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Blunted motivation is a core symptom of Major Depressive Disorder (MDD). Although the empirical picture is mixed, cognitive processes that can be collectively referred to as reward processing have been found to be consistently muted in MDD; most notably, reward sensitivity and reinforcement learning. Works on the modulation of response vigor in individuals with MDD have examined various types of reward, but recent research has shown that in the general population, response vigor is not modulated by type of reward on tasks that are highly similar to those used in these experiments. The present study implemented a form of non-reward related reinforcement which has repeatedly been shown to modulate response vigor in the general population. It investigated whether modulation of response vigor by this type of reinforcement would be effective in individuals with MDD. Clinically depressed individuals (N = 121; 76 post-exclusion) engaged in a task in which their responses led to predictable and immediate sensorimotor effects, or no such effects. Response vigor increased when responses led to sensorimotor effects, which was comparable to the increase found in the general population. These findings support the utility of isolating the computations leading to different reinforcement types and suggest that motivational deficits in MDD may be specific to the type of reward (i.e., hedonically or otherwise explicitly desired stimuli). These results contribute to the literature by suggesting that the reinforcement from sensorimotor predictability stems from processes devolved to motor control, whereas reinforcement from rewards may depend on more general-purpose processes. [ABSTRACT FROM AUTHOR]

Objective: Clinical and theoretical considerations presume that patients with different personality disorder (PD) clusters will be associated with distinct alliance rupture profiles; however, there is scarce empirical literature examining this. The present study adopted a systematic framework for investigating profiles of alliance ruptures for individuals belonging to each of the three PD clusters. Method: The sample consisted of 94 patients from a randomized controlled trial for treatment of depression. PD cluster features were assessed at intake and ruptures were assessed across treatment. Three sets of multilevel analyses were conducted to test differences between the PD clusters in the general tendency to show a rupture profile, rupture development throughout the treatment, and timing of predicting ruptures by PD within sessions. Results: The three clusters were associated with distinct profiles of alliance ruptures. Clusters A and B were characterized by a general tendency to show more withdrawal and confrontation ruptures. Cluster A had a greater decrease in confrontation ruptures over the course of treatment, while cluster B had a greater decrease in withdrawal ruptures. Cluster C was characterized by a general tendency to show fewer withdrawal and confrontation ruptures, with a greater increase in both ruptures over the course of treatment. For withdrawal ruptures, the differences between clusters were evident from the beginning of sessions, whereas for confrontation ruptures, there was less of a difference between beginning and end of sessions. Conclusion: The distinct profiles of alliance ruptures for each PD cluster may contribute to progress towards tailoring treatment to individuals with PDs. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic shifted many traditional face-to-face treatments to telepsychotherapy, forcing many therapists worldwide to adapt effective techniques developed in face-to-face treatment to telepsychotherapy. These include supportive techniques that may be particularly important at a time of rising anxiety, loneliness, helplessness, and depression. The present paper provides detailed guidelines for therapists on how supportive techniques developed in traditional face-to-face treatment can be effectively used in telepsychotherapy to resolve alliance ruptures. To this end, we used the conceptual framework of the core conflictual relationship theme (CCRT) formulation, making adjustments for identifying and resolving ruptures in the therapeutic alliance in telepsychotherapy. We demonstrated the proposed techniques for identifying and repairing ruptures with a case study of a patient participating in an ongoing RCT, whose treatment shifted in mid-therapy to telepsychotherapy because of the COVID-19 pandemic. The techniques presented and illustrated in this article may be used in the transition to remote therapy for a range of reasons, including patient or therapist relocation and more. [ABSTRACT FROM AUTHOR]

Objective: Many active treatments exist for major depressive disorder (MDD), but little is known about their differential effects for various subpopulations of patients to guide precision medicine. This is the first randomized controlled trial (RCT) designed to identify differential treatment effects based on patients' attachment orientations. We tested an a priori preregistered hypothesis of the potential moderating effect of patients' attachment orientation on the outcome of supportive therapy (ST) versus supportive-expressive therapy (SET). Methods: The RCT was conducted between 2015 and 2021. Individuals with MDD were randomly assigned to 16-week ST or SET. The predefined primary outcome measure was the Hamilton Rating Scale for Depression. Hypotheses were formulated and preregistered before data collection. Results: One hundred patients with MDD were enrolled, 57% women, average age 31.2 (SD = 8.25). Data were analyzed using the intention-to-treat approach. Our hypothesis that attachment anxiety is a significant moderator of treatment outcome was supported (B = −0.09, p =.016): Patients with higher levels of attachment anxiety showed greater treatment efficacy following SET than ST. Although the hypothesis regarding a potential moderating effect of avoidant attachment was not supported, sensitivity analyses revealed that individuals with disorganized attachment orientation (higher scores on both anxious and avoidant attachment) benefited more from SET than from ST (B = −0.07, p =.04). Conclusion: The findings support the clinical utility of patients' attachment orientation in selecting the most suitable treatment for individuals and demonstrate the methodological utility of RCTs predesigned to test theoretically based models of personalized treatment. What is the public health significance of this article?: This study is the first randomized controlled trial (RCT) predesigned to test the differential effect of treatments based on the patients' pretreatment attachment orientations. The findings demonstrate the ability of attachment orientation to serve as an empirically informed tool for a personalized match between individuals and their most effective treatment. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder (MDD) is the leading cause of disability worldwide and one of the most heterogeneous mental health disorders. Although there are effective treatments for MDD, about 50% of patients do not respond to treatment. One of the greatest challenges in improving current treatments is identifying the mechanisms responsible for therapeutic change in MDD. The proposed study aims to identify patient-specific mechanisms of change in two treatments for MDD by investigating whether subpopulations of patients differ in the mechanisms of change that operate when receiving a given treatment. Based on theories of targeting weakness and building on strength, we will examine whether the mechanism of change operating when a treatment is provided depends on whether the treatment targets the patient's strength or weakness. Method: To test our hypothesis that two treatments, supportive-expressive treatment (SET) and emotion-focused treatment (EFT), differ in their mechanisms of change and to explore whether focusing on the patient's strength or weakness will result in better treatment outcome, we conduct a mechanistic randomized controlled trial. One hundred and twenty-four individuals diagnosed with MDD are randomized to 16 sessions of either SET or EFT. The two treatments are theorized to differ in their main mechanism of change: SET places emphasis on insight as its main mechanism of change, and EFT places emphasis on emotional processing. Both can serve as strength- or weakness-focused treatments, based on the patient's baseline levels of insight and emotional processing. The primary outcome is the Hamilton Rating Scale for Depression. Additional measures include self-report measures and clinical interviews, hormonal, motion, acoustic, physiological, and neuroimaging assessments, performance on cognitive tasks, and narrative material (collected from the sessions and interviews). Discussion: The RCT will expand our understanding of mechanisms of change in psychotherapy, from one-size-fits-all to patient-specific mechanisms of change. By informing therapists about which of the two approaches is most effective with patients based on their baseline characteristics, the RCT will contribute to progress toward personalized treatment. Trial registration: clinicaltrials.gov Identifier: NCT04576182 submitted on October 1st 2020. Funding: The Israel Science Foundation. Trial status: Recruitment is ongoing. [ABSTRACT FROM AUTHOR]

The therapeutic alliance is one of the most consistent predictors of therapeutic change, including symptom reduction and improvement in wellbeing and quality of life, across a variety of mental health interventions. Yet, little is known about its biological mechanisms. Oxytocin (OT) has been suggested as a biological mechanism by which bonds are formed and strengthened across species. This article is intended to demonstrate the potential of OT as a biomarker of therapeutic change in psychotherapy and counseling psychology, especially of the therapeutic alliance. We delineate three main potential paths of investigation based on the most recent research on OT in parent–child and romantic partner dyads. For each path, we provide a detailed explanation for whom, when, and how OT should be measured. Each path is illustrated using data collected in a randomized controlled trial of psychotherapy for major depressive disorder. These illustrations demonstrate the great potential of OT as a biomarker of (a) trait-like characteristics of the patients and the therapists, (b) the processes of therapeutic change, and (c) the dyadic synchrony between patients and their therapists. The potential clinical contribution of OT as a biomarker for each of these three paths is further demonstrated using a case study. Practical suggestions and directions for future research are discussed. Public Significance Statement: The article highlights the promising potential of OT as a biomarker in psychotherapy research, through the most recent research on the role of OT in parent–child and romantic relationships, as well as through data from a randomized controlled trial of psychotherapy for major depressive disorder. The article provides practical suggestions on how this potential may be realized. Interdisciplinary studies integrating the two fields of inquiry, psychotherapy and OT research, can create new important knowledge that has the potential to make a substantial contribution to clinical practice and complement existing approaches for measuring the process of therapeutic change. [ABSTRACT FROM AUTHOR]

Despite widespread clinical, theoretical, and empirical support for the importance of alliance ruptures, little is known about the underlying biological level at times of rupture. The overarching goal of the present study was to investigate dyadic patterns of in-session oxytocin (OT) change between patients and therapists (e.g., patient's OT increases more than therapist's OT) as markers of withdrawal ruptures. Hypothesis 1 construed that OT incongruence (e.g., larger patient increase in OT in comparison to their therapist OT increase) will mark the occurrence of withdrawal ruptures. Hypothesis 2 construed that this effect of OT incongruence will be more pronounced when anxious attachment orientation is low. Surface analysis was conducted on 628 saliva samples that were gathered before and after therapeutic sessions of 53 patient–therapist dyads enrolled in a randomized control trial treating major depression. Only Hypothesis 2 received empirical support, meaning it was only when anxious attachment orientation was low that there were significantly more withdrawal ruptures when the patient's OT increase was higher than their therapist's OT increase. This is consistent with the literature, suggesting that in times of withdrawal ruptures, the patient and therapist are in an incongruent state. Findings suggest that this incongruence is mirrored at the biological level only when anxious attachment orientation is low. Results shed light on what may be happening between patients and therapists on a biological level during a withdrawal rupture. Public Significance Statement: This article provides the first empirical evidence of a potential biological marker for withdrawal ruptures. Findings suggest that a dyadic pattern of incongruence in oxytocin release emerges in times of withdrawal ruptures. This dyadic pattern of incongruence manifested as a patient's increase in OT that is higher than the therapist's increase in OT. This effect of OT incongruence was found only when anxious attachment orientation was low. [ABSTRACT FROM AUTHOR]