Insight in terms of Behavior in the Clinical Context: Transfer and Rule-governed Behavior / El insight desde el análisis de la conducta: la transferencia y la conducta gobernada por reglas

A redefinition of insight-type events is presented, an initial attempt to view insight in terms of behavior analysis in the clinical context and relevant variables are suggested for their study. This definition assumes the insight as a novel behavior that involves the search for solutions to psychological problems. Solving a problem is discovering an effective behavior pattern, based on the creation of verbal rules that help the client to reach the solution. In this problem-solving process, a new behavior emerges, explained through the solution of a transfer task. The theoretical proposal exposed allows a better understanding of this phenomenon, overcoming the problems of mentalist conceptions about the term of insight, and contributes to a better understanding of some relevant elements of change process. (AU)

Se presenta una redefinición del evento tipo insight, un intento inicial por explicar el insight en términos del análisis de la conducta en el contexto clínico, así como la propuesta de variables relevantes para su estudio. Esta definición asume el insight como una conducta novedosa que involucra la búsqueda de soluciones a problemas de carácter psicológico. Resolver un problema es descubrir un patrón de conducta efectivo, a partir de la creación de reglas verbales que ayudan al cliente a llegar a la solución. En este proceso de resolución de problemas, emerge una conducta novedosa explicada a través de la solución de una tarea de transferencia. La propuesta teórica expuesta permite una mejor comprensión del fenómeno, superando los problemas de concepciones mentalistas y contribuye a un mejor entendimiento de elementos relevantes del proceso de cambio. (AU)

Therapeutic Approaches for ADHD by Developmental Stage and Clinical Presentation.

Attention Deficit Hyperactivity Disorder is a neurodevelopmental disorder with three presentations: inattentive, hyperactive/impulsive and combined. These may represent an independent disease entity. Therefore, the therapeutic approach must be focused on their neurobiological, psychological and social characteristics. To date, there is no comprehensive analysis of the efficacy of different treatments for each presentation of ADHD and each stage of development. This is as narrative overview of scientific papers that summarize the most recent findings and identify the most effective pharmacological and psychosocial treatments by ADHD presentation and age range. Evidence suggests that methylphenidate is the safest and most effective drug for the clinical management of children, adolescents and adults. Atomoxetine is effective in preschoolers and maintains similar efficacy to methylphenidate in adults, whereas guanfacine has proven to be an effective monotherapy for adults and is a worthy adjuvant for the management of cognitive symptoms. The psychosocial treatments with the best results in preschoolers are behavioral interventions that include training of primary caregivers. In adolescents, the combination of cognitive and cognitive-behavioral therapies has shown the best results, whereas cognitive-behavioral interventions are the most effective in adults. Pharmacological and psychosocial treatments must be adjusted to the ADHD presentation and its neurocognitive characteristics through the patient's development.

Biopsychological correlates of repetitive and restricted behaviors in autism spectrum disorders.

BACKGROUND: Autism Spectrum Disorder (ASD) is considered a neurodevelopmental condition that is characterized by alterations in social interaction and communication, as well as patterns of restrictive and repetitive behaviors (RRBs). RRBs are defined as broad behaviors that comprise stereotypies, insistence on sameness, and attachment to objects or routines. RRBs can be divided into lower-level behaviors (motor, sensory, and object-manipulation behaviors) and higher-level behaviors (restrictive interests, insistence on sameness, and repetitive language). According to the DSM-5, the grade of severity in ASD partially depends on the frequency of RRBs and their consequences for disrupting the life of patients, affecting their adaptive skills, and increasing the need for parental support. METHODS: We conducted a systematic review to examine the biopsychological correlates of the symptomatic domains of RRBs according to the type of RRBs (lower- or higher-level). We searched for articles from the National Library of Medicine (PubMed) using the terms: autism spectrum disorders, ASD, and autism-related to executive functions, inhibitory control, inflexibility, cognitive flexibility, hyper or hypo connectivity, and behavioral approaches. For describing the pathophysiological mechanism of ASD, we also included animal models and followed PRISMA guidelines. RESULTS: One hundred and thirty-one articles were analyzed to explain the etiology, continuance, and clinical evolution of these behaviors observed in ASD patients throughout life. CONCLUSIONS: Biopsychological correlates involved in the origin of RRBs include alterations in a) neurotransmission system, b) brain volume, c) inadequate levels of growth factors, d) hypo- or hyper-neural connectivity, e) impairments in behavioral inhibition, cognitive flexibility, and monitoring and f) non-stimulating environments. Understanding these lower- and higher-level of RRBs can help professionals to improve or design novel therapeutic strategies.

Rule Emission: A Possible Variable for Improved Therapeutic Practice.

It has been suggested that achieving greater effectiveness in psychotherapeutic treatment requires analyzing what therapists actually do and say, how they do this and when it is done. Based on this approach, in this study we focused on the rules emitted by therapists, since providing rules is thought to be of fundamental importance in promoting effective and efficient clinical change. Specifically, we sought to determine whether the experience level of therapists and the brevity of therapy would be related to patterns of therapist rule emission as categorized by the Category System of Rules emitted by the Therapist (SISC-RULES-T) (Vargas-de la Cruz & Pardo-Cebrián, 2014). Greater therapist experience and shorter therapy duration were found to be reliably predictive of more rule emissions across most rule categories (Z values between: Z = -3.68 and Z = -2.05; p values: p < .05 and p < .001). These variables were also predictive of more emissions of rules that specified all three operant contingency elements (situation, behavior, and consequence) rather than fewer elements (Z = -2.59, p < .05; Z = -2.26, p < .05). In the expert therapists and therapist with shorter cases, there was a nonsignificant tendency for the emission of general and conceptual rules to increase over sessions whereas emissions of concrete and particular rules tended to decrease; the explicitness of the three contingency elements also tended to decrease as treatment progressed. These findings may help to identify verbal characteristics of therapists that could lead to improved therapeutic practice.

Una Extensión del Concepto de Regla y su Aplicación a la Terapia Psicológica / An extension of the concept of rule and its application to therapy

Proporcionar y seguir reglas se ha considerado un factor importante en la eficacia de los tratamientos psicológicos; sin embargo, hace falta una clarificación conceptual de lo que se entiende por emitir o seguir una regla y su aplicación en el ámbito clínico. Partiendo de una revisión sobre el concepto original de conducta gobernada por reglas, nuestro propósito fue extender la definición de esta conducta orientada al proceso terapéutico. Esta definición permite su identificación y estudio momento a momento a lo largo del proceso. La extensión de esta definición puede ayudarnos a identificar el papel funcional de las reglas en el cambio terapéutico y las variables involucradas que contribuyen al entendimiento de fenómenos clínicos como la generalización. Los hallazgos que se desprendan del estudio de las reglas desde esta perspectiva podrían contribuir a aumentar la información sobre el proceso de cambio terapéutico y la mejora del ejercicio clínico

Providing and following rules has been considered an important factor in the effectiveness of psychological treatments; however, a conceptual clarification is needed of what is meant by issuing or following a rule and its application in the clinical setting. Based on a review of the original concept of rule-governed behavior, our purpose was to extend the definition of this behavior oriented to the clinical process. This definition allows its identification and study moment by moment throughout the therapeutic process. The extension of this definition can help us to identify the al role of rules in clinical change and the variables involved that contribute to the understanding of clinical phenomena such as generalization. The findings that emerge from the study of rules from this perspective could increase the information on the therapeutic change process and, therefore, contribute to the improvement of clinical practice

Rule emission: a possible variable for improved therapeutic practice

It has been suggested that achieving greater effectiveness in psychotherapeutic treatment requires analyzing what therapists actually do and say, how they do this and when it is done. Based on this approach, in this study we focused on the rules emitted by therapists, since providing rules is thought to be of fundamental importance in promoting effective and efficient clinical change. Specifically, we sought to determine whether the experience level of therapists and the brevity of therapy would be related to patterns of therapist rule emission as categorized by the Category System of Rules emitted by the Therapist (SISC-RULES-T) (Vargas-de la Cruz & Pardo-Cebrián, 2014). Greater therapist experience and shorter therapy duration were found to be reliably predictive of more rule emissions across most rule categories (Z values between: Z = -3.68 and Z = -2.05; p values: p < .05 and p < .001). These variables were also predictive of more emissions of rules that specified all three operant contingency elements (situation, behavior, and consequence) rather than fewer elements (Z = -2.59, p < .05; Z = -2.26, p < .05). In the expert therapists and therapist with shorter cases, there was a nonsignificant tendency for the emission of general and conceptual rules to increase over sessions whereas emissions of concrete and particular rules tended to decrease; the explicitness of the three contingency elements also tended to decrease as treatment progressed. These findings may help to identify verbal characteristics of therapists that could lead to improved therapeutic practice

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Las verbalizaciones tipo regla del terapeuta a lo largo del proceso clínico / The Therapist's rule-like Verbalizations throughout the Clinical Process

RESUMEN Se ha reconocido la importancia de las reglas del cliente para explicar un problema psicológico y para lograr superarlo. Sin embargo, no se ha incidido en el papel que podrían tener las reglas del terapeuta en el proceso clínico. Como un primer paso para poder dar una respuesta al respecto, en este estudio realizamos un análisis morfológico de las verbalizaciones en forma de regla emitidas por el terapeuta a lo largo del proceso clínico con el fin de identificar un patrón de emisión de este tipo de verbalizaciones que cambie de acuerdo con los distintos momentos de la terapia. Se analizaron las verbalizaciones en forma de regla emitidas por 9 terapeutas a lo largo de 19 casos clínicos (92 sesiones). Las verbalizaciones se codificaron de acuerdo con un Sistema de Categorización de las Reglas del Terapeuta (SISC-REGLAS-T). Los resultados mostraron diferencias entre el tipo de verbalizaciones en forma de regla y el objetivo que el terapeuta persigue alcanzar en los distintos momentos de la terapia. Estos resultados pueden ayudar a comprender cómo el terapeuta utiliza las verbalizaciones en forma de reglas, lo que contribuye al esclarecimiento del papel de las reglas que emite el terapeuta para conseguir el cambio clínico.

ABSTRACT It has been pointed out the importance of the rules to explain and to treat psychological problems. However it hasn't emphasize the role that the therapist's rules could have in clinical process. As a first step to give an answer, we realize a morphological analysis of verbalization- like-rule emitted by the therapist throughout the clinical process with the aim to identify a patron of emission of this kind of verbalization that changes according to different moments of therapy. This study analyzed the verbalization-like-rules emitted by 9 therapists over 19 clinical cases (92 sessions). The verbalizations were coded according to a system of categorization of the Rules Therapist (SISC-RULES-T). The results showed differences between the type of verbalizations-like-rules and target the therapist aims to achieve at different times of therapy. These results may help to understand how the therapist uses this kind of verbalizations, helping to clarify the functional role of rules issued by the therapist for clinical change.

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

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

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

Tradicionalmente la motivación se ha entendido como algo situado dentro de la persona que podría explicar algunos comportamientos y tener un papel causal sobre la conducta manifiesta de cambio. En el campo de la psicología clínica y de la salud el Modelo Transteórico de Cambio y la Entrevista Motivacional abordan el estudio de la motivación siguiendo esta línea de conceptualización. Frente a esta perspectiva, el análisis de la conducta ha formulado el concepto de operación de establecimiento como estímulo u operación ambiental que altera momentáneamente las funciones de estímulos y la probabilidad de respuestas posteriores, lo que permite estudiar la motivación sin recurrir a inferencias o a términos cognitivistas. Desde este punto de vista el estudio de la motivación en terapia pasaría por el análisis del efecto que determinadas verbalizaciones del terapeuta tienen sobre la conducta del cliente. Concretamente, proponemos que el análisis de las verbalizaciones motivadoras del terapeuta se centre en aquellas descripciones que los terapeutas hacen de las situaciones estimulares que han sido, son o serán consecuencia de la conducta del cliente (AU)

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