Formulations of functional analysis PDF

Preview

Summary

Within the behavioral tradition, the clinical formulation is based on the principle of determinism, that is, that behavior is the result of certain conditions and that when these are systematically manipulated, behavioral consistency is observed. According to this proposal, the clinician must be abl...

Description

FORMULATIONS OF FUNCTIONAL ANALYSIS

The triple contingency relationship One of the first information organization models with the greatest influence on the clinical formulation process is based on functional behavior analysis, which arises from the proposal developed by Skinner and his associates (Baer, 1982; Baer, Wolf and Risley, 1968, 1987; Skinner, 1938, 1953). Although, of course, this type of analysis is not intended to be a model of "clinical formulation", since it refers to a particular way of analyzing behavioral events, it has been considered as an initial molecular approach to the establishment of causal relationships. In fact, it represents an observation methodology and a set of procedures through which hypotheses about functional relationships between behavior and environmental events are generated and experimentally validated. According to this model, it is about looking for regularities between behavioral and environmental events that allow generating a behavior prediction model, instead of looking for the causes of behavior in inferred entities within the organism. From this position emerged a methodology to establish functional relationships between three types of events: antecedent stimuli, behavioral events, and consequent stimuli. This scheme, also called the triple contingency relationship, tries, on the one hand, to establish the nature and characteristics of the environmental events on which the behavior depends, that is, the antecedent stimuli (which facilitate the appearance of the behavior). ), the consequent events and contingencies (which explain the motivational processes that maintain the behavior) and the characteristics of the response (both in topographic terms and in their parametric values, such as frequency, intensity and duration). The functional analysis methodology involves some important steps: to. observing the characteristics of behavior under certain control conditions in relation to certain environmental events; b. formulating hypotheses based on a body of scientific knowledge (eg, investigations of operant behavior) regarding maintenance variables: stimulus control, reinforcement and punishment factors, etc. c. the introduction of systematic changes, that is, the intervention on the identified control variables and the measurement of the behavioral effects. If the prediction is not fulfilled, it is necessary to generate a new hypothesis based either on theoretical approaches or on a larger sample of behavioral observation. These three steps, adapted to different conditions and control restrictions, are what have shaped the methodology of functional analysis, showing its usefulness for a large number of behaviors in different contexts and achieving behavioral changes that had not previously been achieved by other means. .

However, despite the usefulness of functional analysis in a large number of contexts, especially those in which it is possible to determine discrete and specific events (e.g., in relatively controlled contexts, this type of methodology suffers from a limitation characteristic of the level of development of the behavioral explanations of the moment, that is, their degree of molecularity). Functional analysis is very useful in establishing relationships between discrete events that have a certain degree of temporal contiguity, but not in establishing relationships of patterns or sets of events that take place in a temporal continuum. Basic research has seen the insufficiency of molecular models to explain many complex behavioral phenomena and molar models have been developed that are not restricted to specific events and proximal relationships, but rather include patterns of events and distal relationships ( Staddon , 1983). . Molar and molecular data form a continuum along an observation dimension, so both molecular and molar level information is important in understanding behavior ( Rachim , 1976, 1994). At the clinical level, the insufficiency of molecular models in the analysis and modification of complex behaviors and the need to propose models of a more ecological type, in which contextual factors and distant relationships in time are framed , has also been evident ( Biglan , Glasgow and Singer, 1990; Martens and Witt, 1988; Willems, 1974). On the other hand, in the field Clíni co , the molecular functional analysis does not, by its very nature, to assess and include factors prior history that determine, largely behavioral outcomes, and establish relationships between different types of problem. Finally, findings on more complex forms of influence at the family level ( Whaler and Dumas, 1986), as well as advances in the field of health psychology (Schwartz, 1982), have shown the insufficiency of functional analysis models. in explaining complex behaviors. Consequently, the models formulated in terms of functional analysis, although highly useful at the level of analysis of specific behaviors, leave a gap to explain more complex behavioral phenomena (Russo, 1990). Clinical formulations based on multiple response systems The formulation concept has been developed in a way that reflects changes in research and behavioral theory, evolving from proximal and molecular models to more molar and distal formulations. Next I will present a longitudinal view of the evolution of the concept, which will allow us to present, within a coherent context, the formulation proposal by basic processes, not as a finished product but as a logical continuation within a process in continuous evolution. A second approach, coming from psychophysiological and clinical research, has elements in common with functional analysis insofar as it tries to identify relationships between elements of stimuli, responses and contingencies, but adds a dimension that has shown its enormous useful not only in the field of basic research but also in clinical applications: the participation of different response systems, or more specifically, of responses that are regulated by different systems of relationships. The tripartite model for the description of anxiety proposed by Lang (1976) represents a very significant advance to perform a functional analysis of more complex behavioral phenomena, such as emotional behavior, and has played a fundamental role in current anxiety theories ( Hugdahl , 1981). Indeed, the

results of psychophysiological studies on emotional response in which it was found that the effects of anxiety-generating situations manifest themselves differently in different measurement channels or levels, led to a formulation model that includes three basic levels , not necessarily correlated: the physiological-autonomous, the cognitive-verbal and the motor-behavioral level. In this case, it is not only a matter of describing the topographic characteristics of the response and carrying out the contingency analysis, but also of taking into account the differential way in which the different levels of response depend on the influence of different systems of relationships. Consequently, the process of functional analysis becomes more complex to the extent that it is necessary to describe the relationships not only with antecedent and consequent events, but also between the various response systems. This model has fulfilled the important function of enriching the analysis process, giving rise to intervention alternatives in emotional disorders that have shown clinical and theoretical utility for the formulation. Said model constitutes a very useful development in the analysis of emotional and anxiety problems and opens the way to the consideration of the differential influence of various basic processes, such as the biological system, the information transformation processes and the effect of motivational and contingency factors. However, due to the molecular nature of the analysis of response units and by focusing on the interaction of systems in the emotional process, it also does not allow the establishment of molar-type relationships. Finally, although in the analysis of emotional behavior the cognitive, motor and behavioral response systems have shown great utility, it is not clear that they are the only ones, nor the most suitable for studying other types of behavior. Behavioral assessment and clinical formulation We do not want to end the description of behavioral approaches to case formulation without referring to the central role that the concept of behavioral assessment has played and without establishing a clear relationship between the two concepts. From the development of the behavioral model in clinical psychology (which radically departed from the traditional intrapsychic models by looking for the causes of behavior in relationships with the environment and not in supposed intraorganismic constructs ), the need to change form also became clear. radical the way in which the behavioral assessment process was understood. The fundamental objective of the evaluation was therefore focused on the identification and description of the behavioral units and the environmental units that control them (Nelson and Hayes, 1979). Unlike traditional evaluation, in which observable behavior was considered to be a sign of causal constructs, in behavioral evaluation behavior was considered as a sample of general behavior under similar conditions ( Goldfried and Kent, 1972; Goldfried and Pomeranz, 1968; Goldfried and Sprafkin , 1976). Although initially, within the behavioral tradition, organismic variables were not included within the functional relationship between behavioral and environmental events, little by little the concept evolved towards an interactionist perspective in which the variables of the organism were given an important role. through the SORK model, considering the variables of the stimulus, the organism, the response and the consequences (Godfried and

Sprafkin , 1976; Kanfer and Saslow , 1969; Mischel , 1968). However, as Nelson (1983) points out, several aspects of disappointment were observed after the initial boom in behavioral assessment. In the first place, the imperfection of the system, insofar as it did not adequately reflect reality as there was no concordance between different ways of measuring the same behavior. Second, the practical difficulties in applying the behavioral assessment model in natural situations and, third, the difficulty of developing standard behavioral assessment procedures. Although in theoretical terms the characteristics of behavioral assessment have been widely documented ( Bellack , 1993; Ciminero, 1986; FernándezBallesteros ”1994; Fernández-Ballesteros and Carrobles , 1987; Goldfried and Pomeranz, 1968; Haynes , 1978; Kanfer and Saslow , 1969 ; Nelson, 1983; Nelson and Hayes, 1979; Silva and Martorell, 1991), for the purposes of this work in relation to the clinical formulation we can mention the following characteristics. Emphasis on observable behavior. Unlike traditional models of psychometric evaluation, in which indirect evaluations are carried out, mainly through psychometric instruments and projective tests, in behavioral evaluation most of the efforts have focused on the development of a measurement and recording technology of observable behavior. Hence the importance of developing methods to directly measure observable behavior and not simply as a signal of an underlying construct. Emphasis on current events. A typical feature of behavioral assessment is an emphasis on current events and not on previous history. The role of historical variables is minor, not necessarily because of their lower importance, but because of their relevance in explaining current behavioral events (O'Leary, 1972). Research on behavioral measurement instruments. Just as in traditional evaluation, a large part of the efforts focused on the development of theoretical models of the measurement of constructs (Cronbach, 1970), in behavioral evaluation they have also focused on the development of a technology for measuring observable behavior ( Haynes , 1978). Within this approach, emphasis has been placed on the importance of incorporating multiple ways of measuring behavior and not just an isolated channel, especially when considering the lack of covariation of the different behavioral measures (Lang, 1976). Description of the determining situations. It is not only about describing current events but also the way in which they are related to the characteristics of the situation. Indeed, one of the fundamental characteristics of the description of behavior is its functional nature in relation to elements of the associated stimulus. The quality of evaluation techniques varies with the circumstances that are present in their application. Hence the importance of situational specificity in behavioral assessment methodology (Nelson, 1983). Emphasis on molecular functional relationships. Precisely because of the interest in the detailed description of behavioral phenomena and functional events and relationships, a fundamental characteristic of behavioral evaluation is its molecular nature. As Nelson and Hayes (1979) state, "the goals of behavioral assessment

are to identify significant response units and the variables that control them." That is, the nature of behavioral assessment is fundamentally molecular. According to the above description of the characteristics of behavioral assessment, the relationship between the two processes, clinical assessment and formulation, can be clearly seen. Despite the fact that different authors use the concepts of behavioral assessment and clinical formulation interchangeably or have included formulation within the behavioral assessment process (eg, Fernández-Ballesteros, 1994; Muñoz, 1993), important points can be made differences. On the one hand, as Mash (1985) indicates, a distinction has recently been made between specific methods (eg, direct observation formats, reinforcer inventories, and behavioral avoidance tests) and general processes (including synthesis and use of this information). The methods correspond to the category of behavioral evaluation and refer to the technological, objective, structured, reliable and valid aspects of the evaluation. On the other hand, the processes have to do with behavioral analysis, which in this case belongs more to the field of formulation. In a certain sense, it can be said that behavioral evaluation refers to the development of the measurement methodology and is descriptive in nature. The formulation, on the other hand, has to do with the establishment of relationships between observations collected from the behavioral evaluation and has an explanatory character. Second, and directly related to the previous point, while the behavioral assessment emphasizes molecular measurement, the clinical formulation involves relationships between distant events organized according to a theoretical model that allows establishing and validating hypotheses and, thus , to be able to make causal statements. Therefore, it can be affirmed that the evaluation and formulation processes are complementary in the work of clinical activity. The methodological measurement instruments are necessary but not sufficient conditions to generate explanatory models, while it is not possible to generate explanatory hypotheses without having developed a valid and reliable measurement technology for the data that are incorporated in the formulation. To summarize, we can draw several conclusions from the description of the evolution of the various approaches regarding the development of a behavioral clinical formulation model . First, the distinctive features of the clinical behavioral formulation are: to. the development of a systematic methodology that allows to formulate verifiable hypotheses about functional and / or causal relationships between observed events, making possible the development of control mechanisms, that is, ways of modifying the phenomena of clinical interest or reasons for consultation. b. the formulation of these hypotheses is based on the data collected from the behavioral assessment. c. The hypothesis formulation process is based on a body of knowledge acquired through empirical, basic or applied research, in various scientific disciplines that shed light on the behavioral phenomena of interest.

d. It is guided by a theoretical model that allows covering and relating the data obtained in the various fields of research at different levels of molecularity / molarity, both in terms of its temporal dimension (that is, proximal and distant causes), as well as in the structural organization of behavior around different levels of explanation (ranging from the most general or inclusive systems, through intermediate levels of covariation or entities, to the more specific ones such as the responses or complaints that make up the result of the action or interaction of the various processes operating at higher levels). Second, although the revised behavioral formulation models meet the two basic conditions related to the hypothesis validation methodology and being based on a properly validated body of knowledge, they require a broad theoretical context in which results can be framed. of the investigation of diverse systems of behavioral organization. Molecular formulation models based on the functional analysis of the triple contingency relationship have shown their validity and usefulness in explaining discrete behavioral events; but they are insufficient to explain relationships between more general levels of organization. On the other hand, although formulation models that emphasize isolated systems, such as the cognitive or information transformation system or motivational systems, have shown usefulness and efficacy in explaining behavioral phenomena mediated by the corresponding processes, they are not exhaustive for explain phenomena dependent on other organizational systems. Therefore, the characteristics of an alternative proposal for a behavioral clinical formulation will be outlined below that allows the various formulation models to be integrated within a coherent model and, in this way, generate a set of tools that not only have practical utility in the complex process of evaluation and formulation, but has a heuristic value in the generation of research. In order to clearly understand the scope of this proposal, the main assumptions on which it is based will be described below. Behavioral analytical formulation Unlike the previously discussed approaches, which were not expressly intended to be a clinical formulation method, the first attempts to sketch an inclusive and coherent model of behavioral clinical formulation are those proposed by Wolpe (1973) and by Victor Meyer and his associates (Meyer , Liddell, and Lyons , 1977; Meyer and Turkat , 1979). This clinical formulation model is not antagonistic to the previous ones, but incorporates them within a more general scheme that seeks to achieve a total understanding of the causal variables that give rise to specific dysfunctions through the establishment of relationships between the different problems or entities. , with a view to carrying out an intervention method that responds to the particular characteristics of each patient (Hamilton, 1988). Within the behavioral tradition, the clinical formulation is based on the principle of determinism, that is, that behavior is the result of certain conditions and that when these are systematically manipulated, behavioral consistency is observed (Wolpe, 1973, 1980, 1982). According to this proposal, the clinician must be able to determine what behavior, within a very large behavioral repertoire, must be modified and what are the best methods to do so. For Wolpe, the methodology of

behavioral formulation has three phases: a ) the interview with the patient to develop a formulation of the problems (which would be equivalent within the methodology of functional analysis to behavioral observation); b ) a phase of clinical experimentation that seeks to validate the formulation; and c) the modification methodology developed from the formulation. In a similar way to the types of formulation previously described, a single process is assumed, that of learning, and it is assumed that all behavior can be categorized according to the three basic response systems (Lang, 1976; Wolpe , 19...