The prognostic role of emotion regulation dynamics in the treatment of major depressive disorder.

OBJECTIVE: The potential prognostic role of emotion regulation in the treatment of major depressive disorder (MDD) has been highlighted by transtheoretical literature and supported by promising empirical findings. The majority of the literature is based on self-report observations at a single snapshot, thus little is known about the prognostic value of moment-to-moment dynamic evolvement of emotion. The present study is the first to examine the prognostic value of both intra- and interpersonal, moment-to-moment emotion regulation dynamics, and the potential moderating effect of the type of treatment. METHOD: To assess the prognostic value of emotion regulation dynamics, we focused on the first session, using 6,780 talk-turns within 52 patient-therapist dyads. Emotion regulation dynamics were measured using fundamental frequencies of the voice and were calculated using empirical Bayes residuals of the actor-partner interdependence model. Symptomatic change was measured using the Hamilton Rating Scale for Depression across 16 weeks of supportive treatment (ST) or supportive-expressive treatment (SET). RESULTS: Findings suggest that patients who show less regulated intrapersonal dynamics during the first session show less reduction of symptoms throughout treatment (ß = .26, p = .019). Findings further suggest that this association is mitigated when these patients receive SET, as opposed to ST (ß = .72, p = .020). CONCLUSIONS: The findings demonstrate the ability of first-session emotion regulation dynamics to serve as a prognostic variable. The findings further suggest that the adverse effect of emotion regulation dynamics on the patient's prognosis can be mitigated by explicit work on changing maladaptive emotional patterns. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development and evaluation of the HRSD-D, an image-based digital measure of the Hamilton rating scale for depression.

The Hamilton rating scale for depression (HRSD) is considered the gold standard for the assessment of major depressive disorder. Nevertheless, it has drawbacks such as reliance on retrospective reports and a relatively long administration time. Using a combination of an experience sampling method with mobile health technology, the present study aimed at developing and conducting initial validation of HRSD-D, the first digital image-based assessment of the HRSD. Fifty-three well-trained HRSD interviewers selected the most representative image for each item from an initial sample of images. Based on their responses, we developed the prototype of HRSD-D in two versions: trait-like (HRSD-DT) and state-like (HRSD-DS). HRSD-DT collects one-time reports on general tendencies to experience depressive symptoms; HRSD-DS collects daily reports on the experience of symptoms. Using a total of 1933 responses collected in a preclinical sample (N = 86), we evaluated the validity and feasibility of HRSD-D, based on participant reports of HRSD-DT at baseline, and 28 consecutive daily reports of HRSD-DS, using smartphone devices. HRSD-D showed good convergent validity with respect to the original HRSD, as evident in high correlations between HRSD-DS and HRSD (up to Bstd = 0.80). Our combined qualitative and quantitative analyses indicate that HRSD-D captured both dynamic and stable features of symptomatology, in a user-friendly monitoring process. HRSD-D is a promising tool for the assessment of trait and state depression and contributes to the use of mobile technologies in mental health research and practice.

Within-patient perceptions of alliance and attunement: Associations with progress in psychotherapy.

The most frequently examined aspect of the therapeutic relationship is the working alliance, which reflects the conscious collaborative bond, and agreement on task and goal. In addition to the established importance of the working alliance, the therapists' attunement and responsiveness might reflect another important aspect of the therapeutic relationship that can be considered in relation to session-by-session progress over treatments. Emerging research suggests that the quality of the working alliance not only differs between patients but also within patients over time. However, little is known about the quality of the therapeutic relationship between and within patients in relation to progress in psychotherapy. We examined fluctuations of the working alliance measure (WAI) and the newly developed measure of the Patients' Experiences of Attunement and Responsiveness (PEAR) during treatment in a naturalistic sample of patients in an outpatient psychotherapy clinic. Multilevel modelling was used to examine the respective contribution of these measures to subsequent improvement in psychological functioning longitudinally. Results suggest that the within-patient effect, instead of between-patient effect, was significant for WAI (and did not reach significance for PEAR), indicating that the fluctuation of WAI was predictive of psychological functioning in the subsequent month. Based on these findings, therapists and their patients might benefit from regular tracking of the patient-reported working alliance. The findings underscore the importance of the alliance, specifically at the within-patient level. It also highlights the challenge for research to tap into other aspects of the therapeutic relationship that can help explain progress in therapy. Given the breadth and accessibility of the working alliance construct, more work is needed for researchers to examine the construct of attunement and responsiveness.

How Social Experiences Affect Interpretation Bias Among Individuals With Non-clinical Depression: The Role of Ostracism.

BACKGROUND: Extensive knowledge and research indicate that interpretation bias is very common among individuals with sub-clinical and clinical levels of depression. Nevertheless, little is known about the role of social experiences in enhancing interpretation bias. Given the major relevance of social experiences in the context of depression, the present study investigated the role of potential interactions between social experiences and levels of depression symptoms in the interpretation of ambiguous information. METHOD: Seventy participants underwent a laboratory controlled manipulation either of social ostracism or of overinclusion. Participants completed a computerized task that measured both direct and indirect interpretation bias and reported their level of depression symptoms. RESULTS: The findings show that ostracism enhanced interpretation bias when symptom levels were higher, while overinclusion did not. This interaction effect between social ostracism and symptom level was found both for direct and for indirect interpretation bias. CONCLUSION: Whereas previous research showed the existence of interpretation bias among people with symptoms of depression, the present study expands previous knowledge by shedding light on the conditions under which interpretation bias emerges, suggesting that ostracism enhances negative interpretation of ambiguous information when levels of depression symptoms are higher.

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

The importance of interdependence processes of patients' and therapists' affect experiences (AEs) over the course of treatment has been highlighted by numerous therapeutic orientations. Yet, most studies have focused on snapshot observations and there is a dearth of knowledge regarding session-to-session patient-therapist AE interdependence, through which the dynamics of AE across treatment can be explored. Using actor-partner interdependence model analysis in a sample of 70 patient-therapist dyads across 16 sessions of psychodynamic treatment, the present study investigated whether (a) at the sample level, patients' and therapists' changes in positive and negative AEs are interdependent throughout treatment, and (b) whether individuals' differences in AE interdependence can be explained by patients' anticipated or general ability to form a strong therapeutic alliance, and by the actual alliance with the therapist during treatment. Findings suggest that patients' and therapists' changes in positive and negative AEs are interdependent throughout treatment. Moderation analysis suggests that when patients report stronger anticipated ability to form a strong alliance, an increase in therapists' negative AE from one session to another predicts a greater decrease in their patients' negative AE in the following session. Additionally, focusing on patients' actual alliance with the therapist during treatment, when patients report a stronger alliance with their therapist, a subsequent increase in therapists' positive and negative AEs from one session to another predicts greater subsequent increases in their patients' positive and negative AEs in the next session. Taken together, findings suggest that patients' and therapists' AEs are interdependent throughout treatment, though individual differences exist. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The perception and attitudes of Israeli cancer patients regarding advance care planning.

OBJECTIVES: Advance care planning (ACP) allows patients to acknowledge and document their preferences regarding end-of-life care and to ensure their fulfilment. Several factors were found to be related to patients' motivation regarding this process, such as their fear of being a burden on family members; however, the completion rate of the ACP forms is partial. The current study aimed to evaluate the barriers and motives among Israeli cancer patients regarding ACP, including many older adults. SETTING AND MEASUREMENTS: Advanced cancer patients participated in the study. All completed an initial questionnaire to evaluate their basic knowledge regarding the issue. Participants who agreed to talk with a social worker completed a semi open-ended questionnaire which investigated their main motives and barriers regarding the issue. RESULTS: Most of the patients who completed the ACP forms were older and had lung cancer. They mentioned information and open communication with family and staff members as the main enabling factors. Their main motives were to ensure that the best medical decisions would be made and to avoid unnecessary medical procedures. The main reasons for not completing the forms was no close relative who would agree to take the responsibility as well as timing. Most of the participants did not hear about the issue from sources outside the oncology division. CONCLUSIONS: Despite several limitations, the current findings may have important implications regarding ways to establish a more suitable ACP process, adjusted to older patients' needs. This may assist in promoting patients' cooperation with ACP and its implementation in the medical system, including older adults.

The perception of Israeli oncology staff members regarding advance care planning.

BACKGROUND: Advance care planning (ACP) defines end-of-life care in accordance with the patients' preferences. It is highly important during mental and/or physical deterioration, which prevents patients from expressing their wishes. Despite various attempts worldwide to promote the issue, it is not well established, suggesting various challenges in the implementation of the process in the medical system. The current study aimed to evaluate the perception of Israeli oncology staff members regarding the process. METHODS: Physicians and nurses from a division of oncology participated in the study. They completed the study's questionnaires, which included quantitative items regarding staff and patients' motives and barriers, as well as qualitative questions to better evaluate their understanding regarding the process. RESULTS: According to staff members, the optimal time to complete the forms is during the final stages of the disease. Making the right medical decisions and avoiding unnecessary medical procedures were rated as the main motives for patients in the process. The communication factor was perceived as the main barrier for patients, as well as the main motive and barrier for staff. The central role of communication was demonstrated in the qualitative section as well. Various differences were demonstrated between staff members who talked with patients about ACP and those who did not. CONCLUSION: The study demonstrated the central role of communication in the process of ACP from the staff's perception. This highlights the need to further promote training programs for staff members to establish better interactions and communication skills when dealing with end-of-life issues.

Choosing to Regulate Emotions: Pursuing Emotion Goals in Autonomy-Supportive and Controlling Contexts.

We applied self-determination theory to emotion regulation and tested the potential effects of autonomy-supportive and controlling contexts on the pursuit of emotion goals. In four experimental studies (N = 242), participants viewed a fear-eliciting film clip or emotion-eliciting pictures and were prompted to pursue emotion goals with either autonomy-supportive or controlling instructions. Participants in both conditions were equally likely to engage in emotion regulation when directly instructed to do so. However, when they were allowed to spontaneously choose whether to regulate emotions or not, participants in the autonomy-supportive contexts were more likely than those in the controlling ones to independently pursue emotion goals. The latter also engaged in more defensive processing of emotion-eliciting stimuli than the former. These results indicate that people are more likely to pursue emotion goals of their own accord when the context in which they pursue them is autonomy supportive, rather than controlling.