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Objective: Affective flexibility, the capacity to respond to life's varying environmental changes in a dynamic and adaptive manner, is considered a central aspect of psychological health in many psychotherapeutic approaches. The present study examined whether affective two-dimensional (i.e., arousal and valence) temporal variability extracted from voice and facial expressions would be associated with positive changes over the course of psychotherapy, at the session, client, and treatment levels. Method: A total of 22,741 mean vocal arousal and facial expression valence observations were extracted from 137 therapy sessions in a sample of 30 clients treated for major depressive disorder by nine therapists. Before and after each session, the clients self-reported their level of well-being on the outcome rating scale. Session-level affective temporal variability was assessed as the mean square of successive differences between consecutive two-dimensional affective measures. Results: Session outcome was positively associated with temporal variability at the session level (i.e., within clients, between sessions) and at the client level (i.e., between clients). Importantly, these associations held when controlling for average session- and client-level valence scores. In addition, the expansion of temporal variability throughout treatment was associated with steeper positive session outcome trajectories over the course of treatment. Conclusions: The continuous assessment of both vocal and facial affective expressions and the ability to extract measures of affective temporal variability from within-session data may enable therapists to better respond and modulate clients' affective flexibility; however, further research is necessary to determine whether there is a causal link between affective temporal variability and psychotherapy outcomes. What is the public health significance of this article?: The current findings highlight the potential of computerized facial expressions and vocal analyses to capture moment-by-moment processes in psychotherapy sessions. The results suggest that clients' affective flexibility, which in this project was measured by depressed clients' capacity to dynamically shift their emotional states and their arousal levels from one moment to the next, was associated with better session outcomes. The findings support therapeutic interventions aimed at enhancing clients' affective flexibility. Future work is needed to determine the causal links between affective flexibility in depression and outcomes. [ABSTRACT FROM AUTHOR]

ObjectiveMethodResultsConclusionThe literature on affective regulation in psychotherapy has traditionally relied on explicit client self-report measures. However, both clients’ and therapists’ affect fluctuate moment-to-moment during a session, highlighting the need for more implicit and continuous indices to better understand these dynamics. This study examined parasympathetic interpersonal and intrapersonal regulation dynamics between therapists and clients with Major Depressive Disorder during Supportive-Expressive Therapy.Data were collected from 52 dyads across five preselected sessions, using the Respiratory Sinus Arrhythmia (RSA) index. We employed a longitudinal Actor-Partner Interdependence Model, with clients self-reporting their functioning level before and after each session, as the moderator.Therapists’ RSA at one time point negatively associated with clients’ RSA at the next, and vice-versa, indicating interpersonal regulation. Clients’ RSA at one time point was positively associated with their RSA at the next, indicating intrapersonal regulation. However, only interpersonal regulation was significantly moderated by clients’ pre-to-post session functioning. Specifically, sessions where clients led positive dyadic RSA associations showed greater improvement in clients’ functioning than those led by therapists.Physiological interpersonal regulation, measured by RSA, may be a catalyst for change in depression treatment. Therapists who are responsive to clients’ arousal levels may help clients improve their functioning. [ABSTRACT FROM AUTHOR]

Objective: This paper highlights the facilitation of dyadic synchrony as a core psychotherapist skill that occurs at the non-verbal level and underlies many other therapeutic methods. We define dyadic synchrony, differentiate it from similar constructs, and provide an excerpt illustrating dyadic synchrony in a psychotherapy session. Method: We then present a systematic review of 17 studies that have examined the associations between dyadic synchrony and psychotherapy outcomes. We also conduct a meta-analysis of 8 studies that examined whether there is more synchrony between clients and therapists than would be expected by chance. Results: Weighted box score analysis revealed that the overall association of synchrony and proximal as well as distal outcomes was neutral to mildly positive. The results of the meta-analysis indicated that real client-therapist dyad pairs exhibited synchronized behavioral patterns to a much greater extent than a sample of randomly paired people who did not actually speak. Conclusion: Our discussion revolves around how synchrony can be facilitated in a beneficial way, as well as situations in which it may not be beneficial. We conclude with training implications and therapeutic practices. [ABSTRACT FROM AUTHOR]