1. Abstract The research reports the development of a behavioral satisfaction questionnaire (BSQ) for the use in cognitive-behavioral therapies (CBTs). It is purposed for semi-structured psychoanalytic interviews, but can also be used for self-report. The design of BSQ seeks to organize a referential scale with a psychodynamic perspective, in order to bridge the gaps among neurological / psychiatric therapies, psychological therapy, and patient / visitor autonomy. The psychometric evaluations are dissected into different dimensions in the questionnaire design, with a paradigmatic conceptual framework. The test trial has demonstrated high affinity with other major psychometric methods.
2. Keywords: Cognitive-behavioral therapy; psychoanalysis; psychometry; social behaviors; social cognition; semi-structured interview; somatic psychology
3. Introduction Psychological science and sociology are deeply interlaced. In CognitiveBehavioral Therapy (CBT), the focus is often implicitly on social behaviors, and diagnosis relies heavily on social determinants (Short & Mollborn, 2015). Recent developments have borrowed paradigmatic concepts in neurology (psychiatry) and genetics (epigenetics) to overcome the phenomenological limitations (Meyer et al., 2021). Pure biomedical perspectives, however, do not emphasize on the significant elements of personal behaviors such as autonomy and free will, albeit they offer better physiological solutions to the limitations thereof. For example, the neurophysiological explanations on the behavioral tendencies of persons with autism spectrum disorder (ASD) provides a better explanation on their social reactive behavioral tendencies than the classical descriptions (Marco et al., 2011), and genetic determinants have been evidenced on the population diversity (Parellada et al., 2020), i.e. neurodiversity. Pragmatically in clinical settings, post-traumatic injuries mostly prioritize medical conditions without treating psychological symptoms or collecting psychological evidence. The treatment of medical conditions and psychological symptoms can sometimes be interlaced. The HypothalamicPituitary-Adrenal (HPA) axis involves both immunological responses and psychological & psychiatric parameters (Spencer & Deak, 2017). Psychological and psychiatric regulations have an implication to hormonal adjustments in the healing and recovery process, and the U.S. military has researched on the Gateway Process since the 1980s (McDonnell, 1983). The Behavioral Satisfaction Questionnaire (BSQ) is conceptualized after the NCT05711810 trial and during the NCT05839236 trial, with the autism spectrum disorder (ASD) case’s recovery process from autoimmune pathogen. The BSQ is conceptualized for psychoanalysis with semistructured interviews on assessment, evaluation, and treatment with CBT, in concordance with pharmacological treatments. The two facets are bridged by psychodynamics. Figure 1 illustrates the psychodynamic framework behind the BSQ design, corresponding to the HPA axis.
4. Methods With the paradigmatic approach, the BSQ is dissected into two axes: the X axis assesses responses in social situations, and the Y axis assesses the internal dispositions and vulnerabilities. The axial plane not only can be read according to Figure 1’s frontal plane, but also as a psychodynamic metrification on the defense mechanisms. It is best to be used in semistructured CBT interviews. An etiological consideration has motivated the methodological design. Not only is there a neuronal correlation to human behaviors, such as the sensory processing differences in persons with ASD (Marco et al., 2011), but also complex psychological symptoms can exist in one single case, confounding the priorities in CBT treatment. The clinical purpose of the BSQ design is to assist the initial diagnostic process for etiological inference and treatment agenda setting.
4.1. The Behavioral Satisfaction Questionnaire The BSQ guides the patient / visitor from circumstantial behaviors to emotions. Significant parts of the questions may seem repetitive, while the score designs may expand the implications of the familiar circumstances to the schema seen in Figure 1. The Social Situations section with 15 questions constitutes the X axis scores, ranging from -150 to +140; the Inherent Dispositions and Inherent Vulnerabilities sections with 10 questions each constitute the Y axis scores, ranging from -200 to +195. Answers on each question may not need to be confined to singular choices. Some questions’ scoring is designed to be additive, while the others’ can be assigned with weighs to allocate the ratios in each question. Elaboration of scoring method will be provided in the second subsection.
4.1.1. Social Situations According to your own circumstances, please answer the following questions with the past experiences you have; if one or more applies to you, please order them by frequency:
1.Typically, I am: • Welcoming and open to strangers; • Discrete towards strangers; • Hostile or distrust to strangers; • Insensitive to strangers; • Courteous to strangers; • Have negative feelings towards strangers; • Fearing strangers may have negative feelings towards me; • Try to ignore strangers; • Try to keep away from strangers.
2.In a social setting, I often: • Easily recognize or remember persons by their faces and names; • May recognize or remember some persons who try to draw attention in a crowd; • May recognize or remember some persons that I’m interested in; • Can remember people I knew but limited in recognizing new people; • Can remember people I knew and have a hard time recognizing new people; • May not remember all the people, but can recognize persons by introductions; • May not remember all the people, and have a hard time recognize new people; • May not remember all the people, and confused about who they are when they meet me; • Do not remember any people at all.
3.In a social setting, I typically: • Pretend to be someone else for specific purposes; • Just be myself regardless of the occasions; • Cater to other people according to how I am perceived; • Completely lost about who I am; • Enjoy myself and don’t care about other people.
4.When I meet someone new in public, I often: • Actively come forth and greet; • Only greet with who comes to me; • Try to avoid eye contact with people I don’t know; • Run away from any people I don’t know coming towards me; • Only greet by introduction with someone I know; • Feel being intruded.
5.When I meet someone new in small gatherings, I often: • Actively come forth and greet; • Only greet with who comes to me; • Try to avoid eye contact with people I don’t know; • Run away from any people I don’t know coming towards me; • Only greet by introduction with someone I know; • Feel being intruded.
6.When I meet someone new online, I often: • Pretend to be someone else for specific purposes; • Just be myself and see; • Cater to other people according to how I am perceived; • Waiting for someone to greet me; • Feel being intruded.
7.Usually, I:Have specific preferences on people’s certain characteristics; • Have specific dislikes on people’s certain characteristics; • Have both specific preferences and dislikes; • No certain patterns; • Don’t like other people.
8.When there is somebody I’m fond of, I usually: • Directly talk to that person; • Find someone to introduce me to that person; • Try to draw that person’s attention to me; • Avoid direct contact with that person; • Keep it to myself and don’t get influenced; • Keep it to myself but feel bothered.
9.Usually, I have: • Many different friends at the same time; • Only the friends I know since childhood; • Only a few friends in specific periods of my life; • No friends at all.
10.What I value in friendship: • Have specific social values to me; • Being kind and looks after me; • I can look after; • Have specific traits or talents; • Follows my lead; • Knows me well with little effort for communication; • Do things for me as I ask; • Don’t have any special preferences; • I don’t want any friends.
11.If I don’t like a person, I: • Directly tell the person; • Tell other people except for that person; • Try to avoid meeting that person; • Secretly sabotage on that person; • Confront that person either verbally or physically; • Keep it to myself without hard feelings; • Keep it to myself but still bothers me; • Don’t have any person I dislike.
12.To my friends, I think I am: • Usually leader in a group; • The devoted follower; • The peace-maker; • The listener; • The invisible person; • The one who always have something to say or express; • The organizer or planner; • The one who everybody dislikes but still in the group; • The most adorable one with everyone’s attention.
13.I usually get comments from my friends that I: • Am too clingy; • Don’t listen to them; • Am too self-centered; • Am a people-pleaser; • Am caring, kind, and / or responsible; • Am eccentric; • Sometimes make them feel afraid; • Don’t care about them / am distant; • Am unpredictable; • Feel like a parent; • Feel like a child; • Clever / intelligent; • Stupid / moron; • Stubborn / inflexible; • They never tell me how they think about me.
14.In schools or work places, I often: • Get elected in leadership positions; • Being assigned to leadership positions by people in authority; • Follow the leaders and rules without questions; • Rebel against the leaders and / or rules for no reason; • Rebel against the leaders and / or rules whenever I see them unfit; • Follow the leaders and rules even when I feel them not adequate / wrong; • Don’t draw much attention and do my own work; • Do my own work while make collaborations; • Seek approval by the leadership / authorities; • Seek approval from my peers; • Trick other people because it makes me happy; • Trick other people because I think it’s good for them; • Try to do good whether or not I am in the leadership position; • Try to compete with my peers.
15.In the formal settings, I often: • Try to fit in the formalities / customs / procedures; • Try to make connections and seek favors; • Try to understand the whys, hows, and whats; • Get completely lost; • Deliberately go against the formalities; • Don’t like the formal settings but quietly follow to avoid troubles; • Don’t like the formal settings but quietly follow to satisfy others.
4.1.2. Inherent Dispositions Reflecting on the social circumstances, why do you think you behaved in certain ways? Please answer the following questions according to your innermost feelings; if one or more applies to you, please order them by your gut feelings with descending order from what makes you most to least comfortable:16.What pleases my mind the most is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Doing as told.
17.What makes me feel energetic is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Doing as told.
18.What makes me feel hesitant about is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Doing as told.
19.What makes me feel challenging is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Doing as told.
20.What makes me feel powerful is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Doing as told.
21.What makes me feel weak is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Doing as told.
22.What makes me feel rewarding is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Being able to do what are told to.
23.What makes me feel devotional is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Being able to do what are told to.
24.What makes me feel triumphant is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Being able to do what are told to.
25.What makes me feel invincible is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Being able to do what are told to. 4.1.3. Inherent Vulnerabilities Reflecting on the social circumstances, why do you think you behaved in certain ways? Please answer the following questions according to your innermost feelings; if one or more applies to you, please order them by your gut feelings with descending order from what makes you most to least uncomfortable:
26.What usually comes before my feeling of excitement: • Anger; • Impulsion; • Inspiration; • Fear / dread; • Happiness / joy; • Hope; • Relief; • Ambition; • Malice / vengeance; • Trust; • Eagerness; • Curiosity; • Fulfillment; • Drained; • Calmness.
27.What makes me feel afraid is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Being taken control of.
28.What makes me feel vulnerable is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Being taken control of.
29.What makes me feel defeated is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Being taken control of.
30.What makes me feel lonely is: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Being taken control of.
31.I would definitely take revenge if the following is sabotaged: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Personal freedom.
32.Sometime I sabotage the following myself: • Sports with competitive and cooperative elements; • Sports that focus on myself, such as gym; • Family love and being taken care of; • Family love and taking care of them; • Friends doing interesting things together; • The beauty and comfort of natural environment; • The convenience of cities with a place for myself; • Sexual attractions; • The diversity of culture and arts; • Knowledge about nature and mysteries behind them; • Knowing more about myself and others with questions of what is human; • Helping others; • Taking control on the environment and things around me; • Taking control on the people around me; • Being taken control of.
33.Usually, I am more: • Forgiving; • Vengeful; • Grudge-holding; • Forgetful; • Demanding of people; • Hostile against what I don’t like about; • Tolerant; • Ignorant; • Over-protective; • Open.
34.Towards myself, I am more: • Forgiving; • Vengeful; • Grudge-holding; • Forgetful; • Demanding of myself; • Hostile against what I don’t like about myself; • Tolerant; • Ignorant; • Self-protective; • Open.
35.I feel like: • Others don’t know me well enough; • Others know too much about me; • I don’t know too much about others; • I know too much about others; • I want others to know more about me; • I don’t want others to know too much about me; • I want others to know something together that is not about us; • I want to hide in places others don’t see me; • I want to be in the spotlight and be loved; • I want everybody being loved equally; • I want others to feel loved; • I want to feel that I am loved.
4.2. Scoring Design Each question scores from -10 to +10. Table 1 summarizes each choice’s score with additional notes on each question’s purpose. The categorization of social cognition and active and reactive social behavior can be further cross-referenced with inherent dispositions and vulnerabilities. The scoring schema is based on normal reference, and questions 15, 29, and 31 are specifically designed for sociopathy risk screening, with questions 29 and 31 focused on defense-mechanism produced reactive behaviors. The latter two are not marked as sociopathy screening because on legal basis it constitutes as defense-based judgments, albeit high levels of aggression in defense mechanisms can trigger overdefensive behaviors or risk of undue influences.
5. Result Prima facie evaluations on the BSQ’s psychometric functions have been conducted with a case of complexity and overlapping symptoms. Combined with psychoanalysis, there is a high affinity of the BSQ with Personality Belief Questionnaire (PBQ), concerning social cognition and inherent vulnerabilities. The Defeat Scale (D-Scale) is further used to assess the sociopathy screening validities, and its cross-reference with PBQ suggests the same analysis. Dissociative Experiences Scale - II (DES-II) has been used to reference discrepancies between social cognition and active and reactive social behavior. The readings are supplementary to each other with phenomenological affinities. Rosenberg Self-Esteem Scale is used to compared inherent dispositions and vulnerabilities categories’ scores’ implications, and it is considered supplementary with assessments on aggression. Since the BSQ is designed from a somatic psychological inference perspective, Hamilton Anxiety Rating Scale (HAM-A) and Young Schema Questionnaire L3 (YSQ-L3) have been used to assess the limitations. The BSQ’s overall score on the Figure 1 reference plane shows high affinity with HAM-A and YSQ-L3, which eliminates subjective bias in the BSQ design.
6. Conclusions The BSQ design is valid in overall assessments on complicated psychological case. It does not replace the specialized testing methods, but the inherent vulnerabilities section is indicative to pharmacological judgements. From the reverse order of the question designs, the BSQ has a guidance value in tailoring autonomous resilience strategy from a psychodynamic perspective. Between belief and social cognition, and between inherent dispositions and active and reactive social behavior, a patient/visitor-autonomy-centered CBT agenda can hence be put forth from a clinician’s perspective.
7. Acknowledgments Yang I. Pachankis thanks Christopher Bayes for his clowning lessons that inspired the questionnaire design, after several times’ deep explorations of somatic dynamics.
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Yang I. Pachankis. Development of a Behavioral Satisfaction Questionnaire for CBT Psychoanalysis. Annals of Clinical and Medical Case Reports 2023