How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis

Prior meta-analyses have found a moderate but robust relationship between alliance and outcome across a broad spectrum of treatments, presenting concerns, contexts, and measurements. However, there continues to be a lively debate about the therapeutic role of the alliance, particularly in treatments that are tested using randomized clinical trial (RCT) designs. The purpose of this present study was to examine whether research design, type of treatment, or author's allegiance variables, alone or in combination, moderate the relationship between alliance and outcome. Multilevel longitudinal analysis was used to investigate the following moderators of the alliance-outcome correlation: (a) research design (RCT or other), (b) use of disorder-specific manuals, (c) specificity of outcomes, (d) cognitive and/or behavioral therapy (CBT) or other types of treatments, (e) researcher allegiance, and (f) time of alliance assessment. RCT, disorder-specific manual use, specificity of primary and secondary outcomes, and CBT did not moderate the alliance-outcome correlation. Early alliance-outcome correlations were slightly higher in studies conducted by investigators with specific interest in alliance than were those in studies conducted by researchers without such an allegiance. Over the course of therapy, these initial differences disappeared. Apart from this trend, none of the variables previously proposed as potential moderators or mediators of the alliance-outcome relation, alone or in combination, were found to have a mediating impact.     

Valuing clients' perspective and the effects on the therapeutic alliance: a randomized controlled study of an adjunctive instruction

The patterns of growth and development of the therapeutic alliance over the course of therapy have been of continued interest to psychotherapy researchers. The purpose of this study was to investigate whether a simple institutional metacommunication intervention with clients had an effect on the development of the alliance. This adjunctive instruction involved inviting therapy clients to take a proactive role in their treatment by encouraging feedback to their therapist about various aspects of the therapy process. In this randomized controlled study (N = 94), clients were assigned to 1 of 2 conditions: (a) an institutional adjunctive instruction condition in which patients were contacted by clinic personnel at the beginning of the remediation phase (Session 5) and encouraged to take a proactive role in their treatment and (b) a control condition that contained no institutional adjunctive instruction. Between-condition differences in the alliance were tested, controlling for baseline influences and the early therapeutic alliance. Clients' postsession reports from Sessions 1 to 24 indicated that the adjunctive instruction increased the alliance over the course of therapy vis-à-vis the control condition. The adjunctive instruction appeared to have fostered clients' evaluation of their therapists' interest in their welfare. The results indicate that interventions, even brief or subtle, can produce lasting benefits in the alliance when targeted at specific psychological processes. Systematic metacommunication from the institutional level appeared to reinforce clients' therapeutic alliance with their therapists in individual treatment.     

Attachment,perceptions of care and caregiving to romantic partners and friends

Across two studies, we examined the extent to which adults' caregiving responses reflect the quality of care received from their attachment figures. Study 1 showed that romantic caregiving reflected the quality of perceived parental and partner care. Moreover, perceived partner care mediated the link between parental care and romantic caregiving, suggesting that one's parental care affects the type of care one seeks or receives from partners, which in turn affects one's romantic caregiving. This describes a possible process for the intergenerational transmission of caregiving styles. Romantic attachment anxiety was associated with compulsive caregiving to partners. Study 2 examined causal mechanisms by priming a representation of perceived peer care and examining its effect on caregiving responses. As hypothesized, caregiving responses reflected the quality of primed peer care and were associated with attachment orientation. Findings provide evidence that individuals mentally represent the thoughts, feelings and behaviours of the care‐seeker and the caregiver during interactions and both influence one's caregiving to partners and friends. Copyright © 2012 John Wiley & Sons, Ltd.     

Diversity in Pathways to Common Childhood Disruptive Behavior Disorders

Oppositional-Defiant Disorder (ODD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are highly comorbid, a phenomenon thought to be due to shared etiological factors and mechanisms. Little work has attempted to chart multiple-level-of-analysis pathways (i.e., simultaneously including biological, environmental, and trait influences) to ODD and ADHD, the goal of the present investigation. 559 children/adolescents (325 boys) between the ages of 6 and 18 participated in a multi-stage, comprehensive diagnostic procedure. 148 were classified as ODD; 309 were classified as ADHD, based on parent, teacher, and clinician ratings. Children provided buccal or salivary samples of DNA, assayed for select markers in DRD4 and 5HTT. Parents completed the Alabama Parenting Questionnaire and the California Q-Sort. Children completed the Child Perception of Interparental Conflict Scale. Correlational associations consistent with multiple-level-of-analysis pathways to ODD and ADHD emerged. For ODD, children with the short allele of the 5HTT promoter polymorphism had higher neuroticism and ODD symptoms regardless of level of self-blame in relation to inter-parental conflict, whereas children without this allele had more ODD symptoms only in the context of more self-blame for inter-parental conflict. For ADHD (and ODD), children homozygous for the long allele of DRD4 120?bp insertion polymorphism had lower conscientiousness when exposed to inconsistent parenting, whereas children without this genotype were more resilient to effects of inconsistent discipline on conscientiousness. Thus, ODD and ADHD appear to demonstrate somewhat distinct correlational associations between etiological factors and mechanisms consistent with pathway models using a multiple-level-of-analysis approach.     

Simulations of dolphin kick swimming using smoothed particle hydrodynamics

In competitive human swimming the submerged dolphin kick stroke (underwater undulatory swimming) is utilized after dives and turns. The optimal dolphin kick has a balance between minimizing drag and maximizing thrust while also minimizing the physical exertion required of the swimmer. In this study laser scans of athletes are used to provide realistic swimmer geometries in a single anatomical pose. These are rigged and animated to closely match side-on video footage. Smoothed Particle Hydrodynamics (SPH) fluid simulations are performed to evaluate variants of this swimming stroke technique. This computational approach provides full temporal and spatial information about the flow moving around the deforming swimmer model. The effects of changes in ankle flexibility and stroke frequency are investigated through a parametric study. The results suggest that the net streamwise force on the swimmer is relatively insensitive to ankle flexibility but is strongly dependent on kick frequency.     

Cumulative Effects of Prenatal Substance Exposure and Early Adversity on Foster Children's HPA Axis Reactivity During a Psychosocial Stressor

Dysregulated hypothalamic-pituitary-adrenocortical (HPA) axis stress response has been reported among individuals with prenatal substance exposure and those with early adversity. However, few researchers have examined the combined effects of these risk factors. Patterns of HPA reactivity among maltreated foster children with and without prenatal substance exposure (N = 53; ages 9-12 years) were examined using the Trier Social Stress Test for Children. Area under the curve with respect to increase (AUC(I)) analyses revealed that prenatal substance exposure or physical abuse significantly increased the likelihood of a negative AUC(I) (i.e., little or no HPA reactivity). Among children with prenatal substance exposure and physical abuse, 85% exhibited a negative AUC(I). The results underscore the importance of addressing this combined risk.     

Speech presentation cues moderate frontal EEG asymmetry in socially withdrawn young adults

Socially withdrawn individuals display solitary behavior across wide contexts with both unfamiliar and familiar peers. This tendency to withdraw may be driven by either past or anticipated negative social encounters. In addition, socially withdrawn individuals often exhibit right frontal electroencephalogram (EEG) asymmetry at baseline and when under stress. In the current study we examined shifts in frontal EEG activity in young adults (N=41) at baseline, as they viewed either an anxiety-provoking or a benign speech video, and as they subsequently prepared for their own speech. Results indicated that right frontal EEG activity increased, relative to the left, only for socially withdrawn participants exposed to the anxious video. These results suggest that contextual affective cues may prime an individual's response to stress, particularly if they illustrate or substantiate an anticipated negative event.     

Preschoolers' emotion knowledge: self-regulatory foundations, and predictions of early school success

Preschoolers (N=322 in preschool, 100 in kindergarten) were assessed longitudinally to examine the self-regulatory roots of emotion knowledge (labelling and situation) and the contributions of emotion knowledge to early school adjustment (i.e., including social, motivational, and behavioural indices), as well as moderation by age, gender, and risk. Age, gender, and risk differences in emotion knowledge were also examined. Emotion knowledge skills were found to be more advanced in older children and those not at economic risk, and in those with higher levels of self-regulation. Overall, the results support the role of emotion knowledge in early school adjustment and academic success even with gender, age, and risk covaried, especially for boys, older preschoolers, and those at economic risk.     

Executive functions and the down-regulation and up-regulation of emotion

This study examined the relationship between individual differences in executive functions (EF; assessed by measures of working memory, Stroop, trail making, and verbal fluency) and ability to down-regulate and up-regulate responses to emotionally evocative film clips. To ensure a wide range of EF, 48 participants with diverse neurodegenerative disorders and 21 older neurologically normal ageing participants were included. Participants were exposed to three different movie clips that were designed to elicit a mix of disgust and amusement. While watching the films they were either instructed to watch, down-regulate, and up-regulate their visible emotional responses. Heart rate and facial behaviours were monitored throughout. Emotion regulatory ability was operationalised as changes in heart rate and facial behaviour in the down- and up-regulation conditions, controlling for responses in the watch condition. Results indicated that higher verbal fluency scores were related to greater ability to regulate emotion in both the down-regulation and up-regulation conditions. This finding remained significant even after controlling for age and general cognitive functioning. No relationships were found between emotion regulation and the other EF measures. We believe these results derive from differences among EF measures, with verbal-fluency performance best capturing the complex sequence of controlled planning, activation, and monitoring required for successful emotion regulation. These findings contribute to our understanding of emotion-cognition interaction, suggesting a link between emotion-regulatory abilities and individual differences in complex executive functions.     

Assessing the effect of lexical variables in backward recall

In a recent study, Bireta et al. (2010) suggested that when participants are required to recall lists of items in the reverse order, more attention is devoted to the recall of order at the expense of item information, leading to the abolition of item-based phenomena (the item and order trade-off hypothesis). In order to test the item and order trade-off hypothesis, we manipulated 4 lexical factors that are well known to influence item retention. The effects of word frequency, of lexicality, of semantic similarity, and of imageability were tested in forward and backward recall. All 4 phenomena were maintained in backward recall, which contradicts the item and order trade-off hypothesis. Instead, we suggest that backward recall might rely on semantic retrieval strategies.