This manuscript presents a systematic review of mutuality in psychotherapy, including meta-analysis of quantitative and meta-synthesis of qualitative studies. A search with specified keyword combinations yielded 21 studies, including 10 quantitative studies with 1,071 participants and 11 qualitative studies with 81 participants. Researchers calculated effect sizes, conducted homogeneity tests, and assessed potential variables moderating the relationship between mutuality and therapeutic variables from quantitative studies; they analyzed qualitative studies to identify and synthesize themes related to mutuality in psychotherapy. Meta-analysis showed a large weighted mean effect size with a statistically significant overall relationship between mutuality and therapeutic variables (r = 0.51, 95% CI [0.37; 0.66], p < 0.001). The relationship between mutuality and session quality was strongest of the six relationships analyzed (r = 0.70, 95% CI [0.43; 0.97], p < 0.001). Qualitative meta-synthesis of studies produced six themes: 1. Lack of mutuality/strategies for disconnection, 2. Co-created relational process, 3. Meta-communication and misunderstanding, 4. Therapist congruence/being real, 5. Mutual impact and client agency, and 6. Asymmetric role power and boundaries. These findings suggest that mutuality is worthy of further research in psychotherapy, particularly in relation to its strong relationship with session quality.

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The purpose of this study was to investigate the effects of curing mode with a high-power LED curing unit (VALO) in terms of microtensile bond strength (μTBS) to dentin and microhardness of two dual-cure resin cements. Panavia V5 (V5) and Rely X Ultimate (RXU) were polymerized using one of three curing modes with VALO or self-cure mode to bond a CAD/CAM resin block to a flat dentin surface. Specimens were sectioned and subjected to μTBS test. Vickers hardness values of V5 and RXU were also measured. Two-way ANOVA indicated curing mode and resin cement affected μTBS. For self-cure mode, V5 had significantly higher μTBS than RXU (p<0.05). Higher irradiance did not always provide higher μTBS of dual-cure resin cement to dentin. One-way ANOVA indicated the curing modes affected microhardness of each cement. As for microhardness of RXU, there were significant differences between selfcure mode and light cure modes (p<0.05).

Patients tend to feel stress in association with dental treatment due to uneasiness and fear. We investigated the effects of providing advance notice and stress-coping traits on the physiological stress of patients during dental treatment. Sixty non-dental professionals (male, n = 26; female, n = 34; mean age, 49.9 years) were recruited for this study and informed consent was obtained. Subjects were given simulated dental treatment including three stimuli, air, percussion and running of an air turbine, with or without advance notice of the stimulation during dental treatment. Real-time sympathetic nerve activity (SN) and parasympathetic nerve activity (PN) during the treatment were measured using a biological information monitor. The stress-coping traits of each subject were examined using the Lazarus-Type Stress Coping Inventory (SCI). Correlations between the nerve-activity and scores of eight stress-coping strategies of SCI and the presence/absence of advance notice were analyzed. Age, types of stimuli and order of stimuli significantly affected SN, while age, types of stimuli, and the pattern of stimulation significantly affected PN. The interaction of the stress-coping trait and presence/absence of advance notice significantly affected PN. Providing advance notice may have different effects on physiological stress depending on how the patient copes with stress.

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