Effect of Hatha yoga on anxiety: a meta-analysis

OBJECTIVE: Some evidence suggests that Hatha yoga might be an effective practice to reduce anxiety. To examine the effect of Hatha yoga on anxiety, we conducted a meta-analysis of relevant studies extracted from PubMed, PsycINFO, the Cochrane Library, and manual searches. METHODS: The search identified 17 studies (11 waitlist controlled trials) totaling 501 participants who received Hatha yoga and who reported their levels of anxiety before and after the practice. We estimated the controlled and within-group random effects of the practice on anxiety. RESULTS: The pre-post within-group and controlled effect sizes were, Hedges' g = 0.44 and Hedges' g = 0.61, respectively. Treatment efficacy was positively associated with the total number of hours practiced. People with elevated levels of anxiety benefitted the most. Effect sizes were not moderated by study year, gender, presence of a medical disorder, or age. Although the quality of the studies was relatively low, the risk of study bias did not moderate the effect. CONCLUSIONS: Hatha yoga is a promising method for treating anxiety. However, more well-controlled studies are needed to compare the efficacy of Hatha yoga with other more established treatments and to understand its mechanism. This article is protected by copyright. All rights reserved.R01 AT007257 - NCCIH NIH HH

Positive sexuality, relationship satisfaction, and health: a network analysis

IntroductionPositive sexuality, defined as the happiness and fulfillment individuals derive from their sexual experiences, expressions, and behaviors, has been linked to relationship satisfaction and health. However, the intricate associations between positive sexuality and relationship functioning and health indicators have rarely been explored from a network perspective. This approach, by analyzing the interconnections among these factors within a broader system, can offer insights into complex dynamics and identify key variables for targeted interventions.MethodsThe present study applied network analysis to uncover interconnections between positive sexuality, relationship satisfaction, and health indicators, highlight the most relevant variables and explore potential gender-based differences in a sample of 992 partnered individuals (51% women, aged 18–71 years). Networks were estimated via Gaussian Graphical Models, and network comparison test was used to compare men and women.ResultsResults indicated that variables related to positive sexuality were more highly interconnected than the rest of the network. There were small-to-negligible connections between positive sexuality and relationship satisfaction variables, both of which had negligible or no connections with health. The network was globally invariant across gender, though a few connections were gender-specific. The most important variables, regardless of gender, related to pleasurable feelings during sexual intercourse.DiscussionThe findings underscore the importance of enhancing positive sexual experiences within intimate relationships and have implications for research and clinical practice in positive sexuality

Analysis of General Practitioners’ Attitudes and Beliefs about Psychological Intervention and the Medicine-Psychology Relationship in Primary Care: Toward a New Comprehensive Approach to Primary Health Care

The biopsychosocial paradigm is a model of care that has been proposed in order to improve the effectiveness of health care by promoting collaboration between different professions and disciplines. However, its application still faces several issues. A quantitative-qualitative survey was conducted on a sample of general practitioners (GPs) from Milan, Italy, to investigate their attitudes and beliefs regarding the role of the psychologist, the approach adopted to manage psychological diseases, and their experiences of collaboration with psychologists. The results show a partial view of the psychologist’s profession that limits the potential of integration between medicine and psychology in primary care. GPs recognized that many patients (66%) would often benefit from psychological intervention, but only in a few cases (9%) were these patients regularly referred to a psychologist. Furthermore, the referral represents an almost exclusive form of collaboration present in the opinions of GPs. Only 8% of GPs would consider the joint and integrated work of the psychologist and doctor useful within the primary health care setting. This vision of the role of psychologists among GPs represents a constraint in implementing a comprehensive primary health care approach, as advocated by the World Health Organization

Linguistic features of the therapeutic alliance in the first session: a psychotherapy process study

Critical aspects of the therapeutic alliance appear to be established as early as the first session. Specifically, the affective bond between the therapeutic dyad appears to develop early in treatment and tends to remain stable over time, while agreements on goals and tasks tend to fluctuate over the course of treatment. Are there distinguishable early signs of a strong therapeutic alliance? In this study, we examined how some linguistic measures indicative of joint emotional elaboration correlated with a measure of the therapeutic alliance assessed within a single session. Initial intake sessions with 40 patients with varying diagnoses were videotaped, transcribed, and analyzed using linguistic measures of referential process and then scored with the Segmented Working Alliance Inventory-Observer form. Results showed that patients who were rated as more emotionally engaged in relating their experiences and then reflecting on them by mid-session also had higher scores in the therapeutic alliance by the final part of that same session. An implication of this study is that the interpersonal factors facilitating elaboration of inner experience, including elements of warmth, safety, and analytic trust, are related to the development of early therapeutic alliance. These findings did not appear to be dependent on the patient’s psychopathology. This study is one in a growing line of research exploring how patients speak rather than just the content of what they say

Analysis of General Practitioners’ Attitudes and Beliefs about Psychological Intervention and the Medicine-Psychology Relationship in Primary Care: Toward a New Comprehensive Approach to Primary Health Care

The biopsychosocial paradigm is a model of care that has been proposed in order to improve the effectiveness of health care by promoting collaboration between different professions and disciplines. However, its application still faces several issues. A quantitative-qualitative survey was conducted on a sample of general practitioners (GPs) from Milan, Italy, to investigate their attitudes and beliefs regarding the role of the psychologist, the approach adopted to manage psychological diseases, and their experiences of collaboration with psychologists. The results show a partial view of the psychologist’s profession that limits the potential of integration between medicine and psychology in primary care. GPs recognized that many patients (66%) would often benefit from psychological intervention, but only in a few cases (9%) were these patients regularly referred to a psychologist. Furthermore, the referral represents an almost exclusive form of collaboration present in the opinions of GPs. Only 8% of GPs would consider the joint and integrated work of the psychologist and doctor useful within the primary health care setting. This vision of the role of psychologists among GPs represents a constraint in implementing a comprehensive primary health care approach, as advocated by the World Health Organization

Validity and clinical utility of the therapist version of the referential process post-session scale (RPPS-T)

Introduction: According to Bucci’s multiple code theory (Bucci, 1997; Bucci, Maskit, Murphy, 2015) a significant change in the patient-therapist relationship should reflect a referential process that is shaped by alternating phases: (a) arousal: experiencing emotion schemas, (b) symbolization: translating into words the emotional experiences, and (c) reorganization/reflection: recognizing, understanding and expanding the emotional significance. So far, in order to monitor the development of these three phases therapists and researchers have relied on their own clinical sensitivity and automated measures of the referential process (Mariani, Maskit, Bucci, & De Coro, 2013), which require the use of transcribed session material. In order to develop a parallel and less time-consuming method, developed a self-report questionnaire measuring the phases of the referential process, the Referential Process Post-session Scale – Therapist version (RPPS-T). Six constructs we intended to measure through the questionnaire: the emotional arousal of the therapist at the end of the session, the clarity, specificity, concreteness and imagery of therapeutic conversation according to the therapist – the four linguistic dimensions of the symbolization phase – and the extent of reorganization/reflection work performed during the session according to the therapist. Methods: To test the RPPS-T factorial structure psychotherapists were asked to complete an extended version (36 items) of the questionnaire at the end of their sessions. We collected 105 evaluations form eight psychotherapists regarding 29 patients. From the extended version of the questionnaire, through an exploratory factorial analysis we developed a shortened questionnaire (12 items) completed by other nine psychotherapists on 24 patients for a total of 130 compilations. On this second administration we conducted a confirmatory factor analysis. We also tested the concurrent validity checking the correlation between the RPPS-T scores and the computerized linguistic measures of the referential process obtained onto some session transcripts (n=18) and of therapist’s notes (n=18). Results: The exploratory factorial analysis has detected a well-defined solution, consistent with the hypothesized constructs, consisting of four factors (with three items each), one regarding the therapist emotional arousal, two referring the linguistic characteristics of the in-session conversation and one concerning the in-session symbolization work. We called these four factor a) emotion memory clarity, b) concreteness/imagery, c) specificity, and d) symbolization. The four-factor solution has demonstrated a good fit ( 2(48)=105.395, p<.001; CFI=0.940; TLI=0.91; RMSA=0.97; SRMR=0.049) by the confirmatory factor analysis conducted on the second administration. Internal consistency of the scales was adequate (α >.82). Two among the four RPPS-T scales yielded significant correlations with the computerized linguistic measures of the sessions and therapist notes: the RPPS-T symbolization scale positively correlates with High Weighted Referential Activity Dictionary (HWRAD) index measured onto the in-session patients interventions – a measure of the intensity of Referential Activity – and the RPPR-T emotion memory clarity correlates with the Weighted Referential Activity Dictionary (WRAD) and HWRAD indexes measured on the therapist notes. The RPPRS concreteness/imagery and specificity scales instead did not correlate with the linguistic measures of sessions and notes. Conclusions: RPPS-T had shown a valid factor structure and internal consistency and could be considered as a valid instrument from a statistical point of view. The factorial structure found confirms that the questionnaire detects the hypothesized constructs of the referential process. Also the criterion validity is partially confirmed by the correlation with the computerized linguistic measures of the session transcriptions and therapist’s notes. The more the patient has a clear, specific, concrete and vivid language during the session the more the therapist at the end of the session will have the impression of a good work of symbolization and connection jointly carried forward. Moreover, the more the therapist have a clear memory of the emotions experienced during the session, the more her/his notes on the session itself will have a high referential activity indicating a good elaboration and emotional connection with the patient. We can conclude that RPPS-T can be used as a quick and reliable measure of the referential process along the psychotherapeutic treatment. It does not replace the computerized linguistic measures of the session transcriptions, the richer and more direct indicators of the progress of the referential process in the session and in the treatment; however it is a parallel and less timeconsuming measure available to therapists and researchers: the firsts can easily use it as a tool for clinical monitoring and supervision, the seconds can apply it to study the referential process in correlation with the outcome measure and with the other important clinical constructs

First Validation of the Referential Process Post-session Scale \u2013 Therapist version (RPPS-T).

Objective: Bucci\u2019s multiple code theory maintains that for a significant change the patient-therapist relationship should foster a referential process shaping in three alternating phases: arousal of emotion schemas, symbolizing/narrating emotional experiences, and reflecting/reorganizing the emotional meanings. Until now to monitor these phases clinicians and researchers have used several referential process computerized linguistic measures, which however need the sessions verbatim transcription. In order to have a less time-consuming method we developed and tested a therapist self-report questionnaire measuring the referential process phases. Method: We asked eight psychotherapists in a first study and nine psychotherapists in a second study to complete the Referential Process Post-session Scale \u2013 Therapist version (RPPS-T) just after the end of their sessions. In a third study we transcribed 29 sessions conducted by three psychotherapists to calculate the correlations between the RPPS-T scores and the computerized linguistic measures of the referential process calculated on the session transcripts. Results: In the first study we collected 105 evaluations regarding 29 patients and an exploratory factor analysis revealed a four-factor pattern consistent with the hypothesized constructs. The analysis reduced the initial pool of 42 items to 12. In the second study 130 sessions with 25 different patients have been evaluated on the shortened version of the RPPS-T and a confirmatory factor analysis found that the fourfactor model satisfactorily fitted the new data as well. In the third study we found that the factors of RPPS-T regarding the symbolizing phase correlated with the corresponding computerized linguistic measures calculated on the session transcripts. Conclusions: The RPPS-T received a first validation as a concurrent measure of the referential process, especially for the symbolizing phase, and could be considered a useful instrument for research and supervision

FIRST VALIDATION OF THE REFERENTIAL PROCESS POST-SESSION SCALE – THERAPIST VERSION (RPPS-T)

Objective: Bucci’s multiple code theory maintains that for a significant change the patient-therapist relationship should foster a referential process shaping in three alternating phases: arousal of emotion schemas, symbolizing/narrating emotional experiences, and reflecting/reorganizing the emotional meanings. Until now to monitor these phases clinicians and researchers have used several referential process computerized linguistic measures, which however need the sessions verbatim transcription. In order to have a less time-consuming method we developed and tested a therapist self-report questionnaire measuring the referential process phases. Method: We asked eight psychotherapists in a first study and nine psychotherapists in a second study to complete the Referential Process Post-session Scale – Therapist version (RPPS-T) just after the end of their sessions. In a third study we transcribed 29 sessions conducted by three psychotherapists to calculate the correlations between the RPPS-T scores and the computerized linguistic measures of the referential process calculated on the session transcripts. Results: In the first study we collected 105 evaluations regarding 29 patients and an exploratory factor analysis revealed a four-factor pattern consistent with the hypothesized constructs. The analysis reduced the initial pool of 42 items to 12. In the second study 130 sessions with 25 different patients have been evaluated on the shortened version of the RPPS-T and a confirmatory factor analysis found that the fourfactor model satisfactorily fitted the new data as well. In the third study we found that the factors of RPPS-T regarding the symbolizing phase correlated with the corresponding computerized linguistic measures calculated on the session transcripts. Conclusions: The RPPS-T received a first validation as a concurrent measure of the referential process, especially for the symbolizing phase, and could be considered a useful instrument for research and supervisio

Psychotherapy trainees' epistemological assumptions influencing research-practice integration

Over the last few decades a growing number of psychotherapy scholars as well as psychotherapy researchers have joined a paradigm shift, moving from a reductionist to a complexity-oriented epistemology. Many authors recognize that when human subjectivity is the object of intervention and study, it is appropriate to resist simplification and to assume a more complex approach. While this paradigm shift is taking place not only in psychology but also in other disciplines, many psychotherapists still share the assumption that psychotherapy practice and psychotherapy research have opposite values; hence, they are worlds that cannot be reconciled. Considering this as one of the main reasons preventing a useful integration of evidence-based practice and clinical training in psychotherapy, we conducted an online survey of 126 Italian trainees from three differently-oriented psychotherapy institutes (cognitive-behavioral, relational-psychoanalytic and relational-systemic) to explore the epistemology underling the clinical and research practices. After presenting a clinical vignette, we asked questions about diagnostic considerations, case formulations, and treatment plans; we also asked questions about participants' involvement in research projects or in research methodology courses and about willingness to be involved in future research studies in their clinical practice. We found some significant differences among trainees with different orientations, but in general most of the responses reflected a positivistic epistemology underlying both clinical and research activities. These findings suggest that a deeper awareness of one's own epistemological assumptions could help trainees foster a more theory-coherent and research-informed clinical practice

Validity and clinical utility of the Therapist version of the Referential Process Post-session Scale (RPPS-T)

Introduction: According to Bucci’s multiple code theory (Bucci, 1997; Bucci, Maskit, Murphy, 2015) a significant change in the patient-therapist relationship should reflect a referential process that is shaped by alternating phases: (a) arousal: experiencing emotion schemas, (b) symbolization: translating into words the emotional experiences, and (c) reorganization/reflection: recognizing, understanding and expanding the emotional significance. So far, in order to monitor the development of these three phases therapists and researchers have relied on their own clinical sensitivity and automated measures of the referential process (Mariani, Maskit, Bucci, & De Coro, 2013), which require the use of transcribed session material. In order to develop a parallel and less time-consuming method, developed a self-report questionnaire measuring the phases of the referential process, the Referential Process Post-session Scale – Therapist version (RPPS-T). Six constructs we intended to measure through the questionnaire: the emotional arousal of the therapist at the end of the session, the clarity, specificity, concreteness and imagery of therapeutic conversation according to the therapist – the four linguistic dimensions of the symbolization phase – and the extent of reorganization/reflection work performed during the session according to the therapist. Method: To test the RPPS-T factorial structure psychotherapists were asked to complete an extended version (36 items) of the questionnaire at the end of their sessions. We collected 105 evaluations form eight psychotherapists regarding 29 patients. From the extended version of the questionnaire, through an exploratory factorial analysis we developed a shortened questionnaire (12 items) completed by other nine psychotherapists on 24 patients for a total of 130 compilations. On this second administration we conducted a confirmatory factor analysis. We also tested the concurrent validity checking the correlation between the RPPS-T scores and the computerized linguistic measures of the referential process obtained onto some session transcripts (n=18) and of therapist’s notes (n=18). Results: The exploratory factorial analysis has detected a well-defined solution, consistent with the hypothesized constructs, consisting of four factors (with three items each), one regarding the therapist emotional arousal, two referring the linguistic characteristics of the in-session conversation and one concerning the in-session symbolization work. We called these four factor a) emotion memory clarity, b) concreteness/imagery, c) specificity, and d) symbolization. The four-factor solution has demonstrated a good fit (χ2(48)=105.395, p .82). Two among the four RPPS-T scales yielded significant correlations with the computerized linguistic measures of the sessions and therapist notes: the RPPS-T symbolization scale positively correlates with High Weighted Referential Activity Dictionary (HWRAD) index measured onto the in-session patients interventions – a measure of the intensity of Referential Activity – and the RPPR-T emotion memory clarity correlates with the Weighted Referential Activity Dictionary (WRAD) and HWRAD indexes measured on the therapist notes. The RPPRS concreteness/imagery and specificity scales instead did not correlate with the linguistic measures of sessions and notes. Conclusion: RPPS-T had shown a valid factor structure and internal consistency and could be considered as a valid instrument from a statistical point of view. The factorial structure found confirms that the questionnaire detects the hypothesized constructs of the referential process. Also the criterion validity is partially confirmed by the correlation with the computerized linguistic measures of the session transcriptions and therapist’s notes. The more the patient has a clear, specific, concrete and vivid language during the session the more the therapist at the end of the session will have the impression of a good work of symbolization and connection jointly carried forward. Moreover, the more the therapist have a clear memory of the emotions experienced during the session, the more her/his notes on the session itself will have a high referential activity indicating a good elaboration and emotional connection with the patient. We can conclude that RPPS-T can be used as a quick and reliable measure of the referential process along the psychotherapeutic treatment. It does not replace the computerized linguistic measures of the session transcriptions, the richer and more direct indicators of the progress of the referential process in the session and in the treatment; however it is a parallel and less time-consuming measure available to therapists and researchers: the firsts can easily use it as a tool for clinical monitoring and supervision, the seconds can apply it to study the referential process in correlation with the outcome measure and with the other important clinical constructs