Couple EAT World Congress final 2_CL[1]

Imitation and Synchronisation in Schema Work with Couples

Developing a new love strategy

Our Team & Expertise

© Pietrzak, Lohr, Hauke, Jahn (2016)

3 with PhDs2 with masters

Dr Christina Lohr: Munich

Dr Tania Pietrzak: Melbourne

Leanne Kennedy: Melbourne

Beverly Jahn: Leipzig

Dr Gernot Hauke: Munich


Aims

To foster emotional regulation, multifaceted empathy and conflict resolution in conflicted couples using an integrated treatment method to improve partner satisfaction.

Emotional activation + embodied cognition + cognitive affective schemas

We aim to increase understanding of couples’ previous hidden emotion and intentions.


Models of Effective Relationship Therapy & Limitations Behavioural (Johnson & Greenberg 1985): Do not address

cognitive or affective processes by couples. CBT (Davidson & Horvath 1997): cognitive distortions leading to

problematic behavioural patterns, controlling emotions using reason (cognitive change).

EFT (Johnson 1999): emotions essential to problem solving, changes in affect towards partner occurs by focusing on understanding partners emotional experience.

All martial therapies neglect embodiment – role of body in shaping cognitions and emotions.


Definition of Embodiment (Shapiro 2011)“Refers to both embedding of cognitive processing in brain circuitry and to the origin of these processes in an organisms sensory motor experience, THUS ACTION AND PERCEPTION are closely linked”

“Emotions and cognitions & motivational processes are following body activities, for example posture, movement, gesture”

“Feel emotions with the aide of the body” .

Rationale: Conflicted couples (who are flooding or immobilised) find it difficult to access language to express felt emotions.. Therefore the body can aide in the generation and regulation of emotions.


Embodiment as an adjunct to relationship therapy Traditional martial therapies view cognitions and

emotions as ’amodal’ and not embedded within the body. (Top down- therapist helps couples use language to express cognitions and emotions & to assist them to re-interpret their experiences using language only)

Neuroscience inspired research shows that cognitions are emotions are embodied and modal (bottom up). (Barsalou 2011; Damasio 2011)


Empathy

Empathy seen as a multidimensional construct (Fuchs & Koch, 2011; Kim et al., 2013) Affective empathy, e.g. emotional sharing/ contagion or mirroring the feelings

of another person. Cognitive empathy, e.g. inferring mental states and intentions of another

person. Kinesthetic empathy, imitation, moving in synchrony


Kinesthetic empathy Is a motor theory of empathy (Gallese 2009)

Imitation and synchronization of body movements, gestures, facial expressions, vocalizations, etc. in a couple

Explains increase of affiliation, cohesion, prosocial behaviours, higher levels of cooperation

Better outcomes in psychotherapy with higher levels of synchrony (Ramseyer & Tschacher 2010, 2011)


Aims and Hypotheses 1. The treatment group will show statistically significant and

clinically meaningful increases in measures of empathy, relationship satisfaction, a more secure attachment style.

2. The treatment group will show statistically significant and clinically meaningful decreases after treatment in measures of depression.

3. Increases will occur in participants understanding of their emotions and core schemas during conflict and understand their partner’s intentions and hidden emotions.

4. The wait list control group will show no statistically significant or meaningful improvements over time.


Screeners

No Domestic Violence In a committed relationship with clarity around a

defined problematic situation (both want to stay and improve the relationship)

Self selected, voluntary


MaterialsInterpersonal Reactivity Index (IRI, Davis 1983): Affective and Cognitive components of empathy. Personal Distress: the tendency to have feelings of discomfort and

concern when witnessing others’ negative experiences. Empathic Concern: ‘other’ orientated feelings of sympathy and concern Perspective Taking: adopting the psychological point of view of others Fantasy: imagining the feelings and actions of fictitious characters

Relationship Assessment Scale (RAS, Hendrick 1988) Measure of general relationship satisfaction

A

C


Materials

Experience in Close Relationships (ECR-R, Fraley et al. 2000): Measures attachment related anxiety and avoidance in close relationships (not partner specific).

Brief Patient Health Questionnaire (B-PHQ, Kroenke et al. 2001): DSM-IV measure of depression


Procedure Participants self selected, voluntary, advertisement through

internet, GP clinics, PHCNs, community centers, psychology practices.

Initial and follow up interview, assessment, informed consent, relationship ax feedback

Treatment group given 20 hours intervention Wait list control group offered relationship assessment results

only 2 months between baseline and post treatment Measures for treatment group taken 2 weeks post treatment

• Sensitisation of body interaction

• Introduction to the

group: Sharing of pictures.

• Same-boat-exercise- What do I need from the group, what do I give to the group?

• Psychoeducation:

• Ice-berg – metaphor • Scar-metaphor

Establish Group Cohesion

Focus on Self

• Mindfulness – self, spouse, group.

• Partners separated:

• Own Survival strategy & Emotional field

• Other group members give feedback, imitate to show embodied empathy and can support as representatives

• Individual behavioural action goals

• 3 levels of movement pattern: closeness-distance, intensity/speed and up-down

• Couple Mindfulness

• Sharing of individual emotional survival strategy + imitating secondary & primary emotions

• Frustrated partner dance choreogrpahed by couples

• Synchronization & embodied cooperation in motion to the solution

• Love strategy – meta cognitive analysis & couple projects

Focus on Interaction


Definition of Survival Strategy (Sulz &Hauke): cognitive affective schema Problematic situations between couples are highly emotionally charged leading to

interaction of ‘survival’ mode (maladpative schemas), negative sentiment over-ride results.

Describing how central needs are met in a relationship and balanced with approach and avoidance.

Learnt from childhood no longer functional as a healthy adult for emotional survival => explore survival strategies, reaction chain: primary and secondary emotions Every couple problematic situation is associated with a network

of different affects and often distinguishable emotions with opposite action impulses and emotionally charged fragments of learning history

To get the full picture: Emotional Field from Emotional Activation Therapy (EAT, Hauke & Dall‘Occhio, 2013).


SHE

HE

Interacting survival strategies

What do I need from you?

What scares me about you?

What makes me angry about you?

Peace, harmony, feeling safe, not frighten me

SHE Being ignored , not listened to

Her harshness and unrealistic and unfair demands

SHEBeing left financially and emotionally alone

Physical fight, being left

HE

HE

HEROnly if I always (show a specific behaviour): keep my power & punish in front of weak people and putting myself down & feeling ashamed in front of strong peopleNever (forbidden impulses): show my real feelings or vulnerabilities, fear of being rejectedKeep (central needs): Acceptance for being herself Avoid (central anxieties): being rejected and feeling lonely.

HIMOnly if I always (show a specific behaviour): Pacify, avoid conflict, perform, sacrifice.Never (forbidden impulses): Set limits, stand up for my needsKeep (central needs): Security and peaceAvoid (central anxieties): Counter aggression, failure, being alone

Being seen, accepted and desired

Demographics of Participants (n.s.)


Total sample (N=20)

Treatment group (N=14)

Control group (N=6)

Age M=49.3 (SD= 9.32)

M= 49.64 (SD=9.52) M= 48.5 (SD=9.65)

Education 10% post grad; 30% undergrad; 25% diploma/trade; 10% year 12; 10% year 10; 5% year 12.

14.3% post grad; 28.6%; 35.7% diploma/trade; 7.1% for years 10-12.

33.3% undergrad; 16.7% year 11; 16.7% year 10; 33.3% missing.

Gender 9 males; 11 females

6 males; 8 females 3 females; 3 males

Years in relationship M=12.94 (SD=1.55)

M=13 (SD=9.64) M=10.63 (SD=11.10)

Mental illness (depression)

M= 6.9 (SD=6.12) Below clinical cut off

M=6.64 (SD=5.27)Below clinical cut off

M=7.5 (SD=8.34)Below clinical cut off


Score Treatment group

Control group

Total group

N=13 N=6 N=19Interpersonality Reactivity Index (IRI)IRI-Perspective Taking (pre) M=17.61

(SD=4.37)M=20.67 (SD=4.32)

M=18.58 (SD=4.48)

IRI-Perspective Taking (post)

M=19.08 (SD=4.15)

M=18.67 (SD=2.42)

M=18.95 (SD=3.63)

IRI-Fantasy (pre) M=17.62 (SD=5.55)

M=14.33 (SD=2.05)

M=16.58 (SD=4.97)

IRI-Fantasy (post) M=17.62 (SD=4.89)

M=14.33 (SD=3.93)

M=16.58 (SD=4.76)

IRI-Empathic Concern (pre) M=23.85 (SD=4.79)

M=24.17 (SD=3.54)

M=23.95 (SD=4.34)

IRI-Empathic Concern (post)

M=24.85 (SD=4.78)

M=22.83 (SD=4.92)

M=24.21 (SD=4.78)

IRI-Personal Distress (pre) M=12.63 (SD=5.54)

M=15.0 (SD=5.83)

M=13.38 (SD=5.58)

IRI-Personal Distress (post) M=14.62 (SD=6.35)

M=13.00 (SD=4.94)

M=14.11 (SD=5.85)

Results for Empathy - study sample data (mean (SD))

Pre treatment graph of empathy between groupsTime x Measure x Group (F(1,17)=4,920; p<.040)

Cohen’s d = 1.139

Scor

e of

IRI

IRIperspective

taking

IRIfantasy

IRIempathic concern

IRIpersonal distress

Results - Repeated Measure Multivariate ANOVA

TreatmentControl

Post treatment graph of empathy between groups

Time x Measure x Group (F(1,17)=4,920; p<.040)Cohens d = 1.139

IRIperspective

taking

IRIfantasy

IRIempathic concern

IRIpersonal distress

Results - Repeated Measure multivariate ANOVA

TreatmentControl

Scor

e of

IRI

Score M pre M post M change

SD t p

Relationship Assessment Scale

Treatment group

(N=14)

25.43 27.50 -2.07 2.23 -3.47 .004

Control group(N=6)

22.33 26.17 -3.83 5.23 -1.8 .133

Results for Relationship Satisfaction - Paired Sample t-test

Qualitative CommentsMost Useful: Finding solutions for the relationship (3) Focusing on our problem situation and the emotions

behind it (4) Group Cohesion (3)

Take home messages: Behaviour change for self and relationship (9) Emotions in self and partner (3) Undertanding self and partner (3)

Discussion1. Hypothesis 1 partially confirmed for treatment group

compared to control for significant and meaningful increases with intervention in satisfaction and empathy.

2. No significant change in treatment group‘s depression and attachment style in general close relationship.

3. Potential ceiling effects for depression in a non psychopathological baseline treatment group.

4. No change in attachment style possibly due to it being how participants generally experience their relationships (not intervention specific), or not enough time to follow up generalistion of new skills with other people they are close to.

Discussion5. Personal distress upon seeing negative emotions of others (including partner) increased significantly for the treatment group and not the control group. This suggests that as we do deep emotional work initially and our partner embodies these emotions via imitation. Emotional contagion may have occurred. 6. However as the couples were more satisfied with

intervention it suggests couples could stand experiencing increases in personal distress about their

partners suffering. Further follow up testing will clarify whether the PD measure is a reaction to experiencing their partners previously hidden high emotions


For further information

Pietrzak T., Hauke, G. & Lohr, C.: Connecting Couples Intervention: Improving couples’ empathy and emotional regulation using embodied empathy mechanisms in European Psychotherapy 2016/2017 pp66-96

Documents

Couple EAT World Congress final 2_CL[1]