Relationship between environmental factors and burnout of psychotherapists: Meta‐analytic approach

The present study aims to extend the scope of understanding on the relationships between environmental factors and burnout symptoms by targeting and including more extensive occupational demanding variables related to therapist burnout. The present study includes not only common occupational stressors (e.g., working hours, role overload and role conflict) but also variables reflecting the quality of relationship with clients (e.g., case load and negative clientele) that have not been dealt with before in meta‐analytic studies. A meta‐analysis was conducted on 27 original studies published from the year 2006 to 2018. The findings showed that, among environmental factors, role overload had the most significant positive correlations with exhaustion. In addition, negative clientele had the most significant positive correlations with depersonalisation and reduced accomplishment. Furthermore, caseload and low income had relatively weak relations with therapist burnout. Based on these results, implications and limitations of the study are discussed.     

“A definite feel‐it moment”: Embodiment,externalisation and emotion during chair‐work in compassion‐focused therapy

Chair‐work is an experiential method used within compassion‐focused therapy (CFT) to apply compassion to various aspects of the self. This is the first study of CFT chair‐work and is focused on clients' lived experiences of a chair‐work intervention for self‐criticism. Twelve participants with depression were interviewed following the chair‐work intervention and the resulting data were examined using interpretative phenomenological analysis. Three superordinate themes were identified: “embodiment and enactment,” “externalising the self in physical form” and “emotional intensity.” The findings suggest the importance of accessing and expressing various emotions connected with self‐criticism, whilst highlighting the potential for client distress and avoidance during the intervention. The role of embodying, enacting and physically situating aspects of the self in different chairs is also suggested to be an important mechanism of change in CFT chair‐work. The findings are discussed in terms of clinical implications, emphasising how core CFT concepts and practices are facilitated by the chair‐work process.     

A thematic analysis of practitioners' understanding of domestic abuse in terms of post‐traumatic stress disorder (PTSD) and complex‐PTSD (C‐PTSD)

There is a growing body of evidence suggesting that domestic abuse (DA) should be conceptualised within the complex post‐traumatic stress disorder (C‐PTSD) model. Recently, in the draft of the International Classification of Diseases, Eleventh Revision, produced by the World Health Organization (WHO), C‐PTSD was included as a separate criterion in which DA is incorporated (ICD‐11, WHO, 2018). In this study, a thematic analysis was used to explore to what extent practitioners working with DA survivors are familiar with PTSD and C‐PTSD. Research into such a prevalent and detrimental problem as DA is important to understand whether the development of theoretical knowledge about DA and C‐PTSD is addressed in practice. In a Women's Centre in South London, six semi‐structured interviews with middle‐aged female practitioners were conducted to investigate each counsellor's experiences, knowledge and reflections. Six final themes were constructed to summarise the main results. The findings demonstrate limited practitioner understanding of DA in terms of C‐PTSD, which seems to impact not only the effectiveness of treatment plans with DA survivors, but also counsellors’ own psychological and physical states. It is also indicated that DA can be conceptualised within the C‐PTSD model that corresponds with previous literature indicating the complex nature of DA. The overall results of the current research acknowledge that DA sectors should not be neglected and better funding and effective psychoeducation in this field are needed.     

Resistance and outcome expectations in cognitive‐behavioural therapy for generalised anxiety disorder

Greater client resistance has been consistently found to be negatively associated with outcome in psychotherapy. However, the pathways through which resistance impacts such outcomes are underexplored. Given that client outcome expectation (OE) has been identified as an important common factor in psychotherapy, the goals of the present study were to examine: (a) the impact of resistance on subsequent client and therapist OE (COE & TOE, respectively); and (b) whether COE and/or TOE mediate the relationship between resistance and outcome. These relationships were tested among 44 clients with severe generalised anxiety disorder treated with cognitive‐behavioural therapy in the context of a randomised controlled trial (Westra, Constantino, & Antony, 2016). Resistance was measured at a mid‐treatment session, and COE and TOE were assessed at baseline and immediately after the resistance session. Treatment outcome was measured via client‐rated worry severity at post‐treatment. As predicted, higher resistance was associated with lower subsequent COE and TOE; B = ?.73, p < .001 and B = ?.46, p < .001, respectively. In turn, lower post‐resistance COE predicted higher post‐treatment worry (B = ?.5, p < .001), indicating mediation. In contrast, TOE did not mediate the relationship between resistance and outcome (B = ?.02, p = .876). These results suggest that resistance can be demoralising to both clients and therapists. However, only lower client morale may be detrimental to therapy outcome. This study contributes to understanding outcome pathways through two common therapy processes.     

来源记忆中背景的情绪效价与唤醒对提取过程的影响

以往研究表明情绪背景对来源记忆存在影响,但背景的情绪效价和唤醒如何影响熟悉性及回想尚存争议。本研究以ERPs技术作为测量手段,采用来源记忆多键范式,操纵背景的情绪效价及唤醒强度,以探讨编码阶段背景情绪影响来源记忆提取的认知神经机制。学习阶段,呈现中性汉字及情绪图片（正性高唤醒、正性低唤醒、负性高唤醒、负性低唤醒）;测验阶段,仅呈现汉字,被试进行五键判断。行为结果发现：来源正确的比率比来源错误的比率更高,反应时更短;同时提取正性背景的辨别力更强,反应时更短;提取高唤醒背景反应时更短。脑电结果发现了分别代表熟悉性及回想的FN400及LPC新旧效应,且在500～700 ms,提取正性背景及高唤醒背景诱发显著更正的ERPs,但效价与唤醒没有交互作用。总体来说,来源记忆中背景效价及唤醒度对回想过程存在独立影响,体现为正性背景及高唤醒背景对来源提取的促进作用。     

Toward a social psychophysiology of vagally mediated heart rate variability: Concepts and methods in self‐regulation,emotion, and interpersonal processes

Theory and research on self‐regulation, emotional adjustment, and interpersonal processes focus increasingly on parasympathetic functioning, using measures of vagally mediated heart rate variability (vmHRV) or respiratory sinus arrhythmia (RSA). This review describes models of vmHRV in these areas, and issues in measurement and analysis. We propose a framework organizing theory and research as examining (a) vmHRV as an individual difference or a situational response, and (b) resting, reactive, or recovery levels. Evidence supports interpretation of individual differences in resting vmHRV as a broad biomarker for adaptive functioning, but its specificity and underlying mechanisms require elaboration. Individual differences in vagal reactivity (i.e., trait‐like differences in vmHRV decreases during challenge or stress) are less commonly studied in adults and results are mixed. Many stressors and challenges evoke temporary decreases in vmHRV, and in some research self‐regulatory effort evokes increases. In a smaller literature, positive interpersonal experiences and some restorative processes increase resting vmHRV, whereas depletion of self‐regulatory capacity through related effort decreases it. Greater attention to conceptual distinctions regarding vmHRV constructs and several methodological issues will strengthen future research. Importantly, researchers should exercise caution in equating vmHRV with specific psychosocial constructs, especially in the absence of converging assessments and precise experimental manipulations.