Psychotherapy participants show increased physiological responsiveness to a lab stressor relative to matched controls

A complex interplay between autonomic symptoms and symptoms of depression, anxiety, and stress

BACKGROUND

We evaluated the influence of symptoms of depression, anxiety, and stress on the results of COMPASS-31 in a large population of people referred to the head-up tilt test (HUTT) and healthy controls (HC).

METHODS

Nine hundred fifty-nine consecutive patients referred to HUTT and 518 HC were enrolled. All participants completed Composite Autonomic Symptom Score-31 (COMPASS-31). Stress symptoms were evaluated by Depression, Anxiety, and Stress-21 (DASS-21) questionnaire. We corrected the result of the COMPASS-31 with the independent predictors in order to improve the specificity of the test.

RESULTS

In both patients and HC, COMPASS-31 was higher in participants with depression, anxiety, and stress symptoms (all p < 0.001). In a multivariable linear regression analysis, HC was negative, while female sex and symptoms of depression, anxiety, and stress were independent positive predictors of COMPASS-31. In HC, COMPASS-31 had a median of 7.913, and this value differentiated between HC and patients with a high sensitivity of 87% and low specificity of 50%. In order to adjust the value of COMPASS-31 with the parameters that were significant in the multivariable linear regression model, we calculated the new corrected COMAPSS-31 (cCOMPASS-31), which had comparable sensitivity of 77%, but an increased specificity of 73%.

CONCLUSION

This study has shown that symptoms of depression, anxiety, and/or stress worsen the perceived severity of autonomic symptoms in people with symptoms of orthostatic intolerance and healthy population. cCOMPASS-31 is a valuable tool that can help clinicians in discerning the true autonomic background of patients' complaints.

A Mixed Methods Framework for Psychoanalytic Group Therapy: From Qualitative Records to a Quantitative Approach Using T-Pattern, Lag Sequential, and Polar Coordinate Analyses

Conducted within a mixed methods framework, this study focuses on the conversation-facilitation role of a lead therapist during group psychotherapy with adolescents. Conversation is an essential component of psychoanalytic psychotherapies and there is growing interest in describing and studying the impact of conversational techniques. One way to do this is to report on specific approaches, such as questioning, paraphrasing, and mentalization in intervention turns and to analyze their impact on the therapist-patient relationship. The main aim of this study was to investigate differences in communication strategies used by a lead therapist in the early and late stages of therapy with six adolescents aged 13-15 years. We employed a mixed methods design based on systematic direct observation supplemented by indirect observation. The observational methodology design was nomothetic, follow-up, and multidimensional. The choice of methodology is justified by our use of an ad hoc observation instrument for communication strategies combining a field format and a category system. We analyzed interobserver agreement quantitatively by Cohen's kappa using GSEQ5 software. Following confirmation of the reliability of the data, we analyzed the lead therapist's conversation-facilitation techniques in sessions 5 and 29 of a 30-session program by quantitatively analyzing what were initially qualitative data using T-pattern detection (THEME v.6 Edu software), lag sequential analysis (GSEQ5 software), and polar coordinate analysis (HOISAN v. 1.6.3.3.6. software and R software). The results show changes in the techniques used from the start to the end of therapy. Of the 28 communication strategies analyzed, three were particularly common: questioning and paraphrasing in session 5 and questioning and mentalization in session 29. This mixed methods study shows that combined use of T-pattern detection, lag sequential analysis, and polar coordinate analysis can offer meaningful and objective insights into group psychotherapy through the lens of the therapist.

Empathy, Challenge, and Psychophysiological Activation in Therapist-Client Interaction

Two central dimensions in psychotherapeutic work are a therapist's empathy with clients and challenging their judgments. We investigated how they influence psychophysiological responses in the participants. Data were from psychodynamic therapy sessions, 24 sessions from 5 dyads, from which 694 therapist's interventions were coded. Heart rate and electrodermal activity (EDA) of the participants were used to index emotional arousal. Facial muscle activity (electromyography) was used to index positive and negative emotional facial expressions. Electrophysiological data were analyzed in two time frames: (a) during the therapists' interventions and (b) across the whole psychotherapy session. Both empathy and challenge had an effect on psychophysiological responses in the participants. Therapists' empathy decreased clients' and increased their own EDA across the session. Therapists' challenge increased their own EDA in response to the interventions, but not across the sessions. Clients, on the other hand, did not respond to challenges during interventions, but challenges tended to increase EDA across a session. Furthermore, there was an interaction effect between empathy and challenge. Heart rate decreased and positive facial expressions increased in sessions where empathy and challenge were coupled, i.e., the amount of both empathy and challenge was either high or low. This suggests that these two variables work together. The results highlight the therapeutic functions and interrelation of empathy and challenge, and in line with the dyadic system theory by Beebe and Lachmann (2002), the systemic linkage between interactional expression and individual regulation of emotion.

Adding HRV biofeedback to psychotherapy increases heart rate variability and improves the treatment of major depressive disorder

Heart rate variability (HRV) is a significant marker of health outcomes with decreased HRV predicting increased disease risk. HRV is decreased in major depressive disorder (MDD) but existing treatments for depression do not return heart rate variability to normal levels even with successful treatment of depression. Heart rate variability biofeedback (HRVB) increases heart rate variability but no studies to date have examined whether combining HRVB with psychotherapy improves outcome in MDD treatment. The present study used a randomized controlled design to compare the effects of HRVB combined with psychotherapy on MDD relative to a psychotherapy treatment as usual group and to a non-depressed control group. The HRVB+psychotherapy group showed a larger increase in HRV and a larger decrease in depressive symptoms relative to the other groups over a six-week period, whereas the psychotherapy group only did not improve HRV. Results support the supplementation of psychotherapy with HRVB in the treatment of MDD.