Análise da literatura, identificação e descrição dos procedimentos da terapia analítico-comportamental: um requisito para a produção de evidências

Abstract

Introduction: The Behavior Analysis has since its origin a strong commitment to the empirical support of its procedures; therefore, it was expected that Behavioral-Analytic Therapy (TAC) had consistent empirical evidence of efficacy; however, this psychotherapy still lacks such evidence. Moreover, there is an absence of precision in the description of the procedures performed in the TAC, and it has not been possible to conclude precisely what its procedures are and what they consist of. In order to carry out experimental research evaluating the effectiveness of the TAC, according to the criteria of the Evidence-Based Practice, it is previously necessary to produce an operational specification of the TAC procedures, which can "be called" a Manual. Objective: The present study aimed to synthesize the practice of the TAC, pointing out the procedures of case formulation, intervention and results evaluation applied in it and in which they consist objectively. Method: A review of the clinical research literature on TAC of the last 10 years was performed, updating the survey of this literature. The nine selected studies were analyzed by selecting excerpts that expressed applied procedures, inserting them into spreadsheets, separating them by "stage" of the psychotherapy (case formulation, intervention and evaluation of results), and categorizing the procedures identified, through three steps. Other data about each study were also recorded. Then, descriptive statistical analyses of the procedures were performed, identifying: the number and percentage of applications of each procedure in the sample, and the amount and percentage of studies in which the procedure was applied. Therefore, it was verified how much each procedure was applied, and in which the application of each procedure consisted. A subgroup of social anxiety/phobia studies was also analyzed. Results: A total of 117 procedures was identified. The main (most applied) case formulation procedures were respectively: molar analysis; three-term contingency analysis; unclassifiable functional assessments; and establishment of therapy objectives/goals. The main intervention procedures were: provision of rules (contingency descriptions); presentation to the client of functional assessment; exposure procedures to aversive stimuli; and homework. The main results evaluation procedures were: use of psychometric instruments (inventories, questionnaires and scales); frequency of target behaviors as an indicator of outcome; analysis of client's vocal statements; and follow-up. All procedures were described based on the corresponding selected excerpts and their categorizations. Conclusions: In addition to specific findings about the procedures, it was observed that the TAC has a considerable variety of procedures, that quantitative "indicators" are fundamental in its evaluation of results, and that functional assessments and verbal reports of clients are indispensable in all areas of this psychotherapy