Investigating coregulation of emotional arousal during exposure-based CBT using vocal encoding and actor–partner interdependence models.

Abstract

High patient emotional arousal during rationale development for in vivo exposure in CBT for panic disorder with agoraphobia might endanger comprehension of the exposure rationale. Since therapists are supposed to coregulate patients’ emotions, this study investigated whether there was evidence of coregulation of vocally encoded emotional arousal, assessed by fundamental frequency (f0), during rationale development. Furthermore, the association of patient f0 stability and therapist coregulation with patients’ perceived rationale plausibility was analyzed. N = 197 therapy videos—used to deduct f0—from a multicenter randomized controlled trial evaluating therapist-guided exposure on CBT outcome were analyzed post hoc. Plausibility of the exposure rationale was assessed by patients after its development. This trial-specific rating aggregates plausibility ratings for every manual component in the development of the exposure rationale and showed good internal consistency (Cronbach’s alpha = .85). Stability in f0 and its coregulation were calculated using cross-lagged Actor–Partner Interdependence Models (APIMs), and APIM dyad estimates were associated with plausibility using linear regression analyses. Analyses indicated a relative stability in emotional arousal within both patients and therapists. Therapists’ f0 had a significant effect on patients in that with therapist covariation, patients’ f0 departed from their equilibrium level, while patients’ f0 had no effect on therapists. Therapists’ f0 covariation was positively associated with rationale plausibility. This study sheds light on interpersonal regulation mechanisms of patients’ and therapists’ emotional arousal during development of the exposure rationale. It suggests that coregulation of patients’ emotional arousal supports patients’ perceived rationale plausibility.

The “dyadic dance”: Exploring therapist–client dynamics and client symptom change using actor–partner interdependence modeling and multilevel mixture modeling.

“…The Four Components of Therapist-Client Dynamics Summarizing existing studies, scholars conceptualized and examined four specific components of the mutual influence dynamics between the therapist and client, explicitly or indirectly. The first component, client influence on therapist, is defined as the temporal effects of client's states, perceptions, or behaviors on subsequent therapist states, perceptions, or behaviors Paz et al, 2021;Wieder & Wiltshire, 2020). In the context of working alliance perceptions in this study, this means the extent to which the client's perception of working alliance temporally informs subsequent This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

Understanding interdependence of patients’ and therapists’ affect experiencing: Examination at sample and individual difference levels.

“…To further understand patienttherapist AE interdependence over the course of treatment, and identify which dyads are more likely to form AE interdependence than others, we examined two moderation models; one for the trait-like and one for the state-like alliance. Following Kivlighan (2007) and previous studies examining patient-therapist AE interdependence (Bryan et al, 2018;Soma et al, 2019;Wieder & Wiltshire, 2020), the Actor-Partner Interdependence Model (APIM; Kenny et al, 2006) was used to test interdependence between the patient and therapist. The APIM enables us to examine the associations between individuals' independent variable and their own dependent variable (actor effects), and the associations between individuals' independent variable and their interactional partner's dependent variable ( partner effects).…”

Healing in a Social Context: The Importance of Clinician and Patient Relationship

“…In a study of maritally satisfied women in a stressful situation, holding the hand of their husbands attenuated arousal in comparison to holding the hand of a stranger or not holding anyone's hand [( 92 ); see also ( 93 , 94 )]. Coregulation has been detected in moment-to-moment emotional states of psychotherapists and patients ( 95 , 96 ). Coregulation has been discussed as a mechanism involved in the beneficial aspects of empathy in medicine ( 29 , 68 ).…”