Distinctive activities of cognitive–behavioral therapy

Blagys, Matthew D.; Hilsenroth, Mark J.

doi:10.1016/s0272-7358(01)00117-9

Cited by 223Psychotherapy Techniques and ApplicationsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and Assessments

Distinctive activities of cognitive–behavioral therapy

Blagys, Matthew D., Hilsenroth, Mark J.·2002·Clinical Psychology Review

DOI 10.1016/s0272-7358(01)00117-9

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Abstract

The present review examined the comparative psychotherapy process literature in order to identify the distinctive activities of cognitive-behavioral (CB) treatment. Six techniques and interventions were found to distinguish CB from psychodynamic-interpersonal (PI) therapy: (1) use of homework and outside-of-session activities; (2) direction of session activity; (3) teaching of skills used by patients to cope with symptoms; (4) emphasis on patients' future experiences; (5) providing patients with information about their treatment, disorder, or symptoms; and (6) an intrapersonal/cognitive (C) focus. Identifying the distinctive features of CB therapy can improve the measurement of process-outcome correlations by more accurately specifying and operationalizing the treatment-specific processes of CB treatment, help researchers differentiate between common and treatment-specific factors, and aid in development of more psychometrically sound instruments assessing adherence and competence in CB therapy. In addition, this review can improve training of CB therapists by providing a guide for clinical practice.

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Whether treatments work through specific factors (eg, CBT change methods) or factors common to most psychotherapies (eg, therapeutic alliance) remains a core issue in the field.
“whether treatments work through specific factors (eg, CBT change methods) or factors common to most psychotherapies (eg, therapeutic alliance) remains a core issue in the field.11,12”
From Quantifying the association between psychotherapy content and clinical outcomes using deep learning (2020) · cites this paper as [11]

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Ewbank, M. P., Cummins, R., Tablan, V., Bateup, S., Catarino, A., Martin, A. J., & Blackwell, A. D. (2020) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2019.2664 · Cited by 108 · see citing works
Group Cognitive Behavioural Therapy for Depression Outcomes Predicted by Willingness to Engage in Homework, Compliance with Homework, and Cognitive Restructuring Skill Acquisition
Neimeyer, R. A., Kazantzis, N., Kassler, D. M., Baker, K. D., & Fletcher, R. (2008) · Cognitive Behaviour Therapy · doi:10.1080/16506070801981240 · Cited by 113 · see citing works
“Some therapies routinely incorporate assignments into the treatment process (A. T. Beck, Rush, Shaw, & Emery, 1979), whereas others use homework frequently (Neimeyer & Winter, 2007) or occasionally but without regarding it as a core or defining feature of treatment (Blagys & Hilsenroth, 2002).”
A national survey of practicing psychologists’ use and attitudes toward homework in psychotherapy
Kazantzis, N., Lampropoulos, G. K., & Deane, F. P. (2005) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.73.4.742 · Cited by 112 · see citing works
“Homework was also identified as the primary feature of psychotherapy that separated CBT and psychodynamic–interpersonal therapies in a recent survey of published research (Blagys & Hilsenroth, 2002).”
Background
SHORT-TERM PSYCHODYNAMIC PSYCHOTHERAPY FOR DEPRESSION: AN EXAMINATION OF STATISTICAL, CLINICALLY SIGNIFICANT, AND TECHNIQUE-SPECIFIC CHANGE
Hilsenroth, M. J., ACKERMAN, S. J., Blagys, M. D., Baity, M. R., & Mooney, M. A. (2003) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000071582.11781.67 · Cited by 104 · see citing works
Combining cognitive behavioral therapy and contingency management to enhance their effects in treating cannabis dependence: less can be more, more or less.
Carroll, K. M., Nich, C., LaPaglia, D. M., Peters, E. N., Easton, C. J., & Petry, N. M. (2012) · Addiction · doi:10.1111/j.1360-0443.2012.03877.x · Cited by 91 · see citing works
Integrating psychotherapy with the hierarchical taxonomy of psychopathology (HiTOP).
Hopwood, C. J., Bagby, R. M., Gralnick, T. M., Ro, E., Ruggero, C. J., Mullins‐Sweatt, S. N., Kotov, R., Bach, B., Cicero, D. C., Krueger, R. F., et al. (2019) · Journal of Psychotherapy Integration · doi:10.1037/int0000156 · Cited by 95 · see citing works
“The second and third clusters each comprise techniques specified by their underlying theoretical models (see Blagys & Hilsenroth, 2000, 2002).”
Method
A programmatic study of short-term psychodynamic psychotherapy: Assessment, process, outcome, and training
Hilsenroth, M. J. (2006) · Psychotherapy Research · doi:10.1080/10503300600953504 · Cited by 91 · see citing works
“The scale we developed is based on two reviews of the comparative psychotherapy process literature (Blagys & Hilsenroth, 2000, 2002) that sought to identify core features used in PI (defined broadly to include psychodynamic, PI, and interpersonal therapies) and CB (defined broadly to include…”
Method
Towards recovery-oriented psychosocial interventions for bipolar disorder: Quality of life outcomes, stage-sensitive treatments, and mindfulness mechanisms
Murray, G., Leitan, N. D., Thomas, N., Michalak, E. E., Johnson, S. L., Jones, S., Perich, T., Berk, L., & Berk, M. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.01.002 · Cited by 87 · see citing works
The scientific standing of psychoanalysis
Solms, M. (2018) · BJPsych International · doi:10.1192/bji.2017.4 · Cited by 91 · see citing works
Would Confucius benefit from psychotherapy? The compatibility of cognitive behaviour therapy and Chinese values
Hodges, J., & Oei, T. P. S. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.08.015 · Cited by 88 · see citing works
Different processes for different therapies: Therapist actions, therapeutic bond, and outcome.
Ulvenes, P., Berggraf, L., Hoffart, A., Stiles, T. C., Svartberg, M., McCullough, L., & Wampold, B. E. (2012) · Psychotherapy · doi:10.1037/a0027895 · Cited by 76 · see citing works
The Y Model: An Integrated, Evidence-Based Approach to Teaching Psychotherapy Competencies
Plakun, E. M., Sudak, D. M., & Goldberg, D. A. (2009) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000344914.54082.eb · Cited by 75 · see citing works
Effects of training in short-term psychodynamic psychotherapy: changes in graduate clinician technique
Hilsenroth, M. J., DeFife, J. A., Blagys, M. D., & Ackerman, S. J. (2006) · Psychotherapy Research · doi:10.1080/10503300500264887 · Cited by 72 · see citing works
“Developed from an extensive empirical review of the comparative psychotherapy process literature (Blagys & Hilsenroth, 2000, 2002), the scale consists of 20 items to be rated on a 7-point Likert scale (0 /not at all characteristic ; 2 /somewhat characteristic ; 4 /characteristic ; 6 /extremely…”
Method
Behavioral treatment for marijuana dependence: randomized trial of contingency management and self-efficacy enhancement.
Litt, M. D., Kadden, R. M., & Petry, N. M. (2013) · Addictive Behaviors · doi:10.1016/j.addbeh.2012.08.011 · Cited by 71 · see citing works
“CBT generally includes homework exercises to practice skills learned in treatment, and to generalize these skills to the real world (e.g., Blagys & Hilsenroth, 2002; Burns & Spangler, 2000; Kazantzis, 2000).”
Background
Exploring In‐Session Focus on the Patient–Therapist Relationship: Patient Characteristics, Process and Outcome
Kuutmann, K., & Hilsenroth, M. J. (2011) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.743 · Cited by 70 · see citing works
Cognitive behavioral treatment groups for people with chronic depression in Hong Kong: a randomized wait-list control design
Wong, D. F. K. (2008) · Depression and Anxiety · doi:10.1002/da.20286 · Cited by 66 · see citing works
“Indeed, behavioral rehearsal and homework are considered important ingredients for fostering therapeutic changes in CBT for people with mental health problems [Blagys and Hilsenroth, 2002].”
Using a CBT Approach to Teach Social Skills to Adolescents with Autism Spectrum Disorder and Other Social Challenges: The PEERS® Method
Laugeson, E. A., & Park, M. N. (2014) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-014-0181-8 · Cited by 65 · see citing works
“Homework Assignments and Homework Review Homework assignments and homework review are critical components of CBT (Blagys and Hilsenroth 2002; Hudson and Kendall 2002).”
Influential
A systematic review of psychological interventions in total hip and knee arthroplasty
Bay, S., Kuster, L., McLean, N. J., Byrnes, M. L., & Kuster, M. S. (2018) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-018-2121-8 · Cited by 62 · see citing works
“Cognitive behaviour therapy aims to help the patient understand and alter beliefs and thought processes, in order to positively influence consequences [15, 17, 18].”
Interreality in Practice: Bridging Virtual and Real Worlds in the Treatment of Posttraumatic Stress Disorders
Riva, G., Raspelli, S., Algeri, D., Pallavicini, F., Gorini, A., Wiederhold, B. K., & Gaggioli, A. (2010) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2009.0320 · Cited by 61 · see citing works
Therapy was not what I expected: A preliminary qualitative analysis of concordance between client expectations and experience of cognitive–behavioural therapy
Westra, H. A., Aviram, A., Barnes, M. E., & Angus, L. E. (2010) · Psychotherapy Research · doi:10.1080/10503301003657395 · Cited by 61 · see citing works
“…compared with the technical aspects of CBT. Greater specification of desirable interpersonal behaviours and attitudes, such as what it means to ‘‘collaborate,’’ is especially important given that CBT has been found to be more directive compared with other therapies (Blagys & Hilsenroth, 2002).”
Result
Efficacy of Internet-Delivered Psychodynamic Therapy: Systematic Review and Meta-Analysis
Lindegaard, T., Berg, M., & Andersson, G. (2020) · Psychodynamic Psychiatry · doi:10.1521/pdps.2020.48.4.437 · Cited by 61 · see citing works
The Efficacy of Psychodynamic Psychotherapy
Shedler, J. (2011) · Humana Press eBooks · doi:10.1007/978-1-60761-792-1_2 · Cited by 61 · see citing works
Review of Psychodynamic Psychotherapy Neuroimaging Studies
Abbass, A. A., Nowoweiski, S. J., Bernier, D. C., Tarzwell, R., & Beutel, M. E. (2014) · Psychotherapy and Psychosomatics · doi:10.1159/000358841 · Cited by 63 · see citing works
A pilot study of psychodynamic psychotherapy for adult survivors of childhood sexual abuse
Price, J. L., Hilsenroth, M. J., Callahan, K. L., Petretic-Jackson, P. A., & Bonge, D. R. (2004) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.421 · Cited by 58 · see citing works
Boosting: Empowering Citizens with Behavioral Science
Herzog, S. M., & Hertwig, R. (2024) · Annual Review of Psychology · doi:10.1146/annurev-psych-020924-124753 · Cited by 63 · see citing works
Expert clinicians’ prototypes of an ideal child treatment in psychodynamic and cognitive-behavioral therapy: Is mentalization seen as a common process factor?
Goodman, G., Midgley, N., & Schneider, C. (2015) · Psychotherapy Research · doi:10.1080/10503307.2015.1049672 · Cited by 58 · see citing works
“Whereas increasing evidence in adult psychotherapy is emerging to support the idea that PDT and CBT represent distinct therapeutic processes (Blagys & Hilsenroth, 2000, 2002; Goodman, 2010).”
Background
Short-Term Psychodynamic Psychotherapy Versus Treatment as Usual for Depressive and Anxiety Disorders: A Randomized Clinical Trial of Efficacy
Bressi, C., Porcellana, M., Marinaccio, P. M., Nocito, E. P., & Magri, L. (2010) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e3181ef3ebb · Cited by 55 · see citing works
Is integrative use of techniques in psychotherapy the exception or the rule? Results of a national survey of doctoral-level practitioners.
Thoma, N. C., & Cecero, J. J. (2009) · Psychotherapy · doi:10.1037/a0017900 · Cited by 53 · see citing works
“…carried out in RCTs rather than observations of clinical practice (e.g., Ablon & Jones, 1999; Castonguay, Goldfried, Wiser, Raue, & Hayes, 1996; Hill, O’Grady, & Elkin, 1992; Jones & Pulos, 1993; Shapiro & Startup, 1992; Trijsburg, Perry, & Semeniuk, 2005; also see Blagys & Hilsenroth, 2000, 2002).”
Developing Cross-Cultural Competencies in Management Education via Cognitive-Behavior Therapy
Mendenhall, M. E., Arnardóttir, A. A., Oddou, G. R., & Burke, L. A. (2013) · Academy of Management Learning and Education · doi:10.5465/amle.2012.0237 · Cited by 48 · see citing works
“Many CBT models are based on assumptions that rely in large measure on Beck’s 1976 cognitive theory, which proposes that individuals’ physiological, affective, and behavioral responses are mediated by cognitive interpretations (Beck, 2005; Beck, Rush, Shaw, & Emery, 1979; Blagys & Hilsenroth, 2002).”
Background
An Open Trial of In-Home CBT for Depressed Mothers in Home Visitation
Ammerman, R. T., Putnam, F. W., Stevens, J. H., Bosse, N. R., Short, J. A., Bodley, A. L., & Ginkel, J. B. V. (2010) · Maternal and Child Health Journal · doi:10.1007/s10995-010-0691-7 · Cited by 48 · see citing works
“IH-CBT preserves the core features of CBT that are essential to its effectiveness [22] while modifying elements of treatment content and delivery in order to enhance feasibility, engagement, and impact.”
Systematic Development of a Self-Help and Motivational Enhancement Intervention to Promote Sexual Health in HIV-Positive Men Who Have Sex with Men
van Kesteren, N. M. C., Kok, G., Hospers, H. J., Schippers, J., & de Wildt, W. (2006) · AIDS Patient Care and STDs · doi:10.1089/apc.2006.20.858 · Cited by 48 · see citing works
“42,43 Furthermore, cognitive-behavioral therapy recommends various methods for the treatment of sexual dysfunction, such as sexual imaging to promote sexual arousal or reach orgasm 37 and systematic desensitization and exposure in vivo (i.e. sex therapy) to reduce fear and counterbalance avoidance.”
Can between-session (homework) activities be considered a common factor in psychotherapy?
Kazantzis, N., & Ronan, K. R. (2006) · Journal of Psychotherapy Integration · doi:10.1037/1053-0479.16.2.115 · Cited by 48 · see citing works
Psychologists' Use of Motion Pictures in Clinical Practice.
Lampropoulos, G. K., Kazantzis, N., & Deane, F. P. (2004) · Professional Psychology Research and Practice · doi:10.1037/0735-7028.35.5.535 · Cited by 45 · see citing works
Spiritually oriented cognitive-behavioral therapy.
Tan, S., & Johnson, W. B. (2005) · American Psychological Association eBooks · doi:10.1037/10886-004 · Cited by 45 · see citing works
Cognitive Behavioral Therapy for Adolescents with ADHD
Antshel, K. M., & Olszewski, A. K. (2014) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2014.05.001 · Cited by 44 · see citing works
Conceptual and Pragmatic Considerations in the Use of Cognitive-Behavioral Therapy with Muslim Clients
Beshai, S., Clark, C. M., & Dobson, K. S. (2012) · Cognitive Therapy and Research · doi:10.1007/s10608-012-9450-y · Cited by 44 · see citing works
“According to a meta-analysis by Blagys and Hilsenroth (2002), there are six distinctive activities which permeate treatment sessions and that distinguish CBT from other therapeutic approaches.”
Background
The effects of borderline pathology on short-term psychodynamic psychotherapy for depression
Hilsenroth, M. J., DeFife, J. A., Blake, M. M., & Cromer, T. D. (2007) · Psychotherapy Research · doi:10.1080/10503300600786748 · Cited by 43 · see citing works
“Based on the findings of two empirical reviews of the comparative psychotherapy process literature (Blagys & Hilsenroth, 2000, 2002), the CPPS is a brief descriptive measure designed to assess therapist activity and techniques used and occurring during the therapeutic hour.”
The relationship of patient defensive functioning and alliance with therapist technique during short-term psychodynamic psychotherapy
Siefert, C. J., Hilsenroth, M. J., Weinberger, J. L., Blagys, M. D., & Ackerman, S. J. (2006) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.469 · Cited by 43 · see citing works
Clinical experiences in conducting cognitive-behavioral therapy for social phobia
McAleavey, A. A., Castonguay, L. G., & Goldfried, M. R. (2014) · Behavior Therapy · doi:10.1016/j.beth.2013.09.008 · Cited by 42 · see citing works
“Though CBT therapists in general tend to focus less on emotion than psychodynamic therapists (Blagys & Hilsenroth, 2002, 2006), at least some evidence suggests that when they do, it is associatedwith better outcomes in treatment of other disorders (e.g., Castonguay, Goldfried, Wiser, Raue, & Hayes,…”
Background
Therapeutic Interventions Related to Outcome in Psychodynamic Psychotherapy for Anxiety Disorder Patients
Slavin-Mulford, J. M., Hilsenroth, M., Weinberger, J., & Gold, J. R. (2011) · Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3182125d60 · Cited by 41 · see citing works
“The CB subscale consists of items that are significantly more characteristic of CB-oriented therapy (Blagys and Hilsenroth, 2002).”
BackgroundMethod
Occupation-Based Intervention for Addictive Disorders: A Systematic Review
Wasmuth, S., Pritchard, K. T., & Kaneshiro, K. N. (2015) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2015.11.011 · Cited by 42 · see citing works
“For example, research has suggested that clients often struggle to implement the interpersonal skills and tools learned in cognitive behavior therapy groups to real-life scenarios (Blagys & Hilsenroth, 2002).”
Distinction, limites et complémentarité des recherches d’efficacité potentielle et d’efficacité réelle : nouvelles perspectives pour la recherche en psychothérapie
Thurin, J.-M., & Briffault, X. (2006) · L Encéphale · doi:10.1016/s0013-7006(06)76181-4 · Cited by 40 · see citing works
Pilot Test of a Computer-Based System to Help Family Caregivers of Dementia Patients
Gustafson, D. H., Gustafson, D. H., Cody, O. J., Chih, M., Johnston, D. C., & Asthana, S. (2019) · Journal of Alzheimer s Disease · doi:10.3233/jad-190052 · Cited by 40 · see citing works
“Nevertheless, with somanyservicesonD-CHESS(15,notincludingsen-sors),marketing,tutorials,andpromptstoless-used butevidence-basedservicessuchasjournaling(My Journal)[61]andcognitivebehavioraltherapy(Eas-ingDistress)[62]areneeded.”
Working through: In-session processes that promote between-session thoughts and activities.
Owen, J. J., Quirk, K. M., Hilsenroth, M. J., & Rodolfa, E. R. (2011) · Journal of Counseling Psychology · doi:10.1037/a0023616 · Cited by 38 · see citing works
Efficacy of psychological interventions on clinical outcomes of coronary artery disease: Systematic review and meta-analysis
Magán, I., Jurado-Barba, R., Casado, L., Barnum, H., Jeon, A., Hernandez, A. V., & Bueno, H. (2022) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110710 · Cited by 39 · see citing works
Metacognition in persons with substance abuse: Findings and implications for occupational therapists
Wasmuth, S., Outcalt, J., Buck, K. D., Leonhardt, B. L., Vohs, J. L., & Lysaker, P. H. (2015) · Canadian Journal of Occupational Therapy · doi:10.1177/0008417414564865 · Cited by 39 · see citing works
“Indeed, Blagys and Hilsenroth (2002) have suggested that in general, although cognitive behavioural therapy (CBT) is an evidencebased practice that provides tools for effective interpersonal communication and interaction, newly learned approaches to life problems gained in CBT often do not transfer…”
Background
Efficacy of psychological interventions on psychological outcomes in coronary artery disease: systematic review and meta-analysis
Magán, I., Casado, L., Barba, R. J., Barnum, H., Redondo, M. M., Hernández, A. V., & Bueno, H. (2020) · Psychological Medicine · doi:10.1017/s0033291720000598 · Cited by 36 · see citing works
Patients' perspective on homework assignments in cognitive–behavioural therapy
Fehm, L., & Mrose, J. (2008) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.592 · Cited by 36 · see citing works
Impairments in Self Structures in Depression and Suicide in Psychodynamic and Cognitive Behavioral Approaches: Implications for Clinical Practice and Research
Luyten, P., Blatt, S. J., & Fonagy, P. (2013) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2013.6.3.265 · Cited by 38 · see citing works
“…thereby fostering the patient to revise earlier representations through becoming aware of their repetitive distortion of life experiences in the here-and-now of the therapeutic relationship (Blagys & Hilsenroth, 2000, 2002; Diener, Hilsenroth, & Weinberger, 2007; Luyten & Blatt, 2012).”
Definitions of homework, types of homework, and ratings of the importance of homework among psychologists with cognitive behavior therapy and psychoanalytic theoretical orientations
Kazantzis, N., & Dattilio, F. M. (2010) · Journal of Clinical Psychology · doi:10.1002/jclp.20699 · Cited by 35 · see citing works
Multimodal psychodynamic psychotherapy induces normalization of reward related activity in somatoform disorder
de Greck, M., Scheidt, L., Bölter, A. F., Frommer, J., Ulrich, C., Stockum, E., Enzi, B., Tempelmann, C., Hoffmann, T., & Northoff, G. (2011) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2010.539269 · Cited by 35 · see citing works
Changes in brain activity of somatoform disorder patients during emotional empathy after multimodal psychodynamic psychotherapy
de Greck, M., Bölter, A. F., Lehmann, L., Ulrich, C., Stockum, E., Enzi, B., Hoffmann, T., Tempelmann, C., Beutel, M. E., Frommer, J., et al. (2013) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2013.00410 · Cited by 34 · see citing works
“…applied in our study, aims to increase the insight and acceptance of unconscious emotions, needs and conflicts (Blagys and Hilsenroth, 2002; Leichsenring, 2005), and to enable patients to gain “mastery over his or her repressed wishes, desires, fears, or anxieties” (Blagys and Hilsenroth, 2002).”
BackgroundMethodInfluential
Patient Ratings of Psychodynamic Psychotherapy Session Activities and Their Relation to Outcome
DeFife, J. A., Hilsenroth, M. J., & Gold, J. R. (2008) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e31817cf6d0 · Cited by 33 · see citing works
“The CPPS was developed based on 2 extensive reviews of the empirical comparative psychotherapy process literature (Blagys and Hilsenroth, 2000, 2002), which sought to more specifically identify significant differences between the techniques employed in PI (defined broadly to include psychodynamic,…”
Method
The effect of psychological interventions on quality of life in patients with head and neck cancer: A systematic review and meta-analysis
Calver, L., Tickle, A., Moghaddam, N. G., & Biswas, S. (2017) · European Journal of Cancer Care · doi:10.1111/ecc.12789 · Cited by 32 · see citing works
“While psychoeducation is a common component of broader psychological interventions (such as cognitive-behavioural therapy; CBT; Blagys & Hilsenroth, 2002), standalone psychoeducation was not considered to be equitably comparable to these more comprehensive (multifaceted and psychological theory-based) interventions.”
Background
Die Wirksamkeit psychodynamischer Psychotherapie
Shedler, J. (2011) · Psychotherapeut · doi:10.1007/s00278-011-0819-2 · Cited by 32 · see citing works
Structured supervision of graduate clinicians in psychodynamic psychotherapy: Alliance and technique.
Hilsenroth, M. J., Kivlighan, D. M., & Slavin‐Mulford, J. M. (2015) · Journal of Counseling Psychology · doi:10.1037/cou0000058 · Cited by 31 · see citing works
Adherence, flexibility, and outcome in psychodynamic treatment of depression.
Katz, M., Hilsenroth, M. J., Gold, J. R., Moore, M., Pitman, S. R., Levy, S. R., & Owen, J. J. (2018) · Journal of Counseling Psychology · doi:10.1037/cou0000299 · Cited by 31 · see citing works
“The scale is based upon the findings of two reviews of the empirical comparative psychotherapy process literature (Blagys & Hilsenroth, 2000, 2002), which identified significant differences between the techniques used in PI and CB treatments, and it is comprised of two subscales: the…”
Method
Measuring Verbal Psychotherapeutic Techniques—A Systematic Review of Intervention Characteristics and Measures
Gumz, A., Treese, B., Marx, C., Strauss, B. M., & Wendt, H. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01705 · Cited by 31 · see citing works
“Reviews on the subject are either concerned with selected types of techniques (e.g., transference interpretation; Høglend, 2004; Brumberg and Gumz, 2012), methodologically flawed (e.g., Blagys and Hilsenroth, 2000, 2002), or out-dated (Elliott et al., 1987).”
Background
From Mindfulness to Meta-mindfulness: Further Integration of Meta-mindfulness Concept and Strategies into Cognitive-Behavioral Therapy
Phang, C.-K., & Oei, T. P. S. (2012) · Mindfulness · doi:10.1007/s12671-011-0084-z · Cited by 30 · see citing works
“However, themeta-analysis by Blagys and Hilsenroth (2002) has nicely summarized the distinctive processes of CBT: (1) the use of homework outside therapy sessions, (2) the direction of session activities, (3) the teaching of skills for copingwith symptoms, (4) the focus on the client’s present and…”
Method
Affect-Focused Techniques in Psychodynamic Psychotherapy
Diener, M. J., & Hilsenroth, M. J. (2008) · Humana Press eBooks · doi:10.1007/978-1-59745-444-5_10 · Cited by 30 · see citing works
Relationship between Expectation Management and Client Retention in Online Cognitive Behavioural Therapy
Ekberg, S., Barnes, R., Kessler, D. S., Mirza, S., Montgomery, A. A., Malpass, A., & Shaw, A. R. G. (2014) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465814000241 · Cited by 29 · see citing works
“Socialization into CBT can be achieved using techniques such as orienting clients to the structure of the session (Persons, 2001) and agenda-setting (Blagys and Hilsenrot, 2002).”
Method
Comparison of therapeutic action, style and content in cognitive–behavioural and psychodynamic group therapy under clinically representative conditions
Watzke, B., Rüddel, H., Koch, U., Rudolph, M., & Schulz, H. (2008) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.595 · Cited by 29 · see citing works
“…number of studies have analysed core process parameters and their ability to aid in differentiation between CBT and PDT (e.g., Getter, Litt, Kadden, & Cooney, 1992; Goldfried, Castonguay, Hayes, Drozd, & Shapiro, 1997; Jones & Pulos, 1993; for reviews, see Blagys & Hilsenroth, 2000, 2002).”
Background
The Adolescent Psychotherapy Q-Set (APQ): A Validation Study
Calderón, A., Schneider, C., Target, M., & Midgley, N. (2017) · Journal of Infant Child and Adolescent Psychotherapy · doi:10.1080/15289168.2016.1255499 · Cited by 29 · see citing works
“It was developed by Hilsenroth et al. (2005) based on two empirical reviews of the comparative psychotherapy process literature in adults (Blagys & Hilsenroth, 2000, 2002).”
Method
The Poetics of Therapeutic Practice: Motivational Interviewing and the Powers of Pause
Carr, E. S., & Smith, Y. (2013) · Culture Medicine and Psychiatry · doi:10.1007/s11013-013-9352-9 · Cited by 28 · see citing works
Game Design in Mental Health Care: Case Study–Based Framework for Integrating Game Design Into Therapeutic Content
Siriaraya, P., Visch, V., Boffo, M., Spijkerman, R., Wiers, R. W. H. J., Korrelboom, K., Hendriks, V. M., Salemink, E., van Dooren, M. M. M., Bas, M., et al. (2021) · JMIR Serious Games · doi:10.2196/27953 · Cited by 28 · see citing works
“For example, in a therapeutic activity, clients are generally presented with a list of tasks with different content (referred to as content samples) that they would need to resolve to achieve success in the therapy (eg, in the form of homework and out-of-session activities, which are common tasks in psychotherapy and…”
Background
Interaction among Alliance, Psychodynamic–Interpersonal and Cognitive–Behavioural Techniques in the Prediction of Post‐session Change
Owen, J. J., Hilsenroth, M. J., & Rodolfa, E. R. (2012) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.1792 · Cited by 28 · see citing works
A training outline for conducting psychotherapy process ratings: An example using therapist technique
Stein, M. B., Pesale, F. P., Slavin‐Mulford, J. M., & Hilsenroth, M. J. (2009) · Counselling and Psychotherapy Research · doi:10.1080/14733140903229457 · Cited by 27 · see citing works
Early therapy interpersonal process differentiating clients high and low in outcome expectations
Ahmed, M. S., Westra, H. A., & Constantino, M. J. (2012) · Psychotherapy Research · doi:10.1080/10503307.2012.724538 · Cited by 27 · see citing works
“This may be particularly relevant within CBT, which is typically more directive than other therapies (i.e., encourages therapist control; Blagys & Hilsenroth, 2002).”
Background
Determining What is Common: A Theoretical Account of Common Factors in Psychotherapy through the Lens of Self-Determination Theory
Baier‐Mosch, F., Weiher, G. M., & Kananian, S. (2025) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-025-09664-y · Cited by 26 · see citing works
Similarities and differences between practitioners of psychotherapy in Sweden: A comparison of attitudes between psychodynamic, cognitive, cognitive–behavioral, and integrative therapists.
Larsson, B., Kaldo, V., & Broberg, A. (2009) · Journal of Psychotherapy Integration · doi:10.1037/a0015446 · Cited by 38 · see citing works
Therapists’ techniques in the treatment of adolescent depression.
Midgley, N., Reynolds, S. A., Kelvin, R. G., Loades, M. E., Calderón, A., Martin, P., & O’Keeffe, S. (2018) · Journal of Psychotherapy Integration · doi:10.1037/int0000119 · Cited by 26 · see citing works
“For instance, two review papers found seven distinctive features of short-term psychodynamic psychotherapy (STPP; Blagys & Hilsenroth, 2000) and six distinctive features of cognitive-behavioural therapy (CBT; Blagys & Hilsenroth, 2002).”
Finding Psychodynamic Psychiatry's Lost Generation
Plakun, E. M. (2006) · Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry · doi:10.1521/jaap.2006.34.1.135 · Cited by 26 · see citing works
Successful psychotherapies with young adults: an explorative study of the participants' view
Palmstierna, V., & Werbart, A. (2013) · Psychoanalytic Psychotherapy · doi:10.1080/02668734.2012.760477 · Cited by 26 · see citing works
“Blagys and Hilsenroth (2002) found seven features reliably distinguishing psychodynamic therapy from other therapies: focus on affect and expression of emotion, exploration of attempts to avoid distressing thoughts and feelings, identification of recurring themes and patterns, discussion of past…”
Background
Changes in Object Relations over the Course of Psychodynamic Psychotherapy.
Mullin, A. S. J., Hilsenroth, M., Gold, J. R., & Farber, B. A. (2017) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.2021 · Cited by 24 · see citing works
Therapists’ and clients’ perception of each other and working alliance in the behavioral treatment of panic disorder and agoraphobia
Ramnerö, J., & Öst, L. (2007) · Psychotherapy Research · doi:10.1080/10503300600650852 · Cited by 24 · see citing works
“This might sound like an odd finding because directivity has been considered a key feature of cognitive and behavioral therapies (Blagys & Hilsenroth, 2002), but directivity was defined here from a client-centered perspective in the instrument used (i.e., as a negative characteristic of therapists).”
Background
Understanding Borderline Personality Disorder Across Sociocultural Groups: Findings, Issues, and Future Directions
Neacsiu, A. D., Eberle, J. W., Keng, S., Fang, C. M., & Rosenthal, M. Z. (2017) · Current Psychiatry Reviews · doi:10.2174/1573400513666170612122034 · Cited by 25 · see citing works
The Effects of Therapist Competence in Assigning Homework in Cognitive Therapy With Cluster C Personality Disorders: Results From a Randomized Controlled Trial
Ryum, T., Stiles, T. C., Svartberg, M., & McCullough, L. (2010) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2009.10.005 · Cited by 22 · see citing works
Mentalization and play therapy processes between two therapists and a child with Asperger’s disorder.
Goodman, G., Reed, P., & Athey-Lloyd, L. (2015) · International Journal of Play Therapy · doi:10.1037/a0038660 · Cited by 22 · see citing works
Cognitive Behavioral Therapy for Attention-Deficit/Hyperactivity Disorder in College Students: A Review of the Literature
He, J. A., & Antshel, K. M. (2016) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2016.03.010 · Cited by 22 · see citing works
Cognitive Behavioral and Psychodynamic Therapies: Points of Intersection and Divergence
Pilecki, B. C., Thoma, N. C., & McKay, D. (2015) · Psychodynamic Psychiatry · doi:10.1521/pdps.2015.43.3.463 · Cited by 20 · see citing works
“…exercises is another key difference between CBT and psychodynamic approaches. the uSe oF homeWork The use of homework assignments has become one of the most wellknown features that distinguishes cognitive behavioral therapies with psychodynamic forms of therapy (Blagys & Hilsenroth, 2002).”
Longer term outcome of cognitive-behavioural and psychodynamic psychotherapy in routine mental health care: Randomised controlled trial
Watzke, B., Rüddel, H., Jürgensen, R., Koch, U., Kriston, L., Grothgar, B., & Schulz, H. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.04.005 · Cited by 20 · see citing works
Psychodynamic Techniques Related to Outcome for Anxiety Disorder Patients at Different Points in Treatment
Pitman, S. R., Slavin‐Mulford, J. M., & Hilsenroth, M. J. (2014) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000137 · Cited by 20 · see citing works
“The scale is based upon the findings of two reviews of the empirical comparative psychotherapy process literature (Blagys and Hilsenroth, 2000, 2002), which identified significant differences between the techniques used in psychodynamicinterpersonal (defined broadly to include psychodynamic,…”
BackgroundMethod
Psychoeducational intervention for people at high risk of developing another melanoma: a pilot randomised controlled trial
Dieng, M., Kasparian, N. A., Mireskandari, S., Butow, P. N., Costa, D. S. J., Morton, R. L., Mann, G. J., Menzies, S. W., & Cust, A. E. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-015195 · Cited by 19 · see citing works
The Melanoma care study: protocol of a randomised controlled trial of a psycho-educational intervention for melanoma survivors at high risk of developing new primary disease
Dieng, M., Kasparian, N. A., Morton, R. L., Mann, G. J., Butow, P. N., Menzies, S. W., Costa, D. S. J., & Cust, A. E. (2015) · BMC Psychology · doi:10.1186/s40359-015-0074-3 · Cited by 19 · see citing works
“…the telephone-based sessions have been developed in accordance with the latest evidence in melanoma and psycho-oncology research, (McLoone et al. 2013a) as well as core principles of brief psychodynamically-oriented psychotherapy (Abbass et al. 2009; Blagys & Hilsenroth 2002; Shedler 2010).”
Method
Therapist and client processes affecting assimilation and outcome in brief psychotherapy
Rudkin, A., Llewelyn, S. P., Hardy, G. E., Stiles, W. B., & Barkham, M. (2007) · Psychotherapy Research · doi:10.1080/10503300701216298 · Cited by 19 · see citing works
“(For full reviews of comparative process studies identifying differences across approaches, see Blagys & Hilsenroth, 2000, 2002.)”
Background
Teaching Psychodynamic Psychotherapy with the Y Model
Goldberg, D. A., & Plakun, E. M. (2013) · Psychodynamic Psychiatry · doi:10.1521/pdps.2013.41.1.111 · Cited by 19 · see citing works
Évaluation des effets des psychothérapies
Thurin, J.-M. (2018) · EMC - Psychiatrie · doi:10.1016/s0246-1072(09)51470-8 · Cited by 10 · see citing works
“Cette possibilité a été ouverte par le travail de définition des ingrédients spécifiques de ces approches par Blagys et Hilsenroth [79, 80], chez l’adulte pour les thérapies psychodynamiques et cognitivocomportementales, Kramer, De Roten et Despland [81] pour les thérapies systémiques, McLeod et Weisz [82] pour les ps…”
Background
Patient early session experience and treatment outcome
Pesale, F. P., Hilsenroth, M. J., & Owen, J. J. (2012) · Psychotherapy Research · doi:10.1080/10503307.2012.662607 · Cited by 19 · see citing works
“Furthermore, all sessions were rated by independent raters using the Comparative Psychotherapy Process Scale (CPPS: Blagys & Hilsenroth, 2000, 2002) to assess treatment adherence.”
Method
Outcomes from eye movement desensitization and reprocessing in active-duty service members with posttraumatic stress disorder.
McLay, R. N., Webb-Murphy, J. A., Fesperman, S. F., Delaney, E. M., Gerard, S. K., Roesch, S. C., Nebeker, B. J., Pandzic, I., Vishnyak, E. A., & Johnston, S. L. (2016) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000120 · Cited by 17 · see citing works
Measuring psychotherapy process with the Adolescent Psychotherapy Q-set (APQ): Development and applications for training.
Bambery, M., Porcerelli, J. H., & Ablon, J. S. (2007) · Psychotherapy · doi:10.1037/0033-3204.44.4.405 · Cited by 17 · see citing works
Experience of affects predicting sense of self and others in short-term dynamic and cognitive therapy.
Berggraf, L., Ulvenes, P., Øktedalen, T., Hoffart, A., Stiles, T. C., McCullough, L., & Wampold, B. E. (2014) · Psychotherapy · doi:10.1037/a0036581 · Cited by 17 · see citing works

Distinctive Features of Short-Term Psychodynamic-Interpersonal Psychotherapy: A Review of the Comparative Psychotherapy Process Literature
Blagys, M. D., & Hilsenroth, M. J. (2000) · Clinical Psychology Science and Practice · doi:10.1093/clipsy.7.2.167 · Cited by 355 · see citing works
Comparing the process in psychodynamic and cognitive-behavioral therapies.
Jones, E. E., & Pulos, S. M. (1993) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.61.2.306 · Cited by 301 · see citing works
A comparative analysis of the therapeutic focus in cognitive–behavioral and psychodynamic–interpersonal sessions.
Goldfried, M. R., Castonguay, L. G., Hayes, A. M., Drozd, J. F., & Shapiro, D. A. (1997) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.65.5.740 · Cited by 44 · see citing works
Zur theoretischen und empirischen Unterschiedlichkeit von therapeutischen Interventionen, Inhalten und Stilen in psychoanalytisch und verhaltenstherapeutisch begründeten Psychotherapien
Watzke, B., Koch, U., & Schulz, H. (2006) · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie · doi:10.1055/s-2006-932576 · Cited by 11 · see citing works
Comparison of therapeutic action, style and content in cognitive–behavioural and psychodynamic group therapy under clinically representative conditions
Watzke, B., Rüddel, H., Koch, U., Rudolph, M., & Schulz, H. (2008) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.595 · Cited by 29 · see citing works

Authors: Blagys, M. D., & Hilsenroth, M. J.
Affiliations: Harvard University (US)
Adelphi University (US)
Corresponding author: Blagys, Matthew D.
ORCID: Hilsenroth, Mark J.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2002-06
Volume: 22
Issue: 5
Pages: 671-706
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/s0272-7358(01)00117-9
OpenAlex: W1794000606
Cited by: 222
References: 81
Citations by year: 2026: 4 · 2025: 5 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 8 · 2019: 5 · 2018: 12 · 2017: 10 · 2016: 17 · 2015: 15 · 2014: 11 · 2013: 17 · 2012: 17
FWCI: 4.85
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
Keywords: cognitive behavioral therapy, therapeutic process, psychodynamic-interpersonal therapy, homework, skills training, cognitive focus, therapist adherence, therapist competence, psychotherapy training
MeSH terms: Adaptation, Psychological, Humans, Outcome and Process Assessment, Health Care, Personality Inventory, Professional-Patient Relations, Cognitive Behavioral Therapy, Critical Pathways

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Distinctive activities of cognitive–behavioral therapy

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