Carl D. Marci

Neuroimaging and the functional neuroanatomy of psychotherapy.

BACKGROUND Studies measuring the effects of psychotherapy on brain function are under-represented relative to analogous studies of medications, possibly reflecting historical biases. However, psychological constructs relevant to several modalities of psychotherapy have demonstrable neurobiological correlates, as indicated by functional neuroimaging studies in healthy subjects. This review examines initial attempts to measure directly the effects of psychotherapy on brain function in patients with depression or anxiety disorders. METHOD Fourteen published, peer-reviewed functional neuroimaging investigations of psychotherapy were identified through a MEDLINE search and critically reviewed. Studies were compared for consistency of findings both within specific diagnostic categories, and between specific modalities of psychotherapy. Results were also compared to predicted neural models of psychotherapeutic interventions. RESULTS Behavioral therapy for anxiety disorders was consistently associated with attenuation of brain-imaging abnormalities in regions linked to the pathophysiology of anxiety, and with activation in regions related to positive reappraisal of anxiogenic stimuli. In studies of major depressive disorder, cognitive behavioral therapy and interpersonal therapy were associated with markedly similar changes in cortical-subcortical circuitry, but in unexpected directions. For any given psychiatric disorder, there was only partial overlap between the brain-imaging changes associated with pharmacotherapy and those associated with psychotherapy. CONCLUSIONS Despite methodological limitations, initial neuroimaging studies have revealed convergent and mechanistically sensible effects of psychotherapy on brain function across a range of psychiatric disorders. Further research in this area may take advantage of emerging neuroimaging techniques to explore a broader range of psychotherapies, with the ultimate goal of improving clinical decision-making and treatment.

Wearable feedback systems for rehabilitation

In this paper we describe LiveNet, a flexible wearable platform intended for long-term ambulatory health monitoring with real-time data streaming and context classification. Based on the MIT Wearable Computing Groups distributed mobile system architecture, LiveNet is a stable, accessible system that combines inexpensive, commodity hardware; a flexible sensor/peripheral interconnection bus; and a powerful, light-weight distributed sensing, classification, and inter-process communications software architecture to facilitate the development of distributed real-time multi-modal and context-aware applications. LiveNet is able to continuously monitor a wide range of physiological signals together with the users activity and context, to develop a personalized, data-rich health profile of a user over time. We demonstrate the power and functionality of this platform by describing a number of health monitoring applications using the LiveNet system in a variety of clinical studies that are underway. Initial evaluations of these pilot experiments demonstrate the potential of using the LiveNet system for real-world applications in rehabilitation medicine.

Patient and Practitioner Influences on the Placebo Effect in Irritable Bowel Syndrome

Objective: To determine whether placebo responses can be explained by characteristics of the patient, the practitioner, or their interpersonal interaction. Methods: We performed an analysis of videotape and psychometric data from a clinical trial of patients with irritable bowel syndrome who were treated with placebo acupuncture in either a warm empathic interaction (Augmented, n = 96), a neutral interaction (Limited, n = 97), or a waitlist control (Waitlist, n = 96). We examined the relationships between the placebo response and a) patient personality and demographics; b) treating practitioner; and c) the patient-practitioner interaction as captured on videotape and rated by the Psychotherapy Process Q-Set. Results: Patient extraversion, agreeableness, openness to experience, and female gender were associated with placebo response, but these effects held only in the augmented group. Regression analyses controlling for all other independent variables suggest that only extraversion is an independent predictor of placebo response. There were significant differences between practitioners in outcomes; this effect was twice as large as the effect attributable to treatment group assignment. Videotape analysis indicated that the augmented group fostered a treatment relationship similar to a prototype of an ideal healthcare interaction. Conclusions: Personality and gender influenced the placebo response, but only in the warm, empathic, augmented group. This suggests that, to the degree a placebo effect is evoked by the patient-practitioner relationship, personality characteristics of the patient will be associated with the placebo response. In addition, practitioners differed markedly in effectiveness, despite standardized interactions. We propose that the quality of the patient-practitioner interaction accounts for the significant difference between the groups in placebo response. IBS = irritable bowel syndrome; FFI = Five Factor Inventory; PQS = Psychotherapy Process Q-Set; M-PQS = Modified Psychotherapy Process Q-Set.

Physiologic correlates of perceived therapist empathy and social-emotional process during psychotherapy

The present study was designed to investigate the relationship among physiologic concordance, patient-perceived therapist empathy, and social-emotional process during psychotherapy. Simultaneous measures of skin conductance (SC) were obtained from 20 unique and established patient-therapist dyads during a live therapy session followed by patient ratings of therapist empathy. Paired SC data of hypothetical dyads were used to test the reliability of the proposed measure of SC concordance. Observer microanalyses of social-emotional process were used to compare short segments of high versus low physiologic concordance. Results show a significant positive correlation (r = 0.47, p = 0.03) between SC concordance and patient ratings of perceived therapist empathy. Microanalyses suggest that during moments of high versus low SC concordance, there were significantly more positive social-emotional interactions for both patients and therapists (p = 0.01). The results support a biological model of perceived patient empathy and patient-therapist social-emotional process during psychotherapy.

Bone mineral densitometry substantially influences health-related behaviors of postmenopausal women.

Although bone mineral density measurements are helpful in predicting future risk for osteoporotic fractures, there is limited information available on how the results of bone densitometry influence a womans use of therapeutic alternatives. To assess the role of bone mineral densitometry in influencing postmenopausal women to change health behaviors associated with osteoporosis, we prospectively followed, for an average of 2.9 years, 701 postmenopausal women over 50 years of age referred to an osteoporosis prevention program in a large metropolitan area. Assessments included bone mineral densitometry by dual-energy X-ray absorptiometry (with classification of skeletal health), medical history, use of hormone replacement therapy, calcium intake, caffeine intake, exercise, smoking habits, and fall precaution measures.

Psychotherapy process: the missing link: comment on Westen, Novotny, and Thompson-Brenner (2004).

In this comment, J. S. Ablon and C. Marci argue that focusing on the empirical validation of manualized treatment packages misses important information about what is efficacious about a given treatment. Psychotherapy process has demonstrated that treatments may promote change in ways other than their underlying theories claim. Manualized therapies may appear distinct despite important similarities in dyadic interaction. These functional similarities in the emergent transactional process between therapist and patient may help explain the difficulty demonstrating differential outcomes across brands of brief therapy. Rather than focus on treatment packages targeting patient symptomatology, the authors recommend a shift in focus to the empirical validation of change processes coconstructed by therapist and patient in naturalistic settings.

Autonomic reactivity to induced emotion as potential predictor of response to antidepressant treatment.

Distinct factors have been identified as potential predictors of antidepressant treatment response. Although autonomic function changes have been described in depressive subjects, their value as predictors of antidepressant response has not been systematically evaluated. Eight un-medicated patients with major depressive order (MDD) have their skin conductance (SC) and heart rate variability (HRV) measured at basal condition and during four induced emotional states: happy, angry, sad and neutral. The high frequency (HF) and low frequency (LF) power parameters of HRV were assessed. Subsequently, patients were treated with fluoxetine 20 mg/day for 8 weeks. The antidepressant response was measured with the Beck Depression Inventory (BDI). The BDI percentage reduction correlated significantly with HRV responses during sad condition in LF power, and during happy condition with LF/HF ratio. The BDI percentage reduction also correlated significantly with HR responses in happy and in neutral conditions, and also with SC responses in neutral condition. These preliminary findings indicate that automatic responses to induced emotions may predict antidepressant response in MDD patients. Confirmatory studies are warranted.

The relationship among patient contemplation, early alliance, and continuation in psychotherapy.

The present study examined the relationship among contemplation stage of readiness to change, formation of an early therapeutic alliance, and psychological distress following the first session of psychotherapy. Significant correlations between the contemplation scores and the therapeutic alliance were found for patients in the contemplation stage. Although contemplation scores were not a factor in return for a second session of psychotherapy, the bond subscale of the alliance inventory did significantly contribute to whether patients returned for therapy. Patient psychological distress was not a significant factor in predicting the early alliance. Results indicate a need for further focus on contemplation with its inherent ambivalence, its relationship to alliance, and continuation in early psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Physiologic evidence for the interpersonal role of laughter during psychotherapy

The role of laughter during psychotherapy is poorly understood. This study examined 10 unique sessions of psychodynamic psychotherapy with digital videotape and simultaneous measures of skin conductivity (SC) from patients and therapists. Independent observers coded laugh episodes using published criteria. Observers identified 167 laugh responses. Of the 119 patient laughs, 91 (76.5%) were patient as speaker, compared with 28 (23.4%) as nonspeaker audience. In contrast, of the 48 therapist laughs, only five (10.4%) were therapist as speaker, whereas 43 (90.3%) were as nonspeaker audience. The difference was highly significant (p < .001). Physiologic data showed that mean SC level increased regardless of role as patient, therapist, speaker, or audience (p < .001). Two-factor analysis of variance indicated that SC change scores were significantly larger when patients and therapists laughed together compared with laughing alone (p < .05). The results support an empirically based approach to the study of laughter and the use of psychophysiology as a measure of process during psychotherapy.

Leveraging Synergy and Emotion In a Multi-Platform World A Neuroscience-Informed Model of Engagement

ABSTRACT The proliferation of media platforms raises questions among marketers about their relative value. This study tests a neuroscience-informed model of immersive-versus-flexible audience engagement and demonstrates televisions heightened ability to sustain nonconscious emotional response over online viewing. Employing biometrics and eye tracking, 251 participants experienced 24 brands on television, online, or both. Findings indicate that brand advertising proved far more emotionally engaging when experienced on television alone or combined with online viewing. This emotional connection using both platforms proved strongest when the television program and Web site content were related. The results support prior research that demonstrates televisions ability to engage and sustain emotional response.