Publicação
Evidence-based clinical decision-making : Conceptual and empirical foundations for an integrative psychological and neurobiological transtheoretical metamodel
| datacite.subject.fos | Ciências Sociais::Psicologia | pt_PT |
| dc.contributor.advisor | Vasco, António Branco, 1955- | |
| dc.contributor.advisor | Fonseca, Isabel Barahona da | |
| dc.contributor.author | Faustino, Bruno | |
| dc.date.accessioned | 2022-04-21T11:33:23Z | |
| dc.date.available | 2022-04-21T11:33:23Z | |
| dc.date.issued | 2021-11 | |
| dc.date.submitted | 2021-04 | |
| dc.description.abstract | The dialogue between psychotherapy and neuroscience is ongoing. Previous meta-analytic research suggests that 35% of psychotherapy outcome variance is not fully explained, whereas 30% is attributed to patient variables, 15% to therapeutic relationship, 10% to specific therapeutic techniques, 7% to therapist variables and 3% to other factors (Norcross & Wampold, 2019). Several authors emphasize the need for integrative, metatheoretical or transtheoretical approaches to enhance conceptual understanding of clinical phenomena, augmenting psychotherapy responsiveness to patients’ significant variables, such as maladaptive patterns, states of mind, relational styles, emotional difficulties, neurocognitive deficits, and psychological needs. The present doctoral proposal aims to respond to these claims through the establishment of preliminary conceptual and empirical foundations for an Integrative Psychological and Neurobiological Transtheoretical Metamodel. First, an extensive literature review of the relationships between psychotherapy and neuroscience was performed to establish theoretical and conceptual integration of different components of the presently proposed model. Second, several methodological aspects were described to systematize the complex data acquisition process. Third, seven studies were conducted, and implications of the results were discussed. Fourth, an integrative discussion was elaborated, emphasizing the major and general implications of the results for clinical practice and future research. The first empirical study aimed to develop and/or adapt self-report assessment measures to evaluate several psychological variables (e.g., metacognition, states of mind), which resulted in five scientific articles. Thus, the Metacognitive Self-assessment Scale (Pedone et al., 2017) and the Inventory of Interpersonal Problems – 32 (IIP-32, Barkham et al., 1998) were validated and adapted to European Portuguese. The State of Mind Questionnaire (SMQ, Faustino et al., 2021b, Emotional Processing Difficulties Scale – R (EPDS-R, Faustino et al., in press) and the Clinical Decision-Making Inventory (Faustino & Vasco, in press) were developed. All instruments showed satisfactory psychometric properties. Nevertheless, the SMQ showed low reliability in the composite scales in smaller subsamples. For the second empirical study, the main aims were to explore the complex relationships between early disorder determinants, maladaptive schemas and states of mind, defensive maneuvers and critical consequences, mental skills and processes, and adaptive self-domains. This was performed with Structural Equation Modeling (SEM). Results showed significant sequential and mediational models between maladaptive schemas, defensive maneuvers and dysfunctional consequences, mental abilities and processes, and adaptive self-domains with psychological needs. Maladaptive schemas and states of mind were both predictors and mediators in several models. However, the relationship between maladaptive schematic functioning and symptomatology had less significant mediations with the same variables. For the third study, the main aims were to explore the relationships of early disorder determinants, maladaptive schematic functioning and states of mind, defensive maneuvers and dysfunctional consequences, mental abilities and processes, and adaptive self-domains, with several neurocognitive variables. Executive functions were negatively correlated with maladaptive schematic functioning and with defensive maneuvers and dysfunctional consequences. Memory only correlated with psychological needs, self-confidence and with dysfunctional interpersonal cycles. These results emphasize previous assumptions that there is a difference between self-report questionnaires and neuropsychological assessment measures which may difficult the integrated study of psychological and neurocognitive processes. The fourth study aimed to explore the associations of affective subliminal processing with dispositional states and contextual states, defined in the present work as early disorder determinants, schematic functioning, and defensive maneuvers and dysfunctional consequences, mental abilities and processes, and adaptive self-domains. Results showed strong correlations between maladaptive schematic functioning, coping responses, emotional processing difficulties, and expressive suppression with behavioral responses. Dispositional traits and contextual states seem to be associated with affective processing, especially when it comes to the neutral valence of the subliminal stimuli. ERPs waveforms showed an amplitude modulation with a temporal progression: in the first 100 msec the waveform amplitude was highest to the negative condition; Later on, in the time windows after 350 msec, the neutral condition was the one that elicited the ERPs’ heist amplitude. These indexes a cascade of reactions, first a priority to nonconscious negative stimulation; and after that, a later processing phase of affective-cognitive interpretation (350msc) in which neutral stimuli acquire a meaning according to schemas. The fifth study explored the diagnostic and or transdiagnostic potential of early disorder determinants, maladaptive schematic functioning and states of mind, defensive maneuvers and dysfunctional consequences, mental abilities and processes, and adaptive self-domains. Results showed that only early complex trauma and expressive suppression were not statistically different in two subsamples. Individuals in the low-symptoms sub-sample reported lower levels of maladaptive schematic functioning, defensive maneuvers, and psychological inflexibility than individuals in the higher-symptoms subsample. The sixth study was focused on the exploration of the temporal stability of maladaptive schematic functioning and states of mind, defensive maneuvers and dysfunctional consequences, mental abilities, and adaptive self-domains. Results showed significant differences between moment one and two, with a descending pattern in the mean scores of dysfunctional variables. An inverse pattern was found regarding the adaptive variables. However, mean scores of some variables, such as early maladaptive schemas, emotional schemas, psychological needs, and cognitive reappraisal were not statistically significant. The seventh study aimed to explore associations of early disorder determinants, maladaptive schemas and states of mind, defensive maneuvers and critical consequences, mental skills and processes and adaptive self-domains, with an empirical based clinical profile (e.g., psychotherapy and motivational stage, coping styles). Results showed significant negative correlations between maladaptive schematic functioning and stage process, motivational stage, therapeutic relationship, attachment style, reactance, and coping style. An inverse pattern was found regarding the adaptive variables. These preliminary results seem to support a theoretically- and empirically-based integrative and transtheoretical metamodel focused on unifying psychotherapy and neuroscience into a coherent framework. Further research is required to augment and enhance the presently proposed model. | pt_PT |
| dc.identifier.tid | 101667299 | pt_PT |
| dc.identifier.uri | http://hdl.handle.net/10451/52489 | |
| dc.language.iso | eng | pt_PT |
| dc.subject | Trauma complexo precoce | pt_PT |
| dc.subject | Esquemas disfuncionais | pt_PT |
| dc.subject | Estados Mentais | pt_PT |
| dc.subject | Coping | pt_PT |
| dc.subject | Metacognição | pt_PT |
| dc.subject | Neurocognição | pt_PT |
| dc.subject | Processamento afetivo | pt_PT |
| dc.subject | Psicoterapia Integrativa | pt_PT |
| dc.subject | Tomada de decisão | pt_PT |
| dc.subject | Early Complex Trauma | pt_PT |
| dc.subject | Maladaptive Schemas | pt_PT |
| dc.subject | States of Mind | pt_PT |
| dc.subject | oping and Defences | pt_PT |
| dc.subject | Metacognition | pt_PT |
| dc.subject | Neurocognition | pt_PT |
| dc.subject | Affective Processing | pt_PT |
| dc.subject | Integrative Psychotherapy | pt_PT |
| dc.subject | Decison-Making | pt_PT |
| dc.title | Evidence-based clinical decision-making : Conceptual and empirical foundations for an integrative psychological and neurobiological transtheoretical metamodel | pt_PT |
| dc.type | doctoral thesis | |
| dspace.entity.type | Publication | |
| person.familyName | Faustino Almeida | |
| person.givenName | Vitor Bruno | |
| person.identifier.ciencia-id | 6118-6209-CFDC | |
| person.identifier.orcid | 0000-0002-7948-1622 | |
| rcaap.rights | openAccess | pt_PT |
| rcaap.type | doctoralThesis | pt_PT |
| relation.isAuthorOfPublication | 88255183-216c-4d05-ae79-42c1c554788e | |
| relation.isAuthorOfPublication.latestForDiscovery | 88255183-216c-4d05-ae79-42c1c554788e | |
| thesis.degree.name | Tese de doutoramento, Psicologia (Psicologia Clínica), Universidade de Lisboa, Faculdade de Psicologia, 2021 | pt_PT |
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