The identification of relationship ruptures in group therapy coupled with repair efforts by the group leader are addressed from a measurement-based care (MBC) perspective. Several MBC systems are now recognized as evidence-based treatments, and these systems typically use self-report assessment of both outcome and relationship measures. After laying a brief foundation of alliance rupture and repair from an individual therapy perspective, the complexity of applying alliance and repair across the multiple therapeutic relationships and constructs found in the group treatment literature is considered. The Group Questionnaire (GQ) is an empirically derived measure designed to capture the multiple relationship structures (member-member, member-leader, and member-group) and constructs (alliance, cohesion, climate, and empathy) in group therapy. Similarities and differences between the GQ and alliance rupture and repair measures are considered, followed by algorithms used to identify rupture and repair in

Vagal afferent signaling coordinates autonomic reflex function and informs associated behaviors. Thermosensitive transient receptor potential (TRP) channels detect temperature and nociceptive stimuli in somatosensory afferent neurons, however their role in vagal signaling remains less well understood. We report that the TRPM3 ion channel provides a major thermosensitive point of control over vagal signaling and synaptic transmission. We conclude that TRPM3 translates physiological changes in temperature to neurophysiological outputs and can serve as a cellular integrator in vagal afferent signaling.

Circulating blood glucocorticoid levels are dynamic and responsive to stimuli that impact autonomic function. In the brainstem, vagal afferent terminals release the excitatory neurotransmitter glutamate onto neurons in the nucleus of the solitary tract (NTS). Vagal afferents integrate direct visceral signals and circulating hormones with ongoing NTS activity to control autonomic function and behavior. Here we investigated the effects of corticosterone (CORT) on glutamate signaling in the NTS using patch-clamp electrophysiology on brainstem slices containing the NTS and central afferent terminals from male C57BL/6 mice. We found that CORT rapidly decreased both action-potential evoked and spontaneous glutamate signaling. The effects of CORT were phenocopied by dexamethasone and blocked by mifepristone, consistent with glucocorticoid receptor (GR) mediated signaling. While mRNA for GR was present in both the NTS and vagal afferent neurons, selective intracellular quenching of G-protein signaling in postsynaptic NTS neurons eliminated the effects of CORT. We then investigated the contribution of retrograde endocannabinoid (eCB) signaling, which has been reported to transduce non-genomic GR effects. Pharmacological or genetic elimination of the cannabinoid type 1 (CB1) receptor signaling blocked CORT suppression of glutamate release. Together our results detail a mechanism whereby the NTS integrates endocrine CORT signals with fast neurotransmission to control autonomic reflex pathways.

It is not yet fully understood how alliance, cohesion, and climate differentially correlate with client outcome in group therapy, especially when assessed simultaneously. This study aims to elucidate these relationships through an archival analysis of continuous Group Questionnaire (GQ) and Outcome Questionnaire-45 (OQ-45) data from 412 group therapy clients at college counseling centers, which were originally collected by Burlingame, Whitcomb, et al. (2018). We predicted that alliance, cohesion, and climate would each correlate with improvements in outcome and, further, that they would have similar relationships with change in outcome. Results indicate that greater alliance, cohesion, and climate are individually associated with lower distress. This relationship was significant regarding session-to-session fluctuations on individual client scores ( p < .01), as well as regarding differences between clients in their personal averages across sessions ( p < .01). However, when linear growth trajectories were considered, only alliance was significantly associated with improvement ( p < .05). In other words, alliance, climate, and cohesion all correlate with outcome when time is ignored; however, alliance alone significantly correlates with outcome when change over time is taken into account. This study highlights the importance of the client-therapist relationship, emphasizing how alliance is significantly related to change in group therapy. Thus, therapists should prioritize a strong bond with clients. Public Significance StatementThis study explores how clients' outcomes in therapy relate to the relationships that they form in group therapy, including relationships with other members, the group leader, and the group-as-a-whole. Results suggest that a good relationship with the group therapist is especially associated with changes in outcome over time, highlighting the importance of this relationship in group therapy.

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