State of the art of interpersonal physiology in psychotherapy: A systematic review

Introduction: The fast expanding field of Interpersonal Physiology (IP) focuses on the study of co-ordination or synchronization dynamics between the physiological activities of two, or more, individuals. IP has been associated with various relational features (e.g., empathy, attachment security, rapport, closeness…) that overlap with desirable characteristics of clinical relationships, suggesting that the relevant studies might provide objective, economical, and theory-free techniques to investigate the clinical process. The goal of the present work is to systematically retrieve and review the literature on IP in the field of psychotherapy and psychological intervention, in order to consolidate the knowledge of this research domain, highlight its critical issues, and delineate possible developments.Method: Following the guidelines by Okoli and Schabram (2010), a systematic literature search was performed in Scopus, Web of Science, PsycINFO, and PubMed databases by means of multiple keyword combinations; the results were integrated with references to the retrieved articles' bibliography as well as to other published reviews on IP.Results: All the retrieved documents reported clinical interactions that are characterized, at least partially, by IP phenomena. They appear to use fragmented and sometimes ambiguous terminology and show a lack of both specific theory-informed hypotheses and sound analytical procedures.Conclusion: Although the psychological nature of IP and its role in the clinical relationship are still mostly unknown, the potential value of a physiology-based measure of implicit exchanges in psychotherapy drives an acceleration in this research field. On the basis of the highlighted critical issues, possible future directions for clinical IP researchers are discussed

Reciprocal Empathy and Working Alliance in Terminal Oncological Illness: The Crucial Role of Patients\u2019 Attachment Style

Security of attachment is described as an inner resource that may also facilitate the adaptation of individuals during critical life adversity, even when facing end-stage illness and death. This study assessed the relation between attachment styles, patient-caregiver reciprocal empathy, and patient-physician working alliance, in the terminal phase of an oncological disease. We hypothesized that the attachment security of patients, as measured by the Relationship Questionnaire (RQ), is related to the reciprocal empathy with the caregiver, as measured by the Perception of Partner Empathy (PPE) questionnaire, and to the working alliance with the physician, as measured by the Working Alliance Inventory-Short Form (WAI-S). Thirty-seven end-stage cancer patients, their caregivers, and physicians participated in the study. The PPE and WAI-S were administered twice: immediately after the hospice recovery and a week later. Results showed a significant improvement in patient-caregiver empathy and in patient-physician alliance after a week at the hospice. Findings indicated that the patients' attachment style influenced their perception of reciprocal empathy with the caregiver and the working alliance with the physician. Patients with a secure attachment had a greater capacity to show empathic closeness with their caregivers and enjoyed a better working alliance with their physicians. Caregivers' attachment security, otherwise, did not show the same influence on empathy and alliance. Findings support the hypothesis that patients' attachment security plays a crucial role in the relation with their own caregiver and with the physician, even at the terminal phase. Theoretical and clinical implications of these findings are explored in the discussion

The Relation between narrative markers of change and psychophysiological measures in the therapeutic process: a case study.

The Innovative Moments Coding System (Gonçalves et al., 2011) is a reliable tool to assess process markers from psychotherapy transcripts. Innovative Moments (IMs) are narrative innovations (e.g., Action, Reflection, Reconceptualization, etc.) that emerge in the therapeutic process. Previous efforts in literature have shown that during the elaboration of high level IMs, patients showed a distinctive pattern of psychophysiological activity, yet no information in regard to therapist’s physiology were provided. Crucially, the study of simultaneous, interpersonal physiology (IP), is being increasingly studied and employed as a tool to assess the quality of clinical relationship, and the dynamics of key clinical processes, such as empathy and alliance. In this study we aimed to replicate and extend current literature by analysing the data from a patient and a therapist involved in a brief psychodynamic therapy of 16 sessions. Each session was audio-video recorded, and simultaneous electrodermal activity was acquired for both participants. IMs were assessed by two reliable coders, while the dyadic physiological data was analysed through moving windows cross-correlations. Across the 16 sessions, 21.4% of the entire narrative discourse was devoted to IMs. Inter-rater agreement on IMs was 85.68% and Cohen’s Kappa for IM categories was .94, with the most complex form of IM, Reconceptualization, being the most common (8.6%). The results of our ideographic single-case design showed only a partial association between IMs and dyadic physiological patterns with an increased physiological synchronization in the Action and Reconceptualization categories. Notably these high-synchrony sequences were also characterized by the patient leading the physiological co-regulation process, with the therapist following. The discussion will regard the implications of using innovative tools, bridging the gap between verbal and nonverbal content in the study of process in psychotherapy research

Emotion Regulation in Psychodynamic and Cognitive-Behavioural Therapy: An Integrative Perspective

Psychotherapy fragmentation constitutes a significant barrier to progress. In the present article, we argue that emotion regulation processes operate across psychotherapy approaches, serving as an overarching meta-factor of therapeutic change

Measuring empathy: A statistical physics grounded approach.

Empathy plays a major role in changing a pathological mind's configuration, and the establishment of an empathic link between therapist and patient is a crucial component of a good therapeutic alliance and outcome. Yet, the definition of empathy and its facets is still under debate, limiting the development of objective quantitative measures. Most authors, though, agree that a fundamental immediate resonance, based on mimicry, contagion, and interpersonal regulation, is among the grounding processes of empathy. Following the growing literature on interpersonal physiology, we investigated the hypothesis that this basic empathic process should present appreciable physiological underpinnings. We applied a Principal Component Analysis (PCA) on simultaneous electrodermal activity, and heart rate variability signals from a patient therapist dyad involved in a 16-sessions psychodynamic therapy. Confirming our expectations, PCA revealed a first 'shared' component correlated to both participants' signals, and two 'individual' components separately correlating to the patient's and therapist's signals. A session-by-session regression analysis showed that the shared component predicted therapy outcome (R-2 = .28). We further investigated the shared component dynamic via a symbolic Markovian discrete model, and cluster analysis, observing a behaviour that mirrors previously reported properties of a single heart rate dynamic. In conclusion, the PCA extraction of the shared physiological activity is an unsupervised data-driven procedure showing promising properties. Further validation of this novel procedure may lead to a full-fledged objective measure, characterized by simple analysis and interpretation, and a very high temporal resolution, which may offer an objective assessment of fundamental empathy facets, implying exciting practical implications in the study of the clinical process

Measuring empathy: a statistical physics grounded approach

Empathy plays a major role in changing a pathological mind’s configuration, and the establishment of an empathic link between therapist and patient is a crucial component of a good therapeutic alliance and outcome. Yet, the definition of empathy and its facets is still under debate, limiting the development of objective quantitative measures. Most authors, though, agree that a fundamental immediate resonance, based on mimicry, contagion, and interpersonal regulation, is among the grounding processes of empathy. Following the growing literature on interpersonal physiology, we investigated the hypothesis that this basic empathic process should present appreciable physiological underpinnings. We applied a Principal Component Analysis (PCA) on simultaneous electrodermal activity, and heart rate variability signals from a patient–therapist dyad involved in a 16-sessions psychodynamic therapy. Confirming our expectations, PCA revealed a first ‘shared’ component correlated to both participants’ signals, and two ‘individual’ components separately correlating to the patient’s and therapist’s signals. A session-by-session regression analysis showed that the shared component predicted therapy outcome (R2 = .28). We further investigated the shared component dynamic via a symbolic Markovian discrete model, and cluster analysis, observing a behaviour that mirrors previously reported properties of a single heart rate dynamic. In conclusion, the PCA extraction of the shared physiological activity is an unsupervised data-driven procedure showing promising properties. Further validation of this novel procedure may lead to a full-fledged objective measure, characterized by simple analysis and interpretation, and a very high temporal resolution, which may offer an objective assessment of fundamental empathy facets, implying exciting practical implications in the study of the clinical process

Movement Synchrony in the Psychotherapy of Adolescents With Borderline Personality Pathology – A Dyadic Trait Marker for Resilience?

Movement synchrony describes the coordination of body movements. In psychotherapy, higher movement synchrony between therapist and patient has been associated with higher levels of empathy, therapeutic alliance, better therapy outcome, and fewer drop-outs. The current study investigated movement synchrony during the psychotherapeutic treatment of female adolescents with borderline personality disorder. It was hypothesized that there are higher levels of movement synchrony in the analyzed therapy sessions compared to pseudo-interactions. Further, we tested whether higher levels of movement synchrony correlate with stronger patients' symptom reduction and whether higher movement synchrony predicts higher post-session ratings. A total of 356 sessions from 16 completed psychotherapies of adolescent patients with BPD were analyzed. Movement synchrony was assessed with motion energy analysis and an index of synchrony was calculated by lagged cross-correlation analysis. As hypothesized, the findings support higher levels of movement synchrony in therapy sessions compared to pseudo-interactions (Cohen's d = 0.85). Additionally, a correlation of movement synchrony with better therapy outcome was found (standardized beta = -0.43 indicating stronger personality functioning impairment reduction). The post-session ratings were negatively associated with higher levels of movement synchrony (standardized beta = -0.1). The relevance of movement synchrony and potential implications for clinical practice are discussed