Eran Bar-Kalifa

Emotion-focused therapy for social anxiety disorder: Results from a multiple-baseline study.

Objective: The purpose of the present study was to evaluate the efficacy of emotion-focused therapy (EFT) for adults suffering from social anxiety disorder (SAD). Method: Using a nonconcurrent multiple-baseline design, 12 patients (mean age = 26.75 years, SD = 5.15; 7 males) meeting criteria for SAD were treated with up to 28 sessions of EFT. EFT was based on an empathic relationship, 2-chair work for self-criticism, empty-chair work for unresolved feelings, and focusing. Patients were randomized to wait 4, 8, or 12 weeks between the intake and the first therapy session. Intake assessment included the MINI International Neuropsychiatric Interview (MINI; Sheehan et al. 1998), the clinician-administered Liebowitz Social Anxiety Scale (LSAS; Liebowitz, 1987), and various self-report questionnaires. The LSAS was also administered at the end of the baseline period and at posttreatment. The MINI was administered again at posttreatment. Self-reports were administered throughout the baseline, before each therapy session, and at 6-month and 12-month follow-ups. Results: One patient dropped out prematurely. Of the 11 completers, 7 did not meet criteria for SAD at the end of treatment. Intent-to-treat analysis showed that LSAS scores did not change during baseline, significantly improved during treatment (Cohen’s d = −2.37), and remained improved during follow-up. Mixed regression models showed that SAD symptoms and self-criticism did not change during baseline, significantly improved during treatment, and remained improved during follow-up. Self-reassurance improved significantly during the follow-up phase. Conclusion: This study provides initial evidence supporting the efficacy of EFT for SAD.

Now You Have My Attention: Empathic Accuracy Pathways in Couples and the Role of Conflict.

Recent research on empathy finds evidence for 2 different pathways that enable individuals to accurately infer other persons’ inner mental states: an automatic, indirect pathway that operates by having a mental state similar to the target’s and (correctly) assuming that this state is similar to the target’s, and a more controlled direct pathway that involves assessing the target’s mental state with no regard for one’s own. We present 3 daily diary studies (N = 53, 38 and 80 couples) examining the contribution of these pathways to empathic accuracy in daily assessments of romantic partners’ negative moods, and examine the effects of gender and relational conflict on these pathways. Our studies revealed that both pathways consistently contributed to accuracy. Additionally, partners demonstrated greater indirect accuracy on conflict (vs. nonconflict) days, and indirect accuracy was somewhat higher for women than for men on conflict days (with the opposite pattern on nonconflict days). More importantly, we found evidence for a novel third pathway, in which the perception of conflict itself led to (correct) higher estimation of negative affect and thus, to higher accuracy. This pathway figured more consistently for men than for women. In our discussion, we link the pathways obtained in these studies to the extant social neuroscientific literature on empathy systems, arguing that the indirect pathway involves the effects of experience sharing, while the direct and conflict-based pathways involve the mental state attributions (Zaki & Ochsner, 2011). These findings demonstrate the importance of examining various empathic pathways for the understanding of empathic processes.

Affective Instability as a Clinical Feature of Avoidant Personality Disorder

The current study’s main goal was to examine whether affective instability is elevated among individuals suffering from avoidant personality disorder (APD) by comparing it to the affective instability found among individuals suffering from borderline personality disorder (BPD) as well that found among healthy controls. Adults (N = 152, aged 18–65 years) with BPD, APD, or no psychopathology participated in a 3-week computerized diary study. We examined temporal instability in negative affect using experience-sampling methods. Both within and between days, individuals with APD showed greater affective instability compared to the healthy control individuals, although less affective instability compared to individuals with BPD. The findings are in line with affective instability (or emotional lability) as a key dimension relevant across personality disorders. Additionally, they emphasize the need for research and clinical attention to affective characteristics (alongside the more readily recognized interpersonal characteristics) of APD.

Emotional congruence between clients and therapists and its effect on treatment outcome.

The present study aimed to (a) explore 2 indices of emotional congruence—temporal similarity and directional discrepancy—between clients’ and therapists’ ratings of their emotions as they cofluctuate session-by-session; and (b) examine whether client/therapist emotional congruence predicts clients’ symptom relief and improved functioning. The sample comprised 109 clients treated by 62 therapists in a university setting. Clients and therapists self-reported their negative (NE) and positive emotions (PE) after each session. Symptom severity and functioning level were assessed at the beginning of each session using the clients’ self-reports. To assess emotional congruence, an adaptation of West and Kenny’s (2011) Truth and Bias model was applied. To examine the consequences of emotional congruence, polynomial regression, and response surface analyses were conducted (Edwards & Parry, 1993). Clients and therapists were temporally similar in both PE and NE. Therapists experienced less intense PE on average, but did not experience more or less intense NE than their clients. Those therapists who experienced more intense NE than their clients were more temporally similar in their emotions to their clients. Therapist/client incongruence in both PE and NE predicted poorer next-session symptomatology; incongruence in PE was also associated with lower client next-session functioning. Session-level symptoms were better when therapists experienced more intense emotions (both PE and NE) than their clients. The findings highlight the importance of recognizing the dynamic nature of emotions in client-therapist interactions and the contribution of session-by-session emotional dynamics to outcomes.

Congruence of Therapeutic Bond Perceptions and Its Relation to Treatment Outcome: Within- and Between-Dyad Effects.

Objective: The present study investigates the association between congruence of patients’ and therapists’ perceptions of the therapeutic bond and symptom improvement. Method: Bond congruence-outcome associations were examined on the within- and between-dyad level for 580 patients (mainly depression and anxiety) receiving cognitive–behavioral therapy. Symptom change was assessed on a session-to-session level as well as from pre- to posttreatment. For the between-dyad analyses, the truth and bias model was applied. For the within-dyad analyses, polynomial regression and response surface analysis were conducted. Results: On the between-dyad level, higher temporal congruence between patients’ and therapists’ bond ratings (i.e., their correlation) was associated with better treatment outcomes. Additionally, the average discrepancy between therapists’ and patients’ bond ratings showed a significant quadratic association with treatment outcome. A tendency for therapists to moderately rate the bond lower than their patients’ showed lowest posttreatment symptom scores. On the within-dyad level, we found that when patients’ and therapists’ ratings were in “agreement,” higher bond scores were associated with fewer next-session symptoms. For “disagreement,” the results showed that if therapists rated the bond as weak, whereas their patients rated it as strong, higher subsequent symptom distress was observed than if patients rated the bond as weak and their therapists rated it as strong. Conclusions: The present study highlights the importance of therapists being vigilant to session-to-session changes in the therapeutic bond to adjust their interventions accordingly.

Mother–infant sleep patterns and parental functioning of room-sharing and solitary-sleeping families: a longitudinal study from 3 to 18 months

Study Objectives To examine longitudinally differences in (a) objective and subjective sleep patterns and (b) parenting functioning (i.e., maternal emotional distress, maternal separation anxiety and parental involvement in infant care( between room-sharing and solitary sleeping mother-infant dyads. Methods Maternal and infant sleep, sleeping arrangements and parental functioning were assessed at three (N=146), six (N=141), twelve (N=135), and eighteen (N=130) months postpartum. Maternal and infant sleep were assessed with actigraphy and sleep diaries for 5 nights. Questionnaires were used to assess sleeping arrangements, nighttime breastfeeding, and parental functioning. Results Persistent room-sharing mothers (i.e., sharing a room with the infant on at least three assessment points) had significantly lower actigraphy-based sleep percent, lower longest sleep periods and more night-wakings than persistent solitary sleeping mothers. For infants, differences in actigraphic sleep were found only in longest sleep period, although mothers of persistent room-sharing infants reported more infant night-wakings than mothers of persistent solitary sleeping infants. The trajectories of maternal and infant sleep in both room-sharing and solitary sleeping groups demonstrated that sleep became more consolidated with time. Group differences indicated higher maternal separation anxiety and lower paternal overall and nighttime involvement in infant caregiving in room-sharing families compared to solitary-sleeping families. Conclusions The findings are discussed in light of the latest American Academy of Pediatrics recommendation to room-share until 12 months postpartum. Although no causal effects can be inferred from this study, maternal sleep quality and certain parenting characteristics seem to be important factors to consider when parents consult about sleeping arrangements.

Exploring the process of change in emotion-focused therapy for social anxiety

Abstract Objective: This study examined purported change mechanisms in emotion-focused therapy for social anxiety disorder. Methods: The sample included nine clients who had participated in a multiple-baseline case study trial examining the efficacy of emotion-focused therapy for social anxiety disorder (SAD). Multilevel analyses were conducted to examine the trajectories of emotions over the course of treatment, and whether primary adaptive emotions in a given session predicted levels of SAD symptoms, self-criticism, and self-reassurance over the course of the following week. Results: Findings showed a significant decrease in shame, and a marginally significant increase in assertive anger, over the course of treatment. Adaptive sadness/grief in a given session predicted less fear of negative evaluation over the course of the following week. Shame in a given session predicted higher levels of inadequate-self over the course of the following week. Finally, shame, and to a lesser degree assertive anger, in a given session predicted reassurance of self over the course of the following week. Neither assertive anger nor adaptive sadness/grief in a given session predicted levels of self-criticism over the course of the following week. Conclusions: These findings lend partial preliminary support for the therapeutic role of evoking and processing adaptive sadness/grief and assertive anger in the treatment of SAD.

Moderators of congruent alliance between therapists and clients: A realistic accuracy model.

Congruence between therapists’ and their clients’ alliance ratings was found to be beneficial to therapeutic processes and outcomes. To date, however, less is known about the possible moderators of such congruence. The current study adapted Funder’s (1995) realistic accuracy model to identify a judge characteristic (therapists’ affiliative tendencies), a target characteristic (clients’ affiliative tendencies), information (time elapsed in therapy), and traits (bond vs. task/goal aspects of the alliance) that may moderate this congruence. These were examined using the innovative truth-and-bias model (West & Kenny, 2011), which allows the simultaneous estimation of two different congruence indices within repeatedly measured data: therapist/client temporal congruence (i.e., the correlation over time between therapists’ and their clients’ alliance ratings) and directional discrepancy (i.e., the average difference between therapists’ and their clients’ alliance ratings across sessions). Clients (n = 109) and therapists (n = 62) at a university-based clinic rated their affiliation tendencies at the beginning of treatment and rated their alliance perception after each session. Time elapsed in therapy, as well as therapists’ (but not clients’) affiliative tendencies were linked to higher therapist/client temporal congruence and to lower therapist directional discrepancy. In addition, congruence was higher for the bond aspect of the therapeutic alliance than for goals/tasks. Consistent with Funder’s model, multiple factors (including judge, information, and trait) were associated with therapist/client congruence in alliance.

Intraindividual variability in symptoms consistently predicts sudden gains: An examination of three independent datasets.

Objective: Sudden gains are robust predictors of outcome in psychotherapy. However, previous attempts at predicting sudden gains have yielded inconclusive findings. The aim of the present study was to examine a novel, transdiagnostic, transtherapeutic predictor of sudden gains that would replicate in different settings and populations. Specifically, we examined intraindividual variability in symptoms. Method: We examined data from a randomized controlled trial (RCT) of prolonged exposure therapy for posttraumatic stress disorder (PTSD) in children and adolescents (n = 63), an RCT of cognitive and behavioral therapies for obsessive–compulsive disorder (OCD) in adults (n = 91), and psychodynamic therapy delivered under routine clinical conditions in a naturalistic setting for diverse disorders (n = 106). In all 3 data sets, we examined whether a measure of variability in symptoms occurring during the first sessions could predict sudden gains. Results: Variability in symptoms was found to be independent of total change during treatment. Variability in symptoms significantly predicted sudden gains in all 3 data sets and correctly classified 81.0%, 69.2%, and 76.9% of individuals to sudden gain or nonsudden gain status, respectively. Conclusions: The present study represents the first examination of variability in symptoms as a predictor of sudden gains. Findings indicated that sudden gains are significantly predicted by intraindividual variability in symptoms, in diverse settings, contexts, and populations. Advantages of this predictor, as well as clinical and research implications are discussed.

Daily Support Equity in Romantic Couples: Response Surface Analyses of Monadic and Dyadic Data

Receiving support may yield negative outcomes, although these can be offset by reciprocating support. Here, we argue that support receipt and reciprocation should be considered with reference to two separate needs, for relatedness/communion and competence/agency, which underlie differential effects of equity on affective versus relational outcomes. To test these, we go beyond earlier studies by (a) examining equity along a (daily) continuum, (b) using the novel analytic approach of polynomial regression with response surface analyses, and (c) indexing equity from both monadic and dyadic perspectives. Using dyadic daily diaries (N Days = 35, N Couples = 80), we found personal outcomes (positive affect [PA] and negative affect [NA]) to be worst on inequitable days, particularly overbenefit ones. In contrast, equity did not play the same role with regard to relational outcomes (closeness/satisfaction), for which overbenefit proved more positive. Interestingly, the monadic and dyadic perspectives converged more with personal than with relational outcomes.