Investigating coregulation of emotional arousal during exposure-based CBT using vocal encoding and actor–partner interdependence models

Objective. High patient emotional arousal during rationale development for in-vivo exposure in CBT for panic disorder with agoraphobia might endanger comprehension of the exposure rationale. Since therapists are supposed to coregulate patients’ emotions, this study investigated whether there was evidence of coregulation of vocally encoded emotional arousal, assessed by fundamental frequency (f0), during rationale development. Further, the
association of patient f0 stability and therapist coregulation with patients’ perceived rationale plausibility was analyzed.
Method. N = 197 therapy videos - used to deduct f0 - from a multicenter randomized controlled trial evaluating therapist-guided exposure on CBT outcome were analyzed posthoc. Plausibility of the exposure rationale was assessed by patients after its development. This trial-specific rating aggregates plausibility ratings for every manual component in the
development of the exposure rationale and showed good internal consistency (Cronbach’s α = 0.85). Stability in f0 and its coregulation were calculated using Cross-lagged Actor-Partner Interdependence Models (APIM) and APIM dyad estimates were associated with plausibility using linear regression analyses.
Results. Analyses indicated a relative stability in emotional arousal within both patients and therapists. Therapists’ f0 had a significant effect on patients in that with therapist covariation, patients’ f0 departed from their equilibrium level, while patients’ f0 had no effect on therapists. Therapists’ f0 covariation was positively associated with rationale plausibility.
Conclusions. This study sheds light on interpersonal regulation mechanisms of patients’ and therapists’ emotional arousal during development of the exposure rationale. It suggests that coregulation of patients’ emotional arousal supports patients’ perceived rationale plausibility.