Estudio de las instrucciones durante la interacción terapéutica

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Psicología, Departamento de Psicología Biológica y de la Salud. Fecha de lectura: 26-05-2017En la presente tesis doctoral se aborda el estudio de las instrucciones emitidas por los terapeutas durante las intervenciones psicológicas, a través de las cuales, los terapeutas instauran nuevas respuestas en los clientes que permitirá el cambio clínico. A pesar de ser una de las labores más importantes que realizan los psicólogos clínicos durante las intervenciones psicológicas, no es un fenómeno de frecuente interés de los investigadores del campo o bien se estudia mediante una metodología que consideramos insuficiente. Por ello, el presente trabajo aborda cómo los terapeutas instruyen y revisan el cumplimiento de las tareas terapéuticas. Para estudiar el fenómeno, se llevaron a cabo tres estudios mediante el uso de una metodología que consideramos adecuada para tal fin, la metodología observacional, y dando uso de un instrumento creado para analizar la conducta verbal del terapeuta y del cliente durante la emisión de instrucciones y la revisión del cumplimiento (SISC-INTER-INSTR). En el primer estudio, se analizaron en 19 casos tratados (211 sesiones) cómo los terapeutas instruyen y revisan el cumplimiento de las tareas terapéuticas a lo largo de las fases de la intervención (Evaluación, Explicación, Tratamiento y Seguimiento). En un segundo estudio, utilizando la misma muestra del primero, se analizó, por un lado, cómo son las secuencias verbales entre el terapeuta y el cliente cuando se instruyen las tareas terapéuticas y cuando se revisa el cumplimiento de las mismas y, por otro lado, la relación existente entre la forma de instruir del terapeuta y el cumplimiento de las tareas manifestado por el cliente en la siguiente sesión. Finalmente, en un último trabajo se analizaron las diferencias entre terapeutas expertos e inexpertos en la forma de instruir y de revisar el cumplimiento de las tareas terapéuticas, en el que se utilizaron 15 casos tratados (168 sesiones clínicas) y separados según la experiencia del terapeuta. Los resultados encontrados muestran que mientras la forma de instruir de los terapeutas va cambiando a lo largo del tratamiento, la forma de revisar el cumplimiento se mantiene estable. Por otro lado, se encontró que los terapeutas podrían estar poniendo en marcha procedimientos de aprendizaje con el fin de que el cliente cumpla con las tareas instruidas, tanto mediante el uso de instrucciones, como mediante el manejo de las contingencias; y que, además, la forma de instruir se relaciona con el cumplimiento de las tareas. Finalmente, no se encontraron diferencias en la forma de instruir y revisar el cumplimiento de las tareas entre terapeutas expertos e inexpertos.At the present PhD dissertation, we focused on the study of the instructions emitted by the therapists during psychological interventions. This type of verbalizations allows creating new behaviors in the clients’ repertoire to achieve clinical change. Despite the fact that instructions are one of the most important tasks performed by therapists, researchers have not been interested enough in the study of this issue or it has been studied with a methodology that we consider insufficient. For this reason, our work was focused on the study of how therapists instruct and review homework compliance. For this purpose, we carried out three studies with observational methodolody, which we consider the most appropiate one. In these studies we used a tool created by our team in order to code the therapist and client verbal behavior in the emission of instructions and in the review of the homework compliance (SISC-INTER-INSTR). In the first study we coded how therapists instruct and review the homework compliance at each phase of the treatment (Assessment, Explanation, Treatment, Follow-up) in 19 treated cases (211 sessions). In a second study, we used the same sample as in the first study, and we analyzed how verbal sequences between the therapist and the client are when homeworks are instructed and compliance is reviewed. On the other hand, we also studied the relationship between the way of intructing homework by the therapist and the client’s compliance reported in the next session. Finally, in the third study we analyzed the differences between experienced and inexperienced therapists in the way of instructing homework and reviewing the clients’ compliance. Fort the last study we used 15 treated cases (168 clinical sessions), which were divided according to the experience of the therapist. The results showed that while the way of instructing by therapists change over the course of the treatment, the way of reviewing the compliance remains stable. In the second study, we found that therapists could be conducting learning processes in order to improve the client’s compliance with instructions and contingency management. We also found some relationships between the way of instructing and the homeworks compliance by clients. However, no significant differences were found between experienced and inexperienced therapists in the way of instructing and reviewing the homeworks compliance

Emotional Eating and Perfectionism as Predictors of Symptoms of Binge Eating Disorder: The Role of Perfectionism as a Mediator between Emotional Eating and Body Mass Index.

(1) Background: Perfectionism has been linked to eating disorders and might be a risk factor for the appearance of eating pathologies. The aims of this study are (a) to verify the relationship between perfectionism, emotional eating (EE), binge eating (BE), and body mass index (BMI); (b) to identify the variables that predict BE symptoms and BMI; (c) to study the role of perfectionism as a mediator between EE and BMI. (2) Methods: 312 adult participants answered a cross-sectional survey that included the Multidimensional Perfectionism Scale, the Emotional Eater Questionnaire (EEQ), the Binge Eating Scale (BES), and a sociodemographic questionnaire including BMI. (3) Results: The results suggest a direct correlation between EE, BE, and BMI, showing that EE is a powerful predictor of BE symptoms and BMI. Furthermore, two dimensions of perfectionism have a mediator role between EE and BMI, specifically doubts and actions and concern over mistakes: the presence of these two components of perfectionism reverses the relationship between EE and BMI. (4) Conclusions: These results have significant implications for the understanding of the two different (pathological) eating patterns: intake restriction and overeating and should be considered in intervention programs.post-print1043 K

Homework Instructions and Compliance Assessing in the Therapeutic Process: An Analysis of Therapists’ Verbal Behavior.

Instructions are a common resource used by behavioral therapists to assign therapeutic homework. However, understanding how clients learn with instructions is better known in laboratory research than in clinical research. The present study aims to explore changes in the way of instructing and reviewing the client’s compliance throughout the therapeutic process. We analyzed the therapist’s verbal behavior during 211 recorded sessions corresponding to 19 cases treated by 11 behavioral therapists (53% male and 47% female). The sessions were divided into four stages according to the timing of the intervention and coded by using a previously validated coding system (SYST-INTER-INSTR). Results show that instructions become less specific towards the last stage of the intervention. However, therapists assess task compliance in the same way towards the end of the therapeutic process. The change in specificity suggests that the client’s behavior changes from being controlled by instructions to being controlled by natural contingencies. However, to make sure the clinical change remains; therapists assess and reinforce the client’s compliance until the end of the intervention. Although clinical implications of the results, some limitations (i.e., not considering the type of task instructed) should be addressed in future studies.post-print654 K

Are Adherence to the Mediterranean Diet, Emotional Eating, Alcohol Intake, and Anxiety Related in University Students in Spain?.

Research has suggested that university students are at risk from certain unhealthy habits, such as poor diet or alcohol abuse. At the same time, anxiety levels appear to be higher among university students, which may lead to high levels of emotional eating. The aim of this study was to analyze the degree of adherence to the Mediterranean diet (AMD), emotional eating, alcohol intake, and anxiety among Spanish university students, and the interrelationship of these variables. A total of 252 university students filled out the Mediterranean Diet Quality Index (KIDMED) questionnaire for Mediterranean diet adherence, an Alcohol Use Disorders Identification Test, a State-Trait Anxiety Inventory and the Emotional Eater Questionnaire. We analyzed descriptive data, a t-test and analysis of variance (ANOVA) for differences, a Pearson correlation, and multiple regression tests. Results showed low levels of AMD among university students (15.5%) and considerable levels of emotional eating (29%) and anxiety (23.6%). However, levels of alcohol dependence were low (2.4%). State-anxiety was a predictor of the emotional eater score and its subscales, and sex also was predictive of subscale guilt and the total score. However, AMD was predicted only by trait-anxiety. These models accounted for between 1.9% and 19%. The results suggest the need for the implementation of educational programs to promote healthy habits among university students at risk.post-print555 K

Factor Structure and Psychometric Properties of Emotional Eater Questionnaire (EEQ) in Spanish Colleges.

Emotional eating (EE) patterns have been shown to play a relevant role in the development of overweight problems. However, there is a gap in research aimed at validating questionnaires to assess EE in specific populations. The aim of the study was to analyze factor structure and psychometric properties of Emotional Eater Questionnaire (EEQ) in Spanish universities. EEQ, state-anxiety subscale of STAI and a questionnaire about health habits were filled out by 295 students. Exploratory Factor Analysis (EFA) by using Unweight Least Squares (ULS) method was carried out. To determine factor numbers we used eigenvalues, parallel analysis, and goodness of fit statistics. Cronbach’s alpha and Spearman correlations were used to analyze reliability, convergent, and concurrent validity. The parallel analysis and goodness of fit statistics showed that unifactorial structure of seven items was the most appropriate what accounted for 57% of the variance. Internal consistency was good ( = 0.753), as well as convergent validity (r = 0.317; p < 0.001). Concurrent validity was significant for three of the five criteria (r = �����0.224; p < 0.001 and r = �����0.259; p < 0.001). The results suggest some di erences in the structure of the psychometric assessment of EE in sub-clinical population in comparison with previous studies carried on with an overweight population, what could be relevant to obesity prevention.post-print366 K

Internet addiction and executive functions in university students: a systematic review.

Internet addiction is a growing public health problem and university students have number of characteristics which make them a population at risk. Numerous studies suggest a relation between addiction and the impairment of executive functions. This bibliographical review aims to identify neuropsychological variables which indicate a risk of developing an addiction to different internet applications among university students. A systematic search was made of online databases (Medline, PsycInfo, PubMED, ScienceDirect, Scopus & Web of Science) for empirical studies published between 2000 and 2019 on the relation between internet addiction and executive functions in this population. After eliminating duplicates and applying eligibility criteria, a total of 30 studies were selected. The results of these studies suggest an alteration of executive functions due to addiction (inhibitory control, decision-making and verbal fluency), although the findings do not provide a clear internet addiction risk profile. More study is necessary into the nature of this relation, differentiating the different internet applications and controlling certain variables such as gender, the nature of the task and the type of stimuli, in order to design effective addiction prevention strategies.post-print454 K

Psychometric Properties of the Spanish Version of theWork Group Emotional Intelligence Profile Short Version (WEIP-S) in a Sample of Spanish Federated Coaches.

Emotional intelligence has been a topic of great interest to researchers in many different areas as it is associated with mental, psychosomatic, and physical health. In the sports context, it is a significant variable that can play an important role in improving the team’s performance. Although there are numerous tools to assess emotional intelligence, few of them have been validated explicitly in a sports sample, and even fewer have had coaches as a target population. Therefore, this study aimed to validate the Spanish version of the work group emotional intelligence profile short version (WEIP-S) in a sample of Spanish federated coaches. The results confirm that this instrument presents good psychometric properties to measure the emotional intelligence of sports coaches. The original four-factor model (awareness of one’s own emotions, management of one’s own emotions, awareness of others’ emotions, and management of others’ emotions) shows good reliability and convergent validity for all four factors except for the management of one’s own emotions. These findings suggest that it is possible to measure the emotional intelligence of coaches and offer the opportunity to continue investigating the relevance of constructing specific scales to measure this construct in the sports context.post-print363 K

Validation of the Spanish Version of the Work Group Emotional Intelligence Profile Short Version (WEIP-S) in the Sports Context.

Emotional intelligence (EI) is related to better performance in sports. To measure this construct, many tools have been developed and validated in the sports context. However, these tools are based on an individual’s ability to manage their own emotions, but do not consider the emotions of the rest of the team (teammates, coaches, etc.). In this regard, the Workgroup Emotional Intelligence Profile short version (WEIP-S) is a self-reported measure designed to measure the EI of individuals who are part of a team. The aim of this study was to validate the WEIP-S structure to measure EI in the sports context, and to analyze the psychometric properties of this tool in the sample in terms of validity and reliability. A cross-sectional study was conducted among 273 athletes to examine the reliability, factor structure, and evidence of validity (convergent, discriminant, nomological, and concurrent) of the WEIP-S. Confirmatory factor analysis showed that the original four-factor structure is the most appropriate for the sports context. Composite reliability was adequate for all factors except management of one’s own emotions, which also showed poor convergent validity. Evidence of convergent, discriminant, and nomological validity are discussed. This study represents an advance in the use of specific scales to measure EI in the sports context.post-print1021 K

Relación entre inteligencia emocional y ansiedad en un club de fútbol sala de Madrid.

Diversos estudios sugieren que la Inteligencia Emocional en deportistas se relaciona con el rendimiento deportivo y, a su vez, éste se ve perjudicado cuando los deportistas experimentan emociones negativas (e.g, ansiedad) que no son gestionadas adecuadamente. Sin embargo, se necesitan estudios que analicen si esta relación ocurre en todos los niveles deportivos. El objetivo del presente estudio es analizar si existen diferencias en la inteligencia emocional (IE) y los niveles de ansiedad rasgo y estado (A/R y A/E) de jugadores de fútbol sala en función de su nivel deportivo. Para ello, se contó con una muestra de 48 jugadores de fútbol sala de todas las categorías juveniles a los que se les administró los cuestionarios TMMS-24 y STAI. Los resultados obtenidos muestran diferencias significativas en Atención Emocional (AE), A/R y A/E entre los diferentes niveles deportivos. Además, los niveles de A/R se relacionaron con todas las dimensiones de IE, mientras que la A/E únicamente se relacionó con la dimensión de AE.post-print117 K

Deficits in executive functions but not in decision making under risk in individuals with problematic social-network use.

Background: The tendency to strive for immediate gratification by neglecting potential negative long-term outcomes characterizes addictive behaviors, such as substance use or gaming disorder. Problematic socialnetwork use is currently discussed as another potential addictive behavior, which is considered to result from an imbalance between affective and cognitive processes, indicated by traits such as increased impulsivity and/ or decreased executive functions and decision-making abilities. Methods: This study investigates the respective functions in social-network users by use of the Cards and Lottery Task (CLT) – a decision-making task under risk conditions in which options contain conflicting immediate and long-term outcomes at the same time. A sample of German and Spanish participants (N = 290) performed the CLT aswell as the Modified Card Sorting Test (MCST), Barratt Impulsiveness Scale (BIS), the short Internet Addiction Test specified for social-networking (sIAT-SNS), and screeners on other potentially problematic behaviors. Results: Comparing extreme groups based on sIAT-SNS scores (1SD above/below mean), individuals with problematic social-network use (n = 56), as compared to those with non-problematic social-network use (n = 50), showed increased attentional impulsivity and reduced executive functions. No differences were observed in decision-making performance. Conclusion: The findings indicate that problematic social-network use is related to attentional rather than general decision-making deficits. Furthermore, problematic social-network use is likely to co-occurwith other problematic Internet-use behaviors, particularly gaming or shopping.pre-print455 K