Tschacher Wolfgang, Ribeiro Eugénia, Gonçalves Alexandra, Sampaio Adriana, Moreira Pedro, Coutinho Joana
University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal.
Front Psychol. 2025 May 14;16:1545719. doi: 10.3389/fpsyg.2025.1545719. eCollection 2025.
Previous empirical psychotherapy studies have been analyzing patient-therapist physiological synchrony as an important marker of an adaptive interpersonal co-regulation process between patient and therapist, and therefore a process essential for developing the therapeutic alliance. Yet, research on synchrony of the electrodermal activity and its relationship with the therapeutic alliance is still scarce, with inconsistent findings. The present study aimed to analyze the association between electrodermal synchrony, a signature of coordinated sympathetic activation, and the quality of the therapeutic alliance throughout the therapeutic process. Twenty-one therapeutic dyads were recruited, consisting of 21 different patients with a diagnosis of major depressive disorder or social anxiety disorder, treated by six therapists. For each dyad, electrodermal activity was recorded during all 16 sessions of Cognitive-Behavioral Therapy. The Working Alliance Inventory and the Session Evaluation Questionnaire were administered at each session to monitor the quality of the alliance and the respective session. Symptomatic improvements were measured with outcome questionnaires. We found clear evidence for the presence of in-phase electrodermal synchrony of therapists and patients. Additional results were that patient-leading synchrony was significantly more pronounced than therapist-leading synchrony, and that this leading role of patients in their sympathetic interactions during sessions was positively linked with the quality of the therapeutic bond as rated by the therapist, and negatively linked with patients' distress.
以往的实证心理治疗研究一直在分析患者与治疗师之间的生理同步性，将其作为患者与治疗师之间适应性人际共同调节过程的一个重要标志，因此也是建立治疗联盟必不可少的过程。然而，关于皮肤电活动同步性及其与治疗联盟关系的研究仍然很少，且结果不一致。本研究旨在分析作为协调性交感神经激活标志的皮肤电同步性与整个治疗过程中治疗联盟质量之间的关联。招募了21个治疗二元组，由21名诊断为重度抑郁症或社交焦虑症的不同患者组成，由6名治疗师进行治疗。对于每个二元组，在认知行为治疗的所有16次疗程中记录皮肤电活动。在每次疗程中发放工作联盟量表和疗程评估问卷，以监测联盟质量和相应疗程。用结果问卷测量症状改善情况。我们发现了治疗师与患者之间存在同相皮肤电同步性的明确证据。其他结果是，患者主导的同步性比治疗师主导的同步性明显更显著，并且患者在疗程中交感互动中的这种主导作用与治疗师评定的治疗关系质量呈正相关，与患者的痛苦呈负相关。
