synchrony between patient and therapists into account.

Clients' Emotional Experiences Tied to Therapist-Led (but Not Client-Led) Physiological Synchrony during Imagery Rescripting

Imagery rescripting (IR), an effective intervention technique, may achieve its benefits through various change mechanisms. Previous work has indicated that client–therapist physiological synchrony during IR may serve as one such mechanism. The present work explores the possibility that therapist-led vs. client-led synchrony may be differentially tied to clients’ emotional experiences in therapy. The analyses were conducted with data taken from an open trial of a brief protocol for treating test anxiety (86 IR sessions from 50 client–therapist dyads). Physiological synchrony in electrodermal activity was indexed using two cross-correlation functions per session: once for client leading and again for therapist leading (in both cases, with lags up to 10 s). The clients’ and therapists’ in-session emotions were assessed with the Profile of Mood States. Actor–partner interdependence models showed that certain client (but not therapist) in-session emotions, namely higher contentment and lower anxiety and depression, were tied to therapist-led (but not client-led) physiological synchrony. The results suggest that therapist-led synchrony (i.e., clients’ arousal tracking therapists’ earlier arousal) is tied to more positive and less negative emotional experiences for clients.