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.

Multimodal In-Vehicle Hypoglycemia Warning for Drivers With Type 1 Diabetes: Design and Evaluation in Simulated and Real-World Driving

BACKGROUND

Hypoglycemia threatens cognitive function and driving safety. Previous research investigated in-vehicle voice assistants as hypoglycemia warnings. However, they could startle drivers. To address this, we combine voice warnings with ambient LEDs.

OBJECTIVE

The study assesses the effect of in-vehicle multimodal warning on emotional reaction and technology acceptance among drivers with type 1 diabetes.

METHODS

Two studies were conducted, one in simulated driving and the other in real-world driving. A quasi-experimental design included 2 independent variables (blood glucose phase and warning modality) and 1 main dependent variable (emotional reaction). Blood glucose was manipulated via intravenous catheters, and warning modality was manipulated by combining a tablet voice warning app and LEDs. Emotional reaction was measured physiologically via skin conductance response and subjectively with the Affective Slider and tested with a mixed-effect linear model. Secondary outcomes included self-reported technology acceptance. Participants were recruited from Bern University Hospital, Switzerland.

RESULTS

The simulated and real-world driving studies involved 9 and 10 participants with type 1 diabetes, respectively. Both studies showed significant results in self-reported emotional reactions (P<.001). In simulated driving, neither warning modality nor blood glucose phase significantly affected self-reported arousal, but in real-world driving, both did (F2,68=4.3; P<.05 and F2,76=4.1; P=.03). Warning modality affected self-reported valence in simulated driving (F2,68=3.9; P<.05), while blood glucose phase affected it in real-world driving (F2,76=9.3; P<.001). Skin conductance response did not yield significant results neither in the simulated driving study (modality: F2,68=2.46; P=.09, blood glucose phase: F2,68=0.3; P=.74), nor in the real-world driving study (modality: F2,76=0.8; P=.47, blood glucose phase: F2,76=0.7; P=.5). In both simulated and real-world driving studies, the voice+LED warning modality was the most effective (simulated: mean 3.38, SD 1.06 and real-world: mean 3.5, SD 0.71) and urgent (simulated: mean 3.12, SD 0.64 and real-world: mean 3.6, SD 0.52). Annoyance varied across settings. The standard warning modality was the least effective (simulated: mean 2.25, SD 1.16 and real-world: mean 3.3, SD 1.06) and urgent (simulated: mean 1.88, SD 1.55 and real-world: mean 2.6, SD 1.26) and the most annoying (simulated: mean 2.25, SD 1.16 and real-world: mean 1.7, SD 0.95). In terms of preference, the voice warning modality outperformed the standard warning modality. In simulated driving, the voice+LED warning modality (mean rank 1.5, SD rank 0.82) was preferred over the voice (mean rank 2.2, SD rank 0.6) and standard (mean rank 2.4, SD rank 0.81) warning modalities, while in real-world driving, the voice+LED and voice warning modalities were equally preferred (mean rank 1.8, SD rank 0.79) to the standard warning modality (mean rank 2.4, SD rank 0.84).

CONCLUSIONS

Despite the mixed results, this paper highlights the potential of implementing voice assistant-based health warnings in cars and advocates for multimodal alerts to enhance hypoglycemia management while driving.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05183191; https://classic.clinicaltrials.gov/ct2/show/NCT05183191, ClinicalTrials.gov NCT05308095; https://classic.clinicaltrials.gov/ct2/show/NCT05308095.

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.

Verbal Violence and Turnover Intention Among New Nurses in Korea: A Time-Lagged Survey

AIM

To test a model examining the impact of verbal violence against new nurses on their turnover intention and the mediating effects of emotional reaction and burnout based on affective events theory.

BACKGROUND

In Korea, turnover rate of nurses, especially new nurses, is at a serious level. Verifying the paths is important by which nurses decide to turnover intention after experiencing verbal violence, which is the most common form of workplace violence. In particular, Research on new nurses who are vulnerable to exposure to verbal violence and have a high turnover rate is insufficient.

METHODS

Data was collected using a time-lagged online surveys from 212 Korean new nurses. Structural equation modelling was used to test the hypothesized model.

RESULTS

The level of the turnover intention of new nurses was almost 4 out of 5. Verbal violence not only has a direct effect on turnover intention, but also has an indirect effect through burnout. Emotional reactions and burnout sequentially mediated the relationship between verbal violence and turnover intention; these variables explained approximately 57% of turnover intention.

CONCLUSIONS

To decrease negative emotional reactions and burnout caused by verbal violence may benefit to reduction of turnover intention of new nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

The critical need for new nurses' violence interventions that focus on emotional reactions and burnout, and subsequently improving desirable patient-coworker-nurse relationships and quality of life for new nurses.

The Speech Situation Checklist-Emotional Reaction: Normative and comparative study of Kannada-speaking children who do and do not stutter

Purpose: Existing data stemming from investigations with the Speech Situation Checklist (SSC) have shown this standardised test to be a valid and reliable tool for assessing speech-related anxiety in children who stutter (CWS). The main purpose of this study was to compare Speech Situation Checklist-Emotional Reaction (SSC-ER) scores for Kannada-speaking children who do not stutter (CWNS) and CWS. In addition, the Speech Situation Checklist-Emotional Reaction in Kannada (SSC-ER-K) scores among different stuttering severity and age groups were compared in CWS.Method: The English version of the SSC-ER was forward-translated into Kannada and back-translated by the first author. SSC-ER-K was administered on 100 CWS and 275 CWNS aged between 7 and 14 years who were native speakers of the Kannada language. The severity of stuttering was estimated using the Stuttering Severity Instrument-fourth edition (SSI-4).Result: The results revealed that the SSC-ER-K scores of CWS were significantly higher in comparison with CWNS. CWS with moderate and severe degrees of stuttering had significantly higher scores when compared to those with a mild degree of stuttering. Furthermore, the older CWS (11-14 years) had significantly higher scores compared to the younger CWS (7-10 years). In addition, the SSC-ER-K appears to be a reliable self-report test. The above findings suggest the presence of significantly increased speech-related anxiety in CWS. Also, as age and severity of stuttering increased so did the level of their speech-related anxiety.Conclusion: The SSC-ER-K is a useful tool in the assessment of negative emotional reaction to specific speech situations in Kannada CWS and can assist speech-language pathologists in addressing speech-situation specific anxiety during treatment.

Emotional reactions of trained overdose responders who use opioids following intervention in an overdose event

Background: Our aim was to explore emotional reactions to intervening in an overdose event from the perspective of individuals who use opioids (peer responders). In addition, we were interested in the impact this experience may have on peer responders' feelings about helping in an overdose situation in the future. Methods: For this qualitative sub-study of a randomized controlled trial (RCT), data from 61 interviews were analyzed thematically using an inductive approach. Results: Peer responders had diverse emotional reactions to the overdose event. These ranged from a sense of pride and other positive feelings associated with their ability to help to ambivalence about being involved in situations perceived as challenging and burdensome. There were few reports of the overdose event as an exclusively negative experience. Many peer responders perceived it as their duty to use naloxone again if required. However, some had ambivalent feelings toward this responsibility, which may be related to negative experiences with previous intervention efforts. Conclusions: The capacity of people who use opioids to help reduce the harms associated with opioid overdose is experienced as empowering by some. Nonetheless, engaging peer responders in strategies to reduce opioid-related mortality should be coupled with appropriate resources to process their experiences and emotional responses.

2020s Heroes Are Not Fearless: The Impact of the COVID-19 Pandemic on Wellbeing and Emotions of Italian Health Care Workers During Italy Phase 1

Objective

The study aimed to investigate the mental health and emotional reaction of physicians working during phase 1 of the COVID-19 pandemic in Italy.

Methods

A total of 458 Italian Health Care Workers (HCWs) working during phases 1 of the COVID-19 outbreak were voluntarily enlisted in the study and recruited with the snowball technique through an online survey. We examined our variables with the General Health Questionnaire – 12 and with Visual Analog Scales.

Results

The sample has a high level of psychological distress 21.26 (SD = 4.46), the emotional reaction was characterized by high level of fear for family members and cohabitants (M = 77.67, SD = 27.16) and patients (M = 67.16, SD = 27.71). Perceived control, fear for patients, and for family members and cohabitants, feeling alone and anger all contribute to a decreased mental health in Italian physicians (R² = 0.285, p < 0.001).

Conclusion

Italian HCWs’ mental health and emotional reaction have to be considered to prevent high risk of burnout and post-traumatic stress disorder (PTSD). It becomes pivotal in the next months to implement a tailored psychological intervention to take care of HCWs and to prevent costly consequences for them, patients, and the healthcare system.

Notification of Unexpected, Violent and Traumatic Death: A Systematic Review

Background: The way the death of a person is communicated can have a profound impact on the bereavement process. The words and expressions that are used to give the tragic news, the characteristics of who communicates it, the physical setting in which the notification is given, the means used (e.g., in person, via phone call, etc.) are just some of the factors that can influence the way survivors face one of the most difficult moments in their lives. Aim: To review the literature on the topic of death notification to verify the state of the art related to this important procedure. Methods: A systematic review was conducted with PRISMA criteria on English-written materials produced from 1966 to 2019. Results: Out of the initial 3,166 titles considered, 60 articles were extracted for this review. A content analysis has revealed four main areas of interest: (1) protocols and guidelines; (2) emotional reactions of recipients and notifiers; (3) professional figures involved in the notification process; and, (4) types of death. Discussion: The communication of death represents a complex and stressful experience not only for those who receive it but also for those who give it. Alongside the acquisition of a necessary technique and execution methods, the process should involve the selection of notifiers based on personality characteristics and communication styles. Conclusion: Indications for the need of better training and protocols sensitive to different circumstances emerge. Adequate preparation can positively influence the quality of communication and the effects it produces, both on recipients and notifiers. In vocational training, more space should be devoted to this demanding task.

When Emergency Patients Die by Suicide: The Experience of Prehospital Health Professionals

The suicide of a patient can be a disturbing experience for health professionals. According to literature, a patient suicide is a professional hazard in the path of prehospital emergency professionals. In the emergency context, several factors pointed out in literature as predictors of increased emotional impact and more severe traumatic reactions are present. However, the impact of patient suicide on prehospital emergency professionals is still an understudied subject. The aim of this study was to better understand the impact and emotional reactions of prehospital emergency professionals facing a patient suicide, using a qualitative approach. Semi-structured interviews were conducted with 19 prehospital professionals. Fourteen narratives about a patient suicide experience were obtained. Three main categories emerged from the process of content analyses: (1) emotional impact and related factors; (2) perceptions of impact; (3) emergency context and professional growing. Death by suicide in the prehospital emergency context had a considerable emotional impact on these professionals. Several participants described intrusive thoughts and images as a consequence of attending to the death scene. Regarding the perception of impact, there seemed to exist a variation between the levels of exposed to and affected by suicide. There are specific features of the prehospital emergency context that emerged in the narratives of participants as factors which increased the patient suicide impact, namely attending the death scene, encountering the family or other survivors, and managing the feeling of responsibility for not arriving in time of the rescue. The narratives of prehospital professionals also indicated some negative effects on their professional practice, such as doubts about their competence, training, and limits to liability. The death of a patient by suicide in the prehospital emergency context can be a difficult experience, marked with an intense emotional impact. Nevertheless, it can have some positive effects, such as professional growth and increased awareness for the phenomenon. Specific training appears to be fundamental to promote professional growth and to overcome the negative emotional impact.

Insensitivity to Success and Failure: An Experimental Study of Performance-Based Feedback in Depression

OBJECTIVE

This experimental study set out to examine the effects of performance feedback (success or failure) on depressed emotions and self-serving attribution bias in inpatients suffering from major depressive disorder (MDD).

METHODS

The study was based on a 2 × 2 experimental design in which 71 MDD patients and 59 healthy controls participated. Both groups (MDD and controls) were randomly assigned to two conditions: success or failure in the performance feedback. A section of Raven's Standard Progressive Matrices (SPM) was used as a bogus test of the participants' reasoning abilities, and the Core Depressive Factor of the Zung Self-Rating Depression Scale was used to measure changes in depressed emotion in the subjects following the performance feedback. Participants then rated the accuracy of the SPM as a measure of their reasoning capacity.

RESULTS

The levels of depressed emotions in patients with MDD did not differ significantly under the two feedback conditions. In contrast, depressed emotion levels increased significantly in healthy individuals in response to failure feedback but did not change in response to success feedback. With regard to the ratings of SPM accuracy, there was no significant difference across the two feedback conditions for depressed patients; however, the accuracy ratings were higher in the success condition than in the failure condition for the controls.

CONCLUSION

Individuals with MDD exhibit blunted emotional reactivity when experiencing new positive or negative social stimuli, supporting the theory of Emotion Context Insensitivity. In addition, self-serving attribution bias does not occur in MDD, which is consistent with the theory of learned helplessness in depression.

The Role of Response Perceptions in Couples' Ongoing Cancer-Related Disclosure

In efforts to better understand the intricate nature of response, we tested a four-dimension structure of response patterns (measured as support, reciprocity, emotional reaction, and avoidance) as well as four single dimension models within the context of couples managing cancer. All models incorporate dyadic data, including both patient and partner perceptions that relational quality influences response patterns, and response patterns influence ongoing disclosure (measured as breadth and depth). Participants were 95 dyads in which one partner had been diagnosed with cancer. We conducted multilevel analyses using an actor-partner interdependence model. Results supported the four-dimension model as well as individual dimension models. All response types predict within person disclosure. However, only reciprocity predicts the other person's disclosure, and only patient's reports of partner reciprocity predict partner disclosure.

Establishing the "Fit" between the Patient and the Therapy: The Role of Patient Gender in Selecting Psychological Therapy for Distressing Voices

The experience of hearing distressing voices has recently attracted much attention in the literature on psychological therapies. A new “wave” of therapies is considering voice hearing experiences within a relational framework. However, such therapies may have limited impact if they do not precisely target key psychological variables within the voice hearing experience and/or ensure there is a “fit” between the profile of the hearer and the therapy (the so-called “What works for whom” debate). Gender is one aspect of both the voice and the hearer (and the interaction between the two) that may be influential when selecting an appropriate therapy, and is an issue that has thus far received little attention within the literature. The existing literature suggests that some differences in voice hearing experience are evident between the genders. Furthermore, studies exploring interpersonal relating in men and women more generally suggest differences within intimate relationships in terms of distancing and emotionality. The current study utilized data from four published studies to explore the extent to which these gender differences in social relating may extend to relating within the voice hearing experience. The findings suggest a role for gender as a variable that can be considered when identifying an appropriate psychological therapy for a given hearer.

Bereaved parents' experience of stillbirth in UK hospitals: a qualitative interview study

OBJECTIVE

To obtain the views of bereaved parents about their interactions with healthcare staff when their baby died just before or during labour.

DESIGN

Qualitative in-depth interview study, following an earlier national survey. All interviews took place during 2011, either face-to-face or on the telephone. Data analysis was informed by the constant comparative technique from grounded theory.

SETTING

Every National Health Service (NHS) region in the UK was represented.

PARTICIPANTS

Bereaved parents who had completed an e-questionnaire, via the website of Sands (Stillbirth and Neonatal Death Society). Of the 304 survey respondents who gave provisional consent, 29 families were approached to take part, based on maximum variation sampling and data saturation.

RESULTS

22 families (n=25) participated. Births took place between 2002 and 2010. Specific practices were identified that were particularly helpful to the parents. Respondents talked about their interactions with hospital staff as having profound effects on their capacity to cope, both during labour and in the longer term. The data generated three key themes: 'enduring and multiple loss': 'making irretrievable moments precious'; and the 'best care possible to the worst imaginable'. The overall synthesis of findings is encapsulated in the meta-theme 'One chance to get it right.' This pertains to the parents and family themselves, clinical and support staff who care for them directly, and the NHS organisations that indirectly provide the resources and governance procedures that may (or may not) foster a caring ethos.

CONCLUSIONS

Positive memories and outcomes following stillbirth depend as much on genuinely caring staff attitudes and behaviours as on high-quality clinical procedures. All staff who encounter parents in this situation need to see each meeting as their one chance to get it right.

Emotional response to social dancing and walks in persons with dementia

The emotional response to social dancing and walks in persons with dementia was studied to better understand the feasibility, popularity, and meaning of these activities from the perspective of the patient. Social dance events and walks were videotaped and analyzed using Husserl's philosophy as a basis for the analysis. Six persons with dementia participated in the study. The results are described in terms of four interrelated themes: 1) the engaged body; 2) the caregivers' understanding, encouragement, and response to patients during the activity; 3) mutual tenderness and communion; and 4) environmental conditions. Results were then synthesized into a general assessment of the emotional states observed and reported in relation to the activities.