Dissociation and interpersonal autonomic physiology in psychotherapy research: an integrative view encompassing psychodynamic and neuroscience theoretical frameworks

Interpersonal autonomic physiology is an interdisciplinary research field, assessing the relational interdependence of two (or more) interacting individual both at the behavioral and psychophysiological levels. Despite its quite long tradition, only eight studies since 1955 have focused on the interaction of psychotherapy dyads, and none of them have focused on the shared processual level, assessing dynamic phenomena such as dissociation. We longitudinally observed two brief psychodynamic psychotherapies, entirely audio and video-recorded (16 sessions, weekly frequency, 45 min.). Autonomic nervous system measures were continuously collected during each session. Personality, empathy, dissociative features and clinical progress measures were collected prior and post therapy, and after each clinical session. Two-independent judges, trained psychotherapist, codified the interactions\u2019 micro-processes. Time-series based analyses were performed to assess interpersonal synchronization and de-synchronization in patient\u2019s and therapist\u2019s physiological activity. Psychophysiological synchrony revealed a clear association with empathic attunement, while desynchronization phases (range of length 30-150 sec.) showed a linkage with dissociative processes, usually associated to the patient\u2019s narrative core relational trauma. Our findings are discussed under the perspective of psychodynamic models of Stern (\u201cpresent moment\u201d), Sander, Beebe and Lachmann (dyad system model of interaction), Lanius (Trauma model), and the neuroscientific frameworks proposed by Thayer (neurovisceral integration model), and Porges (polyvagal theory). The collected data allows to attempt an integration of these theoretical approaches under the light of Complex Dynamic Systems. The rich theoretical work and the encouraging clinical results might represents a new fascinating frontier of research in psychotherapy

Empirically supported emerging and marginalized psychotherapies: Integration of non-concurrent multiple baseline design and hermeneutic single case efficacy design

According to APA division 12, at least two Randomized Clinical Trials (RCT) or alternatively nine Single Case Experimental Design (SCED) are required to be recognized as Empirically Supported Treatments (EST). Multiple baseline is the most suitable SCED in psychotherapy research because the treatment effects do not reverse after conclusion and do not require withdrawal in ABAB phases. Treatment's introduction is staggered sequentially across multiple participants, which allows the researcher to demonstrate that changes occur when treatment is introduced, simulating a waiting list. Hermeneutic Single Case Efficacy Design (HSCED) ensures time series analysis as the SCED, adding also qualitative and hermeneutic analysis that allow the recognition of bidirectional linkage between outcome and process variables. Furthermore, external judges assess the quality of the studies providing a verdict of good, mixed or poor outcome. To present systematic replication of multiple non-concurrent baseline HSCED as a way to empirically support both emerging and marginalized models of psychotherapy. After a phase of assessment and the collection of a stable three-point baseline, change in a convenience sample of five patients was tracked with quantitative (PHQ9, STAI, CORE-OM, PQ) and qualitative (HAT, CI) measures. Hermeneutic analysis and judge evaluation were conducted according HSCED protocol. Quantitative data show Clinical Significant and Global Reliable Change in all patients, supported by qualitative data. Hermeneutic analysis suggests specific outcome-to-process linkage and therapeutic interventions followed by shift in weekly outcome measures, supporting and refining the theoretical predictions of the manualized Intensive Transactional Analysis Psychotherapy. Combining multiple baseline design and HSCED, it is possible to support recognition as EST of emerging and marginalized treatments, involving less resources than RCT

Assessing self efficacy in caregivers of children with cystic fibrosis

Does the introduction of a parent reported outcome measure improve the self efficacy of caregivers of children with cystic fibrosis? Background: Parent Reported Outcome Measures (PROM) are an integral component of cystic fibrosis (CF) care yet there is little evidence supporting the role of PROM and their benefits. We are conducting a single centre pilot study to assess the impact of a PROM on the Self Efficacy (SE) of caregivers of children with CF. Aims: The aims of this study were to explore the feasibility and benefits of introducing the Challenges of Living with Cystic Fibrosis-Questionnaire (CLCF-Q) into clinical practice. The anticipated outcome was an increase in the SE of the caregivers. Methods: We are conducting a parallel randomised controlled intervention pilot study using the Cystic Fibrosis Self Efficacy-Questionnaire (CFSE-Q) as an outcome measure. All participants completed the CFSE-Q at 2 time points. Between these time points the intervention group completed the CLCF-Q as part of their annual assessment. They received feedback at their next clinic appointment from the team in the form of colour coded tables illustrating both the positive and negative issues raised in the CLCF-Q. They were invited to talk to members of the CF team and others (consultants, CF nurses, dieticians, physiotherapists, psychologists, pharmacists, family doctors and the school) about the issues raised in the CLCF-Q. Select participants (n=1) were also invited to participate in narrative interviews. Results: Preliminary data from 18 cases; of children aged 5-13 years (11♂, 7♀) are reported, (8 control, 10 intervention). The SE score ranged from 26/40 to 35/40 at baseline. In the control group the SE score remained relatively static whilst the intervention group has shown an increase in SE. Baseline SE ranged from 26/40 – 39/40 using only validated items and 36/56 – 53/56 including non-validated items. Average change in SE was -0.1 in the control group and 1.3 in the intervention group. With the inclusion of the non-validated items, average increase in SE was 0.8 in the control group and 4.2 in the intervention group. The control group showed consistent improvement in 4 items and a decline in 3 items. In comparison the intervention group showed consistent improvement in 8 items and decline in only 1 item. Conclusions: The CF team play a significant role in the lives of families of children with CF. They are recognised as invaluable by caregivers and are the first port of call when faced with a challenge. Potentially, the PROM CLCF-Q may have an important role in the annual assessment process. As well as extracting clinical data it raises unidentified concerns which may alert the CF team to otherwise un-recognised issues. A favourable consequence of routinely introducing the CLCF-Q into the annual assessment process may be an increase in the caregiver’s SE through improved communication between the caregiver and the CF team

Assessment and diagnosis of autism spectrum disorder in Latino children

There is an increase in the number of children who are diagnosed with autism spectrum disorder. However, significant racial and ethnic disparities exist in the diagnosis and treatment of the disorder. Based on the literature, Latino children appear to be under diagnosed or misdiagnosed with other psychological disorders rather than autism spectrum disorder. In addition, Latino children are typically diagnosed at a later age than their White peers. There is almost no research devoted to the assessment of autism spectrum disorder with young Latino children and there is insufficient research related to cultural perceptions of symptoms which can influence parental report. There is an increasing need to provide culturally appropriate Spanish language assessment to Latino children and their families. Therefore, this dissertation provides a critical review of those tests that are frequently cited in the literature or available in Spanish for use in the neuropsychological assessment of young Latino children suspected of having autism spectrum disorder within the following domains: Social Communication and Social Interaction; Speech, Language and Communication; Restricted, Repetitive Behaviors, Interests or Activities; Sensory Processing/Sensory Integration and; Developmental and Adaptive Functioning. Tests used to aid in the differential diagnosis of autism spectrum disorder and other emotional and behavioral disorders in Latino children are also included. A few select tools are recommended for use with this population to be used as a resource for those clinicians serving this population

The effect of glycomacropeptide-based foods upon blood phenylalanine control in adults and children with phenylketonuria

Conventional treatment for phenylketonuria restricts dietary phenylalanine to ‘control’ plasma phenylalanine concentrations. Its widespread adoption has largely eradicated the severe neurocognitive defects that previously characterised phenylketonuria. However, interest in alternative treatments continues as deficits in intelligence and other health outcomes remain problematic, conventional treatment has limitations and adherence proves difficult. Glycomacropeptide-based foods (GMP) are a novel treatment that may improve the satiety and acceptability of dietary treatment and address suboptimal health outcomes. However, glycomacropeptide contains some phenylalanine, raising safety concerns regarding its effect on plasma phenylalanine in adults and particularly children who tolerate less phenylalanine. This narrative review attempted to resolve these concerns. Its findings suggest adults and children can maintain control on GMP but individualised titrations, adjusting the amount of GMP consumed whilst monitoring plasma phenylalanine, are necessary in children. Equivalent control is a supportive finding given GMPs many advantages but this must be viewed cautiously as only seven studies were located, predominantly employing bias-prone, heterogeneous designs. GMPs effect upon control thus requires clarification via a systematic review using evidence-based, transparent methods to synthesize the entire evidence base and consider the impact of design quality, bias and heterogeneity upon results

Advances in Autism Research

This book represents one of the most up-to-date collections of articles on clinical practice and research in the field of Autism Spectrum Disorders (ASD). The scholars who contributed to this book are experts in their field, carrying out cutting edge research in prestigious institutes worldwide (e.g., Harvard Medical School, University of California, MIND Institute, King’s College, Karolinska Institute, and many others). The book addressed many topics, including (1) The COVID-19 pandemic; (2) Epidemiology and prevalence; (3) Screening and early behavioral markers; (4) Diagnostic and phenotypic profile; (5) Treatment and intervention; (6) Etiopathogenesis (biomarkers, biology, and genetic, epigenetic, and risk factors); (7) Comorbidity; (8) Adulthood; and (9) Broader Autism Phenotype (BAP). This book testifies to the complexity of performing research in the field of ASD. The published contributions underline areas of progress and ongoing challenges in which more certain data is expected in the coming years. It would be desirable that experts, clinicians, researchers, and trainees could have the opportunity to read this updated text describing the challenging heterogeneity of Autism Spectrum Disorder