AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Michael Linden, Research Group Psychosomatic Rehabilitation at the Charité University Medicine Berlin and Institute for Behavior Therapy, Berlin, Germany.
Citation: Linden M (2019) Cognitive behavior therapists refer to concepts of cognitive behavior therapy when asked what they have done in single sessions.Neural Plasticity and Clinical Practice, 2(1); DOI: 10.31579/NPCP.2019/004
Copyright: © 2019 Linden M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 10 May 2019 | Accepted: 20 June 2019 | Published: 25 June 2019
Keywords: Cognitive behavior therapy; Pivotal topic method; Routine care; Treatment fidelity; Therapeutic schools; Psychotherapy research
Background and objective: An important question is how psychotherapists describe their own treatment under routine care conditions. To what degree do they follow theoretical concepts as defined in psychotherapy schools? The specification of psychotherapy is of interest in regard to training, quality assurance, reimbursement and policy making.
Methods: Using the pivotal topics method, cognitive behavior therapists from a department of behavioral medicine were asked to report what they did in this particular session of individual psychotherapy. Subsequently, pivotal topics were grouped and analyzed by content analysis.
Results: The study involved 23 cognitive behavior therapists who treated 289 inpatients and reported 2,298 pivotal topics. Predominant pivotal topics included behavioral analysis, goal setting, and modification of dysfunctional cognitions, problem solving, emotional self-control, homework assignments and summary of treatment, respectively. The interventions follow a sequential script over the course of treatment.
Conclusion: Therapists describe their treatment with regard to theoretical concepts and techniques as described in CBT manuals and textbooks. In a general sense this suggests that psychotherapy can be applied and conceptualized in reference to specific therapeutic guidelines and is more than an unspecific therapeutic interaction. This is not only the case in scientific studies but also in treatment under routine care conditions.
Psychotherapy is a professional interaction and must be delimited from talking in general. Psychotherapists shall be able to communicate to colleagues, patients, health insurance and even lawyers what they do or have done. They should follow theory-based rules of interaction and apply evidence-based therapeutic techniques. These are elaborated in psychotherapy schools, like cognitive behavior therapy, psychodynamic psychotherapy or humanistic psychotherapy, which are descriptions of theoretical frameworks and therapeutic interventions. These frameworks are often rather vague, however, and this even more the case with a growing discussion on a school integrative or universal psychotherapy [1, 2]. The problem is even more complex when psychotherapists have to explain what they did in a particular treatment session. They then cannot refer to psychotherapeutic schools in general but have to name specific interventions [3].
There is a lack of data on the degree to which psychotherapists under routine care conditions follow rules and concepts of their respective psychotherapy schools in reference to controlled trials) or to what extent they use individual or intuitive strategies [3-9].There are many approaches to study therapist behavior and compliance with defined professional rules. These comprise supervision and peer reviews of individual cases, standardized self- and observer-rating scales or therapist´s reactions to case vignettes [10-15].
Another approach is the pivotal topic method [16,17,13]. Pivotal topics are summaries of single sessions in the view of the therapist. Memory psychology has demonstrated that information is best remembered if it is important or well-learned and can be conveyed in words [18]. When persons are asked after an encounter what they talked about with the other person, they will give a summarizing statement, even of a long discussion, which reflects what they understood and think it is the essential of the encounter. The phrasing depends on their linguistic competence, which in turn also influences what is reported and remembered. Pivotal topics reflect what therapists consider essential about a therapeutic session and how they describe and conceptualize their treatment. Pivotal topics refer to what the therapists see as the primary objective or content of a session. They capture their way of thinking [19]. This allows studying changes of individual treatment concepts over time.
The objective of this study was to investigate how therapists who have been trained in cognitive behavior therapy to describe and conceptualize their interventions and the course of their treatment under conditions of routine treatment. This provides information not only on the importance of theoretical concepts in the provision of treatment, but also allows, to a certain degree, to describe what encompasses CBT, which are the most often used interventions, and how the therapeutic process is structured over time. Such knowledge is of use for the understanding of psychotherapy in general and CBT in particular.
Participants
The study was conducted over a period of about twelve months in a behavioral medicine department. It involved 289 inpatients (67.9
Figure 1 indicates the percentage of therapists who mentioned a certain pivotal topic at least once in one of the three treatment phases. The topics are listed according to their frequency in the initial phase.
At the beginning of the treatment therapists focus on establishing an understanding for the problem and providing an “illness model” to the patient. Micro- and macro-behavioral analysis, goal setting and treatment planning are also relatively frequent. They target dysfunctional cognitions, problem solving, emotional control and homework assignments which can also be part of the diagnostic process, but also indicate the early beginning of the initiation of change-oriented interventions.
In the second phase, work on promoting an understanding of the illness is continued, which includes ongoing micro-behavioral analyses and explanations of the diagnosis. Therapists also motivate and prepare the patient for planned therapeutic interventions. Further topics are dysfunctional cognitions, problem solving, and emotional control, increase of activity and self-control, and self-care. Therapists also explain other treatments like medication and somatic interventions.
In the final phase, therapists summarize the current state of treatment, review the development of treatment, make predictions, discuss the transfer of therapeutic developments into daily life and discuss possibilities of aftercare and summarize the conclusion of the therapy.
There are some interventions which occur at high frequencies across all three phases of therapy. These are the work on the illness model and micro-behavioral analysis, on dysfunctional cognitions, problem solving and emotional control.
Throughout the treatment process there is also a base rate of unspecific interventions which suggests that therapists exercise at a certain degree of freedom in regards to what they do.
From the perspective of cognitive psychology, pivotal topics reflect the “subjective truth”. The pivotal topic method indicates what therapists remember and consider important, what guided their treatment and what they intended to do or thought they have done. This allows assessing the treatment concepts and understanding of therapists, in this case, what cognitive behavior therapists regard as CBT under routine treatment conditions of [22]. The pivotal topic method allows much freedom in describing the ongoing treatment since it does not influence the answers by preset categories. The answers refer to individual patients and treatment sessions and are therefore more valid than just asking what therapists regard as CBT from a purely theoretical perspective [14].
The major finding of this study is, that cognitive behavior therapist refer to theory-based language and concepts as described in respective textbooks and training manuals of this school of psychotherapy when asked what they have done I a particular session with an individual patient [ 23-28]. The topics reflect treatment techniques which are core elements of CBT, like behavioral analysis, modification of cognitions, problem solving, emotional control, homework assignments. CBT therapists are also aware of the need for motivating the patient, of a good working alliance and therapeutic relationship. The overall frequencies demonstrate that the different topics have been reported at least once by the majority of therapists. This allows the conclusion that these interventions are CBT-specific and can define CBT in general, as well as under routine care conditions. The pivotal topics reflect a bottom up definition of CBT. Psychotherapists who intend to do micro- and macro-behavioral analysis, modification of cognitions, problem solving, emotional and self-control, homework assignment, etc., can be called CBT therapists [29]. These core therapeutic interventions can define what therapists must learn in order to be able to apply CBT. This is also very different from what is considered to be psychodynamic or humanistic psychotherapy.
The frequencies differ between topics. There are interventions which can be found across the whole treatment process, like modification of cognitions, problem solving, behavioral analysis and teaching an understanding of the present problem. Other topics are only seen in certain phases of treatment or selected patients like the increase of activities, activation of resources, self-care and self-control.
The data also show that there is a dynamic development over the course of CBT. The early stage of treatment is characterized by the clarification of treatment goals, behavioral analysis, psycho-education and also at a very early stage by coping and cognitive modification. At the intermediate stage of treatment the processes of change, self-control or regulation of emotions become predominant topics; the orientation to the future after the end of therapy is also included. Helping the patient to understand the illness and inform him or her about the diagnosis is also part of the intermediate phase, after the therapist and also the patient had some time to better understand the current problem. Similarly, the therapeutic alliance becomes a prominent topic. In summary, the initial phase is characterized by inducing hope and positive expectations. In the intermediate phase predominant topics are, for example, homework assignment, micro-analysis, and increase of activities or emotional control. At the end the therapist focuses on planning the future, relapse prevention and summarizing what has been learned. This stepwise structure of the therapeutic process over time demonstrates that CBT is applied as a stepwise coherent developmental process. This study involves more than talking about day to day problems.
To our knowledge this is the only study to investigate individual sessions in this particular way.
Limitations of the study are that no tape recording was available to observe what therapists did in the sessions. The data originate from therapists who have undergone comprehensive education for several years with state examinations and licensing and who work full time as professionals in an inpatient setting with close supervision. Results may be different for other therapists and settings. This is not an epidemiological study of care and cannot prove what is done across the world under the label of CBT.
(a) The data suggest that CBT is not an empty word but stands for a specific spectrum of therapeutic perspectives, interventions and processes.
(b) Psychotherapists conceptualize, describe and apply treatment in reference to theoretical concepts as laid down in psychotherapy research, manuals, textbooks, and psychotherapy schools.
(c) This is not only the case in well-controlled scientific studies or specialized institutions but also under routine care conditions [30,31].
(d) The data contradict the concept that psychotherapy is in essence rather a general type of patient-centered interaction and not the application of specific techniques [1,2,22,24] In summary, our results show the importance of psychotherapy theory and professional language.
The author declares that he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki Declaration 1964 and its later amendments or comparable ethical standards. The study was approved by the internal review commission of the Federal German Pension Insurance.
Informed consent was obtained from all individual participants included in the study.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
