Defining high-quality bridging elements in cognitive behavior therapy - a way to support their implementation in patient’s daily lives after psychotherapy daily lives after psychotherapy

The post-treatment continuation of effective elements, strategies, techniques and behaviors acquired in cognitive behavioral therapy (CBT) represents a key element of relapse prevention. Research indicates that the quality rather than the quantity of these elements predict therapeutic outcomes in CBT. However, it remains unclear which factors facilitate the post-treatment implementation and continuation of individually helpful elements. This study investigated whether the quality of "bridging elements" predicts their implementation in the post-treatment phase. Bridging elements were defined as any element of previous therapy that a patient has experienced as helpful and that helps maintain treatment effects from the patient's perspective after treatment termination. Criteria were derived from the literature to rate the quality of patients' open-ended descriptions of their bridging-elements. A prospective longitudinal observational study was conducted with 120 inpatients who had been previously treated with CBT. Multiple linear regression analyses showed that a quality score composed of four quality criteria significantly predicted implementation of bridging elements even after controlling for motivational factors, while none of the single quality criteria alone was predictive at four-month follow-up. Prior to treatment termination individually helpful bridging elements should be identified to foster enduring change. Specific attention should be paid to defining high-quality bridging skills, which should be specific, time-limited, independent from others, action-oriented, measurable, and frequently applicable.