Research has shown that psychotherapy patients experience increased physiological responsivity to stress which might negatively impact their experience in psychotherapy and their overall progress and outcome. The purpose of the present study was to investigate the effect of a heart rate variability biofeedback intervention on the physiological stress responsiveness and the psychotherapy outcomes of participants in psychotherapy. Forty college students attending psychotherapy at their university counseling center were divided into an experimental group and a control group. The experimental group participated in a 6-week biofeedback intervention and we assessed their physiological stress reactivity before and after implementation of the intervention, compared to a matched control group. The Trier Social Stress Test (TSST) was administered pre- and post-intervention to induce a stress reaction. It was hypothesized that psychotherapy patients involved in the biofeedback intervention would show decreased physiological stress reactivity to and faster physiological recovery from a laboratory induced stressor post-intervention compared to psychotherapy patients in the matched control group. It was also hypothesized that these participants would demonstrate larger distress reduction after implementation of the intervention. Results of the study found no significant main effect of the TSST on systolic blood pressure, heart rate, and HRV. There however was a main effect on diastolic blood pressure. The only variable that significantly differed between groups was the LF/HF ration. The results also revealed no significant change from pre-intervention baseline to post-intervention heart rate, blood pressure, and HRV, suggesting that the HRV biofeedback intervention was not effective in changing the stress response over time. Regarding levels of distress, results also revealed no statistical between group differences post-intervention, although the biofeedback group appeared to report significantly lower levels of distress post-intervention.

This study investigated the relationships among attachment styles, affect regulation, and outcome in a clinical sample receiving treatment for depression. Sixty-six clients completed questionnaire measures of adult attachment, dysfunctional attitudes, interpersonal problems, self-esteem, and depression. Clients’ levels of affect regulation were assessed with an observer-rated measure of affect regulation. The study’s purpose was to extend previous research by examining the relationship between adult attachment and affect regulation within a clinical context. Results indicated significant and positive associations between clients’ attachment security and their levels of affect regulation at early and late stages of psychotherapy. Late modulation of expression and arousal were found to mediate the relationship between pre-treatment attachment insecurity and outcome. Pre-treatment attachment avoidance, characterized by high discomfort with closeness, had a direct relationship with depressive symptoms not mediated by the cognitive-affective processes of affect regulation. Implications of present findings for the treatment of depression are discussed.

In this study, two primary hypotheses drawn from Cognitive-Experiential Self-Theory (Epstein, 1994, 1998, 2003) and the treatment preference literature (Arnkoff, Glass, & Shapiro, 2002) were tested in the broader contexts of similarity/matching research and eclecticism in psychotherapy. Specifically, it was hypothesized that client-therapist similarity/dissimilarity in terms of (a) their Rational and Experiential Thinking styles (Pacini & Epstein, 1999), and (b) their preferences for a Cognitive ("Thinking") versus an Experiential ("Feeling") theoretical orientation (Hutchins, 1984), would affect the process and outcome of early therapy. Forty-seven client-therapist dyads participated in the study. In the seven hierarchical linear regressions conducted, no statistically significant effects were found on any of the dependent variables (working alliance, empathic understanding, session depth, session smoothness, satisfaction with treatment, perceived change, and objective change). Study limitations included its modest statistical power to detect small and moderate effect sizes.Three exploratory questions were also investigated in a sample of 89 clients and 79 therapists and were found to be statistically significant. Specifically, client rational and experiential thinking styles made substantial contributions in the expected direction in predicting client preference for a cognitive versus an experiential treatment. Similarly, therapist experiential thinking style was predictive of therapist treatment preference. These findings suggest that client and therapist personality (thinking styles) are more significant predictors of treatment preference than variables such as gender and clinical experience (as a therapist or a client). Last, rational thinking style was predictive of client intrapersonal adjustment, and experiential thinking style was predictive of client social adjustment. / Department of Counseling Psychology and Guidance Services

This study investigated the relationships among attachment styles, affect regulation, and outcome in a clinical sample receiving treatment for depression. Sixty-six clients completed questionnaire measures of adult attachment, dysfunctional attitudes, interpersonal problems, self-esteem, and depression. Clients’ levels of affect regulation were assessed with an observer-rated measure of affect regulation. The study’s purpose was to extend previous research by examining the relationship between adult attachment and affect regulation within a clinical context. Results indicated significant and positive associations between clients’ attachment security and their levels of affect regulation at early and late stages of psychotherapy. Late modulation of expression and arousal were found to mediate the relationship between pre-treatment attachment insecurity and outcome. Pre-treatment attachment avoidance, characterized by high discomfort with closeness, had a direct relationship with depressive symptoms not mediated by the cognitive-affective processes of affect regulation. Implications of present findings for the treatment of depression are discussed.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 90-95). Also available on the Internet.

Thesis (Ph. D.)--University of Missouri-Columbia, 2002. / Typescript. Vita. Includes bibliographical references (leaves 90-95). Also available on the Internet.

Several systems have been designed to monitor psychotherapy outcome, in which feedback is generated based on how a client's rate of progress compares to an expected level of progress. Clients who progress at a much lesser rate than the average client are referred to as signal-alarm cases. Recent studies have shown that providing feedback to therapists based on comparing their clients' progress to a set of rational, clinically derived algorithms has enhanced outcomes for clients predicted to show poor treatment outcomes. Should another method of predicting psychotherapy outcome emerge as more accurate than the rational method, this method would likely be more useful than the rational method in enhancing psychotherapy outcomes. The present study compared the rational algorithms to those generated by an empirical prediction method generated through hierarchical linear modeling. The sample consisted of299 clients seen at a university counseling center and a psychology training clinic. The empirical method was significantly more accurate in predicting outcome than was the rational method. Clients predicted to show poor treatment outcome by the empirical method showed, on average, very little positive change. There was no difference between the methods in the ability to accurately forecast reliable worsening during treatment. The rational method resulted in a high percentage of false alarms, that is, clients who were predicted to show poor treatment response but in fact showed a positive treatment outcome. The empirical method generated significantly fewer false alarms than did the rational method. The empirical method was generally accurate in its predictions of treatment success, whereas the rational method was somewhat less accurate in predicting positive outcomes. Suggestions for future research in psychotherapy quality management are discussed.

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