RESUMO
The ability to adaptively inhibit responses to tempting/distracting stimuli in the pursuit of goals is an essential set of skills necessary for adult competence and wellbeing. These inhibitory capacities develop throughout childhood, with growing evidence of important maturational changes occurring in adolescence. There also has been intense interest in the role of social adversity on the development of executive function, including inhibitory control. We hypothesized that the onset of adolescence could be a time of particular opportunity/vulnerability in the development of inhibition due to the large degree of maturational changes in neural systems involved in regulatory control. We investigated this hypothesis in a longitudinal study of adolescents by examining the impact of socioeconomic status (SES) on the maturation of inhibition and concurrent brain function. Furthermore, we examined gender as a potential moderator of this relationship, given evidence of gender-specificity in the developmental pathways of inhibition as well as sex differences in adolescent development. Results reveal that lower SES is associated with worse behavioral inhibition over time and a concurrent increase in anterior cingulate (ACC) activation, but only in girls. We also found that lower SES girls exhibited decreased ACC â dorsolateral prefrontal cortex (dlPFC) coupling over time. Our findings suggest that female adolescents with lower SES appear to develop less efficient inhibitory processing in dlPFC, requiring greater and relatively unsuccessful compensatory recruitment of ACC. In summary, the present study provides a novel window into the neural mechanisms by which the influence of SES on inhibition may be transmitted during adolescence.
Assuntos
Desenvolvimento do Adolescente/fisiologia , Encéfalo/crescimento & desenvolvimento , Encéfalo/fisiologia , Inibição Psicológica , Caracteres Sexuais , Fatores Socioeconômicos , Adolescente , Mapeamento Encefálico , Criança , Função Executiva/fisiologia , Feminino , Humanos , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Desempenho Psicomotor/fisiologiaRESUMO
In India, tobacco kills 900,000 people every year though the burden of tobacco is faced disproportionately in poorer states such as Bihar. Teachers may be a particularly influential group in setting norms around tobacco use in the Indian context. However, tobacco use among teachers remains high and perceptions of tobacco-related health risks are unexplored. To qualitatively explore perceptions about tobacco use among teachers in Bihar and to examine how risk information may be communicated through a variety of message formats, 12 messages on tobacco health risks varying in formats were tested in focus groups with teachers from Bihar. Participants stated that teachers were already aware of tobacco-related health risks. To further increase awareness of these risks, the inclusion of evidence-based facts in messages was recommended. Communicating risk information using negative emotions had a great appeal to teachers and was deemed most effective for increasing risk perception. Messages using narratives of teachers' personal accounts of quitting tobacco were deemed effective for increasing knowledge about the benefits of quitting. To conclude, messages using evidence-based information, possibly with negative emotions, testimonials with role models and those messages emphasizing self-efficacy in the format of narratives appear to appeal to teachers in Bihar.
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Educação em Saúde/métodos , Fumar/efeitos adversos , Adulto , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Índia , Projetos Piloto , Fatores de Risco , Autoeficácia , Fumar/psicologia , Abandono do Hábito de Fumar/psicologiaRESUMO
Local health departments (LHDs) increasingly depend on volunteers, often Medical Reserve Corps (MRC) volunteers, to assist with a variety of functions. While LHDs have extensive lists of volunteers, only about 10 % are actively involved in LHD activities. Psychological literature has shown that well-designed messages can motivate behavior among individuals. Key to this theory is the concept of "framing," defined as the influence the characterization of an issue can have on its understanding. Research has been conducted on how to frame and disseminate both political and public health messages to alter individual behavior. We aimed to design and test appropriate evidence-based messages to increase volunteer participation rates in LHD flu clinics. After inviting over 900 MRC units to participate during the 2011-2012 influenza season, five were able to collect and report data to the research team. Using a randomized trial design, we tested messages among the five participating MRC units consisting of a total of 2,020 volunteers. Chi Square analysis showed no difference in attendance between those who received either of the test messages versus the control message (p = .305). Our small sample size of MRC units likely biased our sample and reduced the external validity of our study. Our experience in conducting research with MRC coordinators and volunteers highlights the challenges of conducting research with practitioners who lack the time, infrastructure and resources necessary to work with researchers. There is a strong need for more supportive infrastructure for conducting research with practitioners.
Assuntos
Serviços de Saúde Comunitária , Prática Clínica Baseada em Evidências , Comunicação Persuasiva , Voluntários , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Motivação , Pandemias , Estados Unidos/epidemiologia , Recursos HumanosRESUMO
A major challenge for neuroscience, public health, and evolutionary biology is to understand the effects of scarcity and uncertainty on the developing brain. Currently, a significant fraction of children and adolescents worldwide experience insecure access to food. The goal of our work was to test in mice whether the transient experience of insecure versus secure access to food during the juvenile-adolescent period produced lasting differences in learning, decision-making, and the dopamine system in adulthood. We manipulated feeding schedules in mice from postnatal day (P)21 to P40 as food insecure or ad libitum and found that when tested in adulthood (after P60), males with different developmental feeding history showed significant differences in multiple metrics of cognitive flexibility in learning and decision-making. Adult females with different developmental feeding history showed no differences in cognitive flexibility but did show significant differences in adult weight. We next applied reinforcement learning models to these behavioral data. The best fit models suggested that in males, developmental feeding history altered how mice updated their behavior after negative outcomes. This effect was sensitive to task context and reward contingencies. Consistent with these results, in males, we found that the two feeding history groups showed significant differences in the AMPAR/NMDAR ratio of excitatory synapses on nucleus-accumbens-projecting midbrain dopamine neurons and evoked dopamine release in dorsal striatal targets. Together, these data show in a rodent model that transient differences in feeding history in the juvenile-adolescent period can have significant impacts on adult weight, learning, decision-making, and dopamine neurobiology.
Assuntos
Dopamina , Neurobiologia , Animais , Cognição , Dopamina/fisiologia , Feminino , Insegurança Alimentar , Masculino , Camundongos , Núcleo Accumbens/fisiologia , RecompensaRESUMO
Food consumption is controlled by both internal and external factors. Environmental signals associated with food may prepare an animal to forage, consume and digest more effectively. Furthermore, environmental cues that provide information about food availability enable animals to make predictions about future food resources and act upon that knowledge in appropriate fashion. For example, when exposed to a cue that signals the presence of food, animals can eat beyond their present needs to cope with predicted future famine. Interestingly, cues previously paired with meal interruption have a similar effect. In two experiments, food-deprived rats learned to associate one conditioned stimulus (CS+) with delivery of a food unconditioned stimulus (US), and another stimulus (IS) with an unexpected termination of CS-US trials. Subsequently, both CS+ and IS enhanced consumption of the US food by sated rats. The results of Experiment 2 indicated that IS's ability to potentiate feeding of sated rats in test depended more on its accompanying CS+ termination in training than on its signaling reductions in US frequency. These experiments may provide a novel animal model of binge-like behaviors in sated rats induced by external cues paired with meal interruption.
Assuntos
Bulimia/psicologia , Condicionamento Psicológico , Sinais (Psicologia) , Comportamento Alimentar/fisiologia , Comportamento Alimentar/psicologia , Animais , Aprendizagem por Associação/fisiologia , Comportamento Animal , Condicionamento Clássico/fisiologia , Comportamento Consumatório/fisiologia , Ingestão de Alimentos/fisiologia , Ingestão de Alimentos/psicologia , Meio Ambiente , Abastecimento de Alimentos , Hiperfagia/psicologia , Masculino , Ratos , Ratos Long-Evans , Reforço Psicológico , Saciação/fisiologiaRESUMO
Two experiments refined procedures to study Pavlovian influences on goal-directed behavior in mice and studied the effects of CS-US relations in Pavlovian-instrumental interactions. Independent groups of mice underwent Pavlovian training to associate either a 10-sec or 2-min auditory stimulus (CS) with reward. We next assessed the ability of the response-contingent CS presentations to reinforce novel instrumental responding (conditioned reinforcement; CRf) or the ability of noncontingent CS presentations to increase ongoing instrumental responding (Pavlovian-instrumental transfer; PIT). Whereas 10-sec training conditions produced strong CRf (and no PIT), 2-min training conditions produced robust PIT (but no CRf).
Assuntos
Comportamento Animal , Condicionamento Clássico/fisiologia , Objetivos , Reforço Psicológico , Animais , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Transferência de ExperiênciaRESUMO
We examined the reinforcer-specificity of Pavlovian conditioning in the control of appetitive and consummatory behaviors in Pavlovian-to-instrumental transfer, cue-potentiated eating, and devaluation procedures. Rats received pairings of one conditioned stimulus with sucrose and another conditioned stimulus with maltodextrin. In Experiment 1, rats were also trained to earn sucrose for one instrumental response and maltodextrin for another. In a transfer test, the Pavlovian cues enhanced the rate of instrumental responding more when the food reinforcer predicted by the instrumental response and the Pavlovian cue were consistent than when they were inconsistent, but both cues enhanced both responses. In Experiment 2, sated rats' consumption of each food was potentiated in the presence of a cue for that food, but not in the presence of a cue for the other food. In Experiment 3, one food was devalued by pairing it with lithium chloride, prior to testing food consumption and food-cup directed behaviors. The food cues selectively controlled food-cup related behaviors, regardless of the presence of the devalued or nondevalued foods in the food cup. Together, these results are consistent with the view that conditioned cues modulate appetitive and consummatory behaviors with increasing levels of specificity. The closer an action comes to ingestion, the more it is controlled by sensory properties conveyed by learned cues. These data are discussed in the context of allostatic regulation of food foraging and intake.
Assuntos
Comportamento Apetitivo/fisiologia , Condicionamento Clássico/fisiologia , Comportamento Consumatório/fisiologia , Alimentos , Animais , Aprendizagem da Esquiva/fisiologia , Condicionamento Operante/fisiologia , Sinais (Psicologia) , Ingestão de Alimentos/fisiologia , Masculino , Polissacarídeos , Ratos , Ratos Long-Evans , Reforço Psicológico , Saciação/fisiologia , SacaroseRESUMO
Postnatal brain development is studded with sensitive periods during which experience dependent plasticity is enhanced. This enables rapid learning from environmental inputs and reorganization of cortical circuits that matches behavior with environmental contingencies. Significant headway has been achieved in characterizing and understanding sensitive period biology in primary sensory cortices, but relatively little is known about sensitive period biology in associative neocortex. One possible mediator is the onset of puberty, which marks the transition to adolescence, when animals shift their behavior toward gaining independence and exploring their social world. Puberty onset correlates with reduced behavioral plasticity in some domains and enhanced plasticity in others, and therefore may drive the transition from juvenile to adolescent brain function. Pubertal onset is also occurring earlier in developed nations, particularly in unserved populations, and earlier puberty is associated with vulnerability for substance use, depression and anxiety. In the present article we review the evidence that supports a causal role for puberty in developmental changes in the function and neurobiology of the associative neocortex. We also propose a model for how pubertal hormones may regulate sensitive period plasticity in associative neocortex. We conclude that the evidence suggests puberty onset may play a causal role in some aspects of associative neocortical development, but that further research that manipulates puberty and measures gonadal hormones is required. We argue that further work of this kind is urgently needed to determine how earlier puberty may negatively impact human health and learning potential. This article is part of a Special Issue entitled SI: Adolescent plasticity.
Assuntos
Neocórtex/crescimento & desenvolvimento , Neocórtex/fisiologia , Plasticidade Neuronal/fisiologia , Puberdade/fisiologia , Maturidade Sexual/fisiologia , Animais , Humanos , Puberdade/psicologiaRESUMO
Understanding the heterogeneity of groups along the vaccine hesitancy continuum presents an opportunity to tailor and increase the impact of public engagement efforts with these groups. Audience segmentation can support these goals, as demonstrated here in the context of the 2009 H1N1 vaccine. In March 2010, we surveyed 1569 respondents, drawn from a nationally representative sample of American adults, with oversampling of racial/ethnic minorities and persons living below the United States Federal Poverty Level. Guided by the Structural Influence Model, we assessed knowledge, attitudes, and behaviors related to H1N1; communication outcomes; and social determinants. Among those who did not receive the vaccine (n = 1166), cluster analysis identified three vaccine-hesitant subgroups. Disengaged Skeptics (67%) were furthest from vaccine acceptance, with low levels of concern and engagement. The Informed Unconvinced (19%) were sophisticated consumers of media and health information who may not have been reached with information to motivate vaccination. The Open to Persuasion cluster (14%) had the highest levels of concern and motivation and may have required engagement about vaccination broadly. There were significant sociodemographic differences between groups. This analysis highlights the potential to use segmentation techniques to identify subgroups on the vaccine hesitancy continuum and tailor public engagement efforts accordingly.
RESUMO
Abstract Consideration of future consequences is the extent to which people anticipate and are influenced by the potential future consequences of their current behavior. A well-established tool to measure this behavior is the 14-item Consideration of Future Consequences Scale (CFC-14). The CFC-14 has shown appropriate psychometric properties in several languages. This scale comprises two factors: the CFC-Immediate (CFC-I, 7 items) and the CFC-Future (CFC-F, 7 items). The main goal of this study was to assess the psychometric properties and internal consistency of the CFC-14 Scale in Spanish, using an Argentine sample. A second goal was to determine its convergent validity with impulsivity, and determine differences and invariance across gender and age groups. Using a web-based survey, data were collected from 512 participants (75.2% women) aged 13-74 years (M = 30.8). CFA showed a two-factor model as the best solution for the 13-items version (CFI .961, TLI .952, RMSEA .064 90%IC .054/.074, WRMR 0.979). Standardized regression weights (p ≤ .05) ranged from .50 to .66 for CFC-F and between .43 and .83 for CFC-I. Composite reliability was also adequate: CFC-F achieved p = .80 and CFC-I p = .82. There were no differences across gender and age, but there was a progressive invariance between these groups. The CFC-F and UPPS-P subscales correlations were negative and significant, highlighting the negative and moderate correlation between CFC-F and the lack of premeditation (r=-.41). Thus, CFC-14 has adequate psychometric properties in an Argentine population, although more studies are necessary to determine the robustness of these findings.
Resumen La consideración de las consecuencias futuras se define como el grado en el cual las personas anticipan y son influenciadas por las potenciales consecuencias futuras de su comportamiento actual, y una herramienta muy utilizada para medirla es la Escala de Consideración de las Consecuencias Futuras (CFC-14). Esta escala ha exhibido propiedades psicométricas adecuadas en varios idiomas y se encuentra conformada por dos factores: CFC-Inmediato (CFC-I, 7 ítems) y CFC-Futuro (CFC-F, 7 ítems). El objetivo principal de este estudio fue evaluar las propiedades psicométricas y la consistencia interna de la versión en español de la CFC-14 en una muestra argentina, además de identificar las evidencias de validez convergente con la Escala de Impulsividad y la invarianza en función del género y la edad de los participantes. Para esto, se evaluó mediante una encuesta online a 512 participantes (75.2 % mujeres) de 13 a 74 años (M = 30.8) y se realizó un AFC en el que se encontró un modelo de dos factores como aquel con mejor ajuste para una versión de la escala de 13 ítems (CFI = .961; TLI = .952; RMSEA = .064; IC 90 % = .054-.074; WRMR = 0.979). Específicamente, los pesos de regresión estandarizados (p ≤ .05) fueron de .50 a .66 para CFC-F y de .43 a .83 para CFC-I; los valores de confiabilidad compuesta fueron adecuados, con un p = .80 para CFC-F y un p = .82 para CFC-I; no se observaron diferencias estadísticamente significativas en función del sexo y la edad de los participantes, no obstante, hubo una invarianza progresiva entre estos grupos; y las correlaciones entre las subescalas de la Escala de Impulsividad (UPPPS-P) y la CFC-F fueron negativas y significativas, siendo llamativa la correlación negativa y moderada entre la falta de premeditación y la CFC-F (r = -.41). De este modo, la CFC-14 mostró propiedades psicométricas adecuadas en una muestra argentina, aunque se necesita de más estudios para determinar la robustez de estos resultados.
RESUMO
OBJECTIVE: Although the field of crisis risk communication has generated substantial research, the interaction between social determinants, communication processes, and behavioral compliance has been less well studied. With the goal of better understanding these interactions, this report examines how social determinants influenced communications and behavioral compliance during the 2010 Boston, Massachusetts, water crisis. METHODS: An online survey was conducted to assess Boston residents' knowledge, beliefs, attitudes, mass and interpersonal communication, and preventive behaviors on emergency preparedness topics dealing with the water crisis. Of a total sample of 726 respondents, approximately one-third (n = 267) reported having been affected by the water crisis. Only data from affected participants were analyzed. RESULTS: Following an order to boil water, 87.5% of respondents refrained from drinking unboiled tap water. These behaviors and other cognitive and attitudinal factors, however, were not uniform across population subgroups. All communication and behavioral compliance variables varied across sociodemographic factors. CONCLUSIONS: Crisis communication, in conjunction with other public health preparedness fields, is central to reducing the negative impact of sudden hazards. Emergency scenarios such as the Boston water crisis serve as unique opportunities to understand how effectively crisis messages are conveyed to and received by different segments of the population.
Assuntos
Comunicação , Desastres , Inundações , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Boston , Planejamento em Desastres , Escolaridade , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Fatores de Tempo , Populações Vulneráveis , Adulto JovemRESUMO
In Pavlovian fear conditioning, pairing a neutral cue with aversive foot shock endows a cue with fear-eliciting properties. Studies of Pavlovian fear conditioning measuring freezing have demonstrated the basolateral amygdala (BLA) to be critical to both fear learning and memory. The nucleus accumbens core (NAc), while not important to freezing, is important to the enhancement of instrumental responding by cues paired with food reward. In the present study we investigated the role of the BLA and the NAc in another property of fear cues, the ability to suppress instrumental responding for food rewards (conditioned suppression). Sham, BLA and NAc-lesioned rats received a fear discrimination procedure in which one visual cue (CS+) predicted foot shock while a second cue (CS-) did not. Conditioning took place over a baseline of instrumental responding, allowing for concurrent measure of freezing and instrumental suppression. NAc lesions left fear conditioning fully intact. BLA lesions impaired acquisition and discrimination of fear when assessed with conditioned freezing. However, BLA lesions only altered fear acquisition and left discrimination completely intact when assessed with conditioned suppression. These findings suggest a critical role for the BLA in fear when assessed with conditioned freezing but a diminished role when assessed with conditioned suppression.
Assuntos
Tonsila do Cerebelo/fisiologia , Condicionamento Psicológico/fisiologia , Medo/fisiologia , Reação de Congelamento Cataléptica/fisiologia , Animais , Medo/psicologia , Masculino , Ratos , Ratos Long-EvansRESUMO
Early vaccination against influenza viruses is a cost-effective solution to prevent contagion and reduce influenza-related morbidity and mortality. In the face of pandemic viruses, such as the A(H1N1), adequate rates of vaccine uptake play a critical role in containing the spread and effects of the disease. In order to understand the reasons underlying the relatively low 2009-2010 A(H1N1) vaccination rates, we conducted an online survey of 1569 respondents drawn from a nationally representative sample of United States (U.S.) adults age 18, and older. Because prior research suggests that vaccination rates are especially low among some U.S. population subgroups, we oversampled participants from minority ethnic/racial groups and those living under the Federal Poverty Level. Our results show that A(H1N1) vaccine uptake is associated with sociodemographic factors, A(H1N1)-related beliefs and seasonal vaccination. That is, A(H1N1) vaccination is strongly associated with age, urbanicity, perceiving the A(H1N1) vaccine as safe and seasonal flu vaccine uptake. Perceptions of safety and season flu vaccination show the strongest associations with A(H1N1) uptake. The reasons people gave to decline vaccination varied by respondents' sociodemographic group. For example, Black participants were the most likely ethnic/racial group to reported having tried to get the vaccine but found it unavailable. Together, these findings suggest some clear pointers towards strategic public health communication efforts calling for communication campaigns towards audiences segmented by social class, race/ethnicity and beliefs, often what advertisers call "psychodemographics".
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/imunologia , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Cultura , Demografia , Feminino , Disparidades em Assistência à Saúde , Humanos , Vacinas contra Influenza/economia , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Grupos Raciais , Classe Social , Inquéritos e Questionários , Estados UnidosRESUMO
OBJECTIVE: Health information-seeking behaviors (HISBs) are associated with active participation in cancer care decisions which, in turn, may positively impact health outcomes. The goal of this study was to develop a taxonomy of topics for which post-treatment cancer patients sought information, and to explore HISB patterns by sociodemographic factors and cancer type. METHODS: We examined how health information seeking is associated with social determinants in a survey of 521 post-treatment cancer patients. RESULTS: Four major topics of interest were found: disease/treatment, self-care management, health services, and work/finance. Assessment of the relationship between social determinants and these four topics showed associations for (1) HISBs on disease/treatment topics decreased with age and increased with education; (2) HISBs on self-care management increased with education and varied by cancer type; (3) HISBs on health services increased with education; and (4) HISBs on work/finance decreased with age and wealth, but increased with debt. CONCLUSION: These results demonstrate one pathway through which social determinants may drive communication inequalities, which may result in increased disparities in health outcomes. PRACTICE IMPLICATIONS: Further exploration of the relationship between social determinants and information-seeking among post-treatment cancer patients may contribute to the development of strategies to reduce health disparities.
Assuntos
Informação de Saúde ao Consumidor , Conhecimentos, Atitudes e Prática em Saúde , Comportamento de Busca de Informação , Serviços de Informação/estatística & dados numéricos , Avaliação das Necessidades , Neoplasias/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Neoplasias/terapia , Classe Social , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
Considerable evidence shows that environmental cues that signal food delivery when rats are food-deprived can substantially potentiate feeding later when rats are food-sated. Similarly, cues associated with meal interruption, food removal or impending food scarcity may also induce increased eating. For example, after learning the association between a discrete "interruption" stimulus and the unexpected termination of food trials, sated rats show enhanced food consumption when exposed to that stimulus. In Experiment 1, unlike sham-lesioned controls, rats with bilateral excitotoxic lesions of the basolateral amygdala (BLA) failed to display such cue-potentiated feeding. In Experiment 2, potentiation of feeding by an interruption signal was found to be food-specific. That is, a stimulus that signaled interruption of trials with one food but not trials with a second food later only facilitated consumption of the first food. These studies extend our knowledge of the psychological and neural processes underlying cue-induced feeding. Understanding these mechanisms may contribute our understanding of the etiology and treatment of binge eating disorders.
Assuntos
Tonsila do Cerebelo/fisiologia , Condicionamento Clássico/fisiologia , Extinção Psicológica/fisiologia , Comportamento Alimentar/fisiologia , Análise de Variância , Animais , Sinais (Psicologia) , Masculino , Ratos , Ratos Long-EvansRESUMO
Este trabajo se centra en el análisis de los desarrollos centrales de la psicología narrativa respecto de las múltiples formas de comprender la construcción de la experiencia humana, las funciones de la "narrativa" en la vida psíquica y social del sujeto, sus componentes medulares, las formas de entender una psicopatología implícita en dicha perspectiva, y las diferentes definiciones de cambio terapéutico que se generan a partir de ellas. Se recorren para ello los textos más relevantes de los últimos veinte años analizando la coherencia interna de los más importantes desarrollos, similitudes y diferencias entre los autores enrolados en esta línea, sus aportes y contradicciones.
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Humanos , Psicologia , PsicopatologiaRESUMO
Este trabajo se centra en el análisis de los desarrollos centrales de la psicología narrativa respecto de las múltiples formas de comprender la construcción de la experiencia humana, las funciones de la "narrativa" en la vida psíquica y social del sujeto, sus componentes medulares, las formas de entender una psicopatología implícita en dicha perspectiva, y las diferentes definiciones de cambio terapéutico que se generan a partir de ellas. Se recorren para ello los textos más relevantes de los últimos veinte años analizando la coherencia interna de los más importantes desarrollos, similitudes y diferencias entre los autores enrolados en esta línea, sus aportes y contradicciones.(AU)