The Pace of Change in Videoconferencing and Face-to-Face Adult Psychotherapy: A Longitudinal Study.

BACKGROUND: The current study explores the pace of psychological change in face-to-face (F2F) and videoconferencing psychotherapy (VCP). It also aims to offer a methodological tool for studying it and to suggest some hypotheses that could explain the pace of change in F2F and VCP. Change in therapy was predicted to be non-linear and faster in F2F than in VCP. METHOD: Session-by-session records of two measures of change (as assessed by therapists and clients, respectively) were collected from 113 participants from F2F (n = 57) and VCP (n = 56), resulting in 2552 therapy sessions. A non-manipulative longitudinal design was proposed in which multilevel growth curve models were performed. Different models were specified to account for the trajectories followed on average by all cases as closely as possible. RESULTS: The chosen models for therapists' ( χ² = 4.42, p < .05, r² = .54) and clients' ( χ² = 6.31, p < .05, r² = .53)data, showed large effect sizes. The results were significant and showed that change was not linear and was faster in F2F, as we had predicted. CONCLUSIONS: Our results contribute to knowledge about psychological therapy provided through the internet. Several hypotheses are suggested to explain which processes may underlie those results.

Quantitative Indices of Student Social Media Engagement in Tertiary Education: A Systematic Review and a Taxonomy.

Recent studies have evaluated the use of social media as learning aids in tertiary education. Emerging research in this area has focused primarily on non-quantitative approaches to student social media engagement. However, quantitative engagement outcomes may be extracted from student posts, comments, likes, and views. The goal of the present review was to provide a research-informed taxonomy of quantitative and behavior-based metrics of student social media engagement. We selected 75 empirical studies comprising a pooled sample of 11,605 tertiary education students. Included studies used social media for educational purposes and reported student social media engagement outcomes (source databases: PsycInfo and ERIC). We used independent raters and stringent interrater agreement and data extraction processes to mitigate bias during the screening of references. Over half of the studies (52%, n = 39) utilized ad hoc interviews and surveys to estimate student social media engagement, whereas thirty-three studies (44%) used some form of quantitative analysis of engagement. Based on this literature, we present a selection of count-based, time-based, and text-analysis metrics. The proposed taxonomy of engagement metrics resulting provides the methodological basis for the analysis of social media behavior in educational settings, particularly, for human operant and behavioral education studies. Implications for future research are discussed. Supplementary Information: The online version contains supplementary material available at 10.1007/s10864-023-09516-6.

Verbal Behavior Analysis of Expert and Inexperienced Therapists Applying the Socratic Method.

The Socratic method, as an eminently verbal procedure, will be analyzed from a behavioral perspective in order to clarify how verbal conditioning works within. This work compares the verbalizations that expert and inexperienced therapists emit during Socratic method to find out which and why certain therapist verbalizations are most successful in changing client responses. The sample consisted of 113 Socratic method fragments from 18 cases, analyzed by observational methodology. The expert therapists had more than 6 years of experience, the inexperienced less than 2. Experts had fewer failure Socratic method fragments, but there were no differences in successful ones. The way of questioning had a different pattern: Inexperienced therapists suggested more the response, experts used more didactic verbalizations; also, experts used the aversive component more and contingently. The creation of guidelines based on functional description of verbal interaction and the need for novice psychologists training are some implications of these results.

Toward an experimental analysis of verbal shaping in psychotherapy.

AbstractObjective. Some authors have suggested that verbal shaping is an active component in cognitive restructuring. The goal of the current study was to provide experimental evidence in support of the shaping hypothesis. METHOD: Three consecutively admitted adults with symptoms of anxiety and depression participated in the study. Participants underwent baseline, treatment comparison, crossover, and follow-up phases as part of an experimental single-case study. We selected two target irrational beliefs and praised either the client's approximations to a terminal (more adaptive) class of verbalizations (differential reinforcement of approximations) or just the terminal class of verbalizations (terminal reinforcement). RESULTS: Irrational beliefs exposed to differential reinforcement of approximations was a more effective approach to reducing irrational beliefs. CONCLUSION: The study provides experimental evidence in support of the verbal shaping hypothesis. Our findings suggest that it may be possible to enhance clinical outcomes by actively engaging in verbal shaping during client-therapist verbal interaction.

Internet-based cognitive behavioural therapy programme with and without videoconference guidance sessions: A randomized controlled trial to treat work-related symptoms of anxiety and depression.

This study provides the results from the implementation of a highly structured therapist-guided iCBT programme for people with work-related anxiety and depression, in terms of programme efficacy, participants' adherence and satisfaction. Seventy-seven national police workers were randomly allocated to one of two groups: without additional videoconference sessions (web platform with guidance of therapist) and with additional videoconference sessions (same intervention as the previous group, plus two videoconference guidance sessions with a psychologist). The intervention was composed of 12 sessions and took place for 17-20 weeks. We found an adherence rate of 36.4%, with no differences between groups. All participants endorsed lower depression (BDI-II F(1) = 36.98, p < .001; ATQ F(1) = 24.22, p < .001), and anxiety (STAI-State F(1) = 76.62, p < .001) after the programme. As a variable related to anxiety and depression in workplace, participants also showed higher assertiveness levels (RAS F(1) = 8.96, p < .001). A significant reduction of the mean level of anxiety perceived by participants as the intervention programme progressed was observed in both groups (F(2) = 7.44; p = .003). Participants were satisfied with the therapists' intervention and with the programme. No significant group effects were found for any of the measures. Reduction in depression levels was maintained in the 12-month follow-up, but levels of anxiety increased. This study is innovative, as it is the first controlled trial to analyse the effect of two added videoconference sessions, and it includes short- and long-term measures, which is not usual. The results are discussed to clarify the role of the contact with the therapist to improve treatment adherence.

What works in the Socratic debate? An analysis of verbal behaviour interaction during cognitive restructuring.

BACKGROUND: Cognitive restructuring is one of the most complex application procedures in psychotherapy. It is widely used by psychologists from different orientations. However, the guidelines on how to apply it do not usually have empirical evidence and there is a lack of knowledge about the mechanisms of change that explain it. AIMS: The analysis of verbalizations that therapists emit during the Socratic method could help to better understand the functioning and strategies of effective debates. METHOD: In this study, specific verbal interaction sequences were analysed using observational methodology. The sample consisted of 113 Socratic questioning fragments belonging to 18 clinical cases, treated by behavioural therapists. RESULTS: Among other findings, it was found that using questioning together with certain previous verbalizations directed the client's response more effectively and those successful debates were characterized by using the aversive component in a frequent and contingent way. CONCLUSION: This study shows the most effective way to establish such an interaction in the Socratic method (following a style closer to Ellis's argumentative debate), which entails relevant practical applications in therapy.

Applying cognitive restructuring in therapy: The clinical reality in Spain.

Cognitive restructuring is one of the most widely used techniques among psychologists of different orientations. However, there is a lack of clarity in what concerns its precise definition, functioning, effectiveness, and components. OBJECTIVE: To obtain precise information on how psychotherapists use cognitive restructuring in their clinical practice in Spain. METHOD: A survey study was conducted following a descriptive quantitative methodology, with a cross-sectional design and a non-random sampling method. Three hundred and twenty psychotherapists responded to a questionnaire, created ad hoc, on cognitive restructuring. RESULTS: Cognitive restructuring is widely used by therapists with different levels of experience, training, and following different psychotherapeutic approaches. Furthermore, it is applied to address a wide variety of psychological problems. There exist relevant differences in the use of the technique depending on the therapists' level of experience. CONCLUSIONS: This study has shown, for the first time, how cognitive restructuring is applied in daily clinical practice. The main implications of these results are discussed, and new lines of inquiry are proposed. Clinical or methodological significance of this article: This study has contributed to bringing the clinical reality of cognitive restructuring closer to the scientific community, by identifying which of the elements and procedures that are taught or researched are actually applied in daily practice.

A theoretical and methodological proposal for the descriptive assessment of therapeutic interactions.

OBJECTIVE: The goal of this study is to show the development of a strategy for a descriptive assessment of the therapeutic interaction. METHOD: In this study, we develop an observational methodology to analyze the dialogues that took place during 92 sessions conducted in a psychological center in Madrid, Spain, in which 19 adults were treated for various psychological problems by 9 behavioral therapists. A system was developed to codify vocal behavior of both the therapists and the clients; the software The Observer XT was used for recording. Therapeutic interactions were analyzed using sequential analysis. RESULTS: There are three main sequences that synthesize the therapist-client interaction: first, an utterance by the client preceded by a therapist's verbalization, specifically a question (discriminative morphology) and followed by an expression of approval (reinforcement morphology); second, verbalizations of failure or discomfort uttered by the client, followed most often by verbalizations of disapproval (punishing morphology) uttered by the therapist; and third, verbalizations uttered by the client that are discriminated by the therapist after an in-depth explanation and followed by different therapist's utterances (expressions of approval, technical information, etc.). CONCLUSIONS: Depending on how the client responds the results in this study present a starting point for the study of the functional sequences that form the basis of therapeutic change.

Studying the Therapeutic Process by Observing Clinicians' In-Session Behaviour.

UNLABELLED: This paper presents a further step in the use and validation of a systematic, functional-analytic method of describing psychologists' verbal behaviour during therapy. We observed recordings from 92 clinical sessions of 19 adults (14 women and 5 men of Caucasian origin, with ages ranging from 19 to 51 years) treated by nine cognitive-behavioural therapists (eight women and one man, Caucasian as well, with ages ranging from 25 to 48 years). The therapists' verbal behaviour was codified and then classified according to its possible functionality. A cluster analysis of the data, followed by a discriminant analysis, showed that the therapists' verbal behaviour tended to aggregate around four types of session differentiated by their clinical objective (assessment, explanation, treatment and consolidation). These results confirm the validity of our method and enable us to further describe clinical phenomena by distinguishing psychologists' classes of clinically relevant activities. Specific learning mechanisms may be responsible for clinical change within each class. These issues should be analysed more closely when explaining therapeutic phenomena and when developing more effective forms of clinical intervention. KEY PRACTITIONER MESSAGE: We described therapists' verbal behaviour in a focused fashion so as to develop new research methods that evaluate psychological work moment by moment. We performed a cluster analysis in order to evaluate how the therapists' verbal behaviour was distributed throughout the intervention. A discriminant analysis gave us further information about the statistical significance and possible nature of the clusters we observed. The therapists' verbal behaviour depended on current clinical objectives and could be classified into four classes of clinically relevant activities: evaluation, explanation, treatment and consolidation. Some of the therapist's verbalizations were more important than others when carrying out these clinically relevant activities. The distribution of the therapists' verbal behaviour across classes may provide us with clues regarding the functionality of their in-session verbal behaviour.

Descriptive study of the Socratic method: evidence for verbal shaping.

In this study we analyzed 65 fragments of session recordings in which a cognitive behavioral therapist employed the Socratic method with her patients. Specialized coding instruments were used to categorize the verbal behavior of the psychologist and the patients. First the fragments were classified as more or less successful depending on the overall degree of concordance between the patient's verbal behavior and the therapeutic objectives. Then the fragments were submitted to sequential analysis so as to discover regularities linking the patient's verbal behavior and the therapist's responses to it. Important differences between the more and the less successful fragments involved the therapist's approval or disapproval of verbalizations that approximated therapeutic goals. These approvals and disapprovals were associated with increases and decreases, respectively, in the patient's behavior. These results are consistent with the existence, in this particular case, of a process of shaping through which the therapist modifies the patient's verbal behavior in the overall direction of his or her chosen therapeutic objectives.

Functional analysis of the verbal interaction between psychologist and client during the therapeutic process.

The goal of this study is to analyze the verbal interaction that takes place between client and therapist over the course of a clinical intervention so as to analyze the potential learning processes that may be responsible for changes in the client's behavior. A total of 92 sessions were analyzed, corresponding to 19 clinical cases treated by 9 therapists specializing in behavioral therapy. The variables considered were therapist and client verbal behaviors, and these were categorized according to their possible functions and/or morphologies. The Observer XT software was used as a tool for the observational analysis. The results led to the conclusion that the therapist responds differentially to client verbalizations, modifying the verbal contingencies as his or her client content approaches or becomes more distant from therapeutic objectives. These results suggest the possible existence of verbal "shaping" processes through which the therapist guides the client's verbal behavior toward more adaptive forms. In addition, this study proposes an alternative to the traditional controversy regarding the relevance of the therapeutic relationship versus the treatment techniques used to explain clinical change. This article suggests that such differentiation is unnecessary because the therapeutic relationship and the treatment techniques should act in the same manner, this is, in providing the context for the occurrence of what is truly therapeutic, namely, the learning processes.

Descriptive analysis of the verbal behavior of a therapist: a known-group validity analysis of the putative behavioral functions involved in clinical interaction.

This study analyzes the interobserver agreement and hypothesis-based known-group validity of the Therapist's Verbal Behavior Category System (SISC-INTER). The SISC-INTER is a behavioral observation protocol comprised of a set of verbal categories representing putative behavioral functions of the in-session verbal behavior of a therapist (e.g., discriminative, reinforcing, punishing, and motivational operations). The complete therapeutic process of a clinical case of an individual with marital problems was recorded (10 sessions, 8 hours), and data were arranged in a temporal sequence using 10-min periods. Hypotheses based on the expected performance of the putative behavioral functions portrayed by the SISC-INTER codes across prevalent clinical activities (i.e., assessing, explaining, Socratic method, providing clinical guidance) were tested using autoregressive integrated moving average (ARIMA) models. Known-group validity analyses provided support to all hypotheses. The SISC-INTER may be a useful tool to describe therapist-client interaction in operant terms. The utility of reliable and valid protocols for the descriptive analysis of clinical practice in terms of verbal behavior is discussed.

Study of the Socratic method during cognitive restructuring.

Cognitive restructuring, in particular in the form of the Socratic method, is widely used by clinicians. However, little research has been published with respect to underlying processes, which has hindered well-accepted explanations of its effectiveness. The aim of this study is to present a new method of analysis of the Socratic method during cognitive restructuring based on the observation of the therapist's verbal behaviour. Using recordings from clinical sessions, 18 sequences were selected in which the Socratic method was applied by six cognitive-behavioural therapists working at a private clinical centre in Madrid. The recordings involved eight patients requiring therapy for various psychological problems. Observations were coded using a category system designed by the authors and that classifies the therapist's verbal behaviour into seven hypothesized functions based on basic behavioural operations. We used the Observer XT software to code the observed sequences. The results are summarized through a preliminary model which considers three different phases of the Socratic method and some functions of the therapist's verbal behaviour in each of these phases: discriminative and reinforcement functions in the starting phase, informative and motivational functions in the course of the debate, and instructional and reinforcement functions in the final phase. We discuss the long-term potential clinical benefits of the current proposal.

[A behavioral conceptualization of motivation in the therapeutic process]. / Una concepción conductual de la motivación en el proceso terapéutico.

Motivation has traditionally been conceptualized as something situated inside the person, which might explain certain behaviors and play a causal role in overt changes in behavior. This type of approach was assumed by the Transtheoretical Model of Change and Motivational Interviewing in the area of clinical and health psychology. In contrast, the behavioral concept of establishing operation is defined as a stimulus or environmental operation that momentarily alters the functions of other stimuli and the response probability, which allows us to study motivation without making inferences or assuming a cognitivist terminology. From this point of view, the study of motivation in therapy implies the analysis of the effect that certain verbalizations of the therapist have on the client's behavior. Moreover, we propose that the analysis of therapists' motivating verbalizations should focus on descriptions of the past, present and future consequences of the client's behavior.

Meta-analysis on drugs in people with eating disorders.

OBJECTIVE: The aim of this study was to examine whether drug use (DU) is higher in people with eating disorders (EDs) compared to a healthy control group and to perform a meta-analysis on the literature related to DU in people with EDs. METHOD: We searched electronic databases (Medline, PsycINFO, Web of Science and CINAHL) and reviewed studies published from 1994 to August, 2007, in English, German or Spanish. A total of 16 papers fulfilled the inclusion criteria and were included. RESULTS: The general meta-analysis revealed a negligible albeit significant effect size (0.119, p < .05). Risk was found to be higher in bulimia nervosa (BN, delta = 0.462, p = < .001), smaller in binge eating disorder (delta = 0.14, p < .05) and non-significant in anorexia nervosa (AN, delta = -.167, p = .070). CONCLUSIONS: The differential risk observed in patients with BN might be related to differences in temperament or might be the result of reward sensitization.

Analysis of the therapist's verbal behavior during cognitive restructuring debates: a case study.

This paper reports a case study in which the authors analyze the application of the debate technique in cognitive restructuring so as to obtain a deeper understanding of the relevant behavioral processes. The authors examined the recordings of a clinical case of low mood disorder and selected five debates that dealt with the same problem. After their transcription, the authors analyzed the client-therapist verbal interaction. Results show changes in the verbalizations of both parties as the treatment progresses. The authors propose a new explanation of these changes, constituting a step forward in the theoretical explanation of the debate technique within the cognitive-behavioral approach.

[Therapists' verbal behavior category system]. / Sistema de categorización de la conducta verbal del terapeuta.

This paper presents the theoretical and methodological basis of a therapist's verbal behavior category system that allows us to study clinical psychologists' language from a functional-analytic framework and with a rigorous observation method. The procedure to develop the coding system is explained in detail from a very early stage of exploratory observation, to the systematic observation through the use of The Observer XT software. An analysis of intra- and inter-rater reliability using the kappa coefficient and taking into account the factors that affect the values of Cohen's index was carried out. Results show high levels of observer accuracy (between approximately 87% and 93%) that justify the application of this category system to study therapists' verbal behavior in session.

[Why do people change in therapy? A preliminary study]. / ¿por qué la gente cambia en terapia? Un estudio preliminar.

Why do people change in therapy? A preliminary study. This work represents the beginning of a new way to study the processes that can explain the therapeutic change. The method used is the observation and analysis of therapeutic sessions directly recorded and developed inside a behavioural approach. The category system tries to carry out a functional analysis of the therapist-client interaction which enables the identification of learning processes that work in clinical setting and explain success in therapy. Outcomes are provisional but show the utility of this initial trend of investigation to the comprehension of clinical phenomenon. Conclusions also emphasize the importance of associative learning processes on the therapeutic change.