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El Modelo Cognitivo-Conductual

Hoy en da, el modelo conductual ha evolucionado hacia un modelo integrado en el que conducta

y cognicin han equiparado prcticamente su estatus y asumen su papel de agentes causales

recprocos entre s. Por tanto, los primeros modelos ms radicales (conductismo) en los que laconducta manifiesta era el elemento principal de estudio han quedado relegados.

El enfoque cognitivoconductual, en t!rminos generales puede conceptuali"arse seg#n elconocido esquema $%&. 'onde $ representa los acontecimientos de la vida que estn

relacionados con determinadas consecuencias emocionales o conductuales que definen un

prolema o trastorno psicolgico representado por &. $hora ien, entre amas, se sit#a %,elemento que integra las creencias, las imgenes, los pensamientos y que media entre las partes.

*al como se+alan algunos autores, actualmente " la Modificacin de Conducta se caracteriza

por ser una terapia breve, directiva, activa, centrada en el problema, orientada al presente,

que supone una relacin colaboradora y en la que el cliente puede ser un individuo, unapareja, una familia, un grupo o una comunidad." (Marino Prez lvarez en "Caracterizacinde la Intervencin Clnica en Modificacin de Conducta". Manual de Terapia de Conducta,Volumen , !#in$on P$icolo%a&.

Por terapia brevese entienden aquellas que se sit#an alrededor de las - sesiones. /inemargo, hay que mati"ar que hay ciertas terapias dentro del modelo conductual como las

terapias cognitivas de los trastornos de personalidad que suelen necesitar ms sesiones.

0as sesiones son de - hora por t!rmino medio a e1cepcin de las sesiones iniciales que puedenprolongarse un poco ms (234).

Otras caractersticas:

-/on activas en cuanto se supone que el paciente tiene que hacer algo respecto a la postura de

que algo ocurre en ellos.

5/e centran en el prolema como o6etivo a resolver sin suponer la necesidad de otros camios

estructurales.

7/it#a el anlisis y solucin del prolema en el aqu y ahora, es decir, en el presente, en

contraposicin a otras teoras que necesitan seguir el hilo evolutivo de ciertos signos y sntomas

en el pasado.

80a relacin terap!utica se construye desde una relacin colaoradora y de participacin activa

con el paciente. 9o es, por tanto, una relacin directiva en la que se produ"ca la imposicin de

un determinado camino.

:inalmente, el cliente de una terapia psicolgica puede ser un individuo, una pare6a, una

familia o un grupo.

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Adems de la gua, el NICE ha elaborado un Cuestionario de Capacidades yDifcultades para su utilizacin durante la evaluacin inicial de un nio o joven consospecha de trastorno de conducta, as como una interesante herramienta online,ue act!a a modo de rbol de decisin, para "acilitar la tarea del pro"esionalsanitario a la hora de evaluar # manejar este problema $ue puede consultarse enel siguiente enlace% http%&&path'a#s(nice(org(u)&path'a#s&antisocial*behaviour*and*conduct*disorders*in*children*and*#oung*people+(

;ffer multimodal interventions, for e1ample, multisystemic therapy, to children and young

people aged etultimodal interventions should involve the child or young person and their parents and carers

and should

have an e1plicit and supportive family focus

e ased on a social learning model

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dependence. *he frequency and duration of sustance use are helpful dimensions in this regard.

Early (i.e., at -3 to -7 years of age), repeated use of alcohol or illicit drugs is a red flag for the

development of other ehaviors associated

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Emphasi"e parental monitoring of children4s activities (

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child &ehaveiour effectively "ithout the use of physical punishment. Therealso is evidence that multi(systemic therapy is an effective intervention for CDyouth that may &e delivered in family and community settins.Childrens Mental +ealth Ontario(( May 0, 1220

Children and adolescents "ith conduct disorder usually sho" poor academic

achievement and may &e disli%ed &y their teachers and classmates. -aced "ith frustration and e)clusion, the child or youth mayresortto &ullyin and antisocial &ehaviour and associate "ith other students"ho are in a similar situation. Children "ith CD may &e treated effectively inday treatment prorams, &ut ood follo"(up and transition plannin isnecessary if treatment ains are to &e maintained in reular classrooms. T"ocommon school(&ased treatment approaches for CD children thathaveresearch support are continency manaement and the use of to%eneconomies to reinforce positive &ehaviour and reduce neative &ehaviours.Durin the last 02 years, a num&er of school(&ased prorams have &eendeveloped to address conduct pro&lems, includin aner manaement,conflict resolution, social pro&lem solvin, and social s%ill trainin. Only a fe"of these prorams have empirical support for their a&ility to chane pro&lem&ehaviours or to maintain chanes after the proram ends. Adolescent(onsetCD is often associated "ith mem&ership in a roup of antisocial youth. Toavoid conduct(disordered &ehavior, peer intervention may &e necessary toremove the youth from an antisocial roup and help them to develop a ne"peer roup. !everal evidence(&ased peer roup intervention prorams haveproven effective. There also has &een research support for multi(systemic

therapy that treats conduct(disordered adolescents $includin serious andviolent offenders' in their social settins "hile com&inin family andcommunity interventions.

Recommended family intervention includes3*arent counsellin that enhances parental strenths*arent trainin to esta&lish consistent &ehaviour manaement-amily therapy

4.5 *eer 6ntervention !ince adolescents rely more on peersthan parents or teachers for values and direction, intervention"ith adolescents should include a focus on peers as "ell asfamily$-eldman 7 8ein&erer, 099:'.

Adolescent(onset CD is often associated "ith mem&ership inaroup of antisocial youth.To avoid conduct(disordered

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&ehavior,intervention may &e necessary to remove the youthfrom an antisocial roup and help them to develop a ne" peerroup. !ince CD youth often lac% appropriate social s%ills, theymay need specific coachin on ma%in and %eepin friends,

learnin ne" "ays of usin free time, and ;oinin positiveactivities and orani

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Recommended intervention "ith peers includes3B *eer intervention to replace deviant peer roup "ith sociallyappropriate roup

B *romote prosocial interactions "ith peers at school

-A./

on(term oalsBArrest of the development of adolescent antisocial &ehaviours anddru e)perimentation.6ntermediate oalsB 6mprovement of parent family manaement and communication

s%ills.Evaluacioneffective in enain students and their parents and in improvinparent(child relations

Cognitivo*conductual-A./

-or parents3B !trenthened parental competenciesB 6nvolvement in childrens school e)periences to promote

childrens academic and social competencies and reduce conductpro&lems.

-or children3B !trenthened social and academic competenceB Reduced &ehaviour pro&lemsB 6ncreased positive interactions "ith peers, teachers and parents

Enfocado familia-A./6mproved parentin s%illsB Ac#uisition of pro&lemsolvin s%illsB 6mproved family functioninB Development of supportive personal net"or%s for loisticalassistance, information, support and encouraement

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B6ncreased a"areness and utili