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Research | DOI: https://doi.org/10.31579/2768-0487/197
*Corresponding Author: Luísa Soares., Universidade da Madeira, Portuga.
Citation: Carla Vale Lucas, Luísa Soares, (2025), A Clinical Case of Epilepsy, Journal of Clinical and Laboratory Research, 8(6); DOI:10.31579/2768-0487/197
Copyright: © 2025, Luísa Soares. This is an open access article distributed under the creative commons’ attribution license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 01 December 2025 | Accepted: 15 December 2025 | Published: 29 December 2025
Keywords: attachment; cognitive narrative therapy; meaning, experience
In this paper, we share a clinical case study of an adult with epilepsy, who has developed an insecure/ambivalent attachment pattern. Literature analysis indicate that attachment relationship experienced in childhood tends to expand into adulthood. The practical approach used in this case was based on cognitive narrative therapy, which the main goal is the (re)signification of experience and the construction of multiple meanings, promoting understanding of the personal role and impact of the experience for the Self. Cognitive narrative therapy can empower clients into understanding experiences and overcome relational difficulties that were inhibiting new experiences in a positive way. It was found that the client gradually began to be able to construct different narratives around her emotional experience in many aspects of her personal and emotional life, trying to build a progressively more organized narrative and filled with meanings.
Family is the first source of knowledge that the individual has in the world. The way people relate and interact with each other will help the child build an internal representation about herself and others. It is from the moment of birth that the individual initiates the development of attachment patterns with the attachment figures. Caregivers or parents are usually those who serve as attachment models for the child. When models do not adequately respond to the child needs, they do not facilitate the development of a trust relationship (or a secure attachment system) and, as a result, the child may develop some pattern of dysfunctional attachment, such as insecure ambivalent, anxious or avoidant coping styles. Without a secure attachment, i.e., when the child does not feel loved or capable of being loved, when her needs are not recognized or met by the caregiver, when she doesn’t use the attachment figures (father / mother) as a secure base, in order to proceed with the exploration of the environment, she could develop an anxious or ambivalent attachment pattern. Once felt the lack of response to her needs, the child blocks, or excessively activates, biological protection responses, making her more exposed to risks of diseases or psychological disorders. Stress and anxiety have been related to attachment patterns developed in childhood resulting, for the adulthood, in experiencing difficulties in future relationships, as they may develop an excessive anxiety, severe pursuit of social support and affection, or excessive fear of rejection. Liotti (1991, cited by Abreu, 2005) reported that affective bonds formed in childhood could extend to romantic relationships and even attitudes towards work. Simões (2007) developed a study about the theoretical evidences on the relationship between attachment and narratives. It was found that the use of cognitive narrative therapy can be an effective intervention strategy, since the sharing and elaboration of personal experiences works not only as a way of giving meaning to the experience itself but also as a way of creating and strengthening social and emotional bonds. In this paper we take a brief tour through the fields of the theoretical attachment framework and its impact in adult relationships. The case study is about a woman, in her thirties, who seems to develop an insecure/ambivalent attachment pattern, showing difficulties in creating and maintaining healthy relationships, especially romantic ones. She considers herself as being neglected in her childhood, and nowadays easily feels abandoned, thus this could be one of the reasons why she feels insecure in her adult relationships. This paper also aims to discuss the benefits of the use of cognitive narrative therapy in similar cases, when clients describe experiences as a chaotic trait. Psychotherapy intends to help the patient to reorganize his own narratives in a structured sequence and, in a long term, facilitate the construction of brand new and well-structured narratives.
Attachment – impact in adulthood
Mallinckrodt (2000) states that the perception of low parental support can lead to insecure attachment, which may result in some difficulties in social interaction, less ability to seek and establish friendships and difficulties in solving interpersonal conflicts. Other authors, such as Kanning (2006) suggests that an alienated relationship with parents does not create conditions to the development of interpersonal skills of young people and, consequently, these difficulties affect attachment in romantic relationships. A study by Assunção (2009) revealed that the better the quality of bonds created with both parents and youths, less is the dependency in youth romantic relationships. The study of attachment theory had large contributions from authors such as Mary Ainsworth (1969) and Bowlby (1988). The original model of Mary Ainsworth and colleagues point out some attachment styles or patterns that individuals begin to form in childhood, and these patterns can be secure or insecure. Within the insecure pattern there is the "avoidant" style and "anxious/ambivalent" style. These patterns seem to emerge in insecure contexts of social interaction and the child’s attachment behavior is followed by rejection or inconsistency from the attachment figure (i.e. parents or other caregivers). According to the attachment theory, these situations of inconsistency or rejection may result in some strategic child’s responses of hypo or hyper activation of the attachment system (Canavarro, Dias, & Lima, 2006). Bowlby (1988) proposed that children develop a set of expectations about themselves, about others and the world around them, what they called representational models or internal working models. These internal models or representations allow the child to predict and interpret the behavior of the attachment figure and would be used throughout life as an interpretative basis of her relational experiences (Canavarro, Dias, & Lima, 2006). These cognitive representations of the main attachment figure (parent), or relational schemas, shape the expectations of the adult in relation to subsequent relationships with peers and also to romantic relationships, guiding his behavioral responses towards a real or imagined separation of his new attachment figures (Pearson, 2006). When the individual spends his early life, in a family that shows low affection, with weak emotional resources, he or she could develop a poor perception of his ability to build and maintain personal relationships, thinking the problem is on them and the lack of ability to receive affection or even in weak "attractiveness". Hazen and Shaver (1994) also argue about a relation between the bonds that adults create in intimate relationships with those established with early attachment figures. As mentioned early, an insecure relationship towards caregivers may extend into adulthood, leading to insecure patterns in romantic relationships, which may result in constant search for affection and dissatisfaction about the emotional response from others. Moreover, this uncertainty may result in some adult emotional dependency, hesitant and ineffective behaviors in later relationships.
Narrative and Attachment
Simões (2007) refers to authors like Fivush and Vasudeva (2002), Nelson (1993) or Pillemer (1998), who propose that the function of remembering and sharing personal experiences with others is useful not only for searching the meaning of existence but also for the creation and strengthening of social and emotional bonds. Moreover, they propose that it is through the (co-)narrating past experiences, i.e. constructing a story with others, that we organize our knowledge and give a sense of temporal and personal coherence on the Self and the world. Simões (2007) also points out that other authors have conducted studies with dyads of children and parents, in order to investigate the attachment and narrative (such as Bowlby, 1988; Bretherton, 1985, 1990, 1999, Thompson, 2000), suggesting that there are associations between secure attachment and communication skills (either with attachment figures, or with others). Bowlby (1988) argues that one of the biggest aspects he found is that children with insecure attachment tend to exhibit difficulties in communication, emphasizing the concept of defensive exclusion, when too painful subjects for the child are erased from her consciousness and therefore not processed or not included in the narrative. Bretherton (1990) also believes that secure attachment is associated with a style of flowing and emotionally open communication, in which child can express a variety of emotions, thoughts and needs, both in the context of the attachment relationship, or in the speech about this relationship.
A study developed by Flores (1993) showed that children who lived in a chaotic environment were unable to describe events or narratives in a temporal structure, compared with other children with the same age. According to these studies, it is in the relationship with parents (or the main attachment figure) that children begin to construct a conjoint narrative, organizing experiences and meanings in their life.
Narrative cognitive therapy – the influence of constructivism
The human being has been considered, by several theoretical frameworks, as a meaning creator. In this sense, the construction and development identity will depend on the interpretations and representations that he makes about reality and his own experience. In fact, humans are authentic storytellers, and this activity involves the maintenance and development of thought, which is essentially metaphorical and imaginative (Gonçalves, 1998). It is assumed that by the way the individual tells his own experience, it is possible to understand the multiple meanings that arise and the interpretations that he creates in each experienced situation. Cognitive narrative therapy is, in a few words, an updated version of cognitive therapy, being an approach that takes into consideration several cognitive domains. This approach considers the importance of taking into account the five senses to describe the experiences of life, as well as the description of feelings and thoughts and the use of metaphors to give those experiences a meaning (Soares, 2012). It gives language a special focus, in the therapeutic process, emphasizing the organization of discourse, the strategic use of words and concepts, which help describe the painful situation. A constructivist cognitive perspective, considers that when there is a psychological dysfunction, disturbance remains essentially in the Self. In the eminence of this dysfunction, when the individual is unable to understand the connections of the events of his past and his present life, or when there are critical aspects of the experiences that are not integrated into the narrative of his life, these personal narratives shatter and disintegrate (Neimeyer & Raskin, 2001). The main goal of using narrative cognitive therapy is, according to Óscar Gonçalves (2000, p.142), "to make the patient stop the vicious and apparently deterministic cycle of certain emotional and cognitive sets, leading him to the symbolization of a diverse number of internal experiences, to place them in a conversational and narrative context and, intentionally, build new modes of subjective experience." As mentioned above, the temporal organization of life events is jeopardized in people with attachment disorders, thus, it is a real challenge to think about and plan the future. As Mahoney (1998) said, an individual with insecure attachment pattern can only project for the future experiences that can be reminded in the present. So, he can only imagine receiving affection if he can also remember that same experience from his past.
Psychotherapy and attachment
Adult attachment is a concept that has been adopted in clinical psychology because of the growing number of studies that show a connection between insecure attachment patterns and psychological disorders (Daniel, 2006). One of the reasons that shapes the importance of working in attachment relationships in psychotherapy is that the client may reject or neglect his own suffering, i.e., he may use what Bowlby (1980) called defensive exclusion, putting back his attachment-related thoughts and feelings, which can make him more vulnerable to future psychological problems (Goodwin, 2003). It is known that internalizing the disturbance may constitute a risk factor for mental illness and influence subsequent relationships in a way that makes the individual more exposed and vulnerable to stress. Thus, an important aim of psychotherapy involves helping client to mourn his loss. This behavior of openness from client to therapist begins to shape itself as an attachment relationship, what we might call in psychotherapy the therapeutic alliance. Therapeutic alliance, according to Shaw, McMahon, Chan and Hannold (2004), is a collaboration process characterized by shared goals, tasks and attachment bonds, and is the best predictor of benefit in therapy (Platts, Tyson and Mason, 2002). Thus, the therapeutic relation, in psychotherapy, covers the basic human need of attachment, as well as the individual basic skill of learning through and inside a human relationship (Strupp, 1989). Bowlby (1988) considers that, in psychotherapy, the therapist assumes the role of an attachment figure, allowing the establishment of a trusting relationship and providing the client a secure base from which he can explore his internal working models, also giving him the opportunity to reformulate them in this relationship. In this sense, the therapist should constitute a secure base for the client to explore more painful aspects of his life, which he couldn’t be able to deal with, without someone who he truly believes and gives him support, encouragement and orientation. Bowlby also formulated (as Davila and Levy, 2006, refer) some essential keys for psychotherapy, like, as mentioned above, the establishment of a secure base; the exploration of past attachments, expectations, feelings and behaviors; exploration of therapeutic relationship and the analysis of how it may be related to other relationships; exploration of the connection of past and present experiences; looking over internal working models and help the client to feel, think and act in different ways from his past experiences. Simões (2007) emphasizes that these internal models can be updated, taking into account the new experience that the therapeutic relationship constitutes. The change will be possible through interpersonal communication, in which narratives may offer the possibility of (re)defining the attachment experiences.
Clinical case study
Anna is a single woman around thirty years old, working in a management position. She shows difficulties in maintaining relationships. Anna has been adopted when she was around 5 years old, by a family with other children. Nowadays, she lives away from her adopted family because of her work, and admits that she hasn’t had a sense of belonging to that family. Although they have adopted her and took care of her, the best way they could, they show very few emotional content, which makes Anna feel unworthy and unloved, saying that she wishes a real family and, most of all, a father figure. Anna admitted that she shows opposite behaviors towards people she loves, such as compulsive caregiving or rejection, depending on the way she comprehends other people’s actions or intentions towards herself. However, she thinks that she is more likely to move away from people that show some affection for her, not being able to receive that fondness. Anna searched for help, initially, because of problems with her boyfriend, who also lives distant from her. She states she has trust issues and argues a lot with her. After some critical periods in the relation, Anna and her boyfriend tried to revitalize the relationship but with no success, since both started to blame each other for the failure of their attempts at reconciliation. Anna shows insecurity in her decision making about relationships. Her past relationships were never well resolved, which can be related to her constant search, although not in a conscious way, for a father figure. Curiously, Anna says that she has few friends, because during her life course she lost some of them, as she moved around a lot, or maybe because they weren’t “friends enough”. She shows lack of confidence and ambivalent feelings towards others, thinking that she gives much more than she receives. These thoughts, feelings and behaviors, like inhibiting or hyper activating emotional expressions towards the attachment figure are typically presented in individuals with insecure ambivalent attachment patterns (Berlin & Cassidy, 1999). Anna tried to communicate with her biological family but it has resulted in more defrauded expectations, since her mother doesn’t want to maintain a connection with her. These constant losses and deceptions made her even more insecure, worry and suspicious of her relationships, although she always tries to be strong and avoid showing suffering and anger towards her life events. Anna asks for help in order to be happy and build a family, without being afraid of suffering or being abandoned again.
Symptomatology and diagnosis hypothesis
Anna seems to have developed depression symptoms, compulsive crying, isolation, panic attacks, showing sadness and no motivation on doing pleasure activities. Also, she shows difficulties in interpersonal relationships. After starting the therapy, Anna said that her panic attacks became different, since she had seizures and lost conscience. After going to the hospital, Anna said that doctors suspect from epilepsy, although the exams are still not conclusive. In relation to her depressive symptoms, it is not possible to diagnose for mood disorders, since symptoms doesn’t seem to be clinically significant, mostly because of the duration of the events, which doesn’t correspond to the criteria for mood disorder. Also, her panic attacks doesn’t seem to correspond to anxiety disorder, because of the intensity and duration of the events. Anna says that her panic attacks don’t occur frequently and are often developed after a critical period (e.g. anger, fear, discussion). Considering the symptomatology it is important to note that, hypothetically, her symptoms (crying, isolation, panic attacks) may be a response to an attachment disorder, more specifically, because of her insecure/ambivalent attachment. Anna shows typical characteristics of a person who have developed an insecure attachment pattern, more specifically with an ambivalent style, such as the feeling of not being good enough, the constant looking for affection, the feeling of being neglected or rejected when attachment figure is not completely present or available, easily forming unrealistic expectations, excessive preoccupation and suspicious towards partner, compulsive caregiving and so on. Investigations in the twenty century, about childhood and adult attachment, suggested that, in Western society, around one third of adults have relationships characterized by anxious and insecure attachment (Holmes, 1993). Other interesting aspect in Anna’s case is the emergence of the epileptic seizures. We may hypothesize that this recent condition may be a symptom, related to the difficulty on talking about and bringing around her past traumas. Recently, a few studies have found a condition in which there is a sudden disruptive change in a person’s behavior, perception, thinking or feeling, and these factors have been mistaken for an epileptic seizure, although it doesn’t have the electrophysiological changes which accompany a true epileptic seizure (Carton, Thompson & Duncan, 2003). Therefore, these conditions seem to have a psychological etiology. People with non-epileptic attack disorder present with episodes which are similar to epileptic seizures but, in EEG analysis there are no signals of excessive electrical discharge of brain cells, which indicates truly epilepsy. In a literature review, Francis and Baker (1999) showed, through the results of other studies, that there are several differences between non-epileptic events and true epileptic seizures. These differences are, for example, the fact that many non-epileptic attacks may be precipitated by a trauma, contrarily to epileptic seizures; the beginning, in non-epileptic event, is sudden, and gradual in epileptic seizure; the duration of seizures are higher in non-epileptic events; cyanosis is unusual in non-epileptic attacks and common in epileptic seizures; also, weeping is present in non-epileptic events and absent in epileptic seizures. In a psychiatric perspective, non-epileptic attacks disorder were related to dissociative and converse disorders, which are linked to the concept of hysteria. From the eighties onwards, the interest in dissociation as a response to trauma had begun (Fiszman, 2007). Several authors, such as Carton, Thompson and Duncan (2003), consider that there are psychiatric morbidity in non-epileptic attack disorder, being depression the most common diagnosis. Not having the medical confirmation about epilepsy, as Anna says that doctors didn’t find deviations in her exams, this hypothesis may be important to understand her clinical case. A study developed by Akyuz and colleagues (Akyuz, Kugu, Akyuz & Dogan, 2004) revealed that experiences of childhood neglect may be related to non-epileptic attacks. Also, interpersonal difficulties, family dysfunction and early traumatic experiences are common in patients with non-epileptic attack disorder. This condition seems to be more frequent in fearful (or insecure) attachment styles (Holman, Kirkby, Duncan & Brown, 2008). In fact, it is not clear that the development of non-epileptic attacks is influenced by trauma itself or if there has an indirect effect through the development of other psychopathology (e.g. anxiety).
Psychotherapeutic goals
Research about attachment theory and psychological treatment services for people encountering mental health problems, as a result of insecure attachments, focus on the psychotherapeutic process and relationship. Psychotherapy can be conceived as being based on the movement from insecure to secure attachment (Holmes, 1994), as the psychotherapeutic relationship may be an opportunity to develop security, intimacy and autonomy for the patient (Holmes, 1997; Vale Lucas et al 2014). However, this relationship construction is also a challenge, since the therapeutic process may be seen as a microcosm of attachment and separation, as the sessions are punctuated by endings and breaks (Holmes, 1997). Gonçalves (2008) presented a study where it was found that there is a positive correlation between secure attachment and therapeutic alliance, thus, insecure attachment might be a challenge for this alliance. Therefore, the psychotherapeutic goals should include the development of a trust relationship with the therapist; the construction of a secure base system, where the client can feel comfortable to talk and share fears and experiences; the insight of what is happening with her internal working models; help her to understand why she relates to others with an insecure pattern; develop a positive view of herself and her skills for give love and being loved; develop narrative skills that will help her to express feelings, thoughts, experiences and to facilitate the meaning attribution; the construction of a positive and constructive life project, mentally outlining positive future experiences.
Intervention
The intervention, which is still in progress, is based on cognitive narrative therapy, since several authors (such as Bowlby (1988), Bretherton (1985, 1990, 1999) or Thompson, 2000) consider that there is a clear relation between cognitive narrative therapy and attachment styles. In this particular case, it is extremely important that therapeutic relationship is established, and that the therapist acts like a secure base. Also, this relationship will be important in order for the client to start learning to construct a coherent narrative, processing emotional content (such as anger and sadness) and being confident to share those kinds of emotions in the therapeutic relationship. These aspects, as well as the facilitation of self-exploration within the therapeutic relational context, have been considered as essential ingredients of psychotherapy with insecure clients (Holmes, 1994). According to Cassidy (2001), there are two fundamental aspects to develop a safe and functional attachment system, both aspects concerning the matter of trust. Firstly, it is imperious that the individual trust and believe that the other (the therapist, in this case) is available, sensitive and responsive to his needs. Second, and also important, it is imperative that the individual believes that he is lovable, that is, he must perceive himself as someone who can be loved and valued by others. Therefore, it was very important to develop these aspects in the very first contacts with Anna. The therapist clearly pointed out that the therapeutic context is absolutely secure, and encouraged Anna to develop a trust relationship with him. The first sessions, after establishing the therapeutic goals, it was suggested some exercises of adjectivation of experience, as well as an exercise for selecting a particularly important event for each year of life. It was noticed that Anna reveals some difficulties in those kinds of exercises, which can be justified by her tendency for defensive exclusion, and because of her lack of temporal organization. Moreover, it was noticed some difficulties to identify emotions, feelings and thoughts particularly in painful situations, for example the moment of a panic attack. In the following sessions the same kind of exercise was proposed, so that the client could be able to identify and control these situations and to also find a metaphor that can easily help her express her own thoughts and feelings. The therapist also suggested Anna to keep a diary, where she writes down what she felt and thought in difficult situations. This kind of exercise would help her be more proficient in characterizing her own experience with adjectives, helping her to be able to identify specific reactions of her mind and body, to know herself better and develop trust in herself, since it would help her to know how to control her own behavior. Still, Anna showed some initial difficulty in finding time to write but, gradually, she seemed to recognize that it might be helpful and started to write in intense moments, saying that writing was like an escape, just like if she was telling others her feelings, and that felt really good. Her narratives, oral or written, were very reflexive. She started to understand that the way she relates to others is a reflection of what she has lived in early years, and that her behavior towards others can change if she believes in herself as a person who is capable to be loved, trying to change her problematic narrative to a positive one. Also, it was important to work with Anna her losses, as she needs to understand that they are very similar to the death of someone she loved, since the idea and the expectations that she had towards her two families, boyfriends and friends, have been broken, and so she needs to initiate a grief process. This new meaning construction and the use of metaphors to understand her own experience is considered a central aspect for the psychotherapeutic change (White & Epston, 1990; Soares et al 2013). To truly move on to a brand new narrative, it is important that the client identifies and recognizes every single loss as an attempt to revive the anger, the pain, the anxiety, since that helps to give a meaning to that loss. An important author in the field of losses and grief, Neimeyer (2001, 2006, 2012) and Paiva et al (2025) states that it is important that the person must be capable of reformulating meanings, so she can integrate the loss. Also, he argues that as a novel that loses a central character in the middle of the action, life stories affected by losses have to be reorganized and rewritten to find a new future. Neimeyer consider that unsent letters may be a relevant therapeutic writing activity, since it reopens the dialogue with people who the client lost, addressing some questions, fears or thoughts. Such exercises would help Anna in giving new meanings to her losses, to close unresolved chapters in her life and to bring some peacefulness to her, facilitating the construction of new relationships. Simultaneously, it is important to help the client to design new and positive future goals, which is a real challenge, as mentioned above. Óscar Gonçalves (2000) mentioned the challenge of thinking about future goals in a particular phase of narrative therapy described by him, citing a few authors such as Markus and Nurius. They refer to the importance of exploring "possible selves", focusing on the possibility for the client to open himself to experience, to create new narratives, making a proactive construction of a greater variety of content. Gonçalves (2000) also speaks on the concept of "projection", where the term "project" refers to the notion of a moving object, since the individual is himself that object, an active participant of his own experience, a constructor of multiple narratives. Thus, the therapeutic work with Anna, also focus this aspect of projection, helping her to visualize herself in positive scenarios and engage in constructive narratives. Therapeutic change is still occurring, and narratives are being progressively more adaptive and positive, as the client starts to understand her importance in changing and creating her own future.
The narrative gained importance in the field of psychotherapy, as it is acknowledged that finding new meanings for experiences is a good predictor of therapeutic change. Moreover, trust and confidence are central keys for individuals to relate positively, so a truly attachment relationship is needed in the therapeutic context. People with an insecure/ambivalent attachment pattern tend to present a disorganized narrative as well as feelings of insecure and lack of love. These disruptive situations, adding to important losses in life, may lead to difficulties in the relationship with others, as the individual will not believe in positive events in his life.
This work shows a clinical case study where the client lost some of the most important bonds in her life, and seemed to develop an insecure/ambivalent attachment pattern. Because of that, some important symptoms emerged and they are important signs of dysfunction and suffering. The psychotherapeutic intervention focused on cognitive narrative therapy, where constructivism and attachment theory play an important role, helping the client to redefine, reorganize and reinterpret her meanings of her life events. It´s an opportunity to rediscover herself in a brand new and positive relationship in the therapeutic setting, since she started to feel more capable to relate with the therapist and talk about herself and her experiences in a constructive way. This relationship is almost a training process, where the client knows herself better and visualizes, with the therapist help, how she relates to others, and how she can change the way she sees others’ intentions towards her.
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I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
