Blog

January 2014

• Emotionally Focused Couples Therapy Reduces Threat Response in the Brain

  Johnson, S.M, Burgess Moser, M., Beckes, L., Smith, A., Dalgliesh… Coan, J.A. (2013). Soothing the threatened brain: Leveraging contact comfort with emotionally focused therapy. PLoS ONE 8(11): e79314. doi:10.1371/journal.pone.0079314.

  Attachment theory argues that a felt sense of connection to others provides a secure base and safe haven, thus increasing one’s tolerance for uncertainty and threat. Improved access to and experience of social resources likely help us regulate negative emotions thus reducing our perception of threat. In a previous study, women in a couple were confronted with a threat (the possibility of a shock to the ankle) while their brain was scanned by functional magnetic resonance imaging (fMRI). These women were either holding the hand of their spouse or the hand of a stranger. Women with the highest quality relationships showed lower threat response in the brain especially while they held the hand of their spouse. Holding the hand of a spouse with whom they had a loving relationship reduced the fear response in these women measured directly in the brain by fMRI. In the study by Johnson and colleagues (2013) the authors wanted to see if improving attachment relationship between couples following Emotionally Focused Couples Therapy (EFT) would result reduced responses to threat measured in the brain. Twenty-three couples completed a course of EFT (23 sessions on average) with experienced therapists. EFT is an evidence based couples treatment that conceptualizes couple distress as caused by unmet attachment needs. When feeling emotionally disconnected, partners in a couple may be anxiously blaming or withdrawing, and this pattern exacerbates relationship distress and threat. EFT focuses on repairing attachment bonds between spouses. In this trial, EFT significantly improved couples’ self reported distress from pre to post therapy. The brain of the female member of the couple was scanned in an fMRI before and after EFT. An electrode was fixed to her ankle, and she was threatened with a mild shock. This procedure took place while she was on her own and while she held her partner’s hand. Threat response was measured by activity in the prefrontal cortex and dorsal anterior cingulate cortex, both of which are associated with processing threat cues and negative affect. EFT resulted in a decrease activity in these areas of the brain from pre to post couples treatment, and these results were especially prominent during hand holding with the partner.

  Practice Implications

  There is emerging evidence that the effects of psychotherapy like EFT for couples, has a direct impact on the brain that correlates with patients’ self report. In addition, EFT appears to increase the attachment bond between couples and this helps them to regulate their emotions and to moderate their reactions to threat. This study by Johnson and colleagues (2013) also supports some fundamental tenets of attachment theory – that increasing attachment security is possible with psychotherapy and doing so improves affect regulation as measured in the brain. This has broad implications because strong social and attachment bonds help us live longer and enjoy better health.

  Author email: jcoan@virginia.edu