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Cormack B, Stilwell P, Coninx S, Gibson J. The biopsychosocial model is lost in translation: from misrepresentation to an enactive modernization. Physiother Theory Pract 2023; 39:2273-2288. [PMID: 35645164 DOI: 10.1080/09593985.2022.2080130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/15/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There are increasing recommendations to use the biopsychosocial model (BPSM) as a guide for musculoskeletal research and practice. However, there is a wide range of interpretations and applications of the model, many of which deviate from George Engel's original BPSM. These deviations have led to confusion and suboptimal patient care. OBJECTIVES 1) To review Engel's original work; 2) outline prominent BPSM interpretations and misapplications in research and practice; and 3) present an "enactive" modernization of the BPSM. METHODS Critical narrative review in the context of musculoskeletal pain. RESULTS The BPSM has been biomedicalized, fragmented, and used in reductionist ways. Two useful versions of the BPSM have been running mostly in parallel, rarely converging. The first version is a "humanistic" interpretation based on person- and relationship-centredness. The second version is a "causation" interpretation focused on multifactorial contributors to illness and health. Recently, authors have argued that a modern enactive approach to the BPSM can accommodate both interpretations. CONCLUSION The BPSM is often conceptualized in narrow ways and only partially implemented in clinical care. We outline how an "enactive-BPS approach" to musculoskeletal care aligns with Engel's vision yet addresses theoretical limitations and may mitigate misapplications.
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Affiliation(s)
| | - Peter Stilwell
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Sabrina Coninx
- Institute for Philosophy II, Ruhr University Bochum, Bochum, Germany
| | - Jo Gibson
- Physiotherapy Department, Royal Liverpool and Broadgreen University Hospitals, Liverpool, UK
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A Preliminary Analysis of the Effects of Clicker Training and Verbal Instructions on the Acquisition of Relationship-Building Skills in Two Applied Behavior Analysis Practitioners. Behav Anal Pract 2021; 15:383-396. [DOI: 10.1007/s40617-021-00555-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/24/2022] Open
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Walser RD, O'Connell M. Acceptance and commitment therapy and the therapeutic relationship: Rupture and repair. J Clin Psychol 2021; 77:429-440. [DOI: 10.1002/jclp.23114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/15/2020] [Accepted: 12/20/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Robyn D. Walser
- Bay Area Trauma Recovery Clinic Berkeley California USA
- Dissemination and Training Division, VA Palo Alto Health Care System National Center for PTSD Menlo Park California USA
- Psychology Department University of California, Berkeley, Clinical Science Berkeley California USA
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Callahan K, Foxx RM, Swierczynski A, Aerts X, Mehta S, McComb ME, Nichols SM, Segal G, Donald A, Sharma R. Behavioral Artistry: Examining the Relationship Between the Interpersonal Skills and Effective Practice Repertoires of Applied Behavior Analysis Practitioners. J Autism Dev Disord 2019; 49:3557-3570. [PMID: 31127484 PMCID: PMC6707962 DOI: 10.1007/s10803-019-04082-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study investigated interpersonal skills associated with the concept of behavioral artistry (BA), a repertoire of practitioner behaviors including care, attentiveness, and creativity, among others, associated with the effective delivery of applied behavior analysis (ABA) treatment. Survey results indicated parents of children with autism preferred BA descriptors for ABA therapists over non-BA descriptors. A separate survey of 212 university students on a standardized personality assessment revealed students majoring and/or working in the field of ABA had lower levels of BA than those in other human services professions. Practitioners with higher BA scores were observed and rated more positively in their delivery of ABA for children with autism. Implications for training/supervising effective ABA practitioners within a BA model are discussed.
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Affiliation(s)
- Kevin Callahan
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA.
| | - Richard M Foxx
- Pennsylvania State University College of Medicine, Hershey, USA
| | - Adam Swierczynski
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Xing Aerts
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Smita Mehta
- Department of Educational Psychology, UNT, Denton, USA
| | - Mary-Ellen McComb
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Susan M Nichols
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Gabrielle Segal
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Andrew Donald
- Kristin Farmer Autism Center (KFAC), University of North Texas (UNT), 490 S. Interstate 35 East, Denton, TX, 76205, USA
| | - Rachita Sharma
- Department of Rehabilitation and Health Services, UNT, Denton, USA
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Papalini S, Lange I, Bakker J, Michielse S, Marcelis M, Wichers M, Vervliet B, van Os J, Van Amelsvoort T, Goossens L, Schruers K. The predictive value of neural reward processing on exposure therapy outcome: Results from a randomized controlled trial. Prog Neuropsychopharmacol Biol Psychiatry 2019; 92:339-346. [PMID: 30763673 DOI: 10.1016/j.pnpbp.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/04/2019] [Accepted: 02/07/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Exposure is the gold standard treatment for phobic anxiety and is thought to represent the clinical application of extinction learning. Reward sensitivity might however also represent a predictive factor for exposure therapy outcome, as this therapy promotes positive experiences and involves positive comments by the therapist. We hypothesized that high reward sensitivity, as expressed by elevated reward expectancy and reward value, can be associated with better outcome to exposure therapy specifically. METHODS Forty-four participants with a specific phobia for spiders were included in the current study. Participants were randomly assigned to exposure therapy (n = 25) or progressive muscle relaxation (PMR) (n = 19). Treatment outcome was defined as pre- versus post-therapy phobia symptoms. Before treatment, functional brain responses and behavioral responses (i.e. reaction time and accuracy) during reward anticipation and consumption were assessed with the Monetary Incentive Delay task (MID). Behavioral and neural responses in regions of interest (i.e. nucleus accumbens, ventromedial prefrontal cortex and the ventral tegmental area) as well as across the whole-brain were subsequently regressed on treatment outcomes. RESULTS Exposure therapy was more effective in reducing phobia symptoms than PMR. Longer reaction times to reward cues and lower activation in the left posterior cingulate cortex during reward consumption were selectively associated with symptoms reductions following exposure therapy but not following PMR. Only within the exposure therapy group, greater symptom reduction was related to increased activation in the ventrolateral prefrontal cortex during reward anticipation, and decreased activation in the medial prefrontal cortex during reward consumption. CONCLUSION Results indicate that individual differences in reward sensitivity can specifically predict exposure therapy outcome. Although activation in regions of interest were not related to therapy outcome, regions involved in attentional processing of reward cues were predictive of phobic symptom change following exposure therapy but not PMR.
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Affiliation(s)
- Silvia Papalini
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology, Center for Experimental and Learning Psychology, University of Leuven, Leuven, Belgium
| | - Iris Lange
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jindra Bakker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stijn Michielse
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Marieke Wichers
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram Vervliet
- Faculty of Psychology, Center for Experimental and Learning Psychology, University of Leuven, Leuven, Belgium
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychosis Studies, Institute of Psychiatry, King's College London, King's Health Partners, London, UK; Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Therese Van Amelsvoort
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Liesbet Goossens
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Koen Schruers
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; Faculty of Psychology, Center for Experimental and Learning Psychology, University of Leuven, Leuven, Belgium
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Collado A, Zvolensky M, Lejuez C, MacPherson L. Mental health stigma in depressed Latinos over the course of therapy: Results from a randomized controlled trial. J Clin Psychol 2019; 75:1179-1187. [PMID: 30951609 DOI: 10.1002/jclp.22777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 12/27/2018] [Accepted: 03/15/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study examined the course, correlates, and predictors of mental health stigma among depressed, Spanish-speaking Latinos that were receiving treatment. This population faces significant disparities in mental health treatment and carries high levels of mental health stigma. METHOD The study utilized data generated from a randomized clinical trial (N = 46) that evaluated the efficacy of Behavioral Activation and Supportive Counseling for depression among Latinos. RESULTS Mental health stigma decreased over time; these decreases were more pronounced among individuals who were randomized to Supportive Counseling. Mental health stigma was positively associated with depressive symptoms and therapeutic alliance over time. Mental health stigma was not related to treatment attrition. CONCLUSIONS These preliminary findings indicate that mental health stigma continues to be relevant among individuals who are actively participating in treatment. Receiving mental health treatment may be sufficient to dispel some of the stigmatizing views endorsed by underserved clinical populations.
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Affiliation(s)
- Anahi Collado
- Department of Psychology, Cofrin Logan Center for Addiction Research and Treatment, University of Kansas, Lawrence, Kansas
| | | | - Carl Lejuez
- Department of Psychology, University of Kansas, Lawrence, Kansas
| | - Laura MacPherson
- School of Medicine, Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, Maryland
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Kuei T, Tsai M, McLeod HJ, White RG, Kanter J. Using the primary process emotional-behavioural system to better meet patient needs in psychotherapy. Clin Psychol Psychother 2019; 26:55-73. [PMID: 30203890 DOI: 10.1002/cpp.2330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 12/14/2022]
Abstract
In order to increase therapeutic impact by enhancing awareness of clients' nonverbal communications, this article operationalizes the therapeutic alliance as a needs-satisfaction process. The client's competence as a needs seeker and the therapist assisting with the client's expression and satiation of basic social needs are proposed as being key mechanisms of change. Functional model of primary emotions derived from Panksepp's seven primary emotional systems (care seeking, caretaking, lust, fear and anxiety, anger, play, seeking, plus dominance and disgust) is integrated with Functional Analytic Psychotherapy's emphasis on in-session contingent natural reinforcement of clients' target behaviours. By identifying in-the-moment cues of underlying emotional-behavioural functions drawn from a categorization of clients' nonverbal communication can bridge the gap between client private events and therapist observables, in order to maximize therapist attunement and responsiveness to clients, and to increase the effectiveness of clinical interventions.
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Affiliation(s)
- Tien Kuei
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Mavis Tsai
- Department of Psychology, University of Washington, Seattle, Washington, US
| | - Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Ross G White
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, England
| | - Jonathan Kanter
- Department of Psychology, University of Washington, Seattle, Washington, US
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Clinical Observations About the Potential Benefits and Pitfalls of Between-Session Contacts with Borderline Patients. Harv Rev Psychiatry 2016; 24:e8-e14. [PMID: 27603746 DOI: 10.1097/hrp.0000000000000129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Borderline Personality Disorder (BPD) has a reputation for being a challenging disorder to treat due to the nature of the illness. With the development of evidence-based treatments, therapists are becoming more skilled at successfully helping this cohort of patients. A common factor associated with all validated treatments for BPD is the active involvement of therapists. For example, DBT is one treatment where therapists are expected to be available to patients for coaching outside of sessions. However, understanding the benefits and pitfalls associated with therapists' accessibility in between sessions is relevant to any treatment with intersession contact. In this article, three benefits of intersession contact are described: to generalize the use of skills, to improve understanding of the patient's needs, and to facilitate an alliance. This article also addresses the pitfalls of therapists being so accessible to patients. Both the benefits and pitfalls of intersession contact are illustrated using case vignettes. Assessing the function served by a patient's contact in between sessions is an important way to determine whether such contact is a productive part of treatment. Recommendations are provided to avoid detrimental outcomes for both the therapist (therapist burnout) and the patient.
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Integrating Motivational Interviewing and Brief Behavioral Activation Therapy: Theoretical and Practical Considerations. COGNITIVE AND BEHAVIORAL PRACTICE 2016; 23:205-220. [PMID: 29151779 DOI: 10.1016/j.cbpra.2015.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Behavioral Activation and specifically the Brief Behavioral Activation Therapy for Depression (BATD) has a strong record of empirical support but its focus on practical out of session activation-based assignments can lead to poor levels of adherence if efforts to enhance motivation are not prioritized. Towards this end, this manuscript describes the assimilative integration of Motivational Interviewing (MI) and BATD to improve clinical outcomes by integrating MI's focus on building and maintaining motivation to change into BATD. The manuscript provides an overview of MI and BATD, theoretical issue raised in integrating the two approaches, and examples of how this integration results in a nondirective and motivation-focused approach to conducting BATD.
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Laraway S, Snycerski S, Olson R, Becker B, Poling A. The Motivating Operations Concept: Current Status and Critical Response. PSYCHOLOGICAL RECORD 2014. [DOI: 10.1007/s40732-014-0080-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Collado A, Long KE, MacPherson L, Lejuez CW. The efficacy of a behavioral activation intervention among depressed US Latinos with limited English language proficiency: study protocol for a randomized controlled trial. Trials 2014; 15:231. [PMID: 24938081 PMCID: PMC4074338 DOI: 10.1186/1745-6215-15-231] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 06/04/2014] [Indexed: 12/02/2022] Open
Abstract
Background Major depressive disorder is highly prevalent among Latinos with limited English language proficiency in the United States. Although major depressive disorder is highly treatable, barriers to depression treatment have historically prevented Latinos with limited English language proficiency from accessing effective interventions. The project seeks to evaluate the efficacy of behavioral activation treatment for depression, an empirically supported treatment for depression, as an intervention that may address some of the disparities surrounding the receipt of efficacious mental health care for this population. Methods/design Following a pilot study of behavioral activation treatment for depression with 10 participants which yielded very promising results, the current study is a randomized control trial testing behavioral activation treatment for depression versus a supportive counseling treatment for depression. We are in the process of recruiting 60 Latinos with limited English language proficiency meeting criteria for major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders 4th and 5th Edition for participation in a single-center efficacy trial. Participants are randomized to receive 10 sessions of behavioral activation treatment for depression (n = 30) or 10 sessions of supportive counseling (n = 30). Assessments occur prior to each session and at 1 month after completing treatment. Intervention targets include depressive symptomatology and the proposed mechanisms of behavioral activation treatment for depression: activity level and environmental reward. We will also examine other factors related to treatment outcome such as treatment adherence, treatment satisfaction, and therapeutic alliance. Discussion This randomized controlled trial will allow us to determine the efficacy of behavioral activation treatment for depression in a fast-growing, yet highly underserved population in US mental health services. The study is also among the first to examine the effect of the proposed mechanisms of change of behavioral activation treatment for depression (that is, activity level and environmental reward) on depression over time. To our knowledge, this is the first randomized controlled trial to compare an empirical-supported treatment to a control supportive counseling condition in a sample of depressed, Spanish-speaking Latinos in the United States. Trial registration Clinical Trials Register: NCT01958840; registered 8 October 2013.
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Affiliation(s)
- Anahi Collado
- Center for Addictions, Personality, and Emotion Research (CAPER), 2103 Cole Field House, University of Maryland, College Park, MD 20742, USA.
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Distress Tolerance and Rational-Emotive Behavior Therapy: A New Role for Behavioral Analogue Tasks. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2009. [DOI: 10.1007/s10942-009-0090-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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