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The cognitive behavioral model in the 21st century: a critical analysis.

Ricardo de Pascual-Verdú, María Xesús Froxán-Parga, Jesús Alonso-Vega, Víctor Estal-Muñoz, Miguel Núñez de Prado-Gordillo Speaker

Convenor: Ricardo de Pascual-Verdú, Universidad Europea de Madrid

Chair: María Xesús Froxán-Parga, Universidad Autónoma de Madrid

Discussant: Miguel Núñez de Prado-Gordillo, Universidad Autónoma de Madrid

Presenters: Jesús Alonso-Vega (2); Víctor Estal-Muñoz (2); Miguel Núñez de Prado-Gordillo (2); Ricardo de Pascual-Verdú (1);

Affiliations:
1) Universidad Europea de Madrid;
2) Universidad Autónoma de Madrid

Cognitive Behavioral Treatments (CBT) are considered almost unanimously to be the most effective therapeutic alternative for a full range of psychiatric and psychological disorders. This success is the product of the collaborative effort of different practitioners and clinical researchers who continuously work to improve treatments that help create better mental health services. The development of CBT is thus due to an Evidence-Based Practice that has as one of its core principles that clinical decisions should be based on a combination of both critical thinking and the available scientific evidence. Following these principles, the objective of this symposium is to critically review essential clinical and theoretical aspects of the current CBT practice and research. To achieve this goal, four current topics in this area will be discussed: transdiagnostic perspective, outcome research paradigm, biopsychosocial model and case formulations. Transdiagnostic perspective arises in response to the traditional disorders classification, proposing a model that combines both categorical and dimensional models. Its supporters posit that there are common psychological processes that cause and maintain different disorders, and aim to develop interventions and protocols for a set of disorders by addressing these processes in a cross-sectional and non-specific manner. Starting on these assumptions, the objective of the communication entitled Critical analysis of transdiagnostic perspective: A real progress in psychological intervention? is to critically analyse the transdiagnostic model and its contribution to the growth of psychological science. Secondly, outcome research in psychological interventions has helped practitioners and researchers to discern which interventions work and which do not, improving clinical decisions and health services. However, we will discuss that the comparison of treatment techniques is fruitless if the processes underlying clinical behavior change are not analysed. The communication “Is process research a solution to the drift of outcome research?” will review the rationale for outcome research and compare it with that of process research.  Thirdly, the biopsychosocial model is also reviewed. The advantage brought by the biopsychosocial model lies in its rupture with the biomedical model, raising the possibility of an intervention that goes beyond the brain. However, it could be said that nowadays several "biopsychosocial models" coexist, along with what could be called a “biomedicalisation” of some biopsychosocial approaches. These issues will be addressed in the communication titled “A conceptual analysis of the notion of mental disease in the biopsychosocial model”. Finally, to achieve a successful intervention, a series of decisions must be made regarding both the evaluation and the explanation of the problem, and the treatment proposal. An effective intervention hinges fundamentally on how solid is the base from which the therapist is outlining it. Functional behavior analysis will be presented as a scientific alternative that maximises effective assessment and treatment in the communication titled “Case Formulation and Functional Analysis in clinical contexts. A review.”. This symposium analyses different matters of interest for both CBT practitioners and researchers. We believe that it could be an excellent opportunity to create a context of reflection and constructive criticism.

 

1) A conceptual analysis of the notion of mental disease in the biopsychosocial model.

Speaker: Miguel Núñez de Prado-Gordillo1

Authors: Miguel Núñez de Prado-Gordillo1, Gladis Pereira1, Alejandro Ricote1 y María Xesús Froxán-Parga1

Affiliations: Universidad Autónoma de Madrid1

Abstract:

In contrast to both the biomedical approach, the bio-psycho-social model (BPSm) conceives mental disease within a broader conceptualization of disease in general, which also integrates its psychosocial dimensions. The breakthrough of the BPSm lies in its rupture with the narrow framework of the biomedical model and its willingness to provide a broader intervention model. However, we consider that it is nowadays possible to speak of a certain “biomedicalization” of the BPSm. From our perspective, this is due to the attempt of the BPSm to safeguard the nosological architecture inherited from the biomedical model. Taking the comparison between schizophrenia and diabetes as an example, we analyzed the epistemological basis of the BPSm through the elucidation of the “language-games” that health practitioners play in their diagnostic practices. The broader concept of disease proposed by the BPSm mistakes the descriptive use of language of organic diagnoses (i.e., to point to etiopathological processes) with the evaluative use of mental diagnoses (i.e., to judge behavior from a certain normative standard). This could explain how, despite many practitioners have de jure assumed the BPSm, its application de facto seems to be still sometimes rooted in the biomedical model.

 

2) Critical analysis of transdiagnostic perspective: A real progress in psychological intervention?

Speaker: Víctor Estal-Muñoz1

Authors:Víctor Estal-Muñoz1, Miguel Núñez de Prado-Gordillo1, Ricardo de Pascual-Verdú2 & María Xesús Froxán-Parga1.

Affiliations: Universidad Autónoma de Madrid1; Universidad Europea de Madrid2

Abstract:

The transdiagnostic perspective is a response to several limitations that the categorical behavioural-cognitive model has, such as the high comorbidity among disorders or the common characteristics and treatment techniques existing between them. In this way, the aim of this work is to critically analyse the transdiagnostic model and its contribution to the growth of psychological science.The rationale of this work leans on the philosophical and theoretical underpinnings of the functional behavioural analysis intervention model, as well as on the empirical evidences that support it. The transdiagnostic model faces several problems. Firstly, it does not give up the medical-diagnose model that has proven to be reductionist. Secondly, it provides a flawed explanation of the aetiology of psychological problems, falling into circular reasoning. Finally, its interventions are based in standardized protocols instead of using an individualized approach. The transdiagnostic proposal constitutes an attempt to unify theory and research with clinical practice, and it has been shown to be useful in certain contexts. However, further advances could be achieved if certain transdiagnostic assumptions were reconceptualised.

 

3) Is process research a solution to the drift of outcome research?

Speaker: Jesús Alonso-Vega1

Authors: Jesús Alonso-Vega1, Carolina Trujillo1, Víctor Estal-Muñoz1 y Maria Xesús Froxán-Parga1.

Affiliations: Universidad Autónoma de Madrid1

Abstract:

Outcome research is a broad term that includes all the studies that analyze the effectiveness of the psychological interventions. For years, this type of studies has proliferated, with the objective of developing treatment guidelines that constitute a protocolled manual that explains what should be done at any time. The aim of this oral communication is to critically analyze the outcome research rationale. The thesis proposed in this work is that the comparison of treatment techniques is useless if it is not analyzed what it is that makes these techniques work, that is, what process underlies the procedure. To get this objective a narrative review was conducted. The focus has been on the main articles and movements that have shaped the outcome research. Process research has traditionally been presented as an incompatible path with outcome research until recently the APA (2006) itself began to recognize the need to develop both together. From our perspective, process research would be a necessary preliminary step to outcome research so that it could explain how and why psychological treatments work, avoiding that the clinician simply applies the procedures described in the standardized manuals.

 

 

4) Case Formulation and Functional Analysis in clinical contexts. A review.

Speaker: Ricardo de Pascual-Verdú1

Authors: Ricardo de Pascual-Verdú1, Carolina Trujillo2, Imanol Campo2 & María Xesús Froxán-Parga2

Affiliations: Universidad Europea de Madrid1 y Universidad Autónoma de Madrid2

Abstract:

            The cognitive behavioral model in the 21st century: a critical analysis. Introduction:  To face the challenge of clinical success, we must have a solid base that helps us maximize the probability of carrying out an effective intervention. Functional Behavior Analysis is presented as the scientific alternative that maximizes the effectiveness of evaluation and treatment. An alternative is the Case Formulation, a tool that would include Functional Analysis and other elements such as the Functional Analytic Clinical Case Diagrams (FACCD), defined as an integrated set of hypotheses and judgments about the relationships between behaviors, problems and objectives of the treatment and the variables that affect them (Kaholokula, Godoy, Haynes and Gavino, 2013). The aim of this work is to study Case Formulation focusing on the FACCD and Functional Analysis. Method: we analyze what these strategies consist of, what results are obtained when using them, and their usefulness in the clinical context. Results: Functional Analysis shows best results when conducting an assessment and effective intervention. Other Case Formulations have advantages if accompanying functional analysis. Conclusion: Functional Analysis is presented as the best alternative to explain client’s problems and to develop an effective intervention.