{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T08:49:58Z","timestamp":1773046198713,"version":"3.50.1"},"reference-count":88,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T00:00:00Z","timestamp":1649203200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Entropy"],"abstract":"<jats:p>In line with the growing recognition of the role of embodiment, affect and implicit processes in psychotherapy, several recent studies examine the role of physiological synchrony in the process and outcome of psychotherapy. This study aims to introduce Partial Directed Coherence (PDC) as a novel approach to calculating psychophysiological synchrony and examine its potential to contribute to our understanding of the therapy process. The study adopts a single-case, mixed-method design and examines physiological synchrony in one-couple therapy in relation to the therapeutic alliance and a narrative analysis of meaning construction in the sessions. Interpersonal Physiological Synchrony (IPS) was calculated, via a windowed approach, through PDC of a Heart Rate Variability-derived physiological index, which was measured in the third and penultimate sessions. Our mixed-method analysis shows that PDC quantified significant moments of IPS within and across the sessions, modeling the characteristics of interpersonal interaction as well as the effects of therapy on the interactional dynamics. The findings of this study point to the complex interplay between explicit and implicit levels of interaction and the potential contribution of including physiological synchrony in the study of interactional processes in psychotherapy.<\/jats:p>","DOI":"10.3390\/e24040517","type":"journal-article","created":{"date-parts":[[2022,4,6]],"date-time":"2022-04-06T16:21:30Z","timestamp":1649262090000},"page":"517","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Studying Physiological Synchrony in Couple Therapy through Partial Directed Coherence: Associations with the Therapeutic Alliance and Meaning Construction"],"prefix":"10.3390","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3803-4188","authenticated-orcid":false,"given":"Evrinomy","family":"Avdi","sequence":"first","affiliation":[{"name":"Department of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}]},{"given":"Evangelos","family":"Paraskevopoulos","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Cyprus, Nicosia 1678, Cyprus"}]},{"given":"Christina","family":"Lagogianni","sequence":"additional","affiliation":[{"name":"Department of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}]},{"given":"Panagiotis","family":"Kartsidis","sequence":"additional","affiliation":[{"name":"School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}]},{"given":"Fotis","family":"Plaskasovitis","sequence":"additional","affiliation":[{"name":"Department of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece"}]}],"member":"1968","published-online":{"date-parts":[[2022,4,6]]},"reference":[{"key":"ref_1","first-page":"903","article-title":"Non-interpretive mechanisms in psychoanalytic therapy. The \u2018something more\u2019 than interpretation. The Process of Change Study Group","volume":"79","author":"Stern","year":"1998","journal-title":"Int. J. Psychoanal."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Boston Change Process Study Group (2002). Explicating the implicit: The local level and the microprocesses of change in the analytic situation. Int. J. Psychoanal., 83, 1051\u20131062.","DOI":"10.1516\/00207570260338746"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1080\/10503307.2019.1612114","article-title":"Physiological synchrony in psychotherapy sessions","volume":"30","author":"Tschacher","year":"2020","journal-title":"Psychother. Res."},{"key":"ref_4","unstructured":"Rime, B., and Feldman, R.S. (1991). Interpersonal coordination: Behavior matching and interactional synchrony. Fundamentals of Nonverbal Behavior, Cambridge University Press."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0065-2601(08)00405-X","article-title":"Human mimicry","volume":"41","author":"Chartrand","year":"2009","journal-title":"Adv. Exp. Soc. Psychol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1111\/1467-9280.14481","article-title":"Using nonconscious behavioral mimicry to create affiliation and rapport","volume":"14","author":"Lakin","year":"2003","journal-title":"Psychol. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"862","DOI":"10.3389\/fpsyg.2016.00862","article-title":"Synchrony in psychotherapy: A review and an integrative framework for the therapeutic alliance","volume":"7","author":"Koole","year":"2016","journal-title":"Front. Psychol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1067\/mpn.2001.114540","article-title":"Three perspectives regarding what works and does not work in therapy: A comparison of judgments of clients, nurse-therapists, and uninvolved evaluators","volume":"7","author":"Raingruber","year":"2001","journal-title":"J. Am. Psychiatr. Nurses Assoc."},{"key":"ref_9","first-page":"150","article-title":"Synchrony: A core concept for a constructivist approach to psychotherapy","volume":"11","author":"Ramseyer","year":"2006","journal-title":"Constr. Hum. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1037\/a0023419","article-title":"Nonverbal synchrony in psychotherapy: Coordinated body movement reflects relationship quality and outcome","volume":"79","author":"Ramseyer","year":"2011","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1007\/s10608-020-10106-3","article-title":"Interpersonal coordination dynamics in psychotherapy: A systematic review","volume":"44","author":"Wiltshire","year":"2020","journal-title":"Cogn. Ther. Res."},{"key":"ref_12","first-page":"i","article-title":"Rhythms of dialogue in infancy: Coordinated timing in development","volume":"66","author":"Jaffe","year":"2001","journal-title":"Monogr. Soc. Res. Child Dev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1037\/cou0000273","article-title":"Attachment-security prime effect on skin-conductance synchronization in psychotherapists: An empirical study","volume":"65","author":"Palmieri","year":"2018","journal-title":"J. Couns. Psychol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1037\/cou0000383","article-title":"Physiological synchronization in the clinical process: A research primer","volume":"67","author":"Kleinbub","year":"2020","journal-title":"J. Couns. Psychol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/j.1540-5834.2011.00660.x","article-title":"Child development parent\u2014Infant synchrony: A biobehavioral model of mutual influences in the formation of affiliative bonds","volume":"77","author":"Feldman","year":"2005","journal-title":"Monogr. Soc. Res. Child Dev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1080\/10503300802609672","article-title":"Relational psychophysiology: Lessons from mother-infant physiology research on dyadically expanded states of consciousness","volume":"19","author":"Ham","year":"2009","journal-title":"Psychother. Res."},{"key":"ref_17","unstructured":"Beebe, B., and Lachmann, F.M. (2002). Infant Research and Adult Treatment, The Analytic Press."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Beebe, B., and Lachmann, F.M. (2014). The Origins of Attachment: Infant Research and Adult Treatment, Routledge.","DOI":"10.4324\/9780203767498"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1177\/1754073912451630","article-title":"Emotional coregulation in close relationships","volume":"5","author":"Butler","year":"2013","journal-title":"Emot. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1037\/fam0000115","article-title":"Physiological linkage in couples and its implications for individual and interpersonal functioning: A literature review","volume":"29","author":"Timmons","year":"2015","journal-title":"J. Fam. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1080\/14780887.2012.630831","article-title":"Feeling the way: Qualitative clinical research and the affective turn","volume":"9","author":"Cromby","year":"2012","journal-title":"Qual. Res. Psychol. Spec. Issue Qual. Clin. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"508","DOI":"10.3389\/fpsyg.2014.00508","article-title":"Embodied affectivity: On moving and being moved","volume":"5","author":"Fuchs","year":"2014","journal-title":"Front. Psychol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3001","DOI":"10.3389\/fpsyg.2020.591124","article-title":"Exploring conversational and physiological aspects of psychotherapy talk","volume":"11","author":"Avdi","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1037\/1040-3590.3.3.321","article-title":"Psychophysiological approaches to the evaluation of psychotherapeutic process and outcome, 1991: Contributions from social psychophysiology","volume":"3","author":"Cacioppo","year":"1991","journal-title":"Psychol. Assess."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/j.biopsycho.2010.03.010","article-title":"Autonomic nervous system activity in emotion: A review","volume":"84","author":"Kreibig","year":"2010","journal-title":"Biol. Psychol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1080\/10503307.2019.1661541","article-title":"Coregulation of therapist and client emotion during psychotherapy","volume":"30","author":"Soma","year":"2020","journal-title":"Psychother. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1037\/h0077714","article-title":"A circumplex model of affect","volume":"39","author":"Russell","year":"1980","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Gennaro, A., Carola, V., Ottaviani, C., Pesca, C., Palmieri, A., and Salvatore, S. (2021). Affective saturation index: A lexical measure of affect. Entropy, 23.","DOI":"10.3390\/e23111421"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1037\/cou0000391","article-title":"Incorporating physiology into the study of psychotherapy process","volume":"67","author":"Baucom","year":"2020","journal-title":"J. Couns. Psychol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1111\/bjp.12444","article-title":"Studying the process of psychoanalytic psychotherapy: Discursive and embodied aspects","volume":"35","author":"Avdi","year":"2019","journal-title":"Br. J. Psychother."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"258","DOI":"10.3389\/fpubh.2017.00258","article-title":"An overview of heart rate variability metrics and norms","volume":"5","author":"Shaffer","year":"2017","journal-title":"Front. Public Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1089\/brain.2011.0008","article-title":"Functional and effective connectivity: A review","volume":"1","author":"Friston","year":"2011","journal-title":"Brain Connect."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"267","DOI":"10.3389\/fpubh.2017.00267","article-title":"New frontiers in heart rate variability and social coherence research: Techniques, technologies, and implications for improving group dynamics and outcomes","volume":"5","year":"2017","journal-title":"Front. Public Health"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1177\/1088868316628405","article-title":"Interpersonal autonomic physiology: A systematic review of the literature","volume":"21","author":"Palumbo","year":"2017","journal-title":"Personal. Soc. Psychol. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/00006842-195703000-00002","article-title":"Physiological correlates of tension and antagonism during psychotherapy; a study of interpersonal physiology","volume":"19","author":"Dimascio","year":"1957","journal-title":"Psychosom. Med."},{"key":"ref_36","first-page":"211","article-title":"Soft prosody and embodied attunement in therapeutic interaction: A multimethod case study of a moment of change","volume":"30","author":"Kykyri","year":"2017","journal-title":"J. Constr. Psychol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.4236\/psych.2018.97108","article-title":"Heart Rate Synchrony in Psychological Counseling: A Case Study","volume":"9","author":"Kodama","year":"2018","journal-title":"Psychology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s10484-006-9008-4","article-title":"The effect of emotional distance on psychophysiologic concordance and perceived empathy between patient and interviewer","volume":"31","author":"Marci","year":"2006","journal-title":"Appl. Psychophysiol. Biofeedback"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1111\/famp.12382","article-title":"The relational mind in couple therapy: A bateson-inspired view of human life as an embodied stream","volume":"57","author":"Seikkula","year":"2018","journal-title":"Fam. Process"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.newideapsych.2007.07.010","article-title":"Investigation of psycho-physiological interactions between patient and therapist during a psychodynamic therapy and their relation to speech using in terms of entropy analysis using a neural network approach","volume":"26","author":"Villmann","year":"2008","journal-title":"New Ideas Psychol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1080\/10503307.2012.748940","article-title":"Somatic underpinnings of perceived empathy: The importance of psychotherapy training","volume":"23","author":"Messina","year":"2013","journal-title":"Psychother. Res."},{"key":"ref_42","first-page":"395","article-title":"Training in psychotherapy: A call for embodied and psychophysiological approaches","volume":"22","author":"Gennaro","year":"2019","journal-title":"Res. Psychother. Psychopathol. Process Outcome"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"628011","DOI":"10.3389\/fpsyg.2021.628011","article-title":"Oxytocin as the neurobiological basis of synchronization: A research proposal in psychotherapy settings","volume":"12","author":"Palmieri","year":"2021","journal-title":"Front. Psychol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1037\/0022-3514.63.2.234","article-title":"Empathy: A physiological substrate","volume":"63","author":"Levenson","year":"1992","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1002\/dev.21098","article-title":"Dyadic concordance in mother and preschooler resting cardiovascular function varies by risk status","volume":"56","author":"Creaven","year":"2014","journal-title":"Dev. Psychobiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/B978-0-12-407187-2.00002-2","article-title":"The Self-Organization of human interaction","volume":"59","author":"Dale","year":"2013","journal-title":"Psychol. Learn. Motiv."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1037\/a0038561","article-title":"Distinguishing emotional coregulation from codysregulation: An investigation of emotional dynamics and body weight in romantic couples","volume":"15","author":"Reed","year":"2015","journal-title":"Emotion"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1177\/0190272515611054","article-title":"Sharing the emotional load: Recipient affiliation calms down the storyteller","volume":"78","author":"Henttonen","year":"2015","journal-title":"Soc. Psychol. Q."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"530","DOI":"10.3389\/fpsyg.2018.00530","article-title":"Empathy, challenge, and psychophysiological activation in therapist\u2013client interaction","volume":"9","author":"Voutilainen","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/PL00007990","article-title":"Partial directed coherence: A new concept in neural structure determination","volume":"84","author":"Sameshima","year":"2001","journal-title":"Biol. Cybern."},{"key":"ref_51","unstructured":"Safran, J.D., and Muran, J.C. (2000). Negotiating the Therapeutic Alliance: A Relational Treatment Guide, Guilford Press."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1037\/0003-066X.44.2.112","article-title":"Emotions and emotional communication in infants","volume":"44","author":"Tronick","year":"1989","journal-title":"Am. Psychol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1002\/(SICI)1097-0355(199823)19:3<290::AID-IMHJ4>3.0.CO;2-Q","article-title":"Dyadically expanded states of consciousness and the process of therapeutic change","volume":"19","author":"Tronick","year":"1998","journal-title":"Infant Ment. Health J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2053","DOI":"10.3389\/fpsyg.2017.02053","article-title":"State of the art of interpersonal physiology in psychotherapy: A systematic review","volume":"8","author":"Kleinbub","year":"2017","journal-title":"Front. Psychol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1111\/famp.12374","article-title":"The added value of studying embodied responses in couple therapy research: A case study","volume":"58","author":"Laitila","year":"2019","journal-title":"Fam. Process"},{"key":"ref_56","first-page":"226","article-title":"Alliance ruptures and embodied arousal in psychodynamic psychotherapy: An exploratory study","volume":"18","author":"Mylona","year":"2021","journal-title":"Hell. J. Psychol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1080\/10503307.2019.1685139","article-title":"Causation and chance: Detection of deterministic and stochastic ingredients in psychotherapy processes","volume":"30","author":"Tschacher","year":"2020","journal-title":"Psychother. Res."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Smoliak, O., and Strong, T. (2018). Therapy as Discourse: Practice and Research, Springer International Publishing.","DOI":"10.1007\/978-3-319-93067-1"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1080\/13642530701363445","article-title":"Discourse analysis and psychotherapy: A critical review","volume":"9","author":"Avdi","year":"2007","journal-title":"Eur. J. Psychother. Couns."},{"key":"ref_60","unstructured":"Smoliak, O., and Strong, T. (2018). Researching the discursive construction of subjectivity. Therapy as Discourse: Practice and Research, Palgrave."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Norcross, J.C., and Lambert, M.J. (2019). Psychotherapy Relationships That Work: Evidence-Based Therapist Contributions, Oxford University Press.","DOI":"10.1093\/med-psych\/9780190843953.001.0001"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1037\/h0085885","article-title":"The generalizability of the psychoanalytic concept of the working alliance","volume":"16","author":"Bordin","year":"1979","journal-title":"Psychotherapy"},{"key":"ref_63","unstructured":"Norcross, J.C. (2002). The alliance. Psychotherapy Relationships that Work: Therapist Contributions and Responsiveness to Patients, Oxford University Press."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/1467-6427.00138","article-title":"Towards a common ground in psychoanalysis and family therapy: On knowing not to know","volume":"22","author":"Larner","year":"2000","journal-title":"J. Fam. Ther."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/1467-6427.00189","article-title":"Postmodern collaborative and person-centred therapies: What would Carl Rogers say?","volume":"23","author":"Anderson","year":"2001","journal-title":"J. Fam. Ther."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1037\/a0022060","article-title":"Alliance in couple and family therapy","volume":"48","author":"Friedlander","year":"2011","journal-title":"Psychotherapy"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10591-012-9215-5","article-title":"The therapeutic alliance in couple therapy for depression: Predicting therapy progress and outcome from assessments of the alliance by the patient, the spouse, and the therapists","volume":"35","author":"Kuhlman","year":"2013","journal-title":"Contemp. Fam. Ther."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1111\/j.1467-6427.2004.00282.x","article-title":"All aboard in the NHS: Collaborating with colleagues who use different approaches","volume":"26","author":"Speed","year":"2004","journal-title":"J. Fam. Ther."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1037\/pst0000355","article-title":"Alliance predicting progress in couple therapy","volume":"58","author":"Tilden","year":"2021","journal-title":"Psychotherapy"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/j.1467-6427.2010.00503.x","article-title":"Therapeutic alliance and progress in couple therapy: Multiple perspectives","volume":"33","author":"Glebova","year":"2011","journal-title":"J. Fam. Ther."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1111\/1467-6427.12035","article-title":"Pre-therapy relationship adjustment, gender and the alliance in couple therapy","volume":"38","author":"Halford","year":"2016","journal-title":"J. Fam. Ther."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1111\/famp.12152","article-title":"The embodied attunement of therapists and a couple within dialogical psychotherapy: An introduction to the relational mind research project","volume":"54","author":"Seikkula","year":"2015","journal-title":"Fam. Process"},{"key":"ref_73","unstructured":"Andersen, T. (1991). The Reflecting Team: Dialogues and Dialogues about the Dialogues, Norton."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1037\/h0045497","article-title":"Stimulated recall in therapy using video tape: A case study","volume":"10","author":"Kagan","year":"1963","journal-title":"J. Couns. Psychol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1177\/160940690800700102","article-title":"Qualitative interviewing using interpersonal process recall: Investigating internal experiences during professional-client conversations","volume":"7","author":"Larsen","year":"2008","journal-title":"Int. J. Qual. Methods"},{"key":"ref_76","unstructured":"(2022, March 28). Firstbeat Technologies, Oy. Available online: https:\/\/www.firstbeat.com\/en\/."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1192\/bjp.180.1.51","article-title":"Towards a standardised brief outcome measure: Psychometric properties and utility of the CORE-OM","volume":"180","author":"Evans","year":"2002","journal-title":"Br. J. Psychiatry"},{"key":"ref_78","first-page":"91","article-title":"The outcome rating scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure","volume":"2","author":"Miller","year":"2003","journal-title":"J. Br. Ther."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1037\/0022-0167.53.2.214","article-title":"System for observing family therapy alliances: A tool for research and practice","volume":"53","author":"Friedlander","year":"2006","journal-title":"J. Couns. Psychol."},{"key":"ref_80","unstructured":"Kettunen, J., and Saalasti, S. (2008). Procedure for Detection of Stress by Segmentation and Analyzing A Heart Beat Signal. (7,330,752), US Patent."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Leite, A., Silva, M.E., and Rocha, A.P. (2016, January 16\u201320). Modeling volatility in heat rate variability. Proceedings of the 2016 38th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Orlando, FL, USA.","DOI":"10.1109\/EMBC.2016.7591502"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"453","DOI":"10.3414\/ME09-02-0030","article-title":"Assessing frequency domain causality in cardiovascular time series with instantaneous interactions","volume":"49","author":"Faes","year":"2010","journal-title":"Methods Inf. Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1111\/j.1752-0606.2011.00238.x","article-title":"Making sense of multi\u2014Actor dialogues in family therapy and network meetings","volume":"38","author":"Seikkula","year":"2012","journal-title":"J. Marital Fam. Ther."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Codrons, E., Bernardi, N.F., Vandoni, M., and Bernardi, L. (2014). Spontaneous group synchronization of movements and respiratory rhythms. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0107538"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1007\/s10591-016-9393-7","article-title":"Affective arousal during blaming in couple therapy: Combining analyses of verbal discourse and physiological responses in two case studies","volume":"38","author":"Holma","year":"2016","journal-title":"Contemp. Fam. Ther."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1037\/pst0000198","article-title":"Sympathetic nervous system synchrony: An exploratory study of its relationship with the therapeutic alliance and outcome in couple therapy","volume":"57","author":"Tourunen","year":"2020","journal-title":"Psychotherapy"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"Haken, H., and Portugali, J. (2016). Information and selforganization: A unifying approach and applications. Entropy, 18.","DOI":"10.3390\/e18060197"},{"key":"ref_88","doi-asserted-by":"crossref","unstructured":"Orsucci, F. (2021). Human synchronization maps\u2014The hybrid consciousness of the embodied mind. 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