Ana Calero-Elvira

Meta-analysis on drugs in people with eating disorders.

OBJECTIVE The aim of this study was to examine whether drug use (DU) is higher in people with eating disorders (EDs) compared to a healthy control group and to perform a meta-analysis on the literature related to DU in people with EDs. METHOD We searched electronic databases (Medline, PsycINFO, Web of Science and CINAHL) and reviewed studies published from 1994 to August, 2007, in English, German or Spanish. A total of 16 papers fulfilled the inclusion criteria and were included. RESULTS The general meta-analysis revealed a negligible albeit significant effect size (0.119, p < .05). Risk was found to be higher in bulimia nervosa (BN, delta = 0.462, p = < .001), smaller in binge eating disorder (delta = 0.14, p < .05) and non-significant in anorexia nervosa (AN, delta = -.167, p = .070). CONCLUSIONS The differential risk observed in patients with BN might be related to differences in temperament or might be the result of reward sensitization.

Study of the Socratic method during cognitive restructuring.

Cognitive restructuring, in particular in the form of the Socratic method, is widely used by clinicians. However, little research has been published with respect to underlying processes, which has hindered well-accepted explanations of its effectiveness. The aim of this study is to present a new method of analysis of the Socratic method during cognitive restructuring based on the observation of the therapists verbal behaviour. Using recordings from clinical sessions, 18 sequences were selected in which the Socratic method was applied by six cognitive-behavioural therapists working at a private clinical centre in Madrid. The recordings involved eight patients requiring therapy for various psychological problems. Observations were coded using a category system designed by the authors and that classifies the therapists verbal behaviour into seven hypothesized functions based on basic behavioural operations. We used the Observer XT software to code the observed sequences. The results are summarized through a preliminary model which considers three different phases of the Socratic method and some functions of the therapists verbal behaviour in each of these phases: discriminative and reinforcement functions in the starting phase, informative and motivational functions in the course of the debate, and instructional and reinforcement functions in the final phase. We discuss the long-term potential clinical benefits of the current proposal. 

Analysis of the therapist's verbal behavior during cognitive restructuring debates: a case study.

Abstract This paper reports a case study in which the authors analyze the application of the debate technique in cognitive restructuring so as to obtain a deeper understanding of the relevant behavioral processes. The authors examined the recordings of a clinical case of low mood disorder and selected five debates that dealt with the same problem. After their transcription, the authors analyzed the client–therapist verbal interaction. Results show changes in the verbalizations of both parties as the treatment progresses. The authors propose a new explanation of these changes, constituting a step forward in the theoretical explanation of the debate technique within the cognitive–behavioral approach.

Descriptive Study of the Socratic Method: Evidence for Verbal Shaping

In this study we analyzed 65 fragments of session recordings in which a cognitive behavioral therapist employed the Socratic method with her patients. Specialized coding instruments were used to categorize the verbal behavior of the psychologist and the patients. First the fragments were classified as more or less successful depending on the overall degree of concordance between the patients verbal behavior and the therapeutic objectives. Then the fragments were submitted to sequential analysis so as to discover regularities linking the patients verbal behavior and the therapists responses to it. Important differences between the more and the less successful fragments involved the therapists approval or disapproval of verbalizations that approximated therapeutic goals. These approvals and disapprovals were associated with increases and decreases, respectively, in the patients behavior. These results are consistent with the existence, in this particular case, of a process of shaping through which the therapist modifies the patients verbal behavior in the overall direction of his or her chosen therapeutic objectives.

Descriptive analysis of the verbal behavior of a therapist: a known-group validity analysis of the putative behavioral functions involved in clinical interaction.

This study analyzes the interobserver agreement and hypothesis-based known-group validity of the Therapists Verbal Behavior Category System (SISC-INTER). The SISC-INTER is a behavioral observation protocol comprised of a set of verbal categories representing putative behavioral functions of the in-session verbal behavior of a therapist (e.g., discriminative, reinforcing, punishing, and motivational operations). The complete therapeutic process of a clinical case of an individual with marital problems was recorded (10 sessions, 8 hours), and data were arranged in a temporal sequence using 10-min periods. Hypotheses based on the expected performance of the putative behavioral functions portrayed by the SISC-INTER codes across prevalent clinical activities (i.e., assessing, explaining, Socratic method, providing clinical guidance) were tested using autoregressive integrated moving average (ARIMA) models. Known-group validity analyses provided support to all hypotheses. The SISC-INTER may be a useful tool to describe therapist-client interaction in operant terms. The utility of reliable and valid protocols for the descriptive analysis of clinical practice in terms of verbal behavior is discussed.

Análisis de la conducta verbal del cliente durante el proceso terapéutico

Parte de este trabajo ha sido financiado por el Ministerio de Ciencia e Innovacion en el marco del Plan Nacional de I+D+I 2004-2007 (Proyecto SEJ2007_66537_PSIC) y 2008-2011 (Proyecto PSI2010-15908)

Functional Analysis of the Verbal Interaction Between Psychologist and Client During the Therapeutic Process

The goal of this study is to analyze the verbal interaction that takes place between client and therapist over the course of a clinical intervention so as to analyze the potential learning processes that may be responsible for changes in the client’s behavior. A total of 92 sessions were analyzed, corresponding to 19 clinical cases treated by 9 therapists specializing in behavioral therapy. The variables considered were therapist and client verbal behaviors, and these were categorized according to their possible functions and/or morphologies. The Observer XT software was used as a tool for the observational analysis. The results led to the conclusion that the therapist responds differentially to client verbalizations, modifying the verbal contingencies as his or her client content approaches or becomes more distant from therapeutic objectives. These results suggest the possible existence of verbal “shaping” processes through which the therapist guides the client’s verbal behavior toward more adaptive forms. In addition, this study proposes an alternative to the traditional controversy regarding the relevance of the therapeutic relationship versus the treatment techniques used to explain clinical change. This article suggests that such differentiation is unnecessary because the therapeutic relationship and the treatment techniques should act in the same manner, this is, in providing the context for the occurrence of what is truly therapeutic, namely, the learning processes.

A theoretical and methodological proposal for the descriptive assessment of therapeutic interactions

Abstract Objective: The goal of this study is to show the development of a strategy for a descriptive assessment of the therapeutic interaction. Method: In this study, we develop an observational methodology to analyze the dialogues that took place during 92 sessions conducted in a psychological center in Madrid, Spain, in which 19 adults were treated for various psychological problems by 9 behavioral therapists. A system was developed to codify vocal behavior of both the therapists and the clients; the software The Observer XT was used for recording. Therapeutic interactions were analyzed using sequential analysis. Results: There are three main sequences that synthesize the therapist–client interaction: first, an utterance by the client preceded by a therapists verbalization, specifically a question (discriminative morphology) and followed by an expression of approval (reinforcement morphology); second, verbalizations of failure or discomfort uttered by the client, followed most often by verbalizations of disapproval (punishing morphology) uttered by the therapist; and third, verbalizations uttered by the client that are discriminated by the therapist after an in-depth explanation and followed by different therapists utterances (expressions of approval, technical information, etc.). Conclusions: Depending on how the client responds the results in this study present a starting point for the study of the functional sequences that form the basis of therapeutic change.

Analysis of the client's verbal behavior during the therapeutic process

Parte de este trabajo ha sido financiado por el Ministerio de Ciencia e Innovacion en el marco del Plan Nacional de I+D+I 2004-2007 (Proyecto SEJ2007_66537_PSIC) y 2008-2011 (Proyecto PSI2010-15908)