This is the first study to examine within and between session changes in interpretation biases as mechanisms of change in individual cognitive-behavioral therapy for social anxiety disorder (SAD). Twenty-eight patients completed multiple interpretation bias assessments, measured using both strategic (sentence completion, self-report) and automatic (grammatical decision) tasks and weekly measures of SAD symptoms. Preregistered Bayesian analyses results yielded strong evidence for bidirectional, time-lagged, weekly associations between changes in positive and negative interpretation biases and symptom reduction over the course of CBT. The effect of interpretations on subsequent symptoms were more consistent than the effect of symptoms on interpretations, suggesting an important unidirectional and potentially causal link. Increases in earlier, strategic positive biases and decreases in later, negative strategic biases were most consistently associated with symptom reduction. Together, these findings provide strong support for cognitive models that highlight the importance of interpretation biases as mechanisms of change in treatment of SAD.

OBJECTIVE:Traumatic events can evoke significant distress and shape personal and collective identities. In the context of single-event traumas, the relationship between posttraumatic symptoms (PTS) and event centrality (EC) has been found to be reciprocal. However, this dynamic remains unexplored in the context of ongoing conflicts. We examined the temporal dynamics between PTS and EC among Israeli civilians following the events of October 7, 2023. METHOD:We explored the bidirectional relationship between PTS and EC at 3, 7, 12, and 17 months after the conflict began. Participants (N = 464) completed measures of PTS and EC at each time point. Using the cross-lagged panel model and the random intercept cross-lagged panel model, we examined the cross-lagged associations between PTS and EC. RESULTS:Our findings revealed a bidirectional and phase-sensitive association between PTS and EC. During the early phase (3-7 months), EC was associated with an increase in PTS, suggesting that the centrality of the event can exacerbate distress. In contrast, PTS was associated with an increase in EC during the midphase (7-12 months), suggesting that trauma-related distress may shape the degree to which individuals integrate trauma into their sense of self. CONCLUSIONS:These results underscore a dynamic, time-sensitive interplay between distress and meaning-shaping processes. The ascription of centrality to traumatic events in an ongoing conflict may both reflect and amplify PTS. Incorporating identity and meaning-making processes into trauma models may enhance our understanding of coping mechanisms in protracted stress situations. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

This study investigated whether clients' pretreatment attachment insecurity predicted initial alliance and early alliance growth rate. Additionally, we examined whether clients' early alliance growth rate predicted change in attachment insecurity following therapy. Data from 549 clients treated by 53 therapists in a primary care setting were analyzed using multilevel modeling. Associations between attachment styles (anxiety and avoidance), initial alliance, and alliance growth rate in the first four sessions were analyzed. Additionally, the associations between early alliance growth rate and the degree of improvement in anxious and avoidant attachment following treatment were examined. Higher attachment avoidance significantly predicted lower initial alliance levels and was marginally associated with steeper early alliance growth. Attachment anxiety showed no significant associations with alliance formation. Steeper early alliance growth predicted greater improvement in attachment avoidance following therapy. No associations were found between alliance growth and changes in attachment anxiety. The findings suggest that clients with higher attachment avoidance exhibit lower initial alliance levels but may demonstrate greater alliance strengthening during early sessions. Notably, early alliance growth was associated with reductions in avoidant attachment insecurity following treatment. These results underscore the importance of identifying attachment styles in treatment planning and prioritizing alliance formation in early sessions for clients presenting with avoidant attachment. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

BACKGROUND:Social interactions and stable individual differences shape an individual's sense of belongingness -a core need of being accepted by others. Indeed, a sense of belonging is postulated-and found-to affect and be affected by socializing. A diminished sense of belonging and reduced socializing characterizes social anxiety (SA). However, the impact of SA on the temporal dynamics between socializing and belongingness remains unclear. METHOD:Using ecological momentary assessment (EMA), we examined the impact of SA on socializing-belongingness dynamics. Participants (N = 116) provided real-time reports on social interactions (three times a day) and belongingness (five times a day) across a 15-17-day period. RESULTS:SA moderated the relationship between socializing and belongingness. Individuals with low SA exhibited a maximizing pattern, with belongingness increasing continuously as socializing increased. In contrast, individuals with high SA showed a satiation effect, in which belongingness plateaued after a certain amount of socializing. Finally, both SA and socializing prospectively predicted perceived belongingness. CONCLUSIONS:Our findings reveal person-specific dynamics of belongingness, with high levels of SA associated with reduced benefits from social engagement. These findings suggest that enhancing social opportunities and assisting individuals in recognizing optimal levels of socializing may jointly contribute to more fulfilling intra- and interpersonal functioning in SA.

The Reading the Mind in the Eyes Test, Revised (RMET-R) is a widely used measure that purports to assess theory of mind (ToM). However, the psychometric properties of the RMET-R have been called into question. To examine a wider array of the RMET-R's psychometric properties, as compared to prior studies, we recruited undergraduate students (N = 640; 65.31 % women; Mage = 20.33; SD = 4.30) from three public universities. Participants completed the RMET-R, a novel word choice familiarity task, a novel task rating each response option's description of the picture, along with emotional valence and arousal, and two self-report cognitive empathy measures. Results indicated a small positive correlation with one self-report measure of cognitive empathy, and acceptable internal consistency. Performance was related to prior familiarity of words used on the test, and a quarter of the trials had a foil word rated similarly as the target word in describing picture. Item-level analysis found that valence ratings correlated significantly with accuracy, even on the least accurate items. Results corroborate and expand published concerns about the RMET-R's psychometric properties. We propose changes to the measure, including updated stimuli and structural improvements.

Impairments in mentalizing, the capacity for understanding mental states, are central to borderline personality disorder (BPD). This study examined a brief mentalizing intervention aiming to enhance the capacity and motivation for mentalizing in BPD. Forty-eight adults with BPD (Sex: 81

Emptiness is central to borderline personality disorder (BPD), significantly impacts quality of life, and is associated with increased impulsivity. Nevertheless, studies of emptiness in daily life are scarce and little is known about factors that may mitigate the emptiness-impulsivity association in BPD, such as mentalizing (Mz), the capacity to understand mental states. The current study examined whether emptiness predicts impulsive behaviors in daily life and whether this association is moderated by disorder or by Mz. The study utilized data from an existing data set (Berenson et al., 2011) of 153 participants (57 with a BPD diagnosis, 43 with avoidant personality disorder [APD], and 53 serving as healthy controls [HC]). Following a baseline lab assessment of Mz (Baron-Cohen et al., 2001), participants completed 3 weeks of ecological momentary assessment (EMA) with five daily prompts, including self-reported measures of emptiness and impulsivity. EMA data were analyzed using multilevel modeling. Both the BPD and APD groups reported higher levels of momentary emptiness compared to the HC group. The BPD group exhibited higher levels of impulsivity in daily life compared to the HC and APD groups. There were no group differences in Mz. Interestingly, emptiness significantly predicted impulsivity and was positively associated with impulsivity in both the BPD and HC groups but not in the APD group. Finally, Mz did not moderate the emptiness-impulsivity association. Emptiness seems central to impulsivity in daily life. More ecological and emptiness-specific measures of Mz may have better potential to mitigate the negative consequences of emptiness. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

An individual's awareness of their own and others' emotional experience is a key construct in several psychotherapy models, including for clients with personality disorders. Research into emotional awareness in personality disorders and their treatment has been scarce, yet it seems important to understand how these processes change in psychotherapy and how this change explains symptom reduction, in particular by conceptualizing situation-bound fluctuations of emotional awareness. In this current perspective article, we establish a theoretical consensus on models of emotional awareness and discuss current open research questions related to emotional awareness in clients with personality disorders. We conclude with the hypothesis that increased emotional awareness is a central mechanism of change in psychotherapies for personality disorders.

Flexibly updating behaviors towards others is crucial for adaptive social functioning. Previous studies have found that difficulties in flexibly updating behaviors are associated with social anxiety (SA). However, it is unclear whether such difficulties relate to actual social behaviors. The current study investigated the relationships between negative-to-positive social reversal learning, social approach behavior, and SA across time. Participants (MTurk, Time 1 = 275, Time 2 = 126, 16 weeks later) completed a performance-based social reversal-learning task. In the initial phase, participants learned that interactions with certain individuals are associated with negative outcomes, whereas interactions with other individuals are associated with positive outcomes. In the reversal phase, these associations were reversed, requiring participants to update their behaviors. The relationships between the performance in the task, SA severity, and social approach behavior reported by participants were assessed cross-sectionally and longitudinally. We found that negative-to-positive updating was negatively associated with SA severity. Furthermore, negative-to-positive updating was positively correlated with social approach behavior, both cross-sectionally and prospectively. Hence, individuals with better negative-to-positive updating at Time 1 reported significantly more social approach behaviors across time. The results support the role of negative-to-positive updating as a mechanism associated with SA and social approach, advancing and refining interpersonal and cognitive theories of SA.

Background: Mentalizing, making sense of mental states, is hypothesized to have a central role in self-organization and social learning. Findings support this notion, but the extent of the association between mentalizing and various correlates has not been meta-analyzed. Furthermore, mentalizing presumably occurs with (explicit) and without (implicit) awareness but few studies have attempted to disentangle these aspects. We conducted a meta -analysis of implicit and explicit mentalizing in relation to the domains of attachment security, personality, affect, psychopathology, and functioning. Methods: We searched for studies of adult mentalizing in PsycINFO and in related reviews. Overall, 511 studies (N = 78,733) met criteria and were analyzed using multi -level meta -analysis. Results: Implicit (r = 0.19-0.29) and explicit (r = 0.26-0.40) mentalizing were moderately correlated with psychopathology, functioning, personality, affect, and attachment security. The correlations of implicit mentalizing were stronger with more objectively measured correlates (b = 0.02, p < .001) while the correlations of explicit mentalizing were not (b = -0.07, p = .21). Conclusions: Mentalizing is associated with better intra- and interpersonal functioning. Implicit mentalizing is more strongly associated with objectively measured correlates. These findings underscore the importance of an integrative approach considering both implicit and explicit mentalizing.

Innovative moments (IMs) in psychotherapy contradict or challenge clients' maladaptive patterns of meaning associated with their suffering. IMs are receiving increased theoretical and empirical attention in psychotherapy research and are associated with symptomatic improvement. However, little is known about possible predictors of IMs and their impact beyond their association with outcomes. A therapeutic alliance (TA) that implies a collaborative bond between clients and therapists might set the stage for the occurrence of IMs. Additionally, the occurrence of IMs could serve as a relational experience within the session that strengthens the TA. Thus, in the present study, we examined the association over time between IMs and (i) TA, and (ii) functioning, in a time-limited case study with a good outcome. Furthermore, this study is one of the first to explore IMs in psychodynamic therapy (PDT). Transcriptions of ten randomly selected sessions of PDT of a 43-year-old male with dysthymia were coded using the innovative moment coding system. Self-report measures of function and TA were collected at each session. Data were analyzed using simulation modeling analysis. Consistent with good-outcome cases in other therapeutic approaches, high-level IMs (H-IMs) increased while low-level IMs (L-IMs) decreased throughout treatment. H-IMs predicted a change in functioning in the following session. Finally, H-IMs were associated with higher TA post-session, and specifically with agreement on treatment tasks. To conclude, moments of change in the client's pattern of meaning are related to stronger TA and better treatment outcome. If replicated, these findings may provide important insights regarding the unfolding of therapeutic change.

Objective: This study aimed to quantify the instability psychotherapy process variables by using a novel data analytic approach. The study explored instability of the working alliance over 10 treatment sessions and its relationship with self-esteem. Methods: Data were extracted from a randomized controlled trial, conducted in Switzerland, of a short-term intervention for borderline personality disorder. Sixty clients diagnosed as having borderline personality disorder were randomly assigned to receive either 10 sessions of good psychiatric management-brief version (GPM-BV) or GPM-BV combined with a relational principle called motive-oriented therapeutic relationship. Square successive differences were calculated for client and therapist ratings of alliance instability. Multilevel models were used to test within- and between person associations of alliance instability with self-esteem. Results: Although some preliminary analyses showed an association between a more stable alliance and higher selfesteem at the start of psychotherapy, the alliance did not become more stable over time. Alliance instability was not associated with self-esteem at either the within- or between-person level. Conclusions: This study highlights the advantages, procedures, and challenges of applying square successive differences to psychotherapy research data. The results suggest that the working alliance develops in complex ways and indicate the importance of continuing to use novel methods to capture dynamic psychotherapy processes.

ObjectiveDespite the clinical significance of emotional diversity, also known as emodiversity, there has been limited investigation into the therapeutic interventions that influence this construct. In the current study we examined the association between immediate therapist self-disclosure (TSD) and emodiversity among two diagnostic groups who tend to experience emotional difficulties: people with schizophrenia and people with emotional disorders (i.e., depression and/or anxiety).MethodThe sample comprised 74 clients (37 diagnosed with schizophrenia and 37 with emotional disorders) treated by 45 therapists in a university clinic setting. Following each session, clients self-reported their emotions, and therapists completed a measure of frequency and centrality of their immediate TSD during the session.ResultsLongitudinal multilevel models indicated that immediate TSD was positively associated with clients' global emodiversity, both at the within- and the between-client levels, as well as with clients' negative emodiversity at the between-client level. Moreover, clients with emotional disorders and clients with schizophrenia did not differ in the association between immediate TSD and emodiversity. In addition, across groups, clients treated by therapists who used more immediate TSD on average showed greater increases in global emodiversity during treatment.Conclusionsimmediate TSD is associated with clients' ability to experience rich and diverse emotional experiences across different disorders. The theoretical and clinical implications of these findings are discussed.

The present study sought to examine the relation between borderline personality disorder (BPD) symptoms and empathic accuracy while improving on prior methodologies by using daily affect assessment in romantic partners. BPD symptoms were assessed in both members of 81 community couples who also reported on their own and their partner's negative and positive affect daily for 3 weeks. Data were analyzed using the Truth and Bias Model of Judgment, which allows the source of empathic accuracy to be parsed into partner affect (truth) and own affect (bias). Results provided evidence that individuals with higher BPD symptoms exhibited increased empathic accuracy for a partner's negative affect, particularly when partners also had higher BPD symptoms. The source of this accuracy stemmed more from bias forces than truth forces, indicating that participants' own affective states lead to more accurate judgments of partner affective state. The results suggest that this bias reduced the general tendency among participants to underestimate partner negative affect, thus leading to higher empathic accuracy. Overall, our results extend and provide support for previous research indicating that BPD symptoms are associated with heightened, not diminished, empathic accuracy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Introduction: In recent years, several studies were conducted to explore the potential augmenting effect of oxytocin for the treatment of individuals with severe mental illness. Nonetheless, studies exploring its effects in routine inpatient settings using high-quality randomized controlled trials are scarce. The current study assessed the effect of oxytocin administration on treatment process and outcome among psychiatric inpatients, while employing a rigorous experimental methodology. Methods: A double-blind, placebo-controlled, randomized trial was conducted at a public psychiatric hospital in Israel. Patients (N = 87, 71.3% female participants) were administered intranasal oxytocin/placebo twice daily for 4 weeks, as add-on to usual care. Patients were assessed for severity of anxiety and depression symptoms and their working alliance with their therapist after each therapy session, and treatment outcome was assessed weekly. Multilevel modeling was performed to assess the linear change from pre- to post-treatment. Results: Patients receiving OT demonstrated significantly larger symptomatic improvements (B = −0.01, t [437] = −2.36, p = 0.01). Larger gains were also observed for depression (B = −0.14, p < 0.001 in the OT group, B = −0.06, p = 0.02 in the placebo group) and general distress (B = −0.57, p < 0.001 in the OT group, B = −0.29, p = 0.02 in the placebo group). No significant effect was observed for anxiety, the working alliance, or attachment. Discussion: Oxytocin has the potential to improve treatment outcome among inpatients. Nonetheless, additional controlled research is needed to further assess its effects on therapy process, as well as to account for therapeutic, pharmacological, and neuronal intervening factors.

Mentalizing, the capacity to consider mental states, is a fundamental and essential capacity that is associated with mental health. Studies mostly assess mentalizing in lab, neglecting its ecological aspects and short-term fluctuations. The current study presents preliminary psychometric findings from a novel method of assessing mentalizing dynamics in daily life. We also examined how daily life mentalizing is related to features of borderline personality disorder (BPD) which is known to show mentalizing impairments. Twenty non-clinical participants were interviewed for mentalizing capacity and completed self-report measures of mentalizing and BPD features at baseline. Then, participants completed a weeklong ecological momentary assessment (EMA) including six daily surveys of self-reported mentalizing and audio-recorded descriptions of current mental states, and a continuous assessment of stress using wearable devices. Narrative materials were coded using an observer-rated measure of mentalizing. Completion rates were high (M = 94

Belongingness is a central biopsychosocial system. Challenges to belongingness (i.e. exclusion/ostracism) engender robust negative effects on affect and cognitions. Whether overinclusion - getting more than one's fair share of social attention - favourably impacts affect and cognitions remains an open question. This pre-registered meta-analysis includes twenty-two studies (N = 2757) examining overinclusion in the context of the Cyberball task. We found that the estimated overall effect size of overinclusion on positive affect was small but robust, and the effect on fundamental needs cognitions (belongingness, self-esteem, meaningful existence and control) was moderate in size and positive in direction. Notably, the effect sizes of overinclusion were smaller than the corresponding effects of exclusion. Finally, the effects of overinclusion on positive affect were greater for high, as compared to low, socially anxious individuals. Exploring the sequelae of the full range of inclusion experiences - from exclusion to overinclusion - may enrich our understanding of the functioning of the belongingness system as well as its interaction with another central biosocial system - the social status system.

OBJECTIVE Although the clinical significance of the therapeutic alliance (TA) is well documented, the literature regarding the establishment of TA and the relation between client-therapist agreement on it to short-term outcome among various diagnostic groups-and specifically among clients diagnosed with serious mental illness (SMI)-is sparse. The aim of the present study was to examine the effect of client diagnosis on the abovementioned TA characteristics. METHOD Dyadic analyses of session-by-session (SBS) data were used to compare clients diagnosed with schizophrenia and clients diagnosed with emotional disorders (based on a clinical interview) in their TA characteristics. RESULTS TA as initially rated by clients was stronger in the emotional disorders group than in the schizophrenia group. Higher TA ratings, regardless of whether these were provided by the therapist or the client, predicted better subsequent functioning in the emotional disorders group, whereas in the schizophrenia group, this association was observed only among good-outcome cases. CONCLUSIONS Establishing TA, having client-therapist agreement on it, and having clients derive therapeutic benefit from it might be more challenging with clients with schizophrenia than with clients with emotional disorders. Special attention should be given to specific challenges and needs regarding clients' diagnosis in order to enhance favourable therapy outcomes.

Background Difficulties in emotion regulation (ER) abilities have been found to play a central role in different psychiatric disorders. However, researchers rarely compare ER across different diagnostic groups. In the current study, we examined ER and its relation to functional and symptomatic outcome among three distinct diagnostic groups: people with schizophrenia (SCZ), people with emotional disorders (EDs; i.e., depression and/or anxiety), and individuals without any psychiatric diagnosis (controls). Methods Participants in this study comprised 108 adults who requested psychotherapy at a community clinic in the year 2015 and between 2017 and 2019. Clients were interviewed and filled out questionnaires measuring depression, distress, and difficulties in ER abilities. Results Results showed that individuals with psychiatric diagnoses reported higher levels of difficulties in ER abilities than did controls. Moreover, there were very few differences in levels of ER difficulty between SCZ and EDs. Further, the associations between maladaptive ER and psychological outcomes were significant in each diagnostic group, and especially for SCZ. Conclusion Our study indicates that difficulties in ER abilities partially have a transdiagnostic nature, and that these difficulties are associated with psychological outcomes among both clinical populations and controls. There were very few differences in levels of ER ability difficulties between SCZ and EDs, suggesting that the two groups share difficulties in relating and responding to emotional distress. The associations between difficulties in ER abilities and outcome were more robust and stronger among SCZ than the other groups, highlighting the potential contribution of targeting ER abilities in the treatment of schizophrenia.

Objective: Immediate therapist self-disclosure (Im-TSD) can be a powerful intervention. When engaged in judiciously, it can provide clients with a unique opportunity to explore their interpersonal relationship in real time. Relational theories suggest that for Im-TSD to be effective, both client and therapist must have temporally congruent perceptions of its occurrence. The present study examined (a) whether clients and therapists are temporally congruent in their session-by-session ratings of Im-TSD; and (b) whether this congruence is associated with therapy outcomes. Method: After each session, clients (n = 102) and therapists (n = 60) at a university-based clinic indicated whether Im-TSD was present during the session. Before each session, clients self-reported their functioning. They rated session quality after each session. Results: Therapists' ratings of their Im-TSD tended to be temporally congruent with their clients' Im-TSD ratings. Greater temporal congruvdence was associated with greater improvement over time in clients' experience of the session as helpful, but not with changes in clients' functioning. Conclusion: The findings highlight the importance of establishing a stronger temporal congruence of Im-TSD ratings between therapists and clients to further improve clients' experiences in treatment. The findings' implications are discussed as well as situations in which temporal congruence may not be beneficial.