La entrevista motivacional como herramienta para el fomento de cambios en el estilo de vida de personas con enfermedades crónicas no transmisibles sergio. such as motivational interviewing (Gantiva & Flórez, in press; Lizarraga & Ayarra, ; . Entrevista motivacional en consumidores excesivos de alcohol: . Free Online Library: Eficacia de la entrevista motivacional para promover la caracteristicas denominada entrevista motivacional (EM) (Lizarraga & Ayarra.
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Dual Parallel Process in Crisis Situations: Correspondence concerning this article should be addressed to Luis E. The objective of this paper is to present a cognitive-behavioral model that makes it possible to explain the crisis situation CS in terms of intense motivational involvement, and to propose a brief motivational intervention proposal ehtrevista CS. The CS requires the person to implement coping strategies focused on the management of objective damage, as well as on the search for emotional relief, a consideration that gives rise to the name of dual parallel processing in CS DPP-CS.
Brief intervention is understood as the involvement of motivational processes to enable the person to make decisions regarding emotional and instrumental coping which move her in the direction of emotional relief or solution lizarrraga the crisis. The paper concludes with a summary of the three basic sources taken from the psychological literature to inform the design of the DPP-CS: THE AIM of this paper is to characterize a crisis situation CS as a psychobiological state entrwvista a person in which motivational alteration is rntrevista due to the impact of a deep alteration of an emotional sort originated in some external event of a harmful nature.
We do not argue this mptivacional be the only relevant characteristic of such a state, but we do emphasize it with the goal of projecting, based on this concept, the characterization of brief motivational intervention BMI in crisis situations.
In order to characterize CSthe label of dual parallel processing in crisis situation will be used. This concept has been used in the psychological literature particularly to refer to the parallel action of emotional and instrumental coping processes in a harmful situation, which determine the simultaneous motiacional of a pain-control process and a harm-control process. These are not, however, the only two dual processes parallelly occurring in a CS ; from other viewpoints, other simultaneous processes coexist as well which, together with the tradition of the concept in the literature, contribute to the justification of the name assigned to the proposed conceptual model.
A CS is a state of great psychobiological alteration, of varying duration and stages, subsequent to the reception of a signal announcing the event of a significant loss and the danger of a deepening of the entrevvista that has occurred.
The type of CS that is addressed in this paper is defined by the presence of some harmful event that the person perceives as highly damaging or as threatening to produce a lot of damage, signals that something really serious has occurred and that something else might happen in an imminent way.
These lizraraga crises that have been called circumstantial Slaikeu,examples of which include the receipt of bad news e. As a psychological alteration state, a CS entails important changes in psychological processes which influence the person to act in a relatively erratic manner, by means of trial entrvista error responses that entrevvista get her closer or farther motivacioal from adaptation to the situation.
Among these changes, we emphasize the following:. This emotional state can imply fear, anxiety, angst, sadness, or anger as well, but it can also imply adaptive challenging.
Dual Parallel Process in Crisis Situations: Motivational Foundation
Confusion in understanding the causes that led to the event generating the CS. Lack of clarity regarding the causes often leads the person to make distorted attributions of self-blaming or blaming to others, with the resulting deepening of feelings of sadness and anger, and the alteration of social relationships.
Entrevusta is often contaminated by the presence of cognitive distortions, biases, and heuristics which notoriously alter the objectivity of representations about the event cf. Conditioned responses are often of a negative emotional kind and involve instrumental responses of avoidance and escape. Significant changes of a negative sort in the value that the person grants to events occurring in other areas of her vital field different from the area of the CS generating event.
This change can be conceptualized as an important restructuring of the frame of physiological, psychological, and social needs that motivate lizarragw person’s actions, and it motivacinoal an essential element to differentiate a CS from other situations of severe stress that do not represent a crisis as properly defined.
Such a motivational restructuring might either assume a maladaptive path, becoming then a means of deepening the harm associated with the CSlizartaga a means of adaptation and construction of motivacuonal new situation, assuming the opportunity characteristics that a number of Chinese proverbs refer to regarding crises. Confusion regarding the interpretation of support signals coming from the social environment, which leads the person to ignore support chances offered by the environment for enrevista to the situation.
Confusion in the decision-making process for coping with the CS generating event, as a natural consequence of the above mentioned alterations. At an extreme at which emotional pain absence of relief and lack of clarity regarding the possibilities to cope with harm are predominant, motivaciomal CS can lead the person along a path of extreme autonomic arousal where decisions can deliberately assume a path of self-destruction, further leading in both cases to an emergency situation within the CSor in a more general way, the person’s situation can negatively evolve assuming characteristics proper of an anxiety disorder or an affective disorder Barlow, The conceptual psychological model of a motivational type here proposed to account for this psychological characterization of motivacinal, from which further considerations for intervention will be abstracted, has been called dual parallel processing in crisis situations DPP-CS.
This model is proposed here as an explanatory psychological alternative to what occurs during a CS. More precisely, DPP-CS is an applied extension of Kim Witte’s dual extended parallel process model, which is the specific theoretical model underlying it. These factors are represented in a schematic way in Figure 1.
The CS is initiated with the presence of a lizarrqga of objective triggering stimuli. In the perception of these stimuli different factors are important: Differently to what happens with a warning message representing a threat and generating a basic emotion of fear or anxiety, in a CS the reality of harm is not a hypothetical event that might occur in the future unless the person adopts an avoidance behavior, but a harmful, objective, very aversive event that is currently occurring and can become more profound in the immediate future, producing a quite complex emotional state of a negative sort.
Functionally, lizatraga harm and aversion inherent to the set of CS triggering stimuli act in the manner of a punishment, lizarraaga facilitates the person’s eventually interpreting them as such, and her engaging in speculations about which behaviors her own and those of others have produced the supposed punishment, with the lizarraba emotional consequences of self-blaming or blaming others.
This interpretation of punishment is highly likely, but it may or may not occur during a CS ; if it does occur, this interpretation becomes an evaluative element additional to the complex of triggering stimuli which determine the onset and evolution of the situation.
What is inevitable is the interpretation of severe harm, a primary appraisal cognitive process, with the resulting emotional consequence of pain caused by the occurred harm, a pain that stimulates escape behaviors, and the interpretation of the threat of harm worsening, which stimulates avoidance behaviors. In other theoretical contexts originated in the dual processing model, such as the protection motivation theory Rogers,this primary appraisal is called threat appraisaland is operationalized in terms of the perception of severity and of the perception of susceptibility a person has about real or potential damages.
The occurrence of the crisis-triggering event is not merely a stimulus informing about harm by means of a primary appraisal process; it is also a stimulus for coping responses to harm. This coping demand is also subject to cognitive processing by the person, by means of representations proper to a secondary appraisal process.
The fact of being exposed to an aversive event, generally denoting important loss, occurring in some vital area of great personal value, naturally urges the person to act to escape harm and avoid its worsening Bradley, ; the course of action an individual adopts will depend on the margin of harm reversibility in many occasions, actually irreversibleon the responses repertory a person has available, and on the established relation between those responses and the CSparticularly the ability the person attributes to the responses to modify the situation, and the self-attributed ability to get involved in the performance of the response.
In the theoretical frame of protection motivation Rogers,this secondary appraisal process is called coping appraisal. Four different aspects in the analysis of secondary appraisal need to be differentiated, which have been the subject of study within cognitive theories of expectancy-value and social learning:.
Personal beliefs that situations can be modified as a result of personal actions or that, on the contrary, they are subject to determination by external forces escaping the control exerted by oneself; this factor is what Rotter, calls locus of control. As can be anticipated, people tend to be more active and exert more control initiatives in situations in which they consider the outcomes to be determined by their own actions, than when they perceive them as unchangeable in a fatalistic manner e.
Valence or valuation Lang, ; Lewin,the importance a person attributes to a determined element or outcome. In a CSby definition, the event occurs in vital areas highly valued by the person e.
In a parallel manner, valences can be modified in other areas, which affects the general motivation of a person e. Response efficacy, what Bandura would call outcome expectation properly, and that consists in the person’s belief about the ability of an action to produce a particular outcome in this case, a favorable one to the solution of the crisis. These are expectations about the instrumental potency a behavior has as an efficient means to lead to a particular outcome.
That is, reinforcement expectations refer, in motivational terms, to wanted consequences goals that approximate the final expected outcomebut not to the consummatory outcomes that are expected superordinate goals.
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An example can help clarify this distinction: For a student, the fact of passing an exam can be the expected consequence that maintains her study behavior; but this conduct is not maintained only by that wanted consequence of passing exams reinforcement expectancy but by other long-term expectations, such as being a competent professional outcome expectation or consummatory consequence of the studying behavior.
In the natural sequencing of relatively simple behaviors that are chained to form complex actions, the consequences of complex actions being competent as a professional are long-term outcomes of the other consequences having studied for satisfactory passing of the courses. This distinction, of course, acquires importance as long as there is objectivity and certitude in the relation established between reinforcement expectations and outcome expectations, in which case immediate reinforcement is a real incentive leading to the outcome in the medium or long term.
This distinction between reinforcement expectations and outcome expectations acquires additional importance in a CSin that a critical happening significantly alters the valence of a particular outcome, which in turn alters the significance a person will attribute to the relations between reinforcement and outcome.
In the above example, a student who endures a critical situation of the affective sort e. Self-efficacy Bandura, the person’s belief about her ability to get involved in the performance of a determined action in a specific situation. Self-efficacy is the substantial motivational complement of response efficacy, as it is the expectation with the ability to empower the person towards the performance of an action she judges will be able to transform, in this case, a CS.
If self-efficacy fails, the person will be demoralized and it is highly unlikely she would be engaged in action, despite considering it an action able to transform the current situation. The highest levels of active involvement, leading the person to commit to and initiate the implementation of positive actions, can be expected in those cases on which high expectations of response efficacy and self-efficacy exist; on the contrary, the lowest levels of activity, with a predominant role of passive resignation and apathy, can be expected when there are low efficacy and self-efficacy expectations Bandura, An issue to which there is seemingly no final answer is that related to the temporal relations between efficacy expectations and self-efficacy expectations as factors determining whether the person would get involved in a particular behavior.
Bandura argues for the preeminence of self-efficacy expectations in the control that the person exerts over her own actions, and for this reason these are the expectations that, in his view, prevail as determining factors of the agency a person exerts on her activity in general. Nevertheless, this preeminence of the self-efficacy expectation is questionable, particularly in the case of behaviors approximating a superordinate goal in which a logical coherence between reinforcement expectation and outcome expectation must be anticipated.
Wittein her proposal of dual extended parallel process model, argues that response efficacy outcome expectation is the preeminent factor determining that a coping action will assume the course of the control process for objective harm and will not stay only at the level of emotional control action, which is a course of defensive motivation characteristic of the control process of subjective fear.
In the present proposal of DPP-CS we adhere to Witte’s view, as will be analyzed later, because this proposal solves some logical and methodological problems that have been stated by previous versions about dual processing and its motivational impact.
Certainly, efficacy expectations, both of response and of the person’s own ability, play a central role in the maintenance of the motivational process leading the person to initiate and stay committed to the implementation of a particular course of action, in this case a course of action that might lead to the solution of the crisis, whether by way of emotional coping, of instrumental coping, or of both, as suggested in the following proposal. This occurs when transforming the objective perception of the pain generated by the damage -which allows for options of personal management with or without therapeutic support- changing it into a subjective perception of intense suffering.
This emotional reaction in the face of which the individual cannot contemplate efficient options of personal management, requires the implementation of priority attention, or special emergency intervention, occasionally called crisis interventionbut which is in reality an urgency intervention to the aggravation of the crisis caused by the emotional reaction of intense suffering, which the person interprets as an inescapable and unavoidable event.
Crisis intervention, even if brief, is broader and more lasting, encompassing all the time and factors inherent to the crisis Slaikeu,whereas emergency intervention is more restricted in time and covers only some selective aspects of the crisis, such as the consequences of acute biological harm, or the behavioral consequences expressed in acts of aggression to others or self-aggression, as in suicide.
Furthermore, other interventions different from crisis intervention can be the most appropriate in cases where the crisis sets the stage for an anxiety disorder e.
A CS has all of the characteristics of a state of severe stress, although not every stress state can be considered a crisis. In the conceptualization of crisis on the basis of the dual parallel process model, focused on the control of harm and the control of the emotional state, two aspects are particularly important regarding considerations about stress: These two aspects are especially important because of their implications about the elements that should be emphasized when implementing an intervention in CS.
Regarding the role of cognitive appraisal, the viewpoint that we adhere to in the proposal of DPP-CS is that of Lazarus and Folkman a, brelated to the functions of cognitive appraisal in the stress response.
Lazarus and Folkman’s cognitive approach conceptualizes stress as an interaction between external stimuli and the person’s interpretation of them, which partially explains why reactions to one stimulus can vary a lot. Personal interpretation of a situation triggering a crisis can be understood in the frame of the evaluations these authors consider as stressful, such as appraisals of harm or loss, threat, and challenge.
A CS demands coping, which is why the person is faced with the need to find alternatives of action; this quest for alternatives is pressing, particularly when the interpretation of threat brings about anxiety, or the interpretation of challenge generates a challenge perception, stimulating in both cases the search for avoidance responses that prevent the worsening of harm or the influx of new harms additional to the one already experienced by the person.
In this search, as stated before, the appraisal of the efficacy of available response alternatives outcome expectation and that of the self-ability to perform them in a satisfactory way self-efficacy expectation are predominant. These two types of appraisal constitute, according to Lazarus and Folkman, the essence of secondary appraisal in stress situations.
Some factors, both personal and situational, influence the determination of the development of primary and secondary appraisal, and also of reappraisal; among the personal factors, Lazarus and Folkman b have proposed commitment and beliefs; among situational factors, novelty, predictability, and event incertitude, as well as temporal factors, are particularly important.
An additional aspect is that related to the chronology of the events. These authors characterize such factors in the following terms:. In a CSby definition, there is great personal commitment to what is at stake; this commitment is expressed in the high rank of importance that what is at stake has for the individual as a core theme of the crisis e. A favorable consequence of this high extent of commitment and responsibility is that it also leads the person to actively reduce the threat and to maintain the effort during coping, a central, motivational aspect favoring the impact of an intervention, regardless of how brief it is.
These are ideas or conceptual schemata a person uses to interpret reality. The world, in this case the CSis what a person perceives about it, and to what extent it affects her. These are very diverse beliefs, some very general, which can encompass all aspects of a person’s life, and others more specific and restricted to those aspects related to the CS. Both types are learned throughout the course of life, and in their formation the personal experience in the particular socio-cultural environment where the person has grown up plays a very important role.
Attributional cognitive theory Weiner, differentiates between appraisals of control attributed to external causes or to internal causes, which combine with appraisals about the modifiability of such causes i. Attributions to modifiable causes, depending on the easiness or difficulty attributed to the control of such causes, generate a higher propensity to adopting an initiative on the management of the situation. Other general beliefs, not referring to psychological aspects but rather to ideological aspects, are existential beliefs, such as religious beliefs; in a CSthese existential beliefs acquire a very clear function of emotional and motivational determination, by suggesting explanatory alternatives about the meaning of the experienced event, and about the meaning a person can attribute to coping with it e.
The role of beliefs of all kind, particularly that of existential beliefs, is more evident and ostensible when indicating to the individual what is acceptable in the search for adaptation in those cases where high-impact, acute changes in life are imminent, a characteristic fact in any CS. Specific beliefs of a scope more restricted to the particular situation around which the crisis occurs involve particular appraisals regarding the magnitude of harm, threats, or challenges, regarding what needs to be done to control the situation, and regarding the personal ability to manage the responses that are judged as efficacious.
These beliefs were mentioned before as related to outcome expectations and self-efficacy expectations. A cognitive aspect of particular relevance in this case is that referred to incertitude or clarity about those two expectations permanently interacting to determine the subsequent motivational course that the coping process will take, whether in the direction of control of the subjective emotion, or control of the objective harm.
What specific harm should be controlled in the crisis generated by the death of a loved one? What is the threat of additional harm that might occur?
What can be done in such a situation?