Background: Studies with heterogeneous samples in naturalistic treatment settings suggest that movement synchrony (MS) between therapists and patients correlates with therapeutic success. In this study, we examined a homogeneous sample of patients with social anxiety disorder and investigated whether MS in sessions 3 and 8 would be associated with therapy outcome and therapeutic alliance, and whether these associations depend on the therapeutic approach. Methods: The patients (N = 267) were treated with either manual-guided cognitive behavior therapy (CBT), manual-guided psychodynamic therapy (PDT), or naturalistic CBT. The Helping Alliance Questionnaire (HAQ), the Inventory of Interpersonal Problems (IIP) and the Beck-Depression-Inventory (BDI) were used as measures. Body motions were coded with motion energy analysis. MS was quantified using time series analysis methods. Results: MS was observed more frequently in both CBT conditions than in PDT. In both CBT groups, more synchrony was predictive of lower IIP scores at the end of therapy. If the patient lead synchrony more often than the therapist, higher IIP and BDI scores were observed at the end of treatment. PDT showed the largest effect size for the synchrony-alliance-association. Conclusion: Movement synchrony and therapeutic success are associated. The effect of therapeutic approach and leading/following are relevant for this association. Clinical and Methodological Significance of this article: Nonverbal communication is an important ingredient of psychotherapy. Multiple studies of disorder heterogeneous samples examined the synchronization of patients’ and therapists’ nonverbal behavior as a predictor of therapeutic success. In contrast to other studies, we examined a homogeneous sample of patients with social anxiety disorder. The micro-process analysis using Motion Energy Analysis included a comparatively large sample (N = 267 patients resp. 646 videos). We applied multivariate regression which is more conservative and robust against bias caused by confounders than correlations, and considerated the nested data structure by applying multi-level models. Moreover, we examined the therapeutic approach as a possible moderator of synchrony-outcome-association which is unique in this research field. The presented study strengthens the evidence that movement synchrony in an early therapy session is associated with the improvement of interpersonal problems and that the therapeutic approach moderates this association. Moreover, we found that when the therapist imitates patient's movement behavior more often than vice versa, he or she could be more involved in patients’ maladaptive interpersonal pattern which on the other side hampers the therapeutic process as the therapist is unable to implement confrontational interventions. We conclude that in therapeutic practice and professional training of therapists, nonverbal communication especially movement synchrony should be focused.

Premature termination is a problem in psychotherapy. In addition to the examination of demographic and clinical variables as predictors of dropout, research indicates the importance of dyadic variables. Nonverbal synchrony (e.g., movement synchrony) operationalizes the coordination of patient and therapist and is a promising candidate for predicting premature termination. This secondary data analysis included data on patients with social anxiety disorder (N = 267) that were treated with > 20 sessions of cognitive-behavioral therapy or psychodynamic therapy. Therapy outcome was measured by the Inventory of Interpersonal Problems and the Beck Depression Inventory. Individual movements in the third session were assessed by motion energy analysis. Movement synchrony was identified with a windowed cross-lagged correlation and peak-picking algorithm. We performed logistic regressions and mixed effects Cox regressions to investigate synchrony as a predictor of premature termination. Therapist-patient dyads that included a patient who terminated psychotherapy prematurely had significantly lower movement synchrony at the beginning of therapy than patients who completed therapy. Gender-matching and therapeutic approach had a (marginally) significant effect in moderating the relationship. Therefore, low movement synchrony in early therapy sessions may contain clues to premature termination and reflect a mismatch between the patient and therapist or problems in the therapeutic alliance. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

In psychotherapy, movement synchrony seems to be associated with higher patient satisfaction and treatment outcome. However, it remains unclear whether movement synchrony rated by humans and movement synchrony identified by automated methods reflect the same construct. To address this issue, video sequences showing movement synchrony of patients and therapists (N = 10) or not (N = 10), were analyzed using motion energy analysis. Three different synchrony conditions with varying levels of complexity (naturally embedded, naturally isolated, and artificial) were generated for time series analysis with windowed cross-lagged correlation/ -regression (WCLC, WCLR). The concordance of ratings (human rating vs. automatic assessment) was computed for 600 different parameter configurations of the WCLC/WCLR to identify the parameter settings that measure movement synchrony best. A parameter configuration was rated as having a good identification rate if it yields high concordance with human-rated intervals (Cohen’s kappa) and a low amount of over-identified data points. Results indicate that 76 configurations had a good identification rate (IR) in the least complex condition (artificial). Two had an acceptable IR with regard to the naturally isolated condition. Concordance was low with regard to the most complex (naturally embedded) condition. A valid identification of movement synchrony strongly depends on parameter configuration and goes beyond the identification of synchrony by human raters. Differences between human-rated synchrony and nonverbal synchrony measured by algorithms are discussed.