Soothing the Threatened Brain: Leveraging Contact Comfort with Emotionally Focused Therapy

Social relationships are tightly linked to health and well-being. Recent work suggests that social relationships can even serve vital emotion regulation functions by minimizing threat-related neural activity. But relationship distress remains a significant public health problem in North America and elsewhere. A promising approach to helping couples both resolve relationship distress and nurture effective interpersonal functioning is Emotionally Focused Therapy for couples (EFT), a manualized, empirically supported therapy that is strongly focused on repairing adult attachment bonds. We sought to examine a neural index of social emotion regulation as a potential mediator of the effects of EFT. Specifically, we examined the effectiveness of EFT for modifying the social regulation of neural threat responding using an fMRI-based handholding procedure. Results suggest that EFT altered the brain\u27s representation of threat cues in the presence of a romantic partner. EFT-related changes during stranger handholding were also observed, but stranger effects were dependent upon self-reported relationship quality. EFT also appeared to increase threat-related brain activity in regions associated with self-regulation during the no-handholding condition. These findings provide a critical window into the regulatory mechanisms of close relationships in general and EFT in particular

Functional and Structural Neural Effects of Emotionally Focused Therapy for Couples

There is increasing acknowledgement that problematic interpersonal relationships and negative emotions are key factors in the development and maintenance of various forms of psychopathology. Emotionally Focused Therapy (EFT) for couples centers on changing attachment behaviours as a means to improve distressed relationships by helping partners access underlying emotions and foster positive interactions that promote accessibility and trust. EFT is a highly effective therapeutic approach that encourages the development of adaptive emotion regulation observed in secure attachment. The development and emergence of non-invasive neuroimaging techniques, in particular functional magnetic resonance imaging (fMRI), provides a unique opportunity to investigate neural adaptations underlying successful psychotherapeutic change. Eighteen distressed couples received an average of 23 sessions of EFT, and the resulting functional and structural differences in the neural processing of threat were investigated before and after therapy using MRI methods. Female participants engaged in a stressful task in which they were confronted with the threat of electric shock, while they held their partner’s hand, a stranger’s hand, or were alone in the scanner. Results offered preliminary evidence that EFT can significantly impact emotional dysregulation, promote attenuation of neural threat by their partner, and result in structural change in a key region of emotion circuitry. Moreover, physiological data demonstrated that following EFT for couples, female partners were effectively soothed by their male partners, as demonstrated by decreased cortisol levels

Threat Responsive Regions of Interest.

<p>1 =  partner < alone; 2 =  stranger < alone; 3 =  partner < stranger; 4 =  partner < alone among couples with lowest DAS scores; 5 =  stranger < alone among couples with lowest DAS scores. Note: In no case was activity lower in the stranger condition than the partner condition.</p

Percent signal change (±SE) graphed as a function of EFT (pre vs. post) by handholding (stranger vs. partner) interaction effects.

<p>Row A represents activity in the supplementary motor cortex (SMG). Row B represents activity in the right dlPFC.</p

Valence and arousal graphed as a function of EFT (pre vs. post) by handholding (alone vs. stranger vs. partner).

<p>Panel A shows mean (± (anr Pleasantness ratings. Panel B shows mean (±SE) Arousal ratings.</p

Point estimates of percent signal change graphed as a function of EFT (pre vs. post) by handholding (alone vs. partner) and DAS score.

<p>Point estimates were computed separately for individuals high (+1SD) and low (−1SD) in DAS. Row A represents activity in the dorsal anterior cingulate cortex (dACC). Row B represents activity in the right dorsolateral prefrontal cortex (dlPFC).</p