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Action Against Hunger urges the international community to ensure the implementation of the ceasefire agreement, and calls for its efforts to be directed towards the rehabilitation of civilian infrastructure and the establishment of lasting peace. 
After 15 months of conflict, the 600 trucks per day provided for in the ceasefire are not enough to respond to the immense needs of the population.  
“Furthermore, there are numerous limitations on importing certain types of supplies”, adds Anguera. “In addition to the entry of trucks, we need the ease on restrictions on the type of materials allowed, especially those related to the rehabilitation of water and sanitation services and essential items to cope with the winter“, she explains.
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Autism and Other Neurodevelopmental Disorders
Volume 4 - 2025 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/frcha.2025.1477839">https://doi.org/10.3389/frcha.2025.1477839</a>
Background: Small pilot studies have indicated that transcranial photobiomodulation (tPBM) may help alleviate symptoms of neurological conditions like depression
traumatic brain injury and Autism Spectrum Disorder (ASD)
Objective: To examine the effect of tPBM on the behavioral symptoms of ASD and brain electrophysiology in children aged 2&#x2013;7
We delivered non-invasively to all participants pulses of near-infrared light (wavelength 850&#x2005;nm
pulse 40&#x2005;Hz) to cortical nodes of Default Mode Network
The tPBM was delivered using an investigational medical device designed for this purpose
Changes in ASD symptoms were measured using pre- and post-intervention scores on the Childhood Autism Rating Scale (CARS-2
We collected electroencephalogram (EEG) data after each treatment session from all children who tolerated wearing the EEG cap to monitor changes in brain activity
Results: The intervention resulted in a significant 7-point reduction in average CARS-2 scores (t&#x2009;&#x003D;&#x2009;10.23
along with decreased delta power and increased gamma and beta power in EEG readings
The increase in gamma power was statistically significant [t(14)&#x2009;&#x003D;&#x2009;2.30
Changes in EEG power were significantly correlated with the number of sessions (delta: r(192)&#x2009;&#x003D;&#x2009;&#x2212;0.18
p&#x2009;&#x003D;&#x2009;.013; gamma: r(192)&#x2009;&#x003D;&#x2009;.19
p&#x2009;&#x003D;&#x2009;.007; beta: r(192)&#x2009;&#x003D;&#x2009;.15
Improvements in CARS-2 scores were negatively correlated with changes in delta and beta power (delta: r(15)&#x2009;&#x003D;&#x2009;&#x2212;.59
p&#x2009;&#x003D;&#x2009;.020; beta: r(15)&#x2009;&#x003D;&#x2009;&#x2212;.54
No moderate or severe side effects were reported
Trial Registration: <a href="https://clinicaltrials.gov/ct2/show/NCT04660552">https://clinicaltrials.gov/ct2/show/NCT04660552</a>
The prevalence in ASD of both under- and over-connectivity of the default mode network (DMN) might be related to mitochondrial dysfunction and neuroinflammation (<a href="#B20">20</a>). Several studies have correlated DMN dysfunction with conditions such as dementia, schizophrenia, and autism (<a href="#B21">21</a>). Specifically, functional MRI studies have identified aberrant DMN connectivity in both children and adults with ASD (<a href="#B22">22</a>)
2nd Edition or &#x201C;CARS-2&#x201D;) after 8 weeks of tPBM stimulation with the investigational medical device (40&#x2005;hz
which included some cortical nodes of the DMN as well as some areas in pre-frontal cortex and the temporal lobe
we administered the tPBM treatment using the investigational medical device and assessed the generalizability of tPBM as a therapeutic intervention for children aged 2&#x2013;7 with ASD
We used CARS-2 to score the severity of ASD symptoms pre- post-intervention and collected EEG data of known neural signatures after each tPBM session using a high-resolution EEG device
specifically designed for young children (Ant-Neuro Eego Sports 32)
without seeking validation of the mechanism of action of PBM therapy in ASD
This was an 8-week open-label exploratory study designed to validate the safety and efficacy of the tPBM device designed for pediatric autistic patients
The study protocol was approved by WCG institutional review board (IRB, 1280247) and is registered at <a href="https://www.ClinicalTrials.gov">ClinicalTrials.gov</a> (Identifier: NCT04660552)
Two- to seven-year-olds, inclusive of both genders and all ethnicities, with a previous diagnosis of ASD and CARS-2 scores above 28, were eligible to participate in the study. The diagnosis had to be given by a licensed professional (e.g., a developmental pediatrician) in accordance with the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (<a href="#B32">32</a>)
These evaluations typically involved a battery of tests
Autism Diagnostic Observation Schedule (ADOS)
Temperament and Atypical Behavior Scale (TABS)
and Autism Diagnostic Interview-Revised (ADI-R)
Detailed inclusion and exclusion criteria are presented in <a href="#T1">Table&#x00A0;1</a>
Recruitment was conducted through Applied Behavioral Analysis agencies and specialized schools
Informed consent was obtained for each treatment session
Treatments were applied and clinical data collected in an IRB approved location
The device under investigation was: a wireless, light-weight device specifically designed for young children with ASD to remain mobile (see <a href="#F1">Figure&#x00A0;1</a>)
The device is Bluetooth controlled and provides transcranial delivery of pulsed NIR light (40&#x2005;Hz
via 6 LEDs (150&#x2005;mW maximum optical power
each) to targeted brain areas (which included amongst others
Following a two-week titration protocol (described below)
each participant underwent treatment twice a week for 8 weeks
Each treatment session was followed by 15&#x2005;min of EEG data collection from participants that tolerated wearing the EEG cap
Titration protocol: Each participant started with a 2&#x2005;min tPBM treatment
Participants who tolerated the treatment well received incrementally larger doses (2&#x2005;min) in each of 5 subsequent sessions
and ethnicity were collected by staff before intervention
To evaluate the effect of tPBM on ASD symptoms
pre- and post-intervention assessments of CARS-2 were conducted on all participants by the last author
a licensed psychologist experienced in the use of CARS-2 in clinical practice
To minimize the potential bias present in open-label studies
the evaluator did not see the pre-treatment CARS-2 scores during the post-treatment CARS-2 evaluations
CARS-2 is a validated clinical rating scale designed for use by trained clinicians to assess ASD based on direct observation of the child (<a href="#B33">33</a>)
each corresponding to core domains affected by ASD
Total scores on the scale range from 15 to 60
Interpretations of scores are categorized as follows: scores below 30 indicate the non-autistic range; scores from 30 to 36.5 indicate mild to moderate autism; scores from 37 to 60 indicate severe autism
To evaluate the impact of tPBM on brain electrophysiology
trained staff members proficient in operating the EEG devices conducted EEG data collection sessions lasting 15&#x2005;min after each tPBM session
EEG data was collected utilizing the eego&#x2122; sports 32
32-channel EEG device specifically engineered for use in young children (ANT Neuro GmbH
Data collection was limited to children comfortable with wearing the EEG cap
EEG is used for brain electrophysiology, providing valuable insights into the neural dynamics associated with ASD, aiding diagnostic information, and informing early intervention strategies (<a href="#B34">34</a>&#x2013;<a href="#B37">37</a>)
Pre- and post-intervention CARS-2 scores were analyzed and compared using a paired samples t-test
Changes in mean CARS-2 scores were considered significant at p&#x2009;&#x003C;&#x2009;0.05
EEG data was preprocessed using the EEGLAB software (<a href="#B38">38</a>)
Noisy channels identified upon initial visual inspection were removed from the data and interpolated using a spherical spline interpolation
using the average signal of the surrounding channels to reconstruct the data in the removed channel
and a low-pass filter at 50&#x2005;Hz was applied to remove high-frequency noise
Ocular correction was performed by removing segments of data containing eye blinks and lateral eye movements
The data were then re-referenced to the average signal of all channels
Event-related spectral perturbation (ERSP) power in delta (1&#x2013;4&#x2005;Hz)
and gamma (30&#x2013;50&#x2005;Hz) frequency bands were resolved using a fast Fourier transform (FFT)
Here we interrogated the recorded ERSP power by: (1) using a correlation-based analysis involving scaled time as in (<a href="#B31">31</a>) using a traditional pre-post intervention analysis
we evaluated global power by collapsing the ERSP power signal across all electrodes
To assess changes in spectral power over scaled time
Pearson correlations were performed to test the relationship between spectral power in each band collected at each treatment session for each participant
Given that participants had different number of treatment sessions
only participants who had at least 3 treatment sessions were included in the analysis
we directly investigated spectral power pre- and post-treatment using each individual&#x0027;s first and final treatment sessions by paired t-test analysis
each test functioned following a bootstrapping procedure where 1,000 samples were taken to achieve 95&#x0025; confidence interval threshold
Results were significant at p&#x2009;&#x003C;&#x2009;0.05
Thirty-one children aged 2&#x2013;7 years were screened to ensure they met all inclusion and none of the exclusion criteria
Most participants received their diagnosis during the 24 months evaluation period provided through the New York State Department of Health Early Intervention program
Twenty-five children were initially enrolled
Three dropped out due to travel limitations
leaving twenty-two participants who completed the study
The mean age of the participants was 4.9 years old
with a standard deviation (SD) of 1.46 years
86.36&#x0025; of the participants were White
Baseline demographics data are presented in <a href="#T2">Table&#x00A0;2</a>
All twenty-two participants that completed the study tolerated the treatment well and received up-to 12&#x2005;min treatments twice a week for 8 weeks
Seventeen experienced hyperactivity at least once during the study
Fifteen participants tolerated at least three 15&#x2005;min EEG recording sessions
a significant reduction in CARS-2 scores was observed
with a mean decrease of 7 points (t&#x2009;&#x003D;&#x2009;10.23
The pre-intervention CARS-2 scores had a mean of 36.5 (SD&#x2009;&#x003D;&#x2009;5.6
while post-intervention scores averaged 29.7 (SD&#x2009;&#x003D;&#x2009;5.5)
Detailed CARS-2 scores for each participant, along with the overall mean (M) and standard deviation (SD), are presented in <a href="#T3">Table&#x00A0;3</a>. Participant&#x0027;s pre- post-intervention score changes by CARS-2 sub-scale are tabulated in <a href="#T4">Table&#x00A0;4</a>
Patient&#x0027;s CARS-2 Sub-scale change: post-intervention score Minus baseline score
Although the very small sub-group sample sizes make conclusions speculative
a post-hoc analysis of the data revealed no significant differences in the reduction of mean CARS-2 scores between participants aged 2&#x2013;6
The observed 7-point change in mean CARS-2 scores before and after the intervention aligns with the results from the (<a href="#B31">31</a>)
where the difference in mean CARS-2 score change between the two groups was 7.23 (95&#x0025; CI: 2.357&#x2013;12.107
The CARS-2 scores result for the (<a href="#B31">31</a>) study are reproduced in <a href="#T5">Table&#x00A0;5</a>
Table 5. CARS-2 scores, mean (SD) (<a href="#B31">31</a>),
indicating that these neural signals strengthened over time
No significant correlations were found in the other frequency bands (theta: r(192)&#x2009;&#x003D;&#x2009;0.03
p&#x2009;&#x003D;&#x2009;0.72; alpha: r(192)&#x2009;&#x003D;&#x2009;0.07
Scatterplots of spectral power in different frequency bands vs
the number of treatment sessions with EEG recordings by participant
decibels (unitless measure of power amplitude)
Each dot represents an individual observation
We also identified significant negative correlations between improvements in CARS-2 scores (a measure of symptom severity) and changes in both delta power (r(15)&#x2009;&#x003D;&#x2009;&#x2212;0.59, p&#x2009;&#x003D;&#x2009;0.020; see <a href="#F3">Figure&#x00A0;3A</a>) and beta power (r(15)&#x2009;&#x003D;&#x2009;&#x2212;0.54, p&#x2009;&#x003D;&#x2009;0.037; see <a href="#F3">Figure&#x00A0;3B</a>)
no significant associations were found between CARS-2 scores and changes in gamma or theta power (gamma: r(15)&#x2009;&#x003D;&#x2009;&#x2212;0.43
p&#x2009;&#x003D;&#x2009;0.11; theta: r(15)&#x2009;&#x003D;&#x2009;0.11
Scatterplots of change in spectral power (last session minus first session) in different frequency bands vs
the Childhood Autism Rating Scales (CARS-2)
which directly compared ERSP power between the first and final treatment sessions
showed a significant pre- post-treatment increase in gamma power (t(14)&#x2009;&#x003D;&#x2009;2.30
There were no significant differences in any of the other frequency bands
The present open-label one arm study investigated the effect of tPBM (delivered by the investigational medical device) on the symptoms of ASD and brain electrophysiology
We evaluated changes in ASD symptoms using the CARS-2, comparing scores before and after the tPBM intervention. To assess brain activity, we analyzed EEG data collected after each tPBM session using Ant-Neuro EEG cap. After the eight-week tPBM treatment, we observed a significant reduction in ASD symptoms and notable changes in brain activity. These results closely mirrored those of the (<a href="#B31">31</a>)
which were achieved using the same investigational medical device
The observed changes in brain activity were associated with improvements in ASD symptoms and shifts toward more typical brainwave patterns
These findings imply that tPBM could be a promising treatment option for individuals with ASD who also experience seizures
These findings should be interpreted with caution. Studies comparing EEG patterns in children with ASD to neurotypical children have produced mixed results (<a href="#B50">50</a>&#x2013;<a href="#B52">52</a>)
and we only observed changes in gamma power after the intervention
the results suggest that EEG pattern changes could be a valuable tool for assessing treatment effectiveness
Several limitations should be acknowledged when interpreting these findings
and relatively wide age range could confound the results with natural developmental changes
some children were unable to tolerate the EEG cap after each tPBM session
although the CARS-2 is an FDA-required outcome measure for ASD trials
it may not optimally capture the full range of symptom improvements
especially those that substantially impact family life but are not well-reflected in the scale
the study did not include follow-up assessments (CARS-2 or EEG) months later to determine the persistence or transience of the treatment effects
the results should be interpreted with caution
They should be considered only within the specific population and conditions under which the study was conducted
Broad generalizations or extrapolations beyond this context may lead to inaccurate conclusions or misinterpretations
This open-label study adds significant support to using tPBM as a safe and effective intervention for reducing the core symptoms of ASD
larger-scale studies with more rigorous designs are necessary to validate and extend these results
Future research should specifically examine the impact of light-dosing variables&#x2014;such as pulsing frequency&#x2014;on treatment outcomes; assess long-term efficacy and potential side effects; investigate drug interactions; and analyze changes in specific symptoms by evaluating each CARS-2 subscale individually
studies should evaluate the effects on both the child&#x0027;s and parents&#x0027; quality of life
It is also important for future research to consider factors like gender
as well as the high comorbidity of ASD with other neurological and psychiatric disorders&#x2014;including attention deficit hyperactivity disorder (ADHD)
given that a significant percentage of children diagnosed with ASD develop seizures later in life
further studies employing EEG are warranted
The raw data supporting the conclusions of this article will be made available by the authors
The studies involving humans were approved by WCG North America Institutional Review Board
The studies were conducted in accordance with the local legislation and institutional requirements
Written informed consent for participation in this study was provided by the participants&#x0027; legal guardians/next of kin
Written informed consent was obtained from the minor(s)&#x0027; legal guardian/next of kin for the publication of any potentially identifiable images or data included in this article
The author(s) declare financial support was received for the research
This study received funding from The National Science Foundation
partially funded the study and was not involved in the study design
or the decision to submit it for publication
We are thankful to Michael Hamblin for his conceptual contribution to the design of the investigational medical device
We are thankful to Robert Naviaux for his comments on the early versions of this manuscript and for his conceptual guidance
We are thankful to our research assistants: Liza Logounova and Maya Rozenblat and Sara Segal for their assistance with data collection and in running the study
We are thankful to Liza Logounova and Katya Sverdlov for coordinating the study
The authors declare that JelikaLite had the following involvement with the study: JelikaLite developed the investigational treatment device used in this study
manuscript writing and the decision to submit to Frontiers in Neurology
LT was involved in manuscript writing and decision to submit to Frontiers in Neurology
JA and AS were paid consultants on this project
The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations
Any product that may be evaluated in this article
or claim that may be made by its manufacturer
is not guaranteed or endorsed by the publisher
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De Taboada L and Steingold E (2025) Transcranial photobiomodulation for reducing symptoms of autism spectrum disorder and modulating brain electrophysiology in children aged 2&#x2013;7: an open label study
Received: 8 August 2024; Accepted: 3 January 2025;Published: 29 January 2025
Copyright: &#x00A9; 2025 Fradkin, Anguera, Simon, De Taboada and Steingold. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
distribution or reproduction in other forums is permitted
provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited
in accordance with accepted academic practice
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The University of Barcelona (UB) has echoed the dead of the emeritus professor of the Faculty of Psychology Maria Teresa Anguera
A teaching member of the Department of Social Psychology and Quantitative Psychology
she was an expert in behavioural science methodology and held several management positions at the University of Barcelona
The article includes significant and complimentary statements of &nbsp;Joan Guàrdia
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A study initiated from a final degree project at the Universitat Aut&#242;noma de Barcelona
with the involvement of researchers from the INc-UAB
the University of Barcelona and Cuban and Chilean institutions
has resulted in an exhaustive bibliographic review of a group of Mediterranean plants
whose active principles are attributed pharmacological actions in the field of cardiovascular diseases most affecting the population
The study has been published in&nbsp;Food Bioscience
Cardiovascular problems are the leading cause of disease and mortality worldwide
have contributed significantly to the development of drugs
as they offer therapeutic potential for several of these diseases
their use is limited by possible side effects
drug-drug interactions and the lack of scientific evidence from quality preclinical and clinical studies
biologist Mateu Anguera Tejedor made an important contribution in this field with his final year Biology degree project at the UAB
tutored by the then postdoctoral researcher at the Institut de Neuroci&#232;ncies of the UAB (INc-UAB) and current lecturer at the Faculty of Pharmacy and Food Sciences of the University of Barcelona
recently published as a scientific article in the journal Food Bioscience
provides an overview of the mechanisms of action and the preclinical and clinical evidence
as well as the adverse effects of essential bioactive compounds derived from a group of selected Mediterranean plants which form part of the Mediterranean diet
six representative plants and their major active components are reported: garlic (Allium sativum
with rosmarinic acid and carnosic acid) and grapevine (Vitis vinifera
The review focused on the most important pharmacological mechanisms
anti-inflammatory and vasodilatory actions
as well as their regulation of lipid metabolism
which may be relevant for conditions such as atherosclerosis and hypertension
The results show that these active components are promising in the potential treatment of atherosclerosis and could reduce the risk of heat attacks and strokes
In addition to summarizing the current scientific evidence
the study provides a reference guide for future research by identifying potential knowledge gaps and offering timely recommendations for designing preclinical and clinical studies in this area
Key areas for future exploration include the long-term safety of these compounds
the evaluation of their synergistic effects when consumed as part of a Mediterranean diet
and the need to establish standardized protocols in controlled clinical settings
By broadening the scientific basis of these traditional remedies
this review may help pave the way for their use as active pharmaceutical ingredients in the development of future phytomedicines
The research team believes that the use of these natural extracts is promising, but their combined ingestion could influence therapeutic outcomes due to the &quot;matrix effect&quot;, which implies that dietary components can alter <a href="/health/What-Does-Efficacy-Mean.aspx" class="linked-term">the efficacy of</a> each extract
either enhancing or diminishing their individual benefits
Understanding this interaction is essential to optimize the therapeutic application of these plant extracts in a dietary context
It is important to recognize that there is often a lack of robust evidence of the impact of natural extracts in humans
and therefore researchers caution that &quot;the label of &#39;natural&#39; does not guarantee safety
and this emphasizes the need to prioritize pharmacokinetic
toxicological and clinical studies to evaluate their efficacy
safety and efficiency in comparison with existing drugs&quot;
The study was carried out by the research group led by Francesc Jim&#233;nez Altay&#243;
Lecturer in the Department of Pharmacology
Therapeutics and Toxicology at the UAB and researcher at the Centre for Biomedical Research in Cardiovascular Diseases Network (CIBERCV) and the UAB Institut de Neuroci&#232;ncies (INc-UAB)
Jim&#233;nez Altay&#243; was tutor of lecturer Ren&#233; Delgado Hern&#225;ndez
Cuban-born researcher from the University of Havana
assigned during the 2022/23 academic year to the Mar&#237;a Zambrano program in the Department of Pharmacology
Therapeutics and Toxicology of the Faculty of Medicine of the UAB and currently lecturer in the Unit of Clinical Pharmacy and Pharmaceutical Care in the Faculty of Pharmacy and Food Sciences of the University of Barcelona
Teaching and research staff from Cuban and Chilean institutions with renowned experience in the field of pharmacology of natural products also participated in the preparation and final publication of this study
<a href="https://www.uab.cat/web/newsroom/news-detail/-1345830290613.html?detid=1345938708832" rel="noopener">Universitat Aut&#242;noma de Barcelona (UAB)</a>
Anguera-Tejedor, M., et al. (2024). Exploring the Therapeutic Potential of Bioactive Compounds from Selected Plant Extracts of Mediterranean Diet Constituents for Cardiovascular Diseases: A Review of Mechanisms of Action, Clinical Evidence, and Adverse Effects.&nbsp;Food Bioscience. <a href="https://doi.org/10.1016/j.fbio.2024.105487" rel="noopener">doi.org/10.1016/j.fbio.2024.105487</a>
Posted in: <a href="/category/Medical-Science-News.aspx">Medical Science News</a> | <a href="/category/Medical-Condition-News.aspx">Medical Condition News</a>
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Explore how the Radian ASAP mass spectrometer is being used to streamline and enhance seized drug screening
Mariangela Kosmopoulou and Tharan Srikumar
Follow Bruker&#39;s experts as they discuss the SCRUM approach to software development in the scientific industry
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Here we show that multitasking performance
as assessed with a custom-designed three-dimensional video game (NeuroRacer)
exhibits a linear age-related decline from 20 to 79 years of age
By playing an adaptive version of NeuroRacer in multitasking training mode
older adults (60 to 85 years old) reduced multitasking costs compared to both an active control group and a no-contact control group
attaining levels beyond those achieved by untrained 20-year-old participants
age-related deficits in neural signatures of cognitive control
were remediated by multitasking training (enhanced midline frontal theta power and frontal–posterior theta coherence)
this training resulted in performance benefits that extended to untrained cognitive control abilities (enhanced sustained attention and working memory)
with an increase in midline frontal theta power predicting the training-induced boost in sustained attention and preservation of multitasking improvement 6 months later
These findings highlight the robust plasticity of the prefrontal cognitive control system in the ageing brain
of how a custom-designed video game can be used to assess cognitive abilities across the lifespan
and serve as a powerful tool for cognitive enhancement
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Training improves multitasking performance by increasing the speed of information processing in human prefrontal cortex
Media multitasking among American youth: prevalence
in Principles of Frontal Lobe Function 2nd edn (eds D
Knight ) Top-down modulation and cognitive aging
Adult age trends in the relations among cognitive abilities
Models of visuospatial and verbal memory across the adult life span
Deficit in switching between functional brain networks underlies the impact of multitasking on working memory in older adults
Aging and dual-task performance: a meta-analysis
Training-induced plasticity in older adults: effects of training on hemispheric asymmetry
An investigation of response and stimulus modality transfer effects after dual-task training in younger and older
Far transfer in cognitive training of older adults
Top-down suppression deficit underlies working memory impairment in normal aging
Frontal midline EEG dynamics during working memory
Dissociation of sustained attention from central executive functions: local activity and interregional connectivity in the theta range
Theta power as a marker for cognitive interference
Plasticity of executive functioning in young and older adults: immediate training gains
Frontal-midline theta from the perspective of hippocampal ‘theta’
Age-related changes in brain activity across the adult lifespan
Frontal theta EEG activity correlates negatively with the default mode network in resting state
Reduced resting-state brain activity in the ‘default network’ in normal aging
Video game practice optimizes executive control skills in dual-task and task switching situations
The effects of video game playing on attention
Increasing speed of processing with action video games
The influence of perceptual training on working memory in older adults
A cognitive training program based on principles of brain plasticity: results from the improvement in memory with plasticity-based adaptive cognitive training (IMPACT) study
A randomized controlled trial of cognitive training using a visual speed of processing intervention in middle aged and older adults
Effects of cognitive training interventions with older adults: a randomized controlled trial
From Gain Score t to ANCOVA F (and vice versa)
Improving fluid intelligence with training on working memory
Practice-related improvement in working memory is modulated by changes in processing external interference
Auditory event-related dynamics of the EEG spectrum and effects of exposure to tones
Event-Related Dynamics of Brain Oscillations
Delays in neural processing during working memory encoding in normal aging
Age-related top-down suppression deficit in the early stages of cortical visual memory processing
Hilbert- and wavelet-based signal analysis: are they really different approaches
CircStat: A MATLAB Toolbox for Circular Statistics
Statistical Power Analysis for the Behavioral Sciences
<a data-track="click" data-track-action="download citation references" data-track-label="link" rel="nofollow" href="https://citation-needed.springer.com/v2/references/10.1038/nature12486?format=refman&amp;flavour=references">Download references</a>
Yerukhimov for their help with data collection and analyses
Benson for assistance with the NeuroRacer behavioral analysis stream
Omernick for insights and support of NeuroRacer development
Zanto for support on ERSP and coherence analyses
Thanks to all of our participants whose time and efforts made this work possible
and Apple who generously loaned the Gazzaley laboratory all of the MacBook Pro laptops used in this study
Support for this research was provided by the Robert Wood Johnson Foundation's Pioneer Portfolio through a grant from its national program
‘Health Games Research: Advancing Effectiveness of Interactive Games for Health’ (A.G.) and the National Institute of Aging (A.G.)
was supported by a UCSF Institutional Research and Career Development Award (IRACDA)
is co-founder and chief science advisor of Akili Interactive Labs
a newly formed company that develops cognitive training software
has a patent pending for a game–based cognitive training intervention
‘Enhancing cognition in the presence of distraction and/or interruption’
which was inspired by the research presented here
This file contains Supplementary Figures 1-18
Supplementary Materials and Supplementary References
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Our ability to multitask and our capacity for cognitive control decline linearly as we age
A new study shows that cognitive training can help repair this decline
In older adults aged between 60 and 85 who trained at home by playing NeuroRacer
both multitasking and cognitive control improved
The benefits of this training extended to untrained cognitive functions such as sustained attention and working memory
These findings suggest that the ageing brain may be more robustly plastic than previously thought
allowing for cognitive enhancement using appropriately designed strategies
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The Agrupaci&oacute; Barcelonista Penya Anguera is one of the most charismatic supporters clubs in the country
the first team kit man for more than 30 years until his retirement in 1983
and the event was attended by FC Barcelona vice-president of the Social Department
director of the Social Department and responsible for supporters clubs
The ABP Anguera has 574 members and belongs to the Agrupaci&oacute; de Futbol de Clubs i Penyes del FC Barcelona
it is renowned for its work with youth football
The president of the Agrupaci&oacute; Barcelonista Penya Anguera
was joined the secretary general for sport from the Generalitat
and other dignitaries including the vice-president of the Federaci&oacute; Catalana de Futbol
and the governor for the district of l&rsquo;Eixample Gerard Ardanuy
The new clubhouse is located at Carrer C&ograve;rsega
and other guests at the opening included former players Carles Rexach and Pere Valent&iacute; Mora
FCB Foundation patron Josep Maldonado and the president of the Federaci&oacute; de Penyes Barcelonistes del Barcelon&egrave;s Oest
The event included several speeches and the signing of the book of honour
followed by a discussion of the life of Papi Anguera
Vice-president Jordi Cardoner said that &ldquo;this event thrills us
especially because the name of the Penya Anguera refers to a true Bar&ccedil;a icon in Papi Anguera
and is a club that is so close to FC Barcelona&rdquo;
That was the legendary year when we inaugurated our new stadium
The club is very active in sports and the coaching of young players
Clubs should not just be a meeting point for fans
but should also be active in the world of culture
who are the people who need to be raised with the values that do so much for our club and that our club does so much to foster.&rdquo;
 all images courtesy of tiago do vale architects
<a href=https://tiagodovale.com/ target=_blank rel="noopener noreferrer">tiago do vale architects</a> employed a representational technique which lays out the house&rsquo;s construction with the simple
basic language of an IKEA furniture manual
this method developed into a thematic approach &mdash; the representation of the project became a design strategy which guided the generation of form
the operations that allow the transformation of the building are minimal
the complete construction was ultimately condensed to a sequence of simple and clear movements that could be explained in just a few pages
architecture: <a href=https://tiagodovale.com/ target=_blank rel="noopener noreferrer">tiago do vale architects</a>
design team: tiago do vale, camille martin, eva amor, karolina zuba, coraline pothin, riddhi varma
happening now! partnering with antonio citterio, AXOR presents three bathroom concepts that are not merely places of function, but destinations in themselves — sanctuaries of style, context, and personal expression.
Volume 9 - 2018 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2018.00013">https://doi.org/10.3389/fpsyg.2018.00013</a>
Indirect observation is a recent concept in systematic observation
It largely involves analyzing textual material generated either indirectly from transcriptions of audio recordings of verbal behavior in natural settings (e.g.
group discussions) or directly from narratives (e.g.
It may also feature seemingly unobtrusive objects that can provide relevant insights into daily routines
All these materials constitute an extremely rich source of information for studying everyday life
and they are continuously growing with the burgeoning of new technologies for data recording
Narratives are an excellent vehicle for studying everyday life
and quantitization is proposed as a means of integrating qualitative and quantitative elements
this analysis requires a structured system that enables researchers to analyze varying forms and sources of information objectively
we present a methodological framework detailing the steps and decisions required to quantitatively analyze a set of data that was originally qualitative
and coding and preparation of text for quantitative analysis
The quality control stage is essential to ensure that the code matrices generated from the qualitative data are reliable
We provide examples of how an indirect observation study can produce data for quantitative analysis and also describe the different software tools available for the various stages of the process
The proposed method is framed within a specific mixed methods approach that involves collecting qualitative data and subsequently transforming these into matrices of codes (not frequencies) for quantitative analysis to detect underlying structures and behavioral patterns
The data collection and quality control procedures fully meet the requirement of flexibility and provide new perspectives on data integration in the study of biopsychosocial aspects in everyday contexts
The proposed approach combines the strengths and offsets the weaknesses of the qualitative and quantitative perspectives
The presented liquefying method enables the systematic analysis of minor details that arise in a multitude of situations involving text (e.g., conversations, speeches, diary, or blog entries) with a level of granularity (<a href="#B143">Schegloff, 2000</a>) that enables these &#x0201C;natural texts&#x0201D; to be analyzed in combination with other contextual data
The approach is applicable to both conventional and new forms of communication (e.g.
The source may be verbal behavior (informal conversations
Most of the solutions proposed to date for transforming text into quantitative data are either qualitative (e.g.
takes a mixed methods approach in which spontaneously generated qualitative material is transformed into quantifiable code matrices
we discuss key aspects of our proposed system
We analyze the concepts and meaning of systematic observation and one of its two branches
alongside key concepts of mixed methods research
We also look at types of qualitative data used in indirect observation and describe a methodological framework for building ad hoc observation instruments
creating matrices of codes for the data collected
and analyzing data and checking their reliability
we present a protocol specifically designed for indirect observation with examples from each of the stages in the process
Psychologists work in a wide range of fields and subfields that correspond to everyday life situations
they are involved in health education programs in nurseries and nursing homes
or communities with families of multiple nationalities
support programs for families with a history of child abuse or negligence or families of young car crash victims
and social programs in prisons or juvenile correctional institutions
Systematic observation can make important contributions to the study of spontaneous behavior in a vast range of everyday contexts
Systematic observation differs from ethnography in that its purpose is not to obtain a narrative account of subjective experiences in a process that requires the participation of the researcher or person being studied
Ethnographic studies require a qualitative approach
they do not require quantitative analysis and rigorous data quality control
is characterized by highly systematic data collection and analysis
and the merging of qualitative and quantitative methods
Systematic observation follows the four fundamental stages of scientific research: formulation of a research question
The wealth of data collected in an observational study provides researchers with the opportunity to capture valuable chunks or snippets of everyday realities
without having to specifically ask for the information (there are no interviews
it allows the researcher to study spontaneous behavior in a natural
Everyday activity in context is the cornerstone of observational studies
It is the source of a rich fabric of information that the psychologist/researcher needs to tap into in order to extract relevant information that is subsequently processed systematically to produce a set of &#x0201C;net&#x0201D; data that can be analyzed both qualitatively and quantitatively
The study of everyday activity provides insights into the diverse behaviors and events that occur throughout a person&#x00027;s life. It provides thus a privileged vantage point from which to observe changes, but everyday life is a highly complex, dynamic process replete with information that is often not even known to exist (<a href="#B7">Anguera, 2001</a>)
Its study requires the examination of diverse phenomena at different levels of a pyramid-like structure
psychologists analyze how individuals go about their lives and gradually become familiar with what has shaped their life course
they discover everyday realities at different levels (family
etc.) and come to understand how these are influenced by interacting factors
According to <a href="#B116">Mucchielli (1974)</a> observation equation, O = P&#43;I&#43;Pk&#x02212;B, observation equals perception plus interpretation plus previous knowledge minus bias. Observation thus is not possible unless what is being observed is perceivable. Perceptibility is a key concept when it comes to differentiating between direct and indirect observation (<a href="#B3">Anguera, 1979</a>, <a href="#B8">2003</a>)
and Mucchielli&#x00027;s equation is only partially fulfilled
although adequate quality control is needed to reduce bias
While aspects of human communication such as facial expressions
and voice tone are fully perceivable through visual or auditory channels
they are frequently accompanied by verbal behavior
which has very different characteristics in terms of perceptibility
Indirect observation is an appropriate method for studying both verbal behavior and textual material
whether in the form of transcripts or original material produced by the participants in a study
One of their shortcomings is that perceptibility is limited by the documentary nature of the texts
and it is not uncommon for different researchers to draw different conclusions from the same text
surveillance methods (often termed &#x0201C;indicator based&#x0201D; methods) have been developed and refined to provide disciplined
standardized approaches to acquiring and recording important information
ubiquitous and unstandardized data collected from the Internet have been used to gain insight into emerging disease events.&#x0201D;
Indirect observation can be considered a valid scientific method (<a href="#B153">Webb et al., 1966</a>; <a href="#B5">Anguera, 1991</a>, <a href="#B11">2017</a>, <a href="#B12">in press</a>; <a href="#B35">Behar, 1993</a>; <a href="#B113">Morales-Ortiz, 1999</a>; <a href="#B114">Morales-S&#x000E1;nchez et al., 2014</a>)
It uses similar techniques to systematic observation
although there are important differences dictated by the nature of the source data (verbal behavior and text)
Narratives are an excellent vehicle for studying everyday life through indirect observation
and one option for studying them is to apply a procedure for systematizing and structuring the information through quantitization
This approach makes it possible to integrate qualitative and quantitative elements
The data used in indirect observation invariably start out as qualitative and the source material varies according to the level of participation of the person being observed and the nature of the source (textual or non-textual)
Common sources of material used in indirect observation studies include:
&#x02022; Recordings of verbal behavior as it occurs (normally in mp3 files)
There may be single or multiple dialogues and it is essential to clearly distinguish between the different &#x0201C;voices&#x0201D; recorded
&#x02022; Transcripts of audio recordings of verbal behavior in a natural setting (<a href="#B91">Krueger and Casey, 2009</a>)
in which each person can be clearly identified
&#x02022; Written texts produced by the participants in a research study
These include texts produced by the participants or those close to them (e.g.
A variety of communication channels are possible (e.g.
&#x02022; Texts transmitted through the Internet, such as e-mails (<a href="#B39">Bj&#x000F6;rk et al., 2014</a>) and forum posts (<a href="#B152">Vaimberg, 2010</a>)
These constitute an extremely rich source of information and are particularly relevant to psychological interventions
&#x02022; Everyday objects related to the research question(s). While objects may appear to have a secondary role in communication, they can provide relevant insights into everyday life as they evoke or facilitate the expression of emotions through micro-valences (<a href="#B95">Lebrecht et al., 2012</a>)
Technological advances have also opened up new opportunities in this area in recent years
&#x02022; Graphic material, particularly photographs. These can constitute an extremely rich source of information (<a href="#B157">Zaros, 2016</a>)
but a gallery of photographs separated in time can capture the dynamics of an episode or successive episodes in the life of a person
This material can be primary (the only source available) or secondary (complementing other sources)
&#x02022; Unobtrusive objects, also referred to as aggregates (<a href="#B153">Webb et al., 1966</a>)
but in some cases they can reveal the existence of certain behaviors
but only after a process of inference involving variable risk
Examples are fingerprints and objects such as cigarette butts or a napkin with notes or drawings left behind in a caf&#x000E9;
The above sources of information give rise to a varied set of data that provides empirical evidence and can position specific events and everyday behaviors along a continuum of time
the information available becomes progressively richer as one gains access to several sources of documentary material
As mentioned, the material used to collect data in indirect observation is only partly perceivable (<a href="#B5">Anguera, 1991</a>) and any conclusions made need to be inferred by a researcher drawing from a theoretical framework or taking a position
This is the main challenge in indirect observation
rigorous application of a carefully designed observation instrument by duly trained observers offers the necessary guarantees of data reliability
Although direct and indirect observation may vary in terms of source material
the two methods share a scientific procedure that when properly applied can provide quantitative indicators of the processes underlying everyday behavior
mixed methods research lies on a continuum between single-method and fully mixed studies
although the scientific community has yet to agree on which position it holds along this continuum
it is generally agreed that the position will depend on the research objective and the nature of the data
Overall, mixed research is largely understood as &#x0201C;a synthesis that includes ideas from qualitative and quantitative research&#x0201D; (<a href="#B88">Johnson et al., 2007</a>
this is a very broad framework in which many gaps need to be filled
the methodological approach must be extremely rigorous as we are dealing with situations in which substantive areas merge with the multiple realities of everyday life
The exponential growth of mixed methods research in recent decades has generated certain inconsistencies in terms of terminology and definitions
We therefore believe that it is first necessary to clarify the meaning of method/methodology and to discuss the multiple meanings attached to the term &#x0201C;mixed method&#x0201D; before we present our methodological framework for indirect observation
118): &#x0201C;It is important to keep in one&#x00027;s mind
that the word methods should be viewed broadly.&#x0201D; Accordingly
in the approach we describe in this article
we also consider indirect observation to be a method in the broad sense of the word
<a href="#B88">Johnson et al. (2007</a>, p. 123) defined mixed methods research as &#x0201C;the type of research in which a researcher or team of researchers combines elements of qualitative and quantitative research approaches (e.g., use of qualitative and quantitative viewpoints, data collection, analysis, inference techniques) for the broad purposes of breadth and depth of understanding and corroboration&#x0201D; (<a href="#B88">Johnson et al., 2007</a>
They formulated this definition after asking 19 renowned researchers in the field (Pat Bazeley
and Charles Teddlie) to send in their definition of the term &#x0201C;mixed methods&#x0201D; by e-mail
this connection can be achieved through transformation
by quantitizing qualitative data or qualitizing quantitative data
we transform non-systematic qualitative data into a format suitable for quantitative analysis
The quantitative processing of originally qualitative data with the aim of detecting hidden behavioral patterns or underlying structures
adds an element of robustness to the integration of qualitative and quantitative data
particularly in the case of everyday life events and behaviors
455) is not always attainable in applied research
the mixed method framework offers new and interesting possibilities for indirect observation
The combined use of qualitative and quantitative approaches has been tried and tested in multiple studies and has also been analyzed in several systematic reviews (<a href="#B69">Elvish et al., 2013</a>)
we show that it is necessary to start with qualitative inputs and to then quantify these in a process that ensures reliability throughout the various stages
The empirical process in indirect observation starts with the collection of qualitative data
While the characteristics and standards that guarantee quality are perfectly outlined in the literature on quantitative methodology
the same cannot be said of qualitative methodology
Qualitative methodology offers enormous flexibility
but interpretations on content and form vary and are not free of controversy
Content provides personal and interpersonal information
which stems from experiences that are temporally unstable and highly influenced by the context and versatility of the moment
the tools used to support indirect observation (narratives
etc.) cause doubt and distrust in many researchers
Indirect observation shares many of the characteristics previously described for systematic observation
highly systematic data collection and analysis
and an approach that requires the merging of qualitative and quantitative techniques
the stages and sub-stages involved in an indirect observation study
We will focus largely on the extraction and transformation of information from textual material produced using conventional or newer channels of communication in a variety of formats (handwritten letters
informal conversations or focus group discussions or documentary material)
Extracting information on human behavior from text and transforming it into suitably systematized and organized categorical data
is a major challenge in the Behavioral Sciences
the process must offer sufficient scientific and ethical guarantees and produce results in a format that can be rigorously processed using any of a range of quantitative techniques available for analyzing categorical data
Our text-liquefying process consists of six stages: (1) specification of study dimensions, (2) establishment of segmentation criteria to divide the text into meaningful units, (3) building of a purpose-designed observation instrument, (4) coding of information, (5) data quality control, and (6) quantitative analysis of data. Table <a href="#T9">9</a> presents detailed steps and guidelines for the &#x0201C;liquefication&#x0201D; of indirect observations
Each of the steps will be explicated within the following sections
In systematic observation, and by extension, indirect observation, the term &#x0201C;dimension,&#x0201D; also known as level of response (<a href="#B154">Weick, 1968</a>) or criterion, refers to a distinguishable facet related to the research objective. Dimensions are generally derived from a theoretical framework (e.g., the seminal work of (<a href="#B155">Weick, 1985</a>) in the field of social interaction)
but they can also be created ex novo based on experience or expertise
attribution of positive meaning by students
progressive establishment of increasingly expert and complex representations of subject matter
The second step toward liquefying a text is to define the segmentation criteria to divide the text into meaningful units. This process is known as &#x0201C;unitizing.&#x0201D; Although initially proposed by <a href="#B67">Dickman (1963)</a> and <a href="#B38">Birdwhistell (1970)</a>, <a href="#B90">Krippendorff (2013</a>
84) defined unitizing as &#x0201C;the systematic distinctions with a continuum of otherwise undifferentiated text&#x02014;documents
and other observables&#x02014;that are of interest to an analysis
omitting irrelevant matter but keeping together what cannot be divided without loss of meaning.&#x0201D; This definition suggests that it would be logical to first segment the text into primary criteria within the main study dimension and then establish secondary criteria for the other dimensions (e.g.
<a href="#B90">Krippendorff (2013)</a> suggested segmenting text using orthographic
each intervention by an individual is considered a unit
This is a very useful approach for analyzing interactions between various people
We propose using the inter-speaker criterion as the primary criterion and subsequently establishing secondary criteria (subunits) for verbal or written interventions containing various syntactic elements (phrases)
Vignette showing the segmentation of a text (transcribed from a conversation) into units
Indirect observation studies, like systematic observation studies (<a href="#B8">Anguera, 2003</a>; <a href="#B15">Anguera and Izquierdo, 2006</a>; <a href="#B138">S&#x000E1;nchez-Algarra and Anguera, 2013</a>; <a href="#B122">Portell et al., 2015a</a>) require a purpose-built observation instrument to systematically code the information that will form the subsequent datasets
Observation instruments can be built using category systems, a field format system, a combination of these systems, or rating scales (<a href="#B18">Anguera et al., 2007</a>)
One-dimensional studies use category systems and rating scales
while multidimensional studies use field formats or field formats combined with category systems
it must be possible to grade the corresponding dimensions ordinally
the category system must fulfill the requirements of exhaustivity and mutual exclusion
and each category must be accurately defined
The field format is built by creating a catalog of mutually exclusive behaviors for each dimension
the catalog is left open and is therefore considered to be in a permanent state of construction
a theoretical framework is recommendable for field format systems
Observation instruments combining a field format system with category systems are becoming increasingly common
This combination is possible when some or all of the dimensions in the field format have a theoretical framework and the object of research is atemporal (i.e.
it is highly recommendable to code both categories and dimensions using letters
fulfilling the requirements of exhaustivity and mutual exclusion (e.g.
then the notation would be CS (category system) = {A B C D}
they are mutually exclusive but not exhaustive (e.g.
the notation would be Catalogue = A B C D&#x02026;
&#x0201C;coding provides the analyst with a formal system to organize the data
uncovering and documenting additional links within and between concepts and experiences described in the data.&#x0201D;
If the sources have been carefully selected
they will all contribute to creating a stockpile of information on the behaviors or actions of all those involved in the communication process being analyzed (e.g.
Tabular structure for creating a code matrix
(a,b) Hypothetical examples of a code matrix derived from a text
In the ATLAS.ti (v.7) qualitative data analysis program
the text coding feature can be used to supplement the information entered with an object or an audio or video recording
Two programs can be used for both direct and indirect observation. These are HOISAN (<a href="#B82">Hern&#x000E1;ndez-Mendo et al., 2012</a>) (<a href="http://www.menpas.com">http://www.menpas.com</a>), which is open-access and is available in several languages (English, Spanish, Portuguese, French) that can be selected from the tab Archivos (Files), and TRANSANA (<a href="http://www.transana.com">http://www.transana.com</a>)
The issue of data quality in indirect observation has been widely debated in the literature, with a particular focus on reliability and validity, and concerns have led many psychologists and researchers working in this area to modify their approaches. Both intraobserver and interobserver agreement are important measures of reliability, but they are not the only ones. While reliability is necessary, it alone does not guarantee the validity of a dataset (<a href="#B90">Krippendorff, 2013</a>)
There has been much debate in the field of psychology about the extent to which adherence to a particular theoretical framework may influence agreement between observers. To overcome this potential problem, <a href="#B121">Pope et al. (2000)</a> proposed using observers from different backgrounds to analyze the data
would require even more rigorous quality control measures given the greater difficulty of reaching agreement
Table <a href="#T4">4</a> shows the canonical agreement coefficient calculated in HOISAN for the data in Table <a href="#T3">3b</a>
combined with two other sets of data recorded for the same section of text by the same observer and with the same instrument
Example of datasets used to calculate intraobserver canonical agreement
Once the text has been liquefied and the necessary data controls performed
the researcher now has access to a series of code matrices perfectly suited for analysis using different techniques
The novel nature of our proposal is that we do not study frequency counts
were the only measure of quantification used in observation studies for decades
Over the last 15 years, our group has prioritized three analytical techniques that are particularly well-suited to processing qualitative data in both systematic observation (<a href="#B42">Blanco-Villase&#x000F1;or et al., 2003</a>) and indirect observation studies
All three techniques are based on statistical calculations and therefore provide the necessary guarantees of replicability and robustness
Lag sequential analysis, which works with code matrices (see example in Table <a href="#T5">5</a>), is used to detect behavioral patterns that show the structure of interactive episodes (<a href="#B24">Bakeman, 1978</a>, <a href="#B25">1991</a>; <a href="#B26">Bakeman and Gottman, 1987</a>; <a href="#B27">Bakeman and Quera, 1996</a>, <a href="#B28">2011</a>)
The analysis can be performed prospectively (looking forward in time from a given moment) or retrospectively (looking backwards) using positive or negative lag counts
with a lag count of &#43;2 would correspond to a behavior that occurs 2 positions after the behavior(s) of interest
while one with a lag count of &#x02212;2 would correspond to a behavior that occurs 2 positions before the behavior(s) of interest
Table 5. (a) The first row shows the simple frequency counts for the data from Table <a style="color:grey;" href="#T3">3a</a>
The matrix below shows the transition frequencies for the given behavior A with the conditional behaviors shown at the head of each column
(b) The first row shows the unconditional probabilities while the rows below show the conditional probabilities
Using the data from Table <a href="#T3">3a</a> again, we illustrate how to manually calculate the results for the first, and simple, part of the lag sequential analysis process. The first step is to create tables for the matching frequencies and probabilities (Tables <a href="#T5">5a,b</a>) for category A (in our example
is the given behavior (the behavior of interest)
A has a frequency count of 0 because this code does not occur again; B (expressions of self-perceived improvement) has a count of 5 because it occurs after A on five occasions (units 2
and 18); C (expressions of self-perceived worsening) has a count of 1 because it only occurs after A on one occasion (unit 5)
similarly to D (expressions of joy at having overcome the problem) (unit 10)
A has a count of 2 because it occurs on two occasions (units 6 and 11) in the second position after the given behaviors (units 4 and 9
respectively); B has a count of 0 because it does not occur in the second position after the given behavior; and C has a count of 1 because it occurs just once (unit 13) in the second position after the given behavior (unit 11)
The data are analyzed to search for behavioral patterns
with consideration of some or all of the other behaviors
to see if they form part of the pattern(s) detected
The information for each of the categories is shown on a graph with the lags on the X-axis and the probability values (ranging between 0 and 1) on the Y-axis. Each of the four Figures <a href="#F1">1A&#x02013;D</a>
shows the value of the unconditional probability (the line parallel to the Y-axis) and the points corresponding to the conditional probability of each lag
Figure 1. (A&#x02013;D) The lags are shown on the X-axis and the probabilities on the Y-axis. Based on the results from Table <a style="color:grey;" href="#T5">5b</a>
the values corresponding to the unconditional probabilities (first row) are indicated by the horizontal line parallel to the X-axis (e.g.
Also shown are the values for each of the conditional probabilities for each category and lag
These values are linked by a (generally uneven) line for each category
The horizontal line parallel to the X-axis represents the upper limit for the effect of chance
any conditional probabilities in the subsequent lags that are higher than the unconditional probability for the corresponding category are significant and hence form part of the behavioral pattern
Based on this simple visual output and considering all the statistically significant categories at each lag (i.e., the categories with a conditional probability value greater than that of the unconditional probability), we extracted the behavioral pattern shown in Figure <a href="#F2">2</a>. The strength of patterns is assessed using interpretative rules (<a href="#B26">Bakeman and Gottman, 1987</a>)
the first lag that is followed by another lag containing significant categories is considered to be the last lag (max lag) in the pattern (lag 3 in the example)
Behavioral pattern extracted after assigning significant conditional behaviors (behaviors with a conditional probability greater than the unconditional probability) to each lag
The behavior pattern extracted from the presented illustration exhibits a regularity consisting of expressions of sorrow or sadness being followed by expressions of self-perceived improvement and these expressions
being followed by joy at having overcome the problem
leading either to the initial situation of sorrow and sadness or to expressions of self-perceived worsening
The robustness of the pattern must then be further strengthened by building a confidence interval around the conditional probabilities
This upper limit is used to determine whether a given category will form part of the pattern at the lag being analyzed
as the conditional probability obtained has to be higher than unconditional probability
will always be lower than the unconditional probability and as such
Application of this confidence interval increases the requirements for statistical significance for the categories at each lag
resulting in a more robust corrected pattern
The results obtained by applying the formula corresponding to the corrected expected or unconditional probability (shown in Table <a href="#T6">6a</a>) are presented in Table <a href="#T6">6b</a>, which is an extension of Table <a href="#T5">5b</a>
Table 6. (a) Formula for calculating the corrected unconditional (expected) probability. (b) Table showing the probabilities from Table <a style="color:grey;" href="#T5">5b</a> with the addition of the corrected conditional probabilities in the second row (bold values)
A second optimization step involving the calculation of adjusted residuals or hypergeometric Z-values (<a href="#B1">Allison and Liker, 1982</a>) is also possible but cannot be done manually
Figure <a href="#F4">4</a> shows the corrected behavioral pattern extracted from the data in Table <a href="#T6">6b</a>. As shown, it is different to the uncorrected pattern shown in Figure <a href="#F3">3</a>
is statistically associated with B at the first lag and D at the second lag
Optimized corrected behavioral pattern following construction of a confidence interval around the unconditional probabilities
The corrected pattern reveals the typical alternation seen in patients with endogenous depression
Lag sequential analysis is the first of the three key techniques we use in our text-liquefying approach to indirect observation. It has been widely used in systematic observation studies from a range of areas published in journals listed in the Journal Citations Report (JCR) (e.g., <a href="#B78">Gimeno et al., 2006</a>; <a href="#B92">Lapresa et al., 2013</a>; <a href="#B133">Roustan et al., 2013</a>)
we suggest analyzing at least five prospective lags and five retrospective lags (&#x02212;5 to &#43;5)
The genuine retrospective approach considers negative lags from a backwards rather than a forwards perspective
it looks at what happened from lag 0 back to lag &#x02212;5 rather than from lag &#x02212;5 to lag 0
Adjusted residuals, Z-values, and vector length and angles can all be computed in the open-access software program HOISAN (v. 1.6.3.3) (<a href="#B82">Hern&#x000E1;ndez-Mendo et al., 2012</a>)
which also includes a feature to produce the results in graph form
The meaning of the vectors (see below) varies according to the quadrant in which they are located
and the position of a vector in one quadrant or another is determined by the combination of positive or negative signs on the prospective and retrospective Zsum values
the focal and conditional behaviors activate each other; in quadrant II (&#x02212; &#43;)
the focal behavior inhibits and is activated by the conditional behavior; in quadrant III (&#x02212; &#x02212;)
the focal and conditional behaviors inhibit each other; and in quadrant IV (&#43; &#x02212;)
the focal behavior activates and is inhibited by the conditional behavior
The length of the vectors indicates the strength (statistical significance) of the association between the focal and conditional behaviors
Adjusted residuals and corresponding Z-values from the polar coordinate analysis with A as the focal behavior or category and B
Table 8. Polar coordinate analysis results showing the length and angle of the different vectors, the quadrant in which each vector is located, and the Zsum values (<a style="color:grey;" href="#B52">Cochran, 1954</a>) from the prospective and retrospective perspectives
Figure 4. Polar coordinate map showing the vectors for the categories A (focal category), B, C, and D. As indicated in the legend of Table <a style="color:grey;" href="#T8">8</a>
A is the focal behavior and expressions of sorrow or sadness activate expressions of self-perceived improvement (Quadrant IV) and joy at having overcome the problem (Quadrant 1)
The focal behavior is not self-generating (Quadrant III)
expressions of sorrow or sadness do not generate self-perceived worsening (Quadrant II)
although self-perceived worsening does generate the focal behavior
The strongest association detected for the focal behavior A (apart from with itself) was with B (in quadrant IV
Although A and C have the longest vector (0.65)
the fact that C is located in quadrant II (because its angle is 125.79&#x000B0;) means that A inhibits rather than activates C
C does not appear because its excitatory activity was insignificant
features different settings that can be modified to obtain complementary results that
can provide a greater understanding of interactive transitions over time
Theme is an open-access software program that provides all the necessary features for analyzing data and presenting the results graphically as dendrograms or tree diagrams
As with lag sequential and polar coordinate analysis, we have also used the data from Table <a href="#T3">3a</a> to illustrate the use of T-pattern detection
It should be noted that the method applied is rather unconventional
as the temporal distance parameter was set at 1 in all cases
Figure <a href="#F5">5</a> shows the first of the 13 T-patterns obtained (p &#x0003C; 0.05). Note that despite the small size of the dataset, Theme detected a primary relationship between A and B (between expressions of sorrow or sadness and expressions of self-perceived improvement) and A and D (between expressions of sorrow or sadness and expressions of joy at having overcome the problem), as shown graphically in Figure <a href="#F5">5</a>
Figure 5. First of the 13 T-patterns detected in the data from Table <a style="color:grey;" href="#T3">3a</a> (p &#x0003C; 0.05)
Examples of the application of T-pattern detection can be found in studies by <a href="#B51">Casta&#x000F1;er et al. (2013)</a>, <a href="#B66">Diana et al. (2017)</a>, <a href="#B92">Lapresa et al. (2013)</a>, and <a href="#B142">Sarmento et al. (2015)</a> in direct observation and by <a href="#B40">Blanchet et al. (2005)</a> and <a href="#B29">Baraud et al. (2016)</a> in indirect observation
Although the specifics of lag sequential analysis
all three techniques serve to analyze and increase understanding of the internal structure of verbal or textual material derived from indirect observation
they can be applied to the same data to provide complementary insights and unveil invisible structures hidden within data
Their relevance is even greater in indirect observation studies where data have traditionally been analyzed from a purely qualitative perspective
The convergence of results from three different quantitative approaches is a cause for celebration in a field such as indirect observation
where studies to date have largely relied on frequency counts or on qualitative approaches
which of course have their merits but are prone to considerable subjectivity bias
There is growing interest in combining these techniques to gain a greater understanding of behavioral patterns that remain hidden to the naked eye. Two recent examples can be found in the studies of <a href="#B141">Santoyo et al. (2017)</a> and <a href="#B147">Tarrag&#x000F3; et al. (2017)</a>
Procedure for conducting an indirect observation study based on liquefying a text
Within the broad framework of mixed methods
we have presented indirect observation as a structured method consisting of different steps designed to guarantee scientific rigor
The method consists of the quantitization of qualitative data derived from verbal or textual material to produce code matrices which
following appropriate organization and rigorous quality control procedures
we liquefy the text into a form suitable for quantitative analysis
the narratives are categorized on the basis of the chosen theoretical framework (top-down) and the theoretical framework is adapted on the basis of the narratives given (bottom-up)
An exclusively quantitative study would entail the loss of sensitive and relevant information about the spontaneous behavior
as it would require excluding all variables not envisaged in the chosen theoretical framework
Hence our insistence on the enormous potential of mixed methods research
which suitably integrates both qualitative and quantitative elements
for transforming qualitative data into quantitative data that can be analyzed using robust quantitative techniques
it is important to note that it is possible
to return from the quantitative data to the narrative data
this approach presents advantages of both qualitative and quantitative methods
at the same time it covers weaknesses of both methods
All authors listed have made a substantial
direct and intellectual contribution to the work
We gratefully acknowledge the support of the Spanish government (Ministerio de Econom&#x000ED;a y Competitividad) within the Projects Avances metodol&#x000F3;gicos y tecnol&#x000F3;gicos en el estudio observacional del comportamiento deportivo [Grant PSI2015-71947-REDT; MINECO/FEDER
and La actividad f&#x000ED;sica y el deporte como potenciadores del estilo de vida saludable: evaluaci&#x000F3;n del comportamiento deportivo desde metodolog&#x000ED;as no intrusivas [Grant DEP2015-66069-P; MINECO/FEDER
We gratefully acknowledge the support of the Generalitat de Catalunya Research Group (GRUP DE RECERCA E INNOVACI&#x000D3; EN DISSENYS [GRID])
Tecnolog&#x000ED;a i aplicaci&#x000F3; multimedia i digital als dissenys observacionals
This research was also funded by the project Methodological quality and effectiveness from evidence (Chilean National Fund of Scientific and Technological Development -FONDECYT-
first author also acknowledge the support of University of Barcelona (Vice-Chancellorship of Doctorate and Research Promotion)
and second author also acknowledge the support of Universitat Aut&#x000F2;noma de Barcelona
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest
The authors would like to thank the reviewers whose suggestions and comments greatly helped to improve and clarify this manuscript
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Copyright &#x000A9; 2018 Anguera, Portell, Chac&#x000F3;n-Moscoso and Sanduvete-Chaves. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited
*Correspondence: M. Teresa Anguera, <a id="encmail">dGFuZ3VlcmFAdWIuZWR1</a>
Autoimmune diseases tend to strike women more than men and having multiple X chromosomes could be the main reason why
While a process called X chromosome inactivation serves to balance out gene dosage between males and females
some genes on the “inactive X” chromosome in immune cells can sometimes escape this process
giving women an extra dose of immunity-related gene expression
In a new study, a team from the <a href="http://www.upenn.edu">University of Pennsylvania</a> describes how X chromosome inactivation is regulated in the immune system’s B cells as they develop in bone marrow and when they encounter antigens
two-step mechanism in females whereby B cells lacking the markers of X chromosome inactivation regain these modifications during B cell activation
in a process involving the transcription factor YY1
Why are these immune cells priming for this chromosome to be regulated differently and also
how does that lead to autoimmunity and loss of self-tolerance?”
The study, published in <a href="http://dx.doi.org/10.1371/journal.pgen.1007050">PLOS Genetics</a>, was led by Camille M. Syrett, a doctoral student in Anguera’s lab. Coauthors, representing both Penn Vet and Penn’s <a href="http://www.med.upenn.edu">Perelman School of Medicine</a>
In a <a href="https://news.upenn.edu/news/penn-vet-study-identifies-mechanism-explaining-female-bias-autoimmunity">study</a> last year in the journal <a href="http://www.pnas.org/content/113/14/E2029.abstract">Proceedings of the National Academy of Sciences</a>
failed to completely inactivate an X chromosome
The research showed that this was because Xist
a long non-coding RNA transcript well known to initiate and maintain the process of X chromosome inactivation
failed to localize to the inactive X chromosome
Xist RNA reappeared in the proper location
“We saw that the inactivated B cells don’t have this RNA cloud
but it comes back upon stimulation,” said Syrett
“We were really interested in determining what is bringing the Xist RNA back.”
the team began by tracking the location of Xist in developing B cells in female mice
such as hematopoeietic stem cells and common lymphoid progenitors
had clear patterns of Xist RNA on the inactive X chromosome
as these B-cell precursors went down a developmental path toward becoming B cells
but only as diffuse pinpricks across the nucleus instead of being localized to the inactive X
small-molecule tags called heterochromatin modificiations
which are known to maintain gene repression during X chrosomsome inactivation
“We could see these really unusual changes at the chromatin level happening in female B cell development,” Anguera said
To find out how the Xist returned to the inactive X upon B cell activation
as they had shown in last year’s PNAS paper
the researchers tracked Xist RNA in B cells in culture
They found the reappearance took place in two distinct phases: Between four and 16 hours after the cells were stimulated
And between 16 and 30 hours after stimulation
Xist RNA concentrated exclusively at the inactive X chromosome
The heterochromatin modifications appeared to increase and localize on the inactive X in this second phase as well
The team’s earlier study had pointed to the protein YY1 as playing a role in the return of Xist in activated B cells
so they began to look more closely at it in this work
a leader in studies of YY1 in B cell development
was able to lend his expertise to investigate the protein’s role in X chromosome inactivation
When the researchers examined B cells from mice that lacked YY1
they saw greatly reduced levels of heterochromatin marks as well as less localization of Xist RNA to the inactive X
The team also observed evidence that YY1 was influencing the expression of X chromosome genes
When they deleted YY1 from male and female cells and compared genes that were differentially expressed on the X chromosome
they found 68 that were specific to females
one that was specific to males and 11 that were shared
and at least two are known to be overexpressed in human female B cells compared to male B cells
A further set of experiments identified the area of YY1 with DNA binding activity as the key domain of this protein involved in bringing Xist RNA to the inactive X
bringing the Xist RNA together with the DNA of the inactive X chromosome,” Anguera said
She and her colleagues will be exploring the role of YY1 further
using clinical samples as well as mouse models
to look at the protein in diseases like lupus to deepen their understanding of how autoimmunity could result from the “escape” of immune genes from X chromosome inactivation
“If you want to develop a therapy for autoimmune diseases
How do we get Xist to the inactive X chromosome and keep it there so we maintain dosage compensation in these B cells.” said Anguera
“Certainly YY1 is looking like a really promising target.”
The study was supported by the <a href="http://www.nih.gov">National Institutes of Health</a> (grants AI124084, AI079002, BIRCWH, GM111384, GM007229 and HD083185), <a href="http://www.upenn.edu/research/smarts/university_research_foundation/">University of Pennsylvania University Research Foundation</a>, <a href="https://www.lupus.org/">Lupus Foundation of America</a> and McCabe Foundation
the ambitious Dakar Greenbelt project seeks to create an extensive network of ecological infrastructure in and around the city to sustainably address environmental concerns and enhance urban life
With support from David Gouverneur and Ellen Neises
candidate Rob Levinthal in the Weitzman School of Design led two courses that included a field trip to Dakar
that culminated in students presenting their visions for parts of the Greenbelt
The new Vagelos Laboratory for Energy Science and Technology boasts adaptable laboratory spaces to support the dynamic needs of pioneering research
The premises of INEFC at Barcelona’s Olympic Ring held the traditional end-of-season ceremony of the Agrupació Barcelonista Penya Anguera on the 2nd of July
FC Barcelona President Joan Laporta did not want to miss this event
along with board members Josep-Ignasi Macià and Josep M
This blaugrana entity is one of the pioneers within the movement
and also a member of the Agrupació de Futbol de Clubs i Penyes del FC Barcelona
and it currently has more than 30 teams ranging all categories from U8 to senior
Despite the uncertainty of tournaments viability and travelling restrictions due to health and safety measures
the Penya Anguera has never stopped working for its players during this season
Joan Bertran was accompanied by the president of the Barcelonès Oest Barça Supporters’ Clubs Federation
president of the Agrupació de Futbol de Clubs i Penyes del FC Barcelona
who did not miss the chance to show support to this society after closing another season
as well as an acknowledgement to those players who have been longer than 10 years in the entity
the climax of the evening arrived when the new kit of the Penya Anguera was unveiled deserving a round of applause
president Laporta was presented with the shirt the penya is wearing next season
Eight-five percent of people with lupus are female
and their second X chromosome seems partly to blame
According to a new study by Penn researchers
females with lupus don’t fully “silence” their second X chromosome in the immune system’s T cells
leading to abnormal expression of genes linked to that chromosome.&nbsp;
The work, led by <a href="https://www.vet.upenn.edu/people/faculty-clinician-search/MONTSERRATANGUERA">Montserrat Anguera</a> of the <a href="https://www.vet.upenn.edu/">School of Veterinary Medicine</a> and published in the journal <a href="https://doi.org/10.1172/jci.insight.126751">JCI Insight</a>
is the first to connect disruptions in maintaining X chromosome inactivation in T cells to lupus
It also suggests that changes to the nuclear structure in the inactive X chromosome of T cells may play a part in the genetic missteps that can arise in lupus—the first time that nuclear organization has been noted as a feature of this disease
“And it’s ultimately affecting gene expression.”
Anguera’s lab has paid close attention to the link between X chromosome inactivation, an epigenetic process that balances gene expression between males and females, and autoimmune disease. In <a href="https://penntoday.upenn.edu/news/penn-vet-study-identifies-mechanism-explaining-female-bias-autoimmunity">earlier studies</a>
both T cells and B cells have incomplete inactivation of the second X chromosome due to changes in the patterns of Xist
an RNA molecule that is necessary for X inactivation.&nbsp;
Anguera and colleagues wanted to more closely examine this process in T cells and specifically in the context of an autoimmune disease
They first tracked the process of X inactivation in T cells from healthy mice
Xist temporarily diffuses away from the inactive X chromosome
as it would be upon encountering a potential pathogen
then Xist RNA returns to this chromosome.&nbsp;
the researchers used a mouse model that spontaneously develops lupus in a female-biased manner
All female mice of this strain develop the disease
the researchers discovered that those at early stages of disease resembled healthy controls in their patterns of Xist localization
But those in the later stages of disease had a dramatically different pattern
“The only differences we detected happened at late stages of disease,” Anguera says
“What this means is that abnormal X inactivation is a consequence of the disease; it’s not predisposing the animal to develop the disease.”
Interestingly, when the researchers looked at T cells from pediatric lupus patients, provided by study co-author <a href="https://www.med.upenn.edu/apps/faculty/index.php/g275/p18554">Edward M. Behrens</a> of the <a href="https://www.med.upenn.edu/">Perelman School of Medicine</a> and <a href="https://www.chop.edu/">Children’s Hospital of Philadelphia</a>
they found the same mislocalization of Xist that they had seen in the mice with lupus
even though the children were in remission from their disease.&nbsp; &nbsp;
Even stimulating those patients’ cells in vitro wasn’t enough to coax Xist into the normal pattern
“Even though they don’t have active disease
there’s something missing that’s preventing the RNA from staying targeted at that inactive X chromosome,” Anguera says.&nbsp;
the scientists wanted to drill deeper into which genes might be altered in expression from the X chromosome of lupus patients
Comparing additional data from female and male lupus patients with either severe or mild disease
they found a subset of genes altered only in the females with lupus
but not in the healthy females or the males with lupus
And while roughly a quarter of genes from the inactive X chromosome escape inactivation even in healthy individuals
the research team found that a subset of the altered genes in the lupus patients belonged to regions of the X chromosome that didn’t normally escape inactivation
they determined that some that were lower in expression in lupus patients are involved in controlling nuclear organization and structure
“What we think is happening is that in lupus
this Xist RNA is diffusing all over the place
these chromosomal proteins are changing their expression
and nuclear organization in the territory of the inactive X is changing,” Anguera says
“And that may also be contributing to the relaxed silencing of the inactive X and the changes in gene expression that we’re seeing.”
No one has yet attributed changes in nuclear structure to lupus or other autoimmune diseases
and Anguera and her team hope to dig further into the causes and consequences of the altered nuclear DNA organization
“This is taking our research and the field into a whole new direction for understanding the female bias with lupus disease,” she says.&nbsp;
the researchers plan to use single-cell sequencing technology to probe questions about the maintenance and disruption of X inactivation
Anguera is hopeful that further work will lead to new approaches for treating autoimmune diseases such as lupus.&nbsp;
“If you can get Xist RNA to look like it should
then perhaps you can fix the aberrant X-linked gene expression.” Exploring the role of RNA binding proteins
which help to tether Xist to the X chromosome and keep it in place
may be a fruitful area for further study.&nbsp;
Anguera and Behrens’s co-authors on the paper were lead author Camille M
Support for the study came from the <a href="https://research.upenn.edu/funding/university-research-foundation/">University Research Foundation</a>, the <a href="https://www.acs.org/content/acs/en.html">American Chemical Society</a>, the McCabe Foundation, and the <a href="https://www.nih.gov/">National Institutes of Health</a> (grants AI124084, HD085848-03, GM007229, HD083185, GM123604, AI079002, and GM111384).
Montserrat Anguera is an assistant professor in the Department of Biomedical Sciences in the University of Pennsylvania School of Veterinary Medicine.
In Senegal, the ambitious Dakar Greenbelt project seeks to create an extensive network of ecological infrastructure in and around the city to sustainably address environmental concerns and enhance urban life. With support from David Gouverneur and Ellen Neises, Ph.D. candidate Rob Levinthal in the Weitzman School of Design led two courses that included a field trip to Dakar, that culminated in students presenting their visions for parts of the Greenbelt.
The new Vagelos Laboratory for Energy Science and Technology boasts adaptable laboratory spaces to support the dynamic needs of pioneering research.
Volume 12 - 2021 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2021.637304">https://doi.org/10.3389/fpsyg.2021.637304</a>
The objective to which this manuscript is oriented to is focused on the analysis of interpersonal communication in sport
The multimodal essence of human nature adopts special characteristics in individual and team sports
given the roles that athletes adopt in different circumstances
depending on the contingencies that characterize each competition or each training session
The mixed methods framework allows us to advance in the ways of integration between qualitative and quantitative elements
taking advantage of the proven possibilities of systematic observation
which we can consider mixed method in itself
and which provides rigor and flexibility in the study of the communicative flow in sport
the procedure followed by systematic observation may require direct observation
which is characterized by its high perceptiveness
when it comes to verbal behavior or documentary material
the procedure is structured in three macro-stages: QUAL-QUAN-QUAL
In this work we start from a conceptual positioning about interpersonal communication
to later show the sequential gear in sports about obtaining qualitative data
its transformation into other types of data that are still qualitative but have been structured
and return to a qualitative stage where the interpretation of the results is possible
This process of quantitizing constitutes the cornerstone that gives shape and structure to any research on interpersonal communication in sport that combines the fine nuances of qualitative data (a motor action
an exclamation,&#x02026;) with the power of robust quantitative data analysis suitable for the treatment of organized qualitative data
The conceptual and empirical scope of communication in sport is immense and undoubtedly polyhedral, and the unfolding of facets that are derived ranges from interpersonal communication to health, through humanistic, organizational and media approaches, until reaching the 22 sub-disciplines that <a href="#B27">Billings (2017)</a> highlights
and that are grouped into four blocks: (1) how a certain subdiscipline of communication relates to sport
(2) specify the theories based on communication relevant to sport within the subdiscipline (3) search for jobs published that show the connection between sport and the subdiscipline of communication
and (4) articulate possible directions for future research within the framework of sport and the subdiscipline of communication
addressing new perspectives offered by interpersonal
and organizational interaction in sports contexts
Sport is characterized by generating a complex multi-level network where competition, support, conflict resolution, and the creation of new contacts are continuously converged, which, in short, make up very diverse interpersonal relationships. In fact, sport itself, according to <a href="#B87">Turman (2017)</a> can be considered as an interpersonal relationship
since it allows mediating relationships between athletes
families (in the case of children who practice it)
The interaction between coaches and athletes takes place in very different contexts (informal sessions, preparation for competitions, half-times, conversations in the locker room, etc.), which provides a wide range of communication possibilities and different types of messages (<a href="#B87">Turman, 2017</a>) whose study is of great importance to delve into the analysis of interpersonal relationships between them
the communicative exchanges between athletes
around the behavior of the coach or with other social agents
Likewise, this conceptual framework contemplates different levels of analysis, and in the same way that <a href="#B54">Knapp et al. (1973)</a> studied the types of non-verbal behavior that occur in each phase of a communicative exchange
we can contemplate a strategy that allows a structured procedure
both bottom up (inductive path) and top down (deductive path)
Both ways must be possible in the analysis of interpersonal communication structured as a problem of systematic observation
most empirical studies carried out in all the sub-fields of the Social Sciences
had been proposed following a qualitative or quantitative methodological orientation
This position was consolidated by each of the two options
It was precisely from the beginning of the century and the millennium
with variations according to the countries that mixed methods began to be put into practice
It initially implied a complementarity between the two perspectives (qualitative and quantitative)
to finally evolve to an integration between qualitative and quantitative elements
and that it is perfectly applicable to the field of sport
throughout its QUAL-QUAN-QUAL macro stages
and the potential biases attributable to the behavior of the observer-coder
We conclude by summarizing the permeability and robustness attributes of the systematic observation considered as a suitable and good strategy of full integration in MMR
The concern for epistemic and social quality also defines the fundamental axes that move the discourse of the MM methodological perspective (<a href="#B61">Mertens et al., 2016</a>): (i) the requirement of rigor in the design of interpersonal communication studies in sport applied to a wide variety of problems detected or expressed in the sport communities
and (ii) the scientific requirement to be able to share the validity of the new knowledge obtained
which involves reproducing results of the research and transferring them to different contexts in the field of sports
The sustained effort to define the MM methodology in accordance with the issues that the most influential voices are raising at different moments of its trajectory has led (<a href="#B49">Johnson et al., 2007</a>) to point out some currently shared reference points by the members of the MMIRA
which puts the accent on the partiality of knowledge
beliefs and values given that they are also part of this reality
The MM integration emphasizes the central role of the research questions (<a href="#F1">Figure 1</a>) when considering that they are present in all the related phases of the methodological process and that the definition of the research problem through the questions that are posed is, in turn, directly related to the central and guiding components of a rigorous scientific study: purposes, theories and beliefs, methods and validity considerations (<a href="#B61">Mertens et al., 2016</a>)
which is interpersonal communication in sports
and the methodology structures the object of study
Reciprocal relationship between Research Questions and Methodological Process
Main keywords for interaction analysis through systematic observation
We will consider the methods of analysis of the interpersonal communication supporting an objective-negotiated vision of reality (not all representations of reality are equally acceptable) that structures the quantitative methodology committed to the social meaning and the meticulous control of the inference (<a href="#B52">Kendon, 1990</a>; <a href="#B22">Bavelas et al., 2002</a>; <a href="#B56">Levine, 2011</a>; <a href="#B55">Krippendorff, 2013</a>)
Gathering the elements that we have just enumerated, we understand as interpersonal communication analysis (<a href="#B18">Bakeman and Gottman, 1997</a>; <a href="#B53">Keyton, 2018</a>) the systematic observation study focused on the dynamic process of exchanges of interdependent behaviors (or actions) between two or more people with the purpose of classifying them
identifying their functions in the discourse or its structures (sequences
including the context in which the verbal and non-verbal interaction is developed: interpersonal conflicts
Obtaining observational data involves segmenting the stream of interpersonal communication behavior into units
classifying them according to a set of discrete categories and recording the order or sequence in which the behaviors occur
The instrument of observation is conceived as a system for channeling information
or build it ad hoc according to the research problem addressed
In terms of validity (<a href="#B73">Rogers and Millar, 1982</a>; <a href="#B83">Tardy, 1988</a>)
These three modes of observation require different types of evidence
The processes of systematic observation that make up the analysis of interpersonal communication have been deepened and enriched in the last 50 years
providing a neo-positivist vision sensitive to the social burden of behavioral events while proposing methodological controls
and theorizes and protocols the procedure of observation as a methodological option in the strict sense
and this fit is optimal in the field of sport
<a href="#B31">Creswell and Plano Clark (2011</a>
7) affirmed: &#x0201C;There are three ways in which mixing occurs: merging or converging the two datasets by actually bringing them together
connecting the two datasets by having one build on the other
or embedding one dataset within the other so that one type of data provides a supportive role for the other dataset&#x0201D; (highlight is done by us)
This appointment has a fundamental relevance
which is still increasing because it has been backed by practically all the relevant MM researchers
of the three forms of integration that schematize
merging is usually used when initially or at successive moments of time we have qualitative and quantitative information; connecting when the data is processed
among the many possibilities available; and embedding when a minority data type is nested in data of a different nature
The process of systematic observation is perfectly located in the connecting, given that the scientific procedure that supports it corresponds to the three major stages QUAL-QUAN-QUAL, and between the first two is where quantitizing is located, so much studied today (<a href="#B4">Anguera et al., 2020</a>)
In the first place, and in the field of interpersonal communication, we graphically show the three major stages in the procedure of systematic observation, which is a scientific procedure, but with some peculiarities that characterize it (<a href="#F3">Figure 3</a>)
Macro steps of systematic observation process: QUAL-QUAN-QUAL
and analysis in systematic observation: Steps (row 1)
or both behavior is becoming more interesting
so that one more step of the procedure is the transformation of the registry in a code matrix
To continue to guarantee scientific accountability, the QUAL-QUAN-QUAL conversion must engage and shape the process of inferring, discussing and concluding the interpretation of results. The interpretation must be qualitative and based on the communicative acts and their consequences (how the participants do social actions and what for&#x02026; in its immediate communicative context, <a href="#B22">Bavelas et al., 2002</a>
110) on the results obtained through robust quantitative analysis of the data sequences recorded in the studies of direct or indirect observation of interpersonal communication in sport
In effect, the interpretation of communicative behavior (<a href="#B70">Poyatos, 1983</a>; <a href="#B21">Bavelas and Chovil, 2000</a>) is sustained by assuming the intentional and inferential character of social interaction in the communicative context of exchanges (<a href="#B20">Bateson, 1972</a>)
Other fundamental aspects of interpersonal communication are variability
On the other hand, the micro-analytical record of visible and audible communicative interpersonal behavior (stages 1 and 2 of the quantitizing process) that includes the use of highly elaborate notational systems (<a href="#B11">Anguera and Izquierdo, 2006</a>; <a href="#B47">Izquierdo and Anguera, 2018</a>)
makes it possible to identify the linguistic resources of the interlocutors when they have a common or specialized exchange
the linguistic movement markers that correspond to fleeting comments produced from the listener position
Regarding the interpretation of the results that integrate the quantitative and qualitative analysis within the scientific community in the field of sport
the similarities and disparities that other authors have obtained should be commented on
making a substantive and methodological self-criticism of the work carried out
and suggesting those elements that may lead to a continuation of the investigation
We understand the power of the process of the three QUAL-QUAN-QUAL macro-stages, summarized in <a href="#F4">Figure 4</a>
the initially qualitative information obtained in the record
which is extremely rich for the intended purpose
allows a wide range of quantitative and qualitative analysis-interpretation
We have incorporated as a reference for the MM framework the reflection that argues the complete integration of qualitative and quantitative elements
We have approached the exhibition taking as a starting point the consideration that systematic observation is a positive scientific methodology in the strict sense
with an application protocol that covers all the components of the scientific method
regulates the conduct of the methodological process and promotes commitment to quality controls and good research practice
We are convinced that our work will allow interpersonal communication scholars in sport and MM researchers to consider the possibilities and rigor offered by the observational methodology conceived as an integrated QUAL-QUAN-QUAL process applied to the analysis of communicative interaction in a wide range of sports situations
The authors gratefully acknowledged the support of the Spanish government subproject Integration ways between qualitative and quantitative data
and synthesis review as main axis for an innovative future in physical activity and sports research (PGC2018-098742-B-C31) (2019-2021) (Ministerio de Ciencia
Innovaci&#x000F3;n y Universidades/Agencia Estatal de Investigaci&#x000F3;n/Fondo Europeo de Desarrollo Regional)
that is part of the coordinated project New approach of research in physical activity and sport from mixed methods perspective (NARPAS_MM) (SPGC201800X098742CV0)
authors thank the support of the Generalitat de Catalunya Research Group
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Citation: Izquierdo C and Anguera MT (2021) The Analysis of Interpersonal Communication in Sport From Mixed Methods Strategy: The Integration of Qualitative-Quantitative Elements Using Systematic Observation
Received: 08 December 2020; Accepted: 01 March 2021; Published: 31 March 2021
Copyright &#x000A9; 2021 Izquierdo and Anguera. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
&#x0002A;Correspondence: Conrad Izquierdo, <a id="encmail">Y29ucmFkLml6cXVpZXJkb0B1YWIuY2F0</a>; M. Teresa Anguera, <a id="encmail">dGFuZ3VlcmFAdWIuZWR1</a>
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Volume 11 - 2020 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2020.590131">https://doi.org/10.3389/fpsyg.2020.590131</a>
This article is part of the Research TopicBest Practice Approaches for Mixed Methods Research in Psychological Science<a class="Link Link--linkType Link--maincolor Link--medium Link--icon Link--chevronRight Link--right" aria-label="View all 33 articles" href="https://www.frontiersin.org/research-topics/8170/best-practice-approaches-for-mixed-methods-research-in-psychological-science/magazine" target="_self" data-event="customLink-linkType-a_viewAll33Articles">View all 33 articles</a>
Editorial on the Research Topic <a href="https://www.frontiersin.org/research-topics/8170/best-practice-approaches-for-mixed-methods-research-in-psychological-science">Best Practice Approaches for Mixed Methods Research in Psychological Science</a>
Mixed methods research burst onto the scene around the beginning of the second millennium
After decades of intense dispute between those who preferred the qualitative perspective and their quantitative counterparts&#x02014;with both sides having grown deeply entrenched in their respective views&#x02014;a complementary approach promising the possibility of integration had finally been proposed
the vast majority of researchers had committed to one stance or the other; very few of us argued that the two approaches could be complementary
and the authors that have worked on this topic as a part of a big community
The expansion of mixed methods in the scientific community has been expanding rapidly
we are pleased to see that a growing number of fields are generating mixed methods research
and we are eager to assist in promoting this trend
the field has experienced some &#x0201C;growing pains&#x0201D;: a certain degree of heterogeneity in terms of approaches
differences of opinion regarding certain conceptualizations (for example
multiple ways of integrating qualitative and quantitative elements
and various positions on how best to overcome the enduring lack of symmetry between qualitative and quantitative aspects
The methodological and substantive spectrum is vast and broad
possibly because the mixed methods approach has become &#x0201C;obligatory&#x0201D; for much research
not only in psychology but in practically all branches of the social sciences
Our proposal for delineating between mixed methods and multimethods has been presented in a previous work (<a href="#B2">Anguera et al., 2018</a>)
We believe that a study will be multimethod when
it uses a series of complementary methodologies
whether it has a predominantly qualitative or quantitative nature has no bearing on its consideration as a multimethod study
the essence of mixed methods studies is that they contain qualitative and quantitative components that must be integrated to ensure the mixing of the information they carry
Combining and integrating quantitative and qualitative data in the same study
and attempts have been made in recent years to untangle this Gordian knot
generating and developing strategies for successfully integrating qualitative and quantitative data
The aim of this Research Topic is to present a selection of studies whose methodological approaches include
aspects related to the Gordian knot of mixed methods
that also incorporate secondary&#x02014;but no less important&#x02014;elements such as dataset transformation
analytical techniques and data integration
as well as studies in which systematic observation is used as a mixed method in itself
The Research Topic has promoted a transparent presentation of the mixed approach used to develop the conceptual
methodological or application-related contribution of each article
This transparency will enable other researchers to critically appraise and replicate the methods used
The 32 articles that make up the Research Topic Best Practice Approaches for Mixed Methods Research in Psychological Science
are organized from a substantive point of view in different criteria
although each of the published articles could have been &#x0201C;classified&#x0201D; from several points of view
It is important to highlight the contributions made in the articles published in this Research Topic from the methodological criteria
given the conceptual amplitude of the mixed methods topic and its repercussions in applied studies
We distinguish different procedural orientations
which could be structured around different facets
<a href="https://doi.org/10.3389/fpsyg.2019.01369">Schoonenboom&#x00027;s</a> work focuses centrally on case development from the perspective of mixed methods
conceptually showing how to save the successive controversies that may arise
There are several articles published in this Research Topic that have used the TPA, and with a methodological purpose rather than application. <a href="https://doi.org/10.3389/fpsyg.2019.01373">Hunyadi&#x00027;s</a> article is an exponent of the great possibilities in the field of communication understood in a multimodal way, through the HuComTech project, and that of <a href="https://doi.org/10.3389/fpsyg.2019.01680">Szekr&#x000E9;nyes</a>
which technologically allows starting records in ELAN to analyze the data with THEME
and focus groups were the chosen data gathering methods
Reflecting on the transit that has been carried out in certain areas, from controlled clinical trials, considered as mono-method, to mixed methods, there is a conceptual path that is emphasized by <a href="https://doi.org/10.3389/fpsyg.2019.01445">Carey et al.</a>
and paying special attention to causation and operationalization
With a clearly psychometric interest, the works of <a href="https://doi.org/10.3389/fpsyg.2018.02677">Timoszyk-Tomczak et al.</a>, and <a href="https://doi.org/10.3389/fpsyg.2019.01410">Llistosella et al.</a> were published
about the adaptation of a measurement instrument
the following techniques have been used in the empirical studies of this Research Topic: TPA (9)
And we end this block with teaching on mixed methods, with the work of <a href="https://doi.org/10.3389/fpsyg.2018.02709">Roberts et al.</a>
which advocates that the teaching of mixed methods be carried out by insisting from the beginning on the integration of qualitative and quantitative methods
instead of doing it separately and sequentially
The studies that we publish in this section stand out for both substantive and procedural aspects within mixed methods
but we have considered that the emphasis that they represent at the level of application areas was the most important
there are 11 articles in the field of sport
and one in each of the following fields: occupational health
there is one that is purely methodological
and does not refer to any substantive scope
the articles included in the Research Topic make up a broad spectrum
we want to express the satisfaction that comes from having the opportunity to offer the materialization of new studies in the exciting field of mixed methods to the scientific community
The Research Topic proposal has been motivating
as well as the highest level of acceptance of the originals
the originals of the 32 articles that make up this Research Topic were published between January 2019 and July 2020
The authors gratefully acknowledge the support of a Spanish government subproject
Integration ways between qualitative and quantitative data
and synthesis review as main axis for an innovative future in physical activity and sports research [PGC2018-098742-B-C31] (2019&#x02013;2021) (Ministerio de Ciencia
New approach of research in physical activity and sport from mixed methods perspective (NARPAS_MM) [SPGC201800X098742CV0]
We also gratefully acknowledge the support of the Generalitat de Catalunya Research Group GRUP DE RECERCA E INNOVACI&#x000D3; EN DISSENYS [GRID]
Tecnolog&#x000ED;a i aplicaci&#x000F3; multimedia i digital als dissenys observacionals [Grant 2017 SGR 1405]
We sincerely appreciate the work of the Editors: M
we deeply appreciate the work done by the many reviewers who have collaborated
from their important critical and optimizing role in the submitted manuscripts: C
Thanks to all to their effort and dedication
they have managed to improve the originals sent
and we are aware of the long time spent in this work
but of great relevance to Frontiers in Psychology
Number of manuscripts in which they have been editors or reviewers
And we thank Frontiers in Psychology for having trusted in our proposal of the Research Topic Best Practice Approaches for Mixed Methods Research in Psychological Science
as well as the invaluable help given in the management and editing process of the manuscripts throughout of this period
Avances en estudios observacionales en Ciencias del Deporte desde los mixed methods [Advances in mixed methods observational studies in sports sciences]
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Toward a definition of of mixed methods research
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&#x0201C;Overview of contemporary issues in mixed methods research,&#x0201D; in The Sage Handbook of Mixed Methods in Social and Behavioral Research
Losada JL and Portell M (2020) Editorial: Best Practice Approaches for Mixed Methods Research in Psychological Science
Received: 31 July 2020; Accepted: 18 November 2020; Published: 09 December 2020
Copyright &#x000A9; 2020 Anguera, Blanco-Villase&#x000F1;or, Jonsson, Losada and Portell. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
&#x0002A;Correspondence: M. Teresa Anguera, <a id="encmail">bXRhbmd1ZXJhQGdtYWlsLmNvbQ==</a>
&#x02020;Our heartfelt and emotional memory to Angel, co-author of this Editorial, who died prematurely during the development of this Research Topic
Volume 10 - 2019 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2019.00864">https://doi.org/10.3389/fpsyg.2019.00864</a>
Editorial on the Research Topic <a href="https://www.frontiersin.org/research-topics/4846/systematic-observation-engaging-researchers-in-the-study-of-daily-life-as-it-is-lived">Systematic Observation: Engaging Researchers in the Study of Daily Life as It Is Lived</a>
The Research Topic Systematic observation: Engaging researchers in the study of daily life as it is lived (Section Quantitative Psychology and Measurement) faithfully reflects the interest of many researchers to conduct studies based on a methodology that is essentially characterized by being highly flexible and rigorous
and that aims to capture reality as it happens when studying it scientifically
The analysis of a part of reality is complex
given the multifaceted nature of any aspect of daily life
This complexity is manifested in numerous aspects to be considered
from the initial filtering that must be done to conveniently delimit the part of reality to be studied
to the structuring of the ideal observational design
the construction of a customized instrument that allows to properly channel all the behaviors/elements to be observed around the axes or dimensions around which the studied reality pivots
the materialization of a suitably coded record
This process is none other than the scientific method
although adapted to the reality of natural situations
in which it is not possible or convenient to apply the control that other methodologies offer
given that the spontaneity of behavior and the habituality of the context are of primary concern
we could say that in the systematic observation the face and cross of a same coin are focused: &#x0201C;Face&#x0201D; because its proven versatility and adaptability make it extremely interesting and demanded in innumerable situations
and &#x0201C;cross&#x0201D; because the rigor of the own scientific method gives it a very estimable value that prestige such studies
a prestigious scientific journal of high visibility around the world
had accepted the proposal of this Research Topic
gives more body and arguments in favor of systematic observation to the scientific community
The 23 articles that make up the Research Topic Systematic observation: Engaging researchers in the study of daily life as it is lived are organized from a substantive point of view in different criteria
Given the incessant development of systematic observation over the last quarter of a century
this Research Topic has been an occasion to complete aspects that required progress
in order to be taken as a point of reference in future studies and new developments
we differentiate four different aspects that mark a procedural path
and we consider that they are the following:
On the one hand, the conceptualization, development and analysis possibilities of indirect observation (<a href="https://doi.org/10.3389/fpsyg.2018.00013">Anguera et al.</a>)
which is strongly emerging in recent years
More and more researchers are obtaining texts
and they are provided with a procedure to follow
The weak current of systematic observation has traditionally been the psychometric, and the article by <a href="https://doi.org/10.3389/fpsyg.2018.00291">Chac&#x000F3;n-Moscoso et al.</a> focuses
on the measurement of quality of observational studies based on content validity
and taking advantage of the possibilities of the Osterlind index
One aspect that to date had been absent in systematic observation studies is simulation. <a href="https://doi.org/10.3389/fpsyg.2017.00905">Manolov and Losada</a>
offer a computer application developed for this purpose
adaptable to different sampling techniques
And we can also consider as methodological development the work of <a href="https://doi.org/10.3389/fpsyg.2018.01416">Izquierdo and Anguera</a>
centered on the notational development of movement
and for which a structured system of rules and symbols is proposed
The studies that we publish in this section stand out for both substantive and procedural aspects within systematic observation
but we have considered that the emphasis that they represent at the level of application areas was the most important:
This field presents special characteristics that make systematic observation extremely suitable and attractive as the scientific procedure to be followed
studied the identification of factors that may allow predicting success in professional football
and using bivariate and multivariate statistical analysis
<a href="https://doi.org/10.3389/fpsyg.2017.01842">Morillo et al.</a> address the study of referees in handball, also taking advantage of the extraordinary possibilities of systematic observation. As in the articles by <a href="https://doi.org/10.3389/fpsyg.2017.00741">Casta&#x000F1;er et al.</a> and <a href="https://doi.org/10.3389/fpsyg.2018.00389">Maneiro and Amatria</a>
With the exception of the <a href="https://doi.org/10.3389/fpsyg.2017.00878">Zurutuza et al.</a> article
which requires complementing the observation with physiological variables
all the other studies mentioned here constructed a custom observation instrument
From a broad definition of Health Psychology
three articles were published in the Research Topic
On one hand, <a href="https://doi.org/10.3389/fpsyg.2018.00010">Sanduvete-Chaves et al.</a> have built a scale that allows measuring the quality of the work climate in emergency services
in which there is usually tension due to the responsibility involved in making decisions and the necessary quickness that is required
we have worked with questionnaires and surveys
<a href="https://doi.org/10.3389/fpsyg.2017.01188">Arias-Pujol and Anguera</a> is a study of clinical psychology in which the interaction between adolescents in a group therapy has been observed
By means of a polar coordinates analysis it has been possible to analyze the conversation in the therapeutic group
starting from a detailed record obtained by means of a customized observation instrument
Finally, in <a href="https://doi.org/10.3389/fpsyg.2017.01724">Cerezo et al.</a> the influence of parental gender (father/mother) is studied in the interaction with children
and also taking into account the gender of the child; we highlight the study of interaction from the framework of nonlinear dynamic systems
Systematic observation also has innumerable advantages in studies that revolve around school and learning
five articles were published with very different objectives
but with many common elements regarding the procedure
focusing in particular on the description of stability and change in the behavioral patterns of children identified as victims of bullying
Taking the term Social Psychology in a broad sense
we refer to the Research Topic articles of this group
<a href="https://doi.org/10.3389/fpsyg.2017.00757">Cabrera et al.</a> focus on the objective of studying antisocial behavior
and continues its escalation during adulthood; this paper explores the social interaction patterns of adolescents
with and without risk of committing antisocial behaviors and over 2 years
in a situation of conversational negotiation about conflicting topics
And, on the other, <a href="https://doi.org/10.3389/fpsyg.2017.00620">Lappi et al.</a> present as objective an expert driver&#x00027;s gaze behavior in natural driving on a real road
without any instruction; and gaze directionality sequences are obtained in the directionality of the gaze
we want to express the satisfaction that comes from having the opportunity to offer the materialization of new studies in the exciting field of systematic observation to the scientific community
the originals of the 23 articles that make up this Research Topic were sent from December 2016 to November 2017 and were published between April 2017 and November 2018
The time elapsed from submission to publication has ranged between 3 and 21 months (some were delayed due to the difficulty of finding specialist reviewers in the subject)
and 100% of the submitted manuscripts were accepted
The authors gratefully acknowledge the support of a Spanish government project (Ministerio de Econom&#x000ED;a y Competitividad) La actividad f&#x000ED;sica y el deporte como potenciadores del estilo de vida saludable: Evaluaci&#x000F3;n del comportamiento deportivo desde metodolog&#x000ED;as no intrusivas [Grant number DEP2015-66069-P
the authors thank the support of the Generalitat de Catalunya Research Group
Tecnolog&#x000ED;a i aplicaci&#x000F3; multimedia i digital als dissenys observacionals [Grant number 2017 SGR 1405]
We sincerely appreciate the work of the Editors (MA
And we thank Frontiers in Psychology for having trusted in our proposal of the Research Topic Systematic Observation: Engaging Researchers in the Study of Daily Life as It Is Lived
methodological developments in systematic observation
areas of application in systematic observation
Losada JL and Portell M (2019) Editorial: Systematic Observation: Engaging Researchers in the Study of Daily Life as It Is Lived
Received: 07 March 2019; Accepted: 02 April 2019; Published: 24 April 2019
Edited and reviewed by: <a href="http://loop.frontiersin.org/people/50919/overview">Pietro Cipresso</a>
Copyright &#x000A9; 2019 Anguera, Blanco-Villase&#x000F1;or, Jonsson, Losada and Portell. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
*Correspondence: M. Teresa Anguera, <a id="encmail">bXRhbmd1ZXJhQGdtYWlsLmNvbQ==</a>
Volume 11 - 2020 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2020.01922">https://doi.org/10.3389/fpsyg.2020.01922</a>
Conducted within a mixed methods framework
this study focuses on the conversation-facilitation role of a lead therapist during group psychotherapy with adolescents
Conversation is an essential component of psychoanalytic psychotherapies and there is growing interest in describing and studying the impact of conversational techniques
One way to do this is to report on specific approaches
and mentalization in intervention turns and to analyze their impact on the therapist-patient relationship
The main aim of this study was to investigate differences in communication strategies used by a lead therapist in the early and late stages of therapy with six adolescents aged 13&#x2013;15 years
We employed a mixed methods design based on systematic direct observation supplemented by indirect observation
The observational methodology design was nomothetic
The choice of methodology is justified by our use of an ad hoc observation instrument for communication strategies combining a field format and a category system
We analyzed interobserver agreement quantitatively by Cohen&#x2019;s kappa using GSEQ5 software
Following confirmation of the reliability of the data
we analyzed the lead therapist&#x2019;s conversation-facilitation techniques in sessions 5 and 29 of a 30-session program by quantitatively analyzing what were initially qualitative data using T-pattern detection (THEME v.6 Edu software)
The results show changes in the techniques used from the start to the end of therapy
Of the 28 communication strategies analyzed
three were particularly common: questioning and paraphrasing in session 5 and questioning and mentalization in session 29
This mixed methods study shows that combined use of T-pattern detection
and polar coordinate analysis can offer meaningful and objective insights into group psychotherapy through the lens of the therapist
The process for analyzing change in psychotherapy is well established and plenty of opportunities exist within this process (from the definition of the research question to the interpretation of systematically collected and recorded data) to integrate both qualitative and quantitative elements
Conventionally speaking, mixed methods studies integrate qualitative and quantitative perspectives (<a href="#B46">Johnson et al., 2007</a>; <a href="#B30">Creswell and Plano Clark, 2017</a>; <a href="#B65">Onwuegbuzie et al., 2018</a>) in drawing on all types of data
and measures from physiological and other tests
including repeated measures taken over the course of a single study
The means by which these data can be linked has grown exponentially
giving rise to numerous conceptual nuances
and a future that promises to end decades of methodological confrontation
The very essence of the observational methodology consists of seeking complementarity through the integration of qualitative and quantitative elements. A key strength of the observational methodology is that it rigorously guarantees quality through the objective analysis of rigorously collected and processed qualitative data that can be analyzed robustly and quantitatively without loss of information richness (<a href="#B12">Anguera et al., in press</a>)
(2) she encouraged turn-taking from more inhibited participants
(3) she facilitated conversation from the early stages of therapy
and (4) she promoted the capacity to mentalize toward the end of therapy
conducted within a mixed methods framework
was to investigate potential differences in the communication strategies used by a lead therapist in earlier and later stages of therapy
The specific aim was to use T-pattern detection
and polar coordinate analysis to detect changes in the communication flow between a lead therapist and her patients (in this case
analyzing the specific techniques used and their impact on the therapist-patient relationship
The group therapy sessions were conducted in the Eul&#x00E0;lia Torras de Be&#x00E0; Foundation (FETB) Center for Child and Adolescent Mental Health (Barcelona
Spain) with six adolescents (four boys and two girls) aged 13&#x2013;15 years
All the adolescents had difficulties with learning and interpersonal relationships
This research forms part of a broader project involving an 8-month intervention developed to enhance the mentalization and communication capacities of adolescents, whose parents attended parallel sessions on parenting. The goal of the therapists was to facilitate interaction among all the group members by creating an atmosphere of emotional security and support (<a href="#B87">Torras de Be&#x00E0;, 2013</a>)
Written informed consent was obtained from the parents of the minors in accordance with the principles of the Declaration of Helsinki and the Ethical Code of the General Council of the Spanish Official College of Psychologists
Approval by an ethics committee was not required as per applicable institutional and national guidelines and regulations
The participants were informed that they were being filmed and agreed accordingly
and were shown the location of the video cameras
positioned discretely to minimize reactivity bias
They were guaranteed that their identity and privacy would be protected at all times
pseudonyms were used in the transcripts and encodings of the material
The study was approved by the head of the Eul&#x00E0;lia Torras de Be&#x00E0; Foundation (FETB) Research Department
Regulatory provisions regarding clinical research in humans of the European Union (Good Clinical Practice for Trials on Medicinal Products in the European Community: EEC 111/3976/88-EN) and of Spain (Royal Decree 561/1993) were applied
Table 1. Dimensions and category systems in the observation instrument for therapists and patients (adapted from <a href="#B16">Arias-Pujol and Anguera (2017)</a>
The recording instrument used was the freeware GSEQ5, v.5.2<a id="footnote1a"></a><a class="footnoteanchor" href="#footnote1">1</a> (<a href="#B21">Bakeman and Quera, 1996</a>, <a href="#B22">2011</a>), which allowed the sessions to be coded in accordance with the observation instrument. The obtained data were type II data (<a href="#B18">Bakeman, 1978</a>)
GSEQ5 was also used to calculate agreement
Sample clinical vignette for the initial session
Sample clinical vignette for the final session
The reliability of the data was confirmed by calculating <a href="#B28">Cohen (1960</a>, <a href="#B29">1968)</a>; the obtained values of between 0.897 and 0.939, according to <a href="#B50">Landis and Koch(1977</a>
can be interpreted as &#x201C;almost perfect agreement&#x201D;
we compared the content of two sessions in order to showcase an innovative methodological development in group psychotherapy in which qualitative records from the two sessions underwent a powerful quantitative analysis within a mixed methods framework
where X is an event-type or a T-pattern. The general term Xi [d1, d2]i Xi + 1 means that, within occurrences of the pattern, after Xi occurring at t statistically significantly more often than expected by chance, Xi + 1 occurs within interval [t + d1, t + d2], or short [d1, d2], called a critical interval (<a href="#B12">Anguera et al., in press</a>)
Microanalyses are also possible and very useful (<a href="#B5">Anguera, 2005</a>)
which offers different settings that can be modified to obtain complementary results
Combined analysis of these results can provide a better understanding of interactive transitions over time
THEME provides all the necessary features to analyze the data and presents the results graphically as dendrograms or tree diagrams
Two parameters necessary for each analysis are the minimum number of occurrences and the level of significance
We set the minimum number of occurrences to 30 and the significance level to p &#x003C; 0.005
Note that the method applied in this research was rather unconventional
as the temporal distance parameter was set to 1 in all cases
This method was chosen because of the nature of the data (type II)
While T-pattern detection has been used in a wide range of fields, including clinical psychology (<a href="#B25">Blanchet et al., 2005</a>; <a href="#B43">Haynal-Reymond et al., 2005</a>; <a href="#B61">Merten and Schwab, 2005</a>; <a href="#B67">Plumet and Tardif, 2005</a>; <a href="#B45">Horn and Magnusson, 2016</a>; <a href="#B91">Woods et al., 2016</a>)
its application to group therapy with adolescents is novel
This technique, proposed by <a href="#B18">Bakeman (1978)</a>
aims to detect the existence of patterns of behavior within categorical data corresponding to regular behaviors that are not due to random effects
Lag sequential analysis one or more given behaviors (any that
are assumed to generate or initialize a behavior pattern)
one or more conditional behaviors (for which we wish to test the existence of a statistical association with a given behavior)
Behaviors with positive and negative lags occur after and before the given behavior
The number of the lag indicates the order in which it occurs
especially when we want to detect regularities at different points in time
as it expresses the results as adjusted residuals
Once the adjusted residuals have been obtained
the pattern (or patterns) of behavior is (are) &#x201C;constructed,&#x201D; starting with the proposed criterion behavior in each case
Each lag (whether positive or negative) will include the conditional behavior(s) with a significant adjusted residual value: &#x003E;1.96 when the relationship is activation and &#x003C;&#x2212;1.96 when the relationship is inhibition (for a significance level of p &#x003C; 0.05)
Lag sequential analysis has been successfully applied in many direct and indirect observation studies conducted over the past 25 years in clinical psychology (e.g., <a href="#B60">Mart&#x00ED;nez del Pozo, 1993</a>; <a href="#B14">Arias-Pujol and Anguera, 2004</a>, <a href="#B15">Arias-Pujol and Anguera, 2005</a>; <a href="#B74">Roustan et al., 2013</a>; <a href="#B17">Arias-Pujol et al., 2015</a>; <a href="#B89">Venturella et al., 2019</a>; <a href="#B31">Del Giacco et al., 2020</a>)
From the prospective and retrospective Zsum values, <a href="#B76">Sackett (1980)</a> proposed a vectorialization of the relationships between focal behavior and conditional behaviors
Each vector has length or radius L&#x2062;e&#x2062;n&#x2062;g&#x2062;t&#x2062;h=(Zs&#x2062;u&#x2062;m&#x2062;prospective)2+(Zs&#x2062;u&#x2062;m&#x2062;retrospective)2 and an angle &#x03D5; = ArcsenZs&#x2062;u&#x2062;m&#x2062;retrospectiveLength
As many vectors as conditional behaviors are obtained
all graphically with their origins in the focal behavior
Because the prospective and retrospective Zsum values have a positive or negative sign
the corresponding vectors can be plotted such that the prospective and retrospective values will be displayed along the horizontal (X)-axis and the vertical (Y)-axis
The meaning of the vectors varies in function of the quadrant in which they are located
and the position of a vector in one quadrant or another is determined by the combination of positive or negative signs on the prospective and retrospective Zsum values:
Quadrant I (+ +): the focal and conditional behaviors activate each other
Quadrant II (&#x2212; +): the focal behavior inhibits and is activated by the conditional behavior
Quadrant III (&#x2212;&#x2212;): the focal and conditional behaviors inhibit each other
Quadrant IV (+ &#x2212;): The focal behavior activates and is inhibited by the conditional behavior
Vector length indicates the strength (statistical significance) of the association between the focal and conditional behaviors
Like T-pattern detection, polar coordinate analysis has been used in a wide range of fields, including clinical psychology (<a href="#B16">Arias-Pujol and Anguera, 2017</a>; <a href="#B73">Rodr&#x00ED;guez-Medina et al., 2018</a>; <a href="#B1">Alcover et al., 2019</a>; <a href="#B31">Del Giacco et al., 2020</a>)
The way in which the therapist and the adolescents communicated with each other changed from session 5 to 29 and the qualitative changes detected were confirmed quantitatively within a rigorous analytical framework
Sample clinical vignettes for each session are reproduced below
<a href="#T4">Tables 4A,B</a> shows the records corresponding to the vignettes in <a href="#T2">Tables 2</a>, <a href="#T3">3</a> for multi-event sequence data and according to the syntax of the GSEQ5 program
compiled for the program to check for formal errors and generating an .MDS file once verified as correct
Fragment of record with multi-event sequence data using the syntaxis of the GSEQ5 program
The results of the three techniques (T-pattern detection
and polar coordinate analysis) are presented below
For both sessions, the records obtained were transformed using the GSEQ5 program to adapt them to the syntax of the THEME program, which requires two files: the VVT.VVT file corresponding to the observation instrument, and the .RDT file corresponding to the recorded data. <a href="#T5">Tables 5A&#x2013;C</a> shows the VVT.VVT file and the respective records corresponding to the vignettes in <a href="#T2">Tables 2</a>, <a href="#T3">3</a>
maintaining a conventional and constant distance according to the THEME syntax
Fragment of record using the syntaxis of the THEME program
For the initial sesi&#x00F3;n (see <a href="#F1">Figure 1</a>)
we detected four T-patterns for the therapist as focal subject
These were related to two communication modalities: questioning (code QA) and repetition or paraphrasing (code RP)
T-patterns in the initial session: minimum occurrence 30 and p &#x003C; 0.005
Four T-patterns were identified linking turn-taking by the therapist to the questioning (QA
depicted as PA in the graph) and repetition/paraphrasing (RP) categories (both from the &#x201C;facilitating conversation&#x201D; dimension)
The vertical lines correspond to each co-occurrence of t and pa behaviors (patterns 137 and 138)
followed by co-occurrences of t and pa (pattern 137) and t and rp (pattern 138)
The vertical lines also show co-occurrences of t and rp (patterns 139 and 140) followed t and pa (pattern 139)
The length of the horizontal line fragments is proportional to their duration
For the final sesi&#x00F3;n (see <a href="#F2">Figure 2</a>)
again related to two communication modalities: questioning (QA) and mentalization (MNT)
T-patterns in the final session: minimum occurrence 30 and p &#x003C; 0.005
One was linked to the turn-taking of the therapist in the mentalization (MNT) category (from the &#x201C;mentalization&#x201D; dimension)
and the other was linked to the questioning (QA) category (from the &#x201C;facilitating conversation&#x201D; dimension)
Vertical lines reflect co-occurrences of t and mnt (pattern 151) and t and qa (pattern 152) behaviors
followed by co-occurrences of t and mnt (pattern 151)
For both sessions, sequential lag analysis was performed considering T as the criterion behavior and all other observation instrument codes as conditional behaviors. <a href="#T6">Table 6</a> shows the adjusted residual values obtained using the GSEQ5 program
Lag sequential analysis for the initial and final sessions
Sequential lag analysis of the data from session 5 revealed a behavioral pattern in which paraphrasing and use of questioning alternated between lags &#x2212;3 and +2
A sequential pattern with mentalization located in the center (lag 0) was detected for session 29
considering T as the focal behavior and all other observation instrument codes as conditional behaviors
were parameters corresponding to the prospective and retrospective Zsum values
from which vector length and angle values were calculated along with the quadrant in which the values were located
<a href="#T7">Tables 7</a>, <a href="#T8">8</a> show the parameters corresponding to sessions 5 and 29
Parameters corresponding to the prospective and retrospective Zsum values obtained in session 5
considering T (therapist) as the focal behavior
Parameters corresponding to the prospective and retrospective Zsum values obtained in session 29
Graphs of the vectors, created using R, are depicted in <a href="#F3">Figures 3</a>, <a href="#F4">4</a>
The vectors correspond to interventions by the therapist (T) as focal behaviors and the communication strategies questioning (QA)
and mentalization (MNT) as conditional behaviors
The vectors correspond to interventions by the therapist (T) as focal behaviors and the communication modalities questioning (QA)
The polar coordinate analysis showed that the therapist activated questioning and paraphrasing (quadrant I) in the initial session
and questioning and mentalization in the final session (quadrant I)
The results obtained in the T-pattern, lag sequential, and polar coordinate, analyses all show changes in the conversation-facilitation techniques used by the lead therapist from the start to the end of therapy. Although the combination of these three techniques has been used in different fields (e.g., <a href="#B79">Santoyo et al., 2017</a>; <a href="#B86">Tarrag&#x00F3; et al., 2017</a>)
this is the first time they have been applied in combination to clinical psychology
Our findings show that this is a remarkably productive approach to identifying relationships between communication modalities and changes that occur during the therapeutic process
From the observation instrument composed of 15 dimensions and 28 categories (<a href="#T1">Table 1</a>), three communication modalities in particular were identified &#x2013; questions (QA), paraphrasing (RP), and mentalization (MNT) &#x2013; suggesting that these are all powerful communication strategies for encouraging patient interaction in group therapy (<a href="#B64">Oetzel and Scherer, 2003</a>)
Questioning by the therapist was observed in both the earlier and later sessions and its use shows that the therapist expressed interest in what the participants had to say
Questioning stimulates dialogue and encourages more inhibited group members to take the floor in a conversation and to express their experiences and feelings
these strategies were grouped into a single block &#x2014; conversation-facilitating DYN categories &#x2014; formed by seven codes (FF
was that the therapist made significantly greater use of questioning and mentalization in the later session compared to the earlier session to achieve the goals of the intervention
This mixed methods study employed systematic observation and a succession of QUAL-QUAN-QUAL stages
We have shown that the combined use of T-pattern detection
and lag sequential analysis can offer meaningful and objective insights into what occurs in group psychotherapy from the angle of the therapist
This study has three novel methodological aspects
it is the first to apply T-pattern detection to group psychotherapy with adolescents; second
it is first to combine T-pattern detection
and lag sequential analysis to analyze what occurs during the course of group psychotherapy from the perspective of the therapist; and finally
within the framework of a mixed methods study
our research incorporates one of the most powerful methods for linking qualitative and quantitative data
which involves the systematized transformation of qualitative data into robust quantitative data for objective analysis
All datasets generated for this study are included in the article
The studies involving human participants were reviewed and approved by the Head of the Eul&#x00E0;lia Torras de Be&#x00E0; Foundation (FETB) Research Department
Written informed consent to participate in this study was provided by the participants&#x2019; legal guardian/next of kin
MA conducted the method section and T-patterns
Both authors participated in writing the article
This study was supported by the Catalan Government under Grant number 2017 SGR 876 for the project Grup de Recerca de Parella i Fam&#x00ED;lia (GRPF)
We also gratefully acknowledge the support of the Spanish Government subproject Integration ways between qualitative and quantitative data
and synthesis review as main axis for an innovative future in physical activity and sports research (PGC2018-098742-B-C31) (2019&#x2013;2021) (Ministerio de Ciencia
Innovaci&#x00F3;n y Universidades/Agencia Estatal de Investigaci&#x00F3;n/European Regional Development Fund)
part of the coordinated project New approach of research in physical activity and sport from mixed methods perspective (NARPAS_MM) (SPGC201800X098742CV0)
We thank all those at the Center for Child and Adolescent Mental Health of Eul&#x00E0;lia Torras de Be&#x00E0; Foundation in Barcelona
who so willingly helped to make this study possible
as well as all the adolescents and families who participated
we also acknowledge support from Ramon Llull University (PGRiD of FPCEE Blanquerna)
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Citation: Arias-Pujol E and Anguera MT (2020) A Mixed Methods Framework for Psychoanalytic Group Therapy: From Qualitative Records to a Quantitative Approach Using T-Pattern
Copyright &#x00A9; 2020 Arias-Pujol and Anguera. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
*Correspondence: Eul&#x00E0;lia Arias-Pujol, <a id="encmail">ZXVsYWxpYWFwQGJsYW5xdWVybmEudXJsLmVkdQ==</a>
<a href="/articles/s41746-023-00812-z/metrics" data-track="click" data-track-action="view metrics" data-track-label="link" rel="nofollow">Metrics details</a>
An <a href="https://doi.org/10.1038/s41746-023-00826-7" class="relation-link" data-track="click" data-track-action="view linked article" data-track-label="link">Author Correction</a> to this article was published on 25 April 2023
This article has been <a href="#change-history">updated</a>
c An overview of the study timeline with outcome measures collected at each timepoint listed
Abbreviations - CPT: Continuous Performance Task
ITC of CPT: Inter-Trial Coherence of the Continuous Performance Task
</a>Illustration depicting the number of participants at different stages of the study
from consent to enrollment and 1-year follow-up
The embedded table reflects the number of participants with datasets for each of the primary measures of interest at each time point
as well as the number of individuals with data at each paired timepoint
missing data was due to participants not being able to stay to the end of their testing session due to other outside obligations those days
missing data points reflect a hardware error where photodiodes used to time lock the onset of targets were not functioning properly
preventing the analysis of event-related activity
suggesting that participants improved on cognitive measures and showed increased physical effort across the training period on the BBT intervention
</a>a Parent report of inattention (Vanderbilt) over time illustrating the group mean at each time point
b Scatterplot illustrating trending correlation between the change on the Vanderbilt inattention measures versus overall change in accuracy collapsed across BBT training modules (r = 0.42
c CPT (sustained condition) response time variability over time illustrating the group mean at each time point
d CPT (impulsive condition) response time variability over time illustrating the group mean at each time point
</a>a Midline frontal theta inter-trial coherence (ITC) for the sustained condition of the CPT over time
b Correlation between the change in sustained ITC and the change in Vanderbilt inattention measure
c Midline frontal ITC for the impulsive condition of the CPT over time
d Correlation between the change in impulsive ITC and the change in impulsive RTV
The dashed circle on the topographic plot illustrates the electrodes where statistical analyses took place
Given that our recruited population was heterogenous with respect to attention issues
we examined whether there was a relationship between the extent of inattention at baseline
as measured by the score on the Vanderbilt
with the change in performance following the intervention on each of our task-based primary outcome measures
This correlational analysis revealed no significant relationship between baseline Vanderbilt inattention score and the extent of improvement on any of our primary measures of interest: CPT Sustained RTV (r(19) = 0.35
p = 0.14); CPT Impulsive RTV (r(19) = 0.12
with no improvement on RT during this task (t(16) = 0.80
No change was observed on the Push Up (t(19) = 1.06
PACER number of laps completed (t(19) = 0.72
suggesting that participants did not improve their basic motoric abilities after BBT and that any RT-based changes on other outcome measures could not be solely attributed to such changes as well
</a>a Change on Vanderbilt Inattention Measure for BBT cohort and participants from Anguera et al
b Change on CPT task on the Sustained Condition for BBT cohort and participants from Anguera et al
SPD + IA = Children with Sensory Processing Disorder and ADHD comorbidity
With respect to the CPT task (sustained condition) and RTV metric (see Fig. <a data-track="click" data-track-label="link" data-track-action="figure anchor" href="/articles/s41746-023-00812-z#Fig5">5</a> and Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/articles/s41746-023-00812-z#Tab3">3</a> for values)
the same ANOVA approach described above revealed a main effect of session (F(1,49) = 8.43
but no group by session interaction (F(2,49) = 1.04
suggesting that all groups improved equivalently on this metric after training
it should be noted that only the BBT group demonstrated a significant improvement following training
unlike the SPDIA and TDC groups in Anguera et al
we also evidenced benefits on attention with both cognitive and neural assessments
with these improvements persisting for 12 months
our exploratory analyses demonstrated that BBT improved performance on other measures of cognitive control
we discuss the practical consideration of this study
as well as the possible mechanisms of these intervention-related enhancements
which utilized the AKL-T01 tablet-based intervention
the improvements observed involved the same metric of RTV examined here
suggesting that BBT improved objective indices of attentional control comparable to these other works
we also observed persistent performance improvements on the sustained condition 1-year later
illustrating one of the long-lasting potential benefits of the BBT intervention
it should be noted that none of the previously referenced works interrogated these metrics during the impulsive condition
Here we observed comparable improvements on each condition
suggesting that the BBT intervention may have the breadth to generalize to different facets underlying attentional abilities
with those individuals reaching a 13% multitasking cost after training
we observed that the older adults improved their working memory abilities on the same delayed recognition task used here
While we only observed a trend suggestive of similar improvements on this task
it is notable that this measure of far transfer showed potential signs of improvement in a very different heterogenous sample involving a closed-loop adaptive intervention
the improvements on the CPT task with these other measures assessing cognitive control abilities supports the underlying idea of the BBT platform engaging each cognitive control pillar (attention
cognitive flexibility) as envisioned in the training prescription
Note that the examination of RT and RTV on the BRT control task revealed no change on either metric over time
supporting the assertion that the cognitive improvements observed were not simply a function of improved speed of processing
The ability to couple two distinct types of training into a singular experience is also an important practical consideration
This is especially pertinent with respect to engaging this particular population in a meaningful way on more than one intervention in the setting of a limited amount of time
It also provides a secondary option for parents and their children with respect to engaging with these types of treatments
as one could easily imagine individual preferences for “move and play” options versus “sit and play.”
in conjunction with our decision to focus on RTV
It should be repeated that the interpretation of the findings presented should be taken with caution given that there may be other factors unaccounted for here that could have affected the outcomes of the study
unaccounted improvement in one’s personal health or outside activities that were unaccounted for
Here we provide initial evidence for the utility of a novel digital intervention that combines physical and cognitive challenges towards the overarching goal of enhancing attention in children across a range of attention abilities
These findings contribute to the emerging field of digital therapeutics
demonstrating that these approaches may be beneficial to certain populations
the corroboration of the objective testing and parent reports with neural findings provide a specific target for future work to evaluate the neural mechanisms of observed changes
These approaches should not be evaluated in a vacuum; future work should evaluate the utility of each digital intervention with the perspective that individuals may benefit from different approaches
The present findings provide an initial vantage point regarding a non-tablet
motion capture digital therapeutic in children with issues of inattention
the authors affirm that participants provided informed consent for publication
To compensate for the time and effort of participation in this study
caregivers received $20 for each outcome assessment session
With respect to participant characterization and screening
the Wechsler Intelligence Scale for Children Fifth Edition (WISC-V) was administered to all participants at the pre-training visit
with inclusion of children with Verbal Comprehension Index (VCI) ≥ 70
Children were excluded for prematurity (gestational age &lt; 32 weeks)
seizures requiring current medication management
or concern for Autism Spectrum Disorder as measured using the Social Communication Questionnaire (score &gt; 15)
The visual search module demands an active scan of the screen in search of a target
This module involves a constantly evolving amount of cued information as well as number of incongruent distracting elements
such that participants experience less cued information while experiencing more and more distracting elements as they advance
Participants are required to quickly identify the direction of a probe target that is facing at a right angle (up
and are aided by the presence of directional cue indicating in which location of the screen the target will appear amongst distracting elements
Responses are made by reaching their hands to indicate the direction of the probe
with the additional physical challenge of running in place if the target is up or down
participants completed a thresholding session to determine the optimal starting point from both a cognitive and physical perspective
After completing their initial 7 training sessions
participants advance to Level 2 of this module which entailed facing a greater challenge: here participants encountered an increase in the number and salience of distracting elements
including the presence of congruent distractors
as based on their performance on the previous trial
participants moved on to Level 3 of this module: here participants performed the same task as before
but now without the aid of a directional cue
participants only receive game points when they correctly perform a given trial faster than the predetermined
personalized threshold determined at the beginning of each level to optimize the attentional engagement
The working memory module engages spatial working memory resources similar to the Corsi block task<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 88" title="Berch, D. B., Krikorian, R. &amp; Huha, E. M. The Corsi block-tapping task: Methodological and theoretical considerations. Brain Cogn. 38, 317–338 (1998)." href="/articles/s41746-023-00812-z#ref-CR88" id="ref-link-section-d360321279e2723">88</a>
requiring individuals to memorize an additional stimulus following two consecutive correct responses
with two consecutive incorrect trials leading to one element being subtracted
Participants memorize the location of objects on screen followed by a 5-7 second delay period during which the participants perform a directed physical movement
with a correct response leading to a greater number of potential targets to be memorized on the next trial (and vice versa)
Responses are made with both hands and feet by reaching/kicking targets
with additional physical challenges (making a “wood-chopping” motion) occurring during the delay period
participants are asked to also memorize and report the sequential order in which the targets originally appeared on the screen (Level 2)
thus increasing the spatial working memory load
participants perform a working memory/multiple object tracking task that requires memorizing and tracking the targets as they become invisible and move amongst a sea of moving objects (Level 3)
participants only receive game points when they correctly complete a working memory trial faster than a predetermined
personalized threshold so as to challenge the underlying cognitive working memory circuitry
The task switching module challenges cognitive flexibility resources by requiring participants to rapidly switch their focus based on distinct rules
much like a traditional task-switching paradigm
Here a morphing algorithm is used to titrate the perceptual similarity of the target presented
such that a correct trial makes a subsequent exemplar morph more similar to the probe presented (and vice versa)
Participants are presented with exemplar objects along with a target
and move their hands to the target object that is most similar to the exemplar presented
participants decide whether the image is more green or more blue
The target changes its degree of likeness to each exemplar following each trial
with each correct response morphing the probe towards an indistinguishable 50/50 ratio of each exemplar (and vice versa)
the presented probes now have features that integrate two rule bases (Level 2
similar to interference generated by a Stroop task
but the exemplars now spawn in random locations across the screen
heightening the cognitive demands further by requiring visual search (Level 3)
participants receive game points when they perform a trial as fast or faster than a predetermined
personalized threshold to pressure underlying goal-management circuitry
such that participants experience less and less cued information while experiencing more and more distracting elements as they advance
and iii) the working memory module requires individuals to memorize an additional stimulus following two consecutive correct responses
These cognitive adaptive algorithms are designed to assure participants remain at an ~80% rate of accuracy
difficulty is tied to the demands associated with the distance an individual must travel for a given response
and the amount of time allocated to complete this response
These movement-related aspects are directly responsive to whether heart rate is below/within/above a predetermined heart rate window (see below) to ensure a moderately intense workout that does not impede the ability to perform the cognitive task
if one is playing the game below their assigned heart rate range
the software will automatically increase the distance that the participant has to move to respond with their hands/feet on each trial until their heart rate is within the specified range
we used performance on the PACER (see below) to estimate VO2 max to determine the initial physical difficulty level (and each subsequent level) of the BBT intervention:
The adaptivity associated with heart rate allows for an increase (or decrease) in effort within a prescribed window as determined by the participants VO2 max calculation
an increase in HR reflects participants performing at a greater intensity within this prescribed heart rate window
All other outcome measures collected were designated ‘secondary’ measures of interest
including measures of physical fitness that were assessed due to the nature of the intervention
These designations are stipulated in our trial registration as well (ISRCTN registry [59416198])
PLVs were controlled for individual state differences at each session by baseline correcting each individual’s PLVs using their −200 to 0 period (thus
Note that this outcome measure was also collected at the 1-year follow-up
Our first secondary outcome measure was the NeuroRacer multitasking assessment
where participants responded to a designated stimulus presented on a computer monitor (green circles) while ignoring all other color/shape combinations
Participants were exposed to 3 blocks of 36 target stimuli and 36 non-target stimuli
with each stimulus appearing on the screen for 400 ms and an inter-trial interval of 2000–3000 ms (with 500 ms jitter)
A fixation cross was present on the screen at all times above the car and below the color/shape signs
Participants were instructed and reminded after each run to maintain focus on the fixation cross
The fixation cross provided performance feedback on each task: it turned green for 50 ms when the correct sign was selected within the time window or an irrelevant sign was ignored
When either of the aforementioned conditions were not met
For the NeuroRacer multitasking assessment
cognitive performance was evaluated using the signal detection metric of discriminability (d-Prime
This index calculated the percentage change in d’ from when a participant performed a perceptual discrimination task by itself (‘single tasking’) versus when they performed this same task while concurrently performing a visuomotor tracking task (‘multitasking’)
the equation for this index is as follows: (multitasking d’ – single-tasking d’/ single-tasking d’)
Visuomotor tracking performance was measured by the amount of time that the participant was able to keep the car at the center of the road
Note that this behavioral outcome measure was also collected at the 1-year follow-up
this measure was not collected at the 1-year follow-up
a field-test battery for youths used by the Presidential Youth Fitness Program that has established standards for ages 5–17 years
and the PACER run to assess changes in fitness and strength
These measures were not collected at the 1-year follow-up
Before the battery of measures was assessed
each participant performed a warm-up consisting of jumping jacks and running for 2 min prior to performing each of the fitness outcomes
Here we describe each of the measures and associated scoring: i) Curl-up: The subject lies on his/her back with knees bend at a 140-degree angle
The fingers are stretched out and the head is in contact with the floor
The fingertips are touching the tape that runs horizontally under the legs
the subject lifts his/her head and upper chest toward the knees
The fingers should slide across the tape toward the ankles
Scoring on this task was calculated as the total number of curl-ups performed at a set pace (1 curl-up every 3 s) until a break was needed
ii) Push-up: The subject is positioned down on his/her hands and feet
The hands are placed under or slightly wider than the shoulder
legs slightly apart with toes tucked under
The back should be kept in a straight line from head to toe throughout the test
The subject lowers down until elbows are bent at a 90-degree angle and pushes up again
Scoring on this task was calculated as the total number of push-ups at a set pace (1 push-up every 3 s) until a break was needed
iii) Trunk lift: The subject lies down on the floor facing down with toes pointed and hands under the thighs
A marker is placed on the floor in line with the subject’s eyes
the subjects lift his/her upper body up to 12 inches while keeping straight spine and eyes focused on the marker
Scoring on this task was calculated via the distance from the floor to the subject’s chin; the maximum score on this test is 12 inches
anything over this distance is recorded as 12 inches
iv) Pacer run: The subject runs back and forth across a 20-meter distance at a specified pace that gets faster and faster
Participant heart rate was also captured during the PACER exercise period using an Apple Watch
with our primary measure of interest being maximal heart rate achieved during the PACER run exercise
The number of laps before a break was needed was recorded
with one point scored for each 20-meter distance covered
we also collected a control measure in the form of a basic response time (BRT) task to help evidence that any improvements on the cognitive measures were specific to attention and working memory processes and not simply the result of a general increase in basic speed of processing
The goal of the comparisons of 1-year follow-up to both the post- and pre-training time points was to assess if those measures had changed 1-year later (post-training versus 1-year)
as well as at the 1-year mark from when performance was initially evaluated at baseline (pre-training versus 1-year)
To compare the present results versus the historical controls
we conducted repeated measures ANOVAs with a factor of session (pre
SPDIA) on the primary behavioral measures of interest (Vanderbilt inattention score and CPT RTV)
with follow-up independent sample t-tests for direct between group comparisons at each timepoint
Where a session by time window interaction was present
follow-up paired samples t-tests tests were conducted to identify which 50 ms time window (from 0 to 600 ms) showed a significant change between sessions
Statistical tests comparing post-training to 1-year follow-up for the EEG data were conducted using nonparametric Wilcoxon Signed Rank tests due to the small number of participants with available data (less than 10 in these cases)
All statistical analyses were conducted using SPSS 22.0 (SPSS Inc.)
with a p-value of 0.05 set as the threshold for significance
Further information on research design is available in the <a data-track="click" data-track-label="link" data-track-action="supplementary material anchor" href="/articles/s41746-023-00812-z#MOESM2">Nature Research Reporting Summary</a> linked to this article
The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request
The code used in the analysis of the behavioral and EEG data was designed in Matlab R2022b (The MathWorks Inc.) and are available from the corresponding author on reasonable request
A Correction to this paper has been published: <a href="https://doi.org/10.1038/s41746-023-00826-7">https://doi.org/10.1038/s41746-023-00826-7</a>
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<a data-track="click" data-track-action="download citation references" data-track-label="link" rel="nofollow" href="https://citation-needed.springer.com/v2/references/10.1038/s41746-023-00812-z?format=refman&amp;flavour=references">Download references</a>
We would like to thank all the participating children and parents from Neil Cummings Elementary School for helping us with this study
We would also like to thank our funding for this project: the UCSF RAP Academic Senate as well as our Neuroscape donors (Neuroscape Network)
who provided us the freedom to undertake and complete this project
Patty Elliott (principal at Neil Cummings Elementary School) for allowing us to work with her on this project
Vuolo (occupational therapist at Neil Cummings) for helping oversee our training efforts
Delilah Mittermaier for hands on pediBBT data collection
Thompson for help thinking through the most practical physical fitness outcome measures for this study
a company that produces therapeutic video games
No other authors report any competing interests
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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DOI: https://doi.org/10.1038/s41746-023-00812-z
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There has been a comprehensive development over the last few years of low intensity intervention programs that are implemented within a user context and that are made up of everyday life activities
and it has been necessary to adapt the necessary methodological channels in order to guarantee an adequate resolution pathway
The mixed method perspective offers a suitable framework
and observational methodology &#x2013; in itself considered mixed method &#x2013; is appropriate for studying the implementation and evaluation of low intensity intervention programs
allowing the development of the QUAL-QUAN-QUAL stages that correspond to the connect integration pathway of mixed methods
In this work it was applied to a single case
but systematizing it and applying quantitizing to the qualitative data that was treated quantitatively in a rigorous manner
The aim was to analyze the psychotherapist-patient interaction in psychoanalytic psychotherapy
in which we sought to identify which of the therapist&#x2019;s techniques stimulated actions of reciprocal social interaction in the child
and which techniques inhibited non reciprocal social interactions
The patient was a 4-year-old boy with a diagnosis of severe autism spectrum disorder
We used an ad hoc observation instrument combining a field format and a category system
Interobserver agreement was analyzed quantitatively by Cohen&#x2019;s kappa using the free QSEQ5 software program
Polar coordinate analysis was carried out using the free program HOISAN 2.0
Polar coordinate analysis allows us to obtain an inter-relational map of the connections detected between focal behavior established in each case and the different categories
The results provide objective evidence &#x2013; backed up by the application of polar-coordinate-based data analysis &#x2013; that within a framework of psychoanalytic psychotherapy
the techniques of &#x201C;verbalization&#x201D; and &#x201C;vocalization&#x201D; significantly activate reciprocal social interaction behaviors and inhibit non-social reciprocal behaviors in a child with severe autism spectrum disorder with no language
direct gaze promotes the child&#x2019;s withdrawal
The results are of key importance as they show the therapist behaviors most useful for promoting social interaction in a child with severe autism
It is an undoubtedly complex task to make decisions about the implementation and evaluation of intervention programs which, in any case, should be conditional on the applied methodology. The structural dimensions of the evaluation of a program are established in scientific literature (<a href="#B31">Chac&#x00F3;n et al., 2000</a>; <a href="#B33">Chac&#x00F3;n-Moscoso et al., 2002</a>, <a href="#B36">2013</a>, <a href="#B34">2014</a>, <a href="#B35">2021</a>)
and the existing correspondence between these dimensions and methodological quality in the chosen procedural option is extensively relevant
and shape a formative and summative evaluation in continual interaction
it has been established that the greatest shortcomings in the implementation of intervention programs are procedural
and that some of these have barely been addressed
This is mainly due to the complex nature of the reality
and the fact that individuals or collectives who experience the actions of an intervention program may be heterogeneous
the dynamic of the processes is not uniform
making it difficult to collate data in a way that fulfills the requirements demanded by rigor
It is a dyadic program based on the verbal and non-verbal communication between the child and the therapist
An adequate evaluation requires the flexibility and scientific rigor of systematic observation from the mixed method perspective
In <a href="#B35">Chac&#x00F3;n-Moscoso et al. (2021)</a> an adaptation was carried out of the structural dimensions of low intensity level designs when observational methodology is applied (<a href="#B7">Anguera, 2003</a>)
This is characterized as a scientific method that allows for the study of spontaneous behavior in habitual contexts
It should be highlighted that in the last two decades the mixed method perspective has been developed exponentially
generating an important cross-fertilization process in terms of procedure
We would like to point out one final aspect to be developed
relating to the fact that we are dealing with a case study
Here we attempt to transform something that has acquired negative connotations in the literature of the last few years into a worthwhile opportunity that makes a rigorous
intensive study of human behavior possible
that forces us to be vigilant whilst moving forward
The specification of quantitizing in observation methodology is founded on <a href="#B40">Creswell and Plano Clark</a>&#x2019;s, <a href="#B40">2011</a> contribution (3rd ed.
There are three ways in which mixing occurs: merging or converging the two datasets by actually bringing them together
or embedding one dataset within the other so that one type of data provides a supportive role for the other dataset
This mixing, in the CONNECT option, taken both literally and from a wider perspective (<a href="#B13">Anguera, 2022</a>)
is a strong basis for carrying out a reconsideration of quantitizing that fits very well within observational methodology
Once these decisions have been taken and the ad hoc observation instrument built
and will preferably be structured in the form of a code matrix
with columns containing the dimensions (or
the sub-dimensions of the most molecularized level); with each row of the matrix containing the codes corresponding to the co-occurrence of the different dimensions in each unit of behavior
This matrix is essential for the process of quantitizing the qualitative data
Once the data matrix has been obtained, its quality must be controlled via one of the concordance/agreement indexes (<a href="#B29">Blanco-Villase&#x00F1;or and Anguera, 2000</a>); and once this is done then the quantitative analysis of the systematized qualitative data is possible (and
thus allowing a complete integration between qualitative and quantitative elements
Taking this reconsideration into account, the innovative form of quantitizing in the implementation and evaluation of low intensity programs implies important methodological benefits (<a href="#B13">Anguera, 2022</a>)
The mixed method greatly vitalizes the collation
management and analysis of information obtained via observation
An important strengthening of range is achieved from observational methodology (both direct
due to it being considered in itself mixed method; hence
in the Introduction we refer to the process of cross-fertilization
The case study has traditionally been considered marginal and with little convening power; in addition to renowned authors such as <a href="#B48">Gerring (2004</a>
341) stating that &#x201C;the case study survives in a curious methodological limbo.&#x201D;
329) asks the following question: &#x201C;Case study is widely referred to and applied within social research
In our view (<a href="#B10">Anguera, 2018</a>), it is not a methodology, but it is possible to apply diverse methodologies to a single case. Aside from existing typologies (<a href="#B71">Stake, 1994</a>; <a href="#B75">Thomas, 2011</a>; <a href="#B83">Yin, 2014</a>), the logic of the single case is intra-case by nature (<a href="#B52">Hilliard, 1993</a>) and permits the consideration of a diachronic perspective
whilst at the same time emphasizing the richness of the context in the real world in which the phenomenon is produced
There is obviously an inherent weakness in the case study
relating to the non-replication of results
which is totally logical according to its own aim
Its focus of attention is found precisely in the opposing situation
focused on the results of one single case which is studied in depth
the strength of a methodology that is appropriate and adapted to the characteristics of the case study and the profile of the case itself compensates for this weakness
on this occasion we are interested in focusing on the technique used by the therapist
The suitable methodology is systematic observation
this being equipped with design that supports an intensive approach in the study of perceptible behaviors; carrying out continuous recordings throughout the observation sessions
and being able to manage behaviors arising from different dimensions/sub-dimensions
some specific to the therapist&#x2019;s role and others to the child&#x2019;s actions
we transform into a methodological opportunity that which has traditionally been the biggest weakness in case studies
involves taking advantage of the appearance of a third way
which places us in a privileged position of integrating qualitative and quantitative elements
a case study consisting of low intensity psychotherapeutic intervention focused on a child with a diagnosis of severe autism who interacts with the psychotherapist; and in which we aim to identify which actions on the part of the therapist stimulate social interaction from the child
Observational methodology was applied. The observational design is Nomothetic/Follow-up/Multidimensional (N/F/M) (<a href="#B19">Anguera et al., 2001</a>; <a href="#B69">S&#x00E1;nchez-Algarra and Anguera, 2013</a>): nomothetic because we studied the interaction between therapist and autistic child
with inter-session follow-up (three sessions) and intra-session follow-up (because each session was recorded continuously from start to finish); and multidimensional since the complexity of the aim required the application of various dimensions that were included in the observation instrument
The patient was a 4-year-old child with a diagnosis of autism spectrum disorder (ASD), according to the clinical criteria of DSM-5 (<a href="#B4">American Psychiatric Association, 2015</a>), of a severe type according to the results obtained from the ADOS (Autism Diagnostic Observation Schedule; <a href="#B59">Lord et al., 2000</a>)
although did emit sounds and some syllables forming echolalia
The therapist was a clinical psychologist with training and experience in psychoanalytic psychotherapy with children
In accordance with the principles of the Declaration of Helsinki and the Ethical Code of the General Council of the Official College of Psychologists of Spain
the child and the child&#x2019;s family were informed that they were being filmed
They were shown the location of the video cameras
which were positioned discretely to minimize reactivity bias
Written informed consent was also obtained from the parents of the minor
The sessions took place in Carrilet Treatment Center (Barcelona
attached to the educational and therapeutic center
All the sessions were filmed using a video camera installed in the therapy office of the Carrilet Treatment Center attached to the Educational and Therapeutic Center where the child was schooled
We used an ad hoc observation instrument, as a field format modality combined with category systems, adapted by Bachs and Arias-Pujol (<a href="#B28">Bachs, 2019</a>) from a previous study (<a href="#B27">Arias-Pujol et al., 2015b</a>) and recoded for this new study. The instrument has two dimensions for the child: reciprocal social interaction (RSI) and non-reciprocal social interaction (N_RSI) and 12 for the therapist (see <a href="#T1">Table 1</a>)
Observation instrument of ASD child and psychotherapist in psychoanalytic psychotherapy
With the aim of studying the therapist-patient relationship, the sessions were broken down into units, with the adoption of a primary dialogic criterion, and a secondary criterion that differentiated verbal, vocalized and non-verbal behavior in the transcript (<a href="#B11">Anguera, 2020</a>). <a href="#T4">Table 2</a> shows some fragments of the coded clinical material from sessions 9
The inter observer agreement was calculated via Cohen&#x2019;s kappa coefficient (&#x03BA;) (<a href="#B38">Cohen, 1960</a>). Data quality control was performed using the free program GSEQ. An agreement of 85.6% was obtained in the codification of the child&#x2019;s behavior and of 90.4% in that of the therapist, values considered &#x201C;almost perfect&#x201D; according to the criteria of <a href="#B57">Landis and Koch (1977)</a> and <a href="#B28">Bachs (2019)</a>
The aim is to apply the analytical technique of polar coordinate analysis
seeking a possible relationship of activation/inhibition between the behaviors of the therapist and the child that will be quantitatively calculated from the qualitative recordings carried out initially at three different points of the intervention
allows us to obtain the values that correspond to the length of the vector and its angle
The vector angle (that will correspond to one of the quadrants I
allows us to interpret the nature of the relationship that exists between the focal behavior and the respective conditioned behavior
while from the length of the vector we can interpret the intensity of said relationship depending on statistic significance
We have presented all these calculations systematized in our case study (see <a href="#T5">Table 3</a>)
in such a way that the conditioned behaviors appear for each focal behavior; and for each conditioned behavior information is presented
correspondent to the quadrant in which the vector is found: prospective and retrospective values of the Zsum
length of vector (that is crucial for knowing its significance
since if it is &#x003E; 1.96 it is significant
and if it is &#x003E; 2.58 it is very significant)
Table of parameters corresponding to the analysis of polar coordinates
with the focal behavior &#x201C;Verbalizes,&#x201D; &#x201C;Vocalizes,&#x201D; &#x201C;Verbal imitation,&#x201D; &#x201C;Nonverbal imitation,&#x201D; &#x201C;Stimulates,&#x201D; &#x201C;FEXT,&#x201D; and &#x201C;GA&#x201D; as the center of the analysis and all the others as conditional of sessions 9
Polar coordinate analysis was carried out using the free program HOISAN 2.0 (<a href="#B51">Hern&#x00E1;ndez-Mendo et al., 2012</a>), and additionally R (<a href="#B66">Rodr&#x00ED;guez-Medina et al., 2022</a>) in order to obtain a graphic optimization in the vector representation
In this case study, the focal behaviors were selected from the therapist&#x2019;s highest frequency categories or dimensions (see <a href="#T1">Table 1</a>)
The analysis was carried out with seven focal behaviors: &#x201C;Verbalization,&#x201D; &#x201C;Vocalization,&#x201D; &#x201C;Stimulation&#x201D; (combining all the categories of each dimension); &#x201C;Verbal imitation,&#x201D; &#x201C;Non-verbal imitation,&#x201D; &#x201C;Facial expression&#x201D; and &#x201C;Gaze.&#x201D; In terms of conditioned behaviors
the child&#x2019;s 28 categories were included from the observation instrument
excluding the codes SAP (sentence approximation) and VD (verbal demand) due to low frequency
the behaviors of the therapist and the child were recorded in the first 20 min of sessions 9
From the results obtained in the polar coordinate analysis
the conditioned behaviors (the child&#x2019;s actions) were selected
that were significantly activated or inhibited prospectively
They were grouped by dimensions of reciprocal social interaction (RSI) or non-reciprocal social interaction (N_RSI)
The dimension &#x201C;Reciprocal social interaction&#x201D; consists of the categories: Instrumentalized Demand (I)
The dimension &#x201C;Non-reciprocal social interaction&#x201D; consists of the categories: Motor Stereotypes (MS)
The following categories were excluded: NA
referring to normal actions in relation with the therapeutic framework without a sensory purpose
referring to actions with objects appropriate to the purpose for which they were created
For each of the therapist&#x2019;s focal behaviors the percentage of RSI and N_RSI behaviors that were activated and inhibited was calculated
The fact that one of the therapist&#x2019;s focal behaviors activated RSI behaviors and inhibited N_RSI behaviors was considered clinically favorable
The chi-squared test was used to determine whether the clinically favorable behaviors activated by the therapist were statistically significant
we describe the relationships detected between interventions by the therapist and the child&#x2019;s behaviors using polar coordinate analysis and a descriptive study of clinically favorable behaviors
Significant results were obtained in activation/inhibition relationships between all the therapist&#x2019;s and the child&#x2019;s behaviors
<a href="#T5">Table 3</a> show the level of significance of the focal behavior &#x201C;Verbalizes,&#x201D; &#x201C;Vocalizes,&#x201D; &#x201C;Verbal imitation,&#x201D; &#x201C;Non-verbal imitation,&#x201D; &#x201C;Stimulates,&#x201D; &#x201C;FEXT,&#x201D; &#x201C;GA&#x201D; as the main analysis of sessions 9
<a href="#F1">Figures 1&#x2013;</a><a href="#F4">4</a> shows the significant vectors for all the focal behaviors in each of the therapist&#x2019;s seven actions
Graphic representation of the significant (purple) and very significant (red) vectors obtained in the polar coordinate analysis
Focal behavior &#x201C;Verbalizes&#x201D; as the center of the analysis and all the others as conditional of sessions 9
Focal behavior &#x201C;Vocalizes&#x201D; as the center of the analysis and all the others as conditional of sessions 9
Focal behavior &#x201C;Verbal imitation&#x201D; as the center of the analysis and all the others as conditional of sessions 9
Focal behavior &#x201C;Non-verbal imitation&#x201D; as the center of the analysis and all the others as conditional of sessions 9
Focal behavior &#x201C;Stimulates&#x201D; as the center of the analysis and all the others as conditional of sessions 9
Focal behavior &#x201C;Facial expression&#x201D; as the center of the analysis and all the others as conditional of sessions 9
Focal behavior &#x201C;Gaze&#x201D; as the center of the analysis and all the others as conditional of sessions 9
<a href="#T9">Table 4</a> shows the type and percentage of behaviors that prospectively activated or inhibited each of the therapist&#x2019;s dimensions
Type and percentage of behaviors that prospectively activated or inhibited each of the therapist&#x2019;s dimensions
In the analysis of the child&#x2019;s clinically favorable behaviors
the therapist&#x2019;s verbalization was related with 78.9% of clinically favorable behaviors (&#x03C7;2 = 6.53; df = 1; p = 0.01) and vocalization with 76.5% (&#x03C7;2 = 5.87; df = 1; p = 0.02)
Of the therapist&#x2019;s imitation behaviors
verbal imitation was related with 53.3% (&#x03C7;2 = 0; df = 1; p = 1) and non-verbal also with 53.3% (&#x03C7;2 = 0.13; df = 1; p = 0.71)
stimulation with 54.5% (&#x03C7;2 = 0.10; df = 1; p = 0.74) and facial expression with 71.4% (&#x03C7;2 = 1.59; df = 1; p = 0.20)
while gaze produced 38.1% of clinically unfavorable behaviors (&#x03C7;2 = 0.5; df = 1; p = 0.47)
In this single case study, we have applied an approach that allows observational methodology and mixed methods as the main analysis (<a href="#B21">Anguera et al., 2017</a>)
we aimed to identify which of the therapist&#x2019;s techniques elucidated clinically favorable behaviors in a child with severe autism
specifically those that promoted RSI actions and inhibited non-RSI actions
verbalization and vocalization by the therapist produced significant clinically favorable behaviors
whereas direct gaze promoted the child&#x2019;s withdrawal
Results show that verbalization activates different behaviors of the RSI dimension related to producing a vocal demand (VOCD)
physical contact (BPC); and in joint attention and also protoconversation behaviors (WA
verbalization is shown to produce significant clinically favorable behaviors in the child
suggesting that this technique is appropriate for activating resources of the child&#x2019;s RSI dimension
It is of key relevance that verbalization prospectively activates the categories &#x201C;word&#x201D; (WO) and &#x201C;word approximation&#x201D; (WA)
Results suggest that verbalization promotes language and communication
which are also important in developing the symbolization process
&#x201C;Vocalization&#x201D; is the technique used when the therapist seeks interaction by using exclamations
laughing or encouraging the child to express himself/herself vocally
It has been suggested as especially useful for children with verbal communication difficulties
Results show that use of the &#x201C;Vocalization&#x201D; (consisting of EE
PF) activates behaviors of vocal and non-vocal demand (I
eye contact (EC) and word approximation (WA)
It also inhibits the attentive gaze at the object (AGO)
the verbal stereotype (VS) and solitary play (SP)
&#x201C;Vocalization&#x201D; is an appropriate technique for activating interaction
The present results show that verbal imitation
activates the actions of instrumentalization (I)
word approximation (WA) and lack of response to the demand (NAF)
approximation (APRO) and brief physical contact (BPC)
It also inhibits sensory action (SA) and solitary play (SP)
activates actions of no response to the demand (NAF)
eye contact (EC) and distancing behavior (DPB)
There were some moments when the child appeared to enjoy a kind of dance with music with the therapist
while the child was moving drawing or repeating sounds (ti-ti-ti-ti) he/she gazed with curiosity at how the therapist repeated it
non-verbal imitation prospectively inhibited erratic behavior (EB)
an attentive gaze at the object (AGO) and the action of solitary play (SP)
the behaviors were not statistically significant in the analysis of clinically favorable responses in the child
We believe that these results differ from those of the previous study because on that occasion the use of verbal and non-verbal imitation by the therapist was applied systematically and not depending on the child&#x2019;s spontaneous behavior
SPRO) is used when the child is disconnected from the relationship and the therapist tries to seek his/her attention by giving or showing an object
directing the child&#x2019;s attention toward something or toward him/herself
Results show that &#x201C;stimulation&#x201D; activates instrumentalized and vocal demand (I
distancing proxemic behavior (DPB) and the child&#x2019;s non-verbal imitation (NVI)
the blank stare (BS) and solitary play (SP)
stimulation did not produce statistically significant clinically favorable behaviors
These results suggest that stimulating the child when he/she is very disconnected from the relationship can be more intrusive than verbalizations or vocalizations
and does not always promote reciprocal social interaction
Dramatization of an emotion consisting of FEXT means making faces or moving the arms and torso, expressing oneself through the body (<a href="#B79">Viloca, 2003</a>; <a href="#B44">Farr&#x00E9;s, 2014</a>)
Results show that it activates behaviors of the RSI dimension
in sessions 9 and 16 it activates the instrumentalized and vocal demand (I
approximation and distance proxemic behavior (APRO
the use of words (WO) and the child&#x2019;s non-verbal imitation (NVI); and prospectively inhibits
sensory action (SA) and the attentive gaze at the object (AGO)
the results did not achieve significance as clinically favorable behaviors
This study shows how observational methodology
can be useful for the evaluation of a low intensity intervention program
The greatest advantage is that the mixed method perspective allows us to capture the reality just as it happens
guarantee its quality and treat it quantitatively in a rigorous way
our results provide objective evidence &#x2013; backed up by the application of polar-coordinate-based data analysis &#x2013; that within a framework of psychoanalytic psychotherapy of a child with severe ASD and no language
the therapeutic techniques of &#x201C;verbalization&#x201D; and &#x201C;vocalization&#x201D; significantly activate reciprocal social interaction behaviors and inhibit non-social reciprocal behaviors
Written informed consent was obtained from the individual(s)
and minor(s)&#x2019; legal guardian/next of kin
for the publication of any potentially identifiable images or data included in this article
EA-P and MTA contributed to conception and design of the study
MTA conducted the method section and polar coordinate analysis
and JM performed the interpretation of the data
NB adapted and validated the observational instrument
All authors contributed to manuscript revision
MTA gratefully acknowledges the support of a Spanish government subproject Integration ways between qualitative and quantitative data
Innovaci&#x00F3;n y Universidades/AgenciaEstatal de Investigaci&#x00F3;n/Fondo Europeo de Desarrollo Regional)
that is part of the coordinated project New approach of research in physical activity and sport from mixed methods perspective (NARPAS_MM) (SPGC201800 &#x00D7; 098742CV0)
MTA thanks for the support of the Generalitat de Catalunya Research Group
GRUP DE RECERCA I INNOVACI&#x00D3; EN DISSENYS (GRID)
Tecnolog&#x00ED;a i aplicaci&#x00F3; multimedia i digital als dissenys observacionals (Grant number: 2017 SGR 1405)
We thank our colleagues in Carrilet for their help and suggestions
We also thank the child and his/her family
without whom this study would not have been possible
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Introduction: Cognitive impairment is a debilitating symptom in people with multiple sclerosis (MS). Most of the neuropsychological tasks have little resemblance to everyday life. There is a need for ecologically valid tools for assessing cognition in real-life functional contexts in MS. One potential solution would involve the use of virtual reality (VR) to exert finer control over the task presentation environment; however, VR studies in the MS population are scarce.
Objectives: To explore the utility and feasibility of a VR program for cognitive assessment in MS.
Methods: A VR classroom embedded with a continuous performance task (CPT) was assessed in 10 non-MS adults and 10 people with MS with low cognitive functioning. Participants performed the CPT with distractors (i.e., WD) and without distractors (i.e., ND). The Symbol Digit Modalities Test (SDMT), California Verbal Learning Test—II (CVLT-II), and a feedback survey on the VR program was administered.
Results: People with MS exhibited greater reaction time variability (RTV) compared to non-MS participants, and greater RTV in both WD and ND conditions was associated with lower SDMT.
Conclusions: VR tools warrant further research to determine their value as an ecologically valid platform for assessing cognition and everyday functioning in people with MS.
Volume 17 - 2023 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fnhum.2023.1139316">https://doi.org/10.3389/fnhum.2023.1139316</a>
Introduction: Cognitive impairment is a debilitating symptom in people with multiple sclerosis (MS)
Most of the neuropsychological tasks have little resemblance to everyday life
There is a need for ecologically valid tools for assessing cognition in real-life functional contexts in MS
One potential solution would involve the use of virtual reality (VR) to exert finer control over the task presentation environment; however
VR studies in the MS population are scarce
Objectives: To explore the utility and feasibility of a VR program for cognitive assessment in MS
Methods: A VR classroom embedded with a continuous performance task (CPT) was assessed in 10 non-MS adults and 10 people with MS with low cognitive functioning
Participants performed the CPT with distractors (i.e.
California Verbal Learning Test&#x02014;II (CVLT-II)
and a feedback survey on the VR program was administered
Results: People with MS exhibited greater reaction time variability (RTV) compared to non-MS participants
and greater RTV in both WD and ND conditions was associated with lower SDMT
Conclusions: VR tools warrant further research to determine their value as an ecologically valid platform for assessing cognition and everyday functioning in people with MS
We hypothesized that participants with MS would show lower performance on the VRAT compared to those without MS
we hypothesized that performance on the VRAT program would show associations with performance on standard cognitive measures [i.e.
SDMT and California Verbal Learning Test&#x02014;II (CVLT-II)]
an SDMT z-score cut-off of &#x02212;1.0 was chosen to allow for a broader range of cognitive functioning in the recruited MS participants in this pilot study
referred to as &#x0201C;low cognitive functioning&#x0201D;
and motor impairment that would reduce the ability to operate the VR program (i.e.
or to push the trigger on the VR controller)
and education level-matched adults with no chronic autoimmune diseases were also recruited
All study procedures were approved and in accordance with the ethical standards of the Committee for Human Research at the University of California
Written informed consent was obtained from all participants
The 1.5-h study visit began with standard measures (SDMT and CVLT-II)
followed by the VR cognitive assessment (VRAT (vide infra)) and the feedback survey
Participants performed the VRAT testing under two conditions: with distractors (WD) and with no distractors (ND)
The order of the two conditions was counterbalanced across participants
The study session did not include a pre-determined break
but participants were informed at the beginning of the visit that they could take a break at any time if needed
SDMT is a widely used measure of information processing speed and selective attention in MS (<a style="color:red;" href="#B5">Benedict et al., 2017</a>) which requires the participant to substitute geometric symbols for numbers while scanning a response key
The written version of SDMT was administered
Correct responses that were made within 90 s were counted as the SDMT score
The CVLT-II is a reliable and valid measure of verbal learning and memory in MS (<a style="color:red;" href="#B13">Gromisch et al., 2013</a>). The total correct recall score (sum of the five trials) was used as the immediate free recall outcome measure, as it is reported to be one of the most sensitive CVLT-II measures in MS (<a style="color:red;" href="#B31">Stegen et al., 2010</a>)
The VRAT program (VRAT, Version 1.9, Cognitive Leap Inc.) provides a simulation of a standard classroom scenario (<a style="color:red;" href="#B30">Rizzo et al., 2006</a>) embedded with CPT task (<a style="color:red;" href="#F1">Figure 1</a>)
The environment consists of the interior of a standard classroom with several student avatars
and windows looking out onto the street on the left-side wall
The VR environment was presented in an HTC Vive system head-mounted display (1,440 &#x000D7; 1,600 pixels per eye resolution
110&#x000B0; field of view) connected to a desktop computer: Intel Core i7-4820K
All the participants were na&#x000EF;ve users of VR technology
the participants did not have any problems when adjusting to or using the HTC Vive headset
and no testing session had to be interrupted or halted due to simulator sickness
Screenshot of Virtual Reality Attention Tracker (VRAT) program
The 52 targets &#x0201C;AX&#x0201D; were equally distributed in the 13-min task
with 26 targets in the first half of the test and 26 targets in the second half of the task
A total of 30 distracters were included in the 13-min task
Three questions were included in the survey: &#x0201C;Did you enjoy the experience with the VRAT system?&#x0201D; (all participants)
&#x0201C;Do you think the system will be helpful for assessment of your cognition?&#x0201D; (participants with MS)
and &#x0201C;Do you think you would be able to tolerate a VR session for an hour?&#x0201D; (participants with MS)
There were five response options for the first two questions: not at all
Response options to the last question were &#x0201C;yes&#x0201D; or &#x0201C;no&#x0201D;
To compare these variables between participants with and without MS
The effect size was calculated using eta square for all of the analyses
All the measured data are presented as mean &#x000B1; standard error of the mean (SEM)
The association between standard neuropsychological measures and VRAT performance was examined using Pearson&#x02019;s correlation
The statistical analyses were performed using IBM SPSS Statistics version 22.0 (IBMs Corp)
The threshold of statistical significance was set at p &#x02264; 0.05
Baseline demographic and clinical characteristics of participants enrolled in the study
The participants with and without MS did not differ in terms of age (t13.3 = &#x02212;1.99, p = 0.07, &#x003B7;2 = 0.17) or years of education (t18 = 0.54, p = 0.59, &#x003B7;2 = 0.01; <a style="color:red;" href="#T2">Table 2</a>)
participants with MS had lower SDMT score (t18 = 5.07
&#x003B7;2 = 0.58) and CVLT-II total correct number (t18 = 3.41
&#x003B7;2 = 0.39) compared to those without MS
Participants with MS showed a significantly higher RTV than participants without MS, in both the &#x0201C;With Distractor&#x0201D; (WD; 122.60 &#x000B1; 20.67 ms vs. 66.87 &#x000B1; 11.91 ms, t18 = &#x02212;2.33, p = 0.03, &#x003B7;2 = 0.23) and &#x0201C;No Distractor&#x0201D; (ND, 121.24 &#x000B1; 13.43 ms vs. 71.05 &#x000B1; 12.22 ms, t18 = &#x02212;2.76, p = 0.01, &#x003B7;2 = 0.29) conditions (<a style="color:red;" href="#F2">Figure 2</a>)
In order to examine whether the difference in RTV between the two groups is more pronounced in one of the conditions (i.e.
2-way repeated measures ANOVA with group (MS
non-MS) as between-subject factor and condition (WD
ND) as within-subject factor was performed
The results showed no significant group &#x000D7; condition interaction (F(1,18) = 0.13
suggesting that the levels of difference in RTV between the two groups are the same across the two conditions (i.e.
Group differences between people with MS and non-MS participants in RTV
No significant differences between the two groups in terms of CR (WD: 0.97 &#x000B1; 0.01 vs
&#x003B7;2 = 0.01; ND: 0.93 &#x000B1; 0.02 vs
&#x003B7;2 = 0.01; ND: 3.2 &#x000B1; 1.1 vs
&#x003B7;2 = 0.01; ND: 1.4 &#x000B1; 0.4 vs
it is possible that task performance may decline over time due to fatigue
To examine whether VRAT task performance changed over the 13-min task
the CPT task performance data from the first and the second half of the task were submitted to 2-way repeated measures ANOVA with group (MS
non-MS) as between-subject factor and block (first
The results showed no significant group &#x000D7; block interaction for CR (WD: F(1,18) = 2.14
&#x003B7;2 = 0.01) and RTV (WD: F(1,18) = 0.15
Given that participants with MS had a significantly higher RTV than non-MS participants
post-hoc analyses were performed to confirm that the group differences can be observed in both the first and second half of the task
the group differences in RTV were shown in both the first half (WD: t13.2 = 2.54
&#x003B7;2 = 0.16) and the second half (WD: t18 = 2.59
These results suggest that group differences in task performance were stable over the 13-min task and could be observed during the first half of the task alone
but this did not persist when restricting the analysis to participants with MS and adjusting for disease duration and cognitive fatigue as covariates
These results indicate that VRAT performance is associated with standard MS cognitive measures (i.e.
(A) Association between SDMT score and RTV in WD (left panel) and ND (right panel) conditions
(B) Association between CVLT-II total recall score and RTV in WD condition
The feasibility and tolerability of the VRAT program was assessed by a feedback survey administered at the end of the study visit
Sixty-five percent of participants (13 out of 20
including eight MS) reported that they enjoyed the experience with the VRAT system &#x0201C;much&#x0201D; (n = 8) or &#x0201C;very much&#x0201D; (n = 5)
Seventy percent (7 out of 10) of the participants with MS agreed &#x0201C;much&#x0201D; (n = 3) or &#x0201C;very much&#x0201D; (n = 4) that the VRAT program could be helpful for assessing their cognition
Informing future development of the VR program as a cognitive assessment for people with MS
eighty percent (8 out of 10) of people with MS reported they felt they would be able to tolerate the VR session for an hour
These findings suggest acceptance by people with MS of the VR program as a tool for assessing cognition
was explored for its feasibility and utility as a tool to assess cognition in people with MS
The findings suggest that VRAT can reveal group-level differences between people with and without MS
as demonstrated by a higher RTV in people with MS compared to non-MS participants
Participants with better performance on standard cognitive measures performed better on the VRAT assessment
the participant feedback survey suggests that VRAT is feasible and tolerable as a VR-based cognitive assessment in people with MS
Demyelination and neurodegeneration in these brain regions may also increase variability in cognitive performance and cause cognitive fatigue
Few studies have examined the correlation between the VR-based cognitive assessment and standard neuropsychological examination in MS (<a style="color:red;" href="#B28">Realdon et al., 2019</a>)
The current findings showed that participants with lower RTV in VRAT showed higher scores in SDMT and CVLT-II
since the SDMT z-score was used as an inclusion criterion for participants with MS
the association between SDMT and VRAT may have been underestimated
Future work is needed with larger samples to understand the association between VRAT performance and standard cognitive measures
the VRAT feedback survey results suggested high patient enthusiasm for VR-based cognitive assessment
Eighty percent and 70% of enrolled people with MS reported that they enjoyed VRAT and found it helpful for cognitive assessment
These results provide the preliminary support the notion that VR-based cognitive assessments could represent a meaningful and helpful tool for detecting cognitive changes in people with MS
There are some limitations to the present study
the overall low sample size makes it difficult to draw a definitive conclusion with respect to the VR testing validity in people with MS
the results must be interpreted with caution
with an inter-stimulus interval of 1,500 ms and 10% of targets
the VRAT is probably not as challenging as tasks in daily living (e.g.
medication management and bill payment tasks) that people with MS would face
Future development of VR-based cognitive assessment for people with MS should focus on designing tasks that are more relevant to everyday life functioning and making the task look like what it is supposed to measure
the present study provides preliminary evidence suggesting that the VRAT
allowing for the recording and standard measurements of task performance
may be sensitive for detecting cognitive impairment and evaluating relevant everyday functioning in people with MS
Further studies with a larger cohort of people with MS are warranted to replicate current findings and to determine an ideal duration for the testing session to make it more feasible
It is also important to design tasks that are presentative of what people with MS experience in their daily living and includes real-life task characteristics (i.e.
shopping) to enhance the ecological validity of the VR platform in cognitive assessment for MS
Success in this area could lead to future test development that could serve to enhance the ecological validity of the VR platform to better meet the needs for more reliable
and relevant in cognitive assessment of people having MS
The studies involving human participants were reviewed and approved by The Committee for Human Research at the University of California
The patients/participants provided their written informed consent to participate in this study
We would like to thank our research participants
We would also like to thank Cognitive Leap
Inc for the support in providing the Virtual Reality Attention Tracker (VRAT) system for the study use
All authors contributed to the article and approved the submitted version
W-YH is supported by National Multiple Sclerosis Society (FG-1908-34831)
RB is the recipient of a National Multiple Sclerosis Society Harry Weaver Award
AR is a Chief Science Officer for Cognitive Leap
NC is on an Advisory Board for Akili Interactive and is a member of the Editorial Boards of Multiple Sclerosis Journal and Frontiers in NeuroTrauma
JD is an Associate Editor of the Archives of Physical Medicine and Rehabilitation; received compensation for consulting services and/or speaking activities from Biogen Idec
and Novartis; and receives research support from Biogen Idec
The National MS Society of Canada and the National Institutes of Health
She has received research support from the National Multiple Sclerosis Society
She has also received research support from Biogen
She has received personal compensation for consulting from Alexion
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Gazzaley A and Bove RM (2023) A virtual reality program to assess cognitive function in multiple sclerosis: A pilot study
Received: 06 January 2023; Accepted: 17 February 2023; Published: 16 March 2023
Copyright &#x000A9; 2023 Hsu, Anguera, Rizzo, Campusano, Chiaravalloti, DeLuca, Gazzaley and Bove. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
*Correspondence: Riley M. Bove, <a id="encmail">cmlsZXkuYm92ZUB1Y3NmLmVkdQ==</a>
Studies examining sustained attention abilities typically utilize metrics that quantify performance on vigilance tasks, such as response time and response time variability. However, approaches that assess the duration that an individual can maintain their attention over time are lacking.
Here we developed an objective attention span metric that quantified the maximum amount of time that a participant continuously maintained an optimal “in the zone” sustained attention state while performing a continuous performance task.
In a population of 262 individuals aged 7–85, we showed that attention span was longer in young adults than in children and older adults. Furthermore, declines in attention span over time during task engagement were related to clinical symptoms of inattention in children.
These results suggest that quantifying attention span is a unique and meaningful method of assessing sustained attention across the lifespan and in populations with inattention symptoms.
Volume 2 - 2023 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fcogn.2023.1207428">https://doi.org/10.3389/fcogn.2023.1207428</a>
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Introduction: Studies examining sustained attention abilities typically utilize metrics that quantify performance on vigilance tasks
such as response time and response time variability
approaches that assess the duration that an individual can maintain their attention over time are lacking
Methods: Here we developed an objective attention span metric that quantified the maximum amount of time that a participant continuously maintained an optimal &#x0201C;in the zone&#x0201D; sustained attention state while performing a continuous performance task
Results: In a population of 262 individuals aged 7&#x02013;85
we showed that attention span was longer in young adults than in children and older adults
declines in attention span over time during task engagement were related to clinical symptoms of inattention in children
Discussion: These results suggest that quantifying attention span is a unique and meaningful method of assessing sustained attention across the lifespan and in populations with inattention symptoms
Objective metrics that quantify different aspects of SA may provide useful information for how individuals engage in daily activities (e.g.
and workplace policy) with cognitive limitations in mind
receiving feedback about when SA wanes can help signal when a break may be beneficial
these types of analyses still do not quantify the amount of time that an individual is able to maintain a stable optimal attentional state
objective metric of attention span (A-span)&#x02014;the length of time that an individual can maintain an optimal attentional state
We also quantified vigilance decrements in A-span to examine changes in A-span over the course of the CPT (&#x0201C;A-span decrements&#x0201D;)
we assess whether A-span can serve as a unique and meaningful approach to evaluate SA abilities in separate age groups across the lifespan and in populations with attention impairments
All participants and their parents and/or legal guardians (for all children under the age of 16) gave informed consent to participate in the study according to procedures approved by the Committee for Human Research at the University of California San Francisco
The methods employed in this study were performed in accordance with the relevant guidelines specified in the Declaration of Helsinki
Participants were instructed to respond to target stimuli (squares at the top half of the screen) with the spacebar and to withhold responses to non-target stimuli (squares at the bottom half of the screen)
Each stimulus remained on the screen for 100 milliseconds
with a 1,400 millisecond inter-trial-interval
The CPT consisted of two conditions: The first condition had infrequent target stimuli (a 1:4 target to non-target ratio)
while the second condition had frequent target stimuli (a 4:1 target to non-target ratio)
we only analyzed the condition with frequent targets to maximize the number of trials with correct (target) RT values
which are required for a precise A-span measurement
participants completed 2 blocks that each contained 125 total trials (100 targets and 25 non-targets) per block
The blocks were separated by a brief break in the task
The break was included to maintain consistency with the TOVA
there were a total of 200 targets and 50 non-targets and took 6 min and 15 seconds to complete
with 80% targets and 20% randomly occurring non-targets
(B) Z-scored RTs from an example participant
Each RT was z-scored and plotted over time
RTs that are faster than 1 z-score above the mean are plotted in dark gray and are labeled as &#x0201C;in the zone&#x0201D; trials
RTs slower than 1 z-score above the mean are plotted in light gray and are labeled as &#x0201C;out of the zone&#x0201D; trials
Trials in which there was an error were plotted in red and were labeled as &#x0201C;error trials&#x0201D;
The dashed vertical line represents the break between the first and second CPT blocks
The dotted box highlights the longest period during the CPT when this participant was able to maintain an &#x0201C;in the zone&#x0201D; state (i.e.
We computed traditional SA metrics, average RT and RTV (the standard deviation of RTs), for all correct responses to target stimuli across the entire CPT. RTs that were faster than 150 msec were excluded from the traditional metric computations, as this is often considered too fast for accurate perceptual discrimination and thus likely reflects a more error-prone state (<a href="#B26">Leark et al., 2007</a>)
We also computed RT and RTV in each of the 2 blocks separately to examine vigilance decrements (defined as the percent change in RT and RTV from the first to the second block)
We computed the novel A-span metric using custom MATLAB code that built upon an approach commonly used in the literature to quantify moment-to-moment fluctuations of attention (<a href="#B13">Esterman et al., 2013</a>, <a href="#B14">2014</a>; <a href="#B24">Kucyi et al., 2017</a>). This approach characterizes when a participant is &#x0201C;in the zone&#x0201D; or &#x0201C;out of the zone&#x0201D; (defined below) using trial wise accuracy and RT (<a href="#F1">Figure 1B</a>)
we extended this approach to characterize an individual&#x00027;s A-span by computing the maximum amount of time that a participant was able to maintain an &#x0201C;in the zone&#x0201D; state without deviating to an &#x0201C;out of the zone&#x0201D; state
We then examined whether this new metric was distinct from traditional SA metrics (e.g.
we asked how these A-span metrics differed across age groups and how they were related to symptoms of inattention in children
Of the 8 children in this study who were taking ADHD medication at the time of data collection
we did not control for medication status during this analysis
All statistical analyses were conducted in IBM&#x00027;s SPSS Statistics 20 software
we examined A-span metrics within each age group independently
We assessed whether there were significant A-span decrements across the CPT (i.e.
if the percent change scores significantly differed from 0) using Wilcoxon signed rank tests
We chose to use this non-parametric approach to reduce the influence from potential extreme values
Since the Wilcoxon signed rank test compares our sample median against a hypothetical median
we highlighted the median percent change scores when reporting A-span decrements in each age group
We then evaluated relationships between traditional and A-span metrics by conducting Spearman correlations between these metrics in young adults only. We chose to use Spearman correlations to reduce the influence that potential extreme values had on the correlations (<a href="#B1">Akoglu, 2018</a>)
Bayesian non-parametric correlations were conducted to test the independence between A-span and traditional metrics
To examine age group differences on A-span and traditional metrics, we conducted one-way ANOVAs on each metric with a between-subjects factor of age group (children, young adults, and older adults). We followed these analyses with an interrogation of pairwise differences between age groups with independent samples t-tests (see <a href="#SM1">Supplementary material</a>)
For each set of analyses where we ran multiple statistical tests (e.g.
correlations between inattentive symptoms and both A-span metrics)
we corrected p-values using an FDR correction for multiple comparisons and used a two-tailed significance threshold of p &#x0003C; 0.05
We began by calculating and characterizing the new A-span metrics in each age group separately (<a href="#T1">Table 1</a>)
We found that children had an A-span of 29.61 seconds
which declined significantly (&#x02212;27.41%) over the course of the CPT (Z = 687.00
Young adults had an A-span of 76.24 seconds
which did not decline significantly (&#x02212;2.54%) over the course of the CPT (Z = 2,193.00
the older adults had an A-span of 67.01 seconds
which also did not decline significantly (&#x02212;8.40%) over the course of the CPT (Z = 2,672.00
Although the median A-span percent change was negative in each of the age groups
there were several participants who experienced very large increases in A-span (&#x0003E;100%) throughout the CPT
Most of these participants were young adults (n = 15 out of 88)
while fewer were older adults (n = 7 out of 106)
and the fewest were children (n = 2 out of 68)
Descriptive statistics of A-span and A-span percent change for each age group
these findings suggest that A-span and A-span decrement metrics may be distinct from traditional metrics and their vigilance decrements
(A) A-span was unrelated to RT and (B) RTV
and that A-span percent change was unrelated to (C) RT percent change and (D) RTV percent change
We then examined changes in A-Span across the three age groups to assess whether A-span metrics follow similar patterns of SA change across the lifespan as reported elsewhere (<a href="#B29">McAvinue et al., 2012</a>; <a href="#B38">Staub et al., 2013</a>; <a href="#B16">Fortenbaugh et al., 2015</a>)
We specifically examined age group effects for all CPT metrics
as well as for vigilance decrements in each metric from the first to second block of the task
First, we examined whether there were age group differences in A-span. A one-way ANOVA revealed a significant age group effect for A-span [<a href="#F3">Figure 3A</a>; F(2,259) = 66.32, p &#x0003C; 0.001, &#x003B7;2 = 0.34], such that young adults had longer A-spans than children and older adults. See <a href="#T2">Table 2</a> for details on pairwise comparisons between age groups
The age group effect on A-span was nearly identical when excluding children who were taking ADHD medication at the time of data collection [F(2,251) = 66.23
the age group effect on A-span was similar when using an ANCOVA that used a type III sum of squares to control for differences in sample size between age groups while also setting the study in which the data were originally collected as a covariate [F(2,262) = 33.96
(A) Age effects on A-span were driven by children and older adults having shorter A-spans than young adults
(B) Age effects on A-span percent change were driven by children having greater A-span decrements (i.e.
a more negative A-span percent change) than young adults
Box and whisker plots represent the bounds of each quartile
Blue significance bars indicate significant interactions revealed from the ANOVAs and black significance bars indicate significant t-test results
Pairwise comparisons of A-span measures comparing young adults to children and older adults separately
The similarities between the way that A-span and traditional metrics differ across age groups suggest that they may reflect distinct attentional processes that similarly fluctuate during development and aging
We then examined whether A-span decrements followed this pattern of age group differences. A one-way ANOVA revealed a significant age group effect for A-span decrements, as indexed by A-span percent change [<a href="#F3">Figure 3B</a>; F(2,259) = 4.91, p = 0.008, &#x003B7;2 = 0.04]. Young adults experienced smaller A-span decrements than children but had similar A-span decrements as older adults. See <a href="#T2">Table 2</a> for details on pairwise comparisons between age groups
The age group effect on A-span percent change was similar when excluding children who were taking ADHD medication at the time of data collection [F(2,251) = 6.27
the age group effect on A-span percent change was similar when using an ANCOVA that used a type III sum of squares to control for differences in sample size between age groups while also setting the study in which the data were originally collected as a covariate [F(2,262) = 3.79
Like the metrics computed across the entire task
the similarities between the way that decrements in A-span and traditional metrics differ across age groups suggest that they may reflect distinct attentional processes that similarly fluctuate during development and aging
We then assessed the potential clinical utility of A-span measurements by examining whether A-span metrics were related to real-world symptoms of inattention in children. We subsequently followed these analyses by testing for similar relationships between traditional metrics and inattention symptoms, to determine if the children included here exhibit similar SA deficits as reported elsewhere (<a href="#B22">Huang-Pollock et al., 2006</a>, <a href="#B21">2012</a>)
Relationships between A-span measures and inattention in children
(A) There was no significant relationship between the VADRS-IA score and A-span
(B) There was a significant relationship between the VADRS-IA score and the A-span % change
we sought to determine if the relationship between A-span percent change and inattention symptoms was significantly stronger than the relationships between traditional metrics and inattention symptoms
We found that the correlation between A-span percent change and inattention symptoms was significantly stronger than that for each of the traditional metrics and inattention symptoms (RT: z = &#x02212;2.77
p = 0.035; RTV % change: z = &#x02212;2.43
we report a method of quantifying attention span by calculating the maximum amount of time that a participant was able to maintain an &#x0201C;in the zone&#x0201D; high performance state while performing a CPT
Our approach revealed that children had an A-span of 29.61 seconds
young adults had an A-span of 76.24 seconds
and older adults had an A-span of 67.01 seconds
A-span decrements were most pronounced in children
who experienced an A-span decline of &#x02212;27.41% over the course of the CPT
while young and older adults experienced non-significant A-span decrements (&#x02212;2.54 and &#x02212;8.40%
A-span decrements were also sensitive to detecting inattention symptoms in children
The results we report here suggest that our approach of quantifying A-span is a unique and meaningful method of assessing SA abilities in separate age groups across the lifespan and in clinical populations
Although A-span performance followed previously seen patterns of change across the lifespan as the traditional metrics
A-span metrics were uncorrelated with traditional metrics in young adults
Bayesian analysis also provided evidence that A-span was independent from traditional metrics
suggesting that they may reflect distinct attentional processes
These findings are likely the result of two possible scenarios
A-span and traditional metrics may reflect different aspects of a common
set of SA processes that change with development and aging
unrelated cognitive processes that both happen to increase during development and decline during aging
Future work is warranted to address this question by identifying the neural activity profiles that facilitate A-span maintenance
as this type of interrogation would identify the similarities and differences between the neural correlates of A-span and traditional SA metrics
thereby enhancing our understanding of these cognitive processes
our results suggest that A-span might be more sensitive to detecting age-related vigilance decrements than RTV
Although we saw effects of age on A-span decrements, only children displayed significant A-span decrements over the course of the CPT (see <a href="#T1">Table 1</a>)
This finding highlights how children are poorer at maintaining stable attention over time relative to adults
and is even more intriguing when considering that A-span decrements in this age group are associated with symptoms of inattention
these results suggest that A-span stability is sensitive to development
and impairments in an individual&#x00027;s ability to maintain a stable A-span over time could be an important marker of attention impairments
While this work has illuminated how performance in traditional metrics change over the course of a task
it has not helped researchers understand how the amount of time that an individual is able to maintain a stable optimal attentional state is relevant
Our new A-span metric achieves this while also providing an approach to quantify an ability that is seemingly intuitively understood amongst the general public
When considering A-span as a measure of interest, researchers should consider the type of tasks that are aligned with its use. In general, CPTs, such as the SART, TOVA, and gradCPT (<a href="#B26">Leark et al., 2007</a>; <a href="#B8">Carriere et al., 2010</a>; <a href="#B13">Esterman et al., 2013</a>, <a href="#B14">2014</a>)
which have been used to assess metrics of SA
are likely to yield meaningful A-span measurements
These types of paradigms that sample a participant&#x00027;s focus frequently (i.e.
ones that require frequent responses) are more likely to capture brief fluctuations in attention
and thus will yield more precise A-span metrics
Further research is necessary for determining which SA tasks are best suited for measuring A-span
Investigators should use caution when calculating A-span from more complex cognitive tasks (e.g.
Longer RTs and errors in these types of tasks may not reflect attentional lapses
but instead may stem from other difficulties in cognitive processing
such as reaching working memory capacity limits or when there is uncertainty during complex decision making
measuring A-span during a more challenging task might not purely reflect how long an individual can stay in an optimal SA state
the task duration is an important factor to take into consideration when computing A-span
The CPT employed in this study was relatively short
A longer CPT may yield A-span measurements that reflect SA abilities differently
Utilizing CPTs that require less frequent responses may also provide meaningful
since these types of CPTs have fewer trials
they will likely need to be longer than the task used in this study to obtain a precise A-span
Understanding how different task parameters contribute to A-span measurements is an important extension of this research
future research should seek to identify whether longer tasks capture more meaningful A-span fluctuations than the A-span % change reported in this study
Establishing the minimum task length that can be used for calculating A-span is also an important avenue of future work
identifying the effects that taking a short break between blocks has on A-span decrements may illuminate how vigilance decrements may be mitigated or exacerbated
It could also explain the disproportional distribution of these individuals across age groups that we observed here
future work examining individual differences in A-span dynamics over longer timescales is warranted to better understanding the utility of this metric in different scenarios
doing so could facilitate the use of A-span in real-world settings
Closed-loop systems can interpret shortening A-spans as an indication of a need to take a rest
or lengthening A-spans as a sign that an individual has yet to reach their maximum A-span
Although we found evidence that A-span is unique from traditional measures
there are likely some individuals whose A-spans are affected by their RTV
an individual with frequent attentional lapses (i.e.
slower responses) will likely have a shorter A-span than an individual with infrequent
even though they may have similar RTV values
Understanding how the temporal distribution of variable responses impacts A-span measurements is a topic that future studies should examine more thoroughly
the result that A-span is independent from traditional metrics should be interpreted with caution and replicated before concluding that A-span is truly measuring a unique aspect of SA that is not captured by traditional metrics
although we analyzed data from participants from a wide age range
we did not have any participants between the ages of 14&#x02013;18 and 33&#x02013;55
it remains unknown how A-span and A-span decrements change during adolescence and middle adulthood
the present study did not examine the relative contribution of state (i.e.
Future studies should seek to disentangle state vs
we demonstrated that A-span is a unique and meaningful index of SA abilities that differs between age groups across the lifespan
and that A-span decrements are related to clinical inattention symptoms in children
Our work suggests that A-span is a promising new approach for characterizing SA performance at the behavioral level
and should be further utilized when examining the effects of development and aging on SA abilities
and in clinical conditions that impact cognition
The data analyzed in this study is subject to the following licenses/restrictions: The data were compiled from a series of recent studies conducted by the present authors. The data used to generate A-span measurements reported in this paper is available from the corresponding authors upon reasonable request. Requests to access these datasets should be directed to <a id="encmail">YWRhbS5nYXp6YWxleUB1Y3NmLmVkdQ==</a>
One of the studies that provided data for the current study was approved WIRB Copernicus Group (<a href="#B17">Gallen et al., 2021</a>). The Committee for Human Research at the University of California San Francisco approved the other studies that provided data for the current study (<a href="#B44">Ziegler et al., 2019</a>; <a href="#B30">Mishra et al., 2021</a>; <a href="#B6">Anguera et al., 2022</a>)
Written informed consent to participate in this study was provided by the participants&#x00027; legal guardian/next of kin
Conceptualization and writing&#x02014;original draft preparation: AS
Investigation and writing&#x02014;review and editing: AS
This research was funded by the generous support of our Neuroscape donors
Each funder provided financial support for the data collection efforts in the various published and unpublished studies that we compiled data from in the present study
The funder Akili Interactive Labs was not involved in the study design
The research was also supported by UCSF Resource Allocation Program award
Klingenstein Third Generation Foundation fellowship
and the Hellman Foundation award for Early Career Faculty
and our research assistants for help with data collection and data interpretation
The Supplementary Material for this article can be found online at: <a href="https://www.frontiersin.org/articles/10.3389/fcogn.2023.1207428/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fcogn.2023.1207428/full#supplementary-material</a>
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Anguera JA and Gazzaley A (2023) Quantifying attention span across the lifespan
Received: 17 April 2023; Accepted: 09 June 2023; Published: 22 June 2023
Copyright &#x000A9; 2023 Simon, Gallen, Ziegler, Mishra, Marco, Anguera and Gazzaley. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
&#x0002A;Correspondence: Alexander J. Simon, <a id="encmail">YWouc2ltb25AeWFsZS5lZHU=</a>; Adam Gazzaley, <a id="encmail">YWRhbS5nYXp6YWxleUB1Y3NmLmVkdQ==</a>
Volume 10 - 2019 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2019.01476">https://doi.org/10.3389/fpsyg.2019.01476</a>
Performance analysis in complex sports like soccer requires the study of the influence of the interaction between both teams during the game on final performance
The mixed methods approach involves the collection
and interpretation of qualitative and quantitative data for the same purpose and within the framework of the same study
mixed methods are necessary in order to take advantage of integration between qualitative and quantitative elements
The aim of this study was to develop a new no standard observation tool to analyze soccer offensive performance considering not only the observed team but also some aspects of the opponent behavior
The process consisted in expert meetings and exploratory observations
Experts carried out several design and re-design steps of the observation tool to its final form which includes two macro-criteria and 31 dimensions
The basic unit of analysis was the &#x201C;team possession&#x201D; and the main aims of study were: (a) technical
tactical and spatial characteristics of the start
the development and the end of the team possession and its offensive performance
(b) the behavior of the observed team just after losing the ball possession and its defensive performance
Inter-observer and intra-observer analysis were carried out and kappa coefficient was calculated to test the observation tool reliability and improve the quality of data
Results indicate that optimal inter and intra-reliability levels obtained in this work are high enough as for suggesting that the observation tool for offensive performance in soccer (REOFUT) could be an adequate tool for analyzing offensive play actions and their performance in soccer
Some instruments have been proposed to evaluate individual tactical behaviors. <a href="#B22">Gonz&#x00E1;lez-Villora et al. (2015)</a> review different instruments for the evaluation of the tactical knowledge of football players. All instruments reported there are used to evaluate the tactical knowledge of the soccer player. We would like to highlight the FUT-SAT (<a href="#B51">Teoldo et al., 2011</a>)
which is conceived to assess the tactical knowledge of the player in game situations
However, the difficulty of interpreting the team actions in a complex, dynamic and situational context such as a soccer match makes it necessary to correctly define the criteria to limit the errors of interpretation and codification (<a href="#B30">James et al., 2007</a>), as well as to assess the validity and reliability of the data collected to be analyzed (<a href="#B26">Hughes et al., 2004</a>)
No experimental analysis involving human studies is performed in the study
who met the following criteria: (1) graduate in physical activity and sport sciences
(3) more than 1 year as a soccer coach in a soccer team of an official competition
(4) postgraduate master in sports sciences or PhD in sports sciences
and (5) experience in performance analysis research (final master&#x2019;s thesis
doctoral thesis or scientific publication)
Scheme of the macro-criteria and dimensions that REOFUT record
The design of the research instrument was carried out in five stages:
&#x201C;A team possession starts when a player gains possession of the ball by any means other than from a player of the same team
The player must have enough control over the ball to be able to have a deliberate influence on its subsequent direction
The team possession may continue with a series of passes between players of the same team but ends immediately when one of the following events occurs: a) the ball goes out of play; b) the ball touches a player of the opposing team (e.g.
an intercepted pass or a shot being saved)
A momentary touch that does not significantly change the direction of the ball is excluded
or c) the regulation is violated (out of play or foul).&#x201D;
the completeness was considered when any behavior under analysis could be assigned to one of the categories proposed in each dimension while the mutual exclusivity was fulfilled when there was no overlap of the categories and each analyzed behavior was assigned to a single category
In the third stage, a study was carried out by one of the researchers for the analysis of the offensive game of the Spanish soccer national team in the FIFA World Cup in South Africa 2010, the champion team (852 possessions were analyzed from 7 played matches), using the newly designed first version of REOFUT (<a href="#B21">Gonz&#x00E1;lez-R&#x00F3;denas, 2013</a>)
The reliability was verified through the analysis of 20 randomly selected possessions of the Spain-Germany match
a series of meetings of the 6 participating experts took place to analyze and discuss the results obtained in the first study in order to verify the usefulness of the criteria and categories of the first REOFUT design
as well as to add other criteria that might be necessary for a better understanding of tactical performance analysis in soccer
the REOFUT was modified from its initial design of 3 macro criteria and 45 dimensions to two macro criteria and 31 dimensions that make up the second version of the instrument
several dimensions were redefined as well as categories were grouped or eliminated in order to make the process of data collection and analysis of results more operative and effective
where the values between 0.8 and 1.0 were considered very good agreement
0.21&#x2013;0.40 low and &#x003C;0.21 very low
medium or low depending on their position in the classification) and time of game (first part
Description and categories for the dimensions related to the start of the possession
Description and categories for the dimensions related to the possession development
Description and categories for the dimensions related to the penultimate action of the possession
Description and categories for the dimensions related to the end of the possession
Description and categories for the defensive dimensions if the following possession is against
Zones of the field and &#x201C;score pentagon.&#x201D; The &#x201C;score pentagon&#x201D; is subdivided into different zones in order to perform a more specific analysis of the dimensions related to goals and goal scoring opportunities
Figure 3. Space of defensive occupation that define the level of invasion over the opponent (Adapted from previous studies, <a style="color:gray;" href="#B12">Castellano, 2000</a>; <a style="color:gray;" href="#B23">Gr&#x00E9;haigne, 2001</a>; <a style="color:gray;" href="#B46">Seabra and Dantas, 2006</a>; <a style="color:gray;" href="#B8">Aranda et al., 2009</a>)
These zones are dynamic and change every second depending on the positioning on the opposing players
Specific positions within the system of play used by the team in order to determine the player that performs the action
This characterization depends on the system used by each analyzed team
Example of different tactical behaviors related to the penetration over the opponent and their tactical performance
The fifth stage, which was carried out to analyze the tactical dimensions related to offensive performance of Major League matches, was carried out using the recording instrument LINCE (v.1.2.1) (<a href="#B19">Gab&#x00ED;n et al., 2012</a>)
Dimensions and categories of REOFUT were coded and the observation of behaviors by the two observers was done using this software
To assess the inter- and intra-observer concordance of the REOFUT, kappa index <a href="#B15">Cohen&#x2019;s (1960)</a> was calculated using SPSS 21.0 for Windows (SPSS
oriented to the construction of an observation instrument
the results refer to the quality control of the data
focused on the intra-observer and inter-observer concordance
<a href="#T6">Table 6</a> shows the Kappa values for each of the dimensions of the observation instrument. We can observe how the values for the intra-observer analysis are higher than those obtained in the inter-observers. In this sense, according to the criterion of <a href="#B1">Altman (1991)</a> the intra-observer analysis shows how 83.9% of the dimensions present very good reliability (0.81&#x2013;1.0) and 16.1% good (0.61&#x2013;0.80)
the intra-observer analysis shows how 96.8% of the dimensions present a very high reliability (0.81&#x2013;1.0) and the remaining 3.2% show a good reliability (0.61&#x2013;0.80)
Kappa values obtained for the dimensions of the REOFUT observation tool
The central axis of the work has been to present the process of construction of the observation instrument REOFUT
from the qualitative behavior of the soccer team
demonstrating that this tool is suitable and consistent for the analysis of offensive possessions in soccer
the offensive performance dimension has been defined by four categories that reflect the degree of offensive penetration achieved by the team observed on the opponent during possession (no depth
the REOFUT provides a methodological framework of analysis that allows future researchers the possibility of studying globally or specifically different dimensions of the game
such as possessions that originate goals or goals
as well as the study of game patterns at different times of possession
The first step is to correctly record and code the data, and this is where the ad hoc observation instrument (REOFUT) is used. The record can be managed and processed systematically within an empirical research setting that ensures replicability. The recorded data can be transformed into a series of complete or incomplete code matrices containing purely qualitative information (<a href="#B3">Anguera et al., 2017</a>)
This transformation is achieved by organizing the dimensions into columns and adding the behavioral units (possessions) to the corresponding rows
Once the necessary data controls (as Kappa coefficient for inter-observers agreement) has been performed
these authors add that factors such as training in the analytical procedure
operational definitions and the nature of the dimensions should be considered in the interpretation of the results
high reliability values were obtained with a training period of the observer of 4 weeks and the operational definitions of the analytical procedure were specially specified and studied both theoretically and practically during the exploratory observation phase of the study
In terms of the nature of dimensions and categories, some observations may naturally be more difficult to perform without errors than others (<a href="#B30">James et al., 2007</a>)
This study has observed how the behaviors in which the interpretation by the observers was more relevant have obtained lower agreement values than the behaviors with lower interpretative demands
the dimensions referred to the location of the initial action
penultimate and last action in the rival invasive space obtained lower values of agreement than the dimensions related to the location of them in the formal game space
This result must be understood in relation to the fact that the zones of the opponent SDO are changing with the evolution of the game action
which requires more experience for interpretation by the observers
while the formal field zones are invariable and the references on the field help to draw imaginary lines on the playing field that facilitate location
showing satisfactory levels of inter-observer and intra-observer reliability
On the other hand, the present study presents higher concordance values in comparison with the study carried out by <a href="#B50">Tenga et al. (2009)</a>, who developed an observation instrument for soccer performance analysis with 22 dimensions. It is worth noting that the defensive dimensions presented by <a href="#B50">Tenga et al. (2009)</a> based on pressure
coverage and positioning of the defenders obtained a very low reliability
this study showed greater concordance for the intra-observer analysis (73% of the criteria very good
23% good and 4% moderate) than for the inter-observers (32% very good
In addition, our study presents lower reliability values with respect to the instrument designed by <a href="#B42">Sarmento et al. (2010)</a> for the analysis of the offensive process in soccer
which achieved reliability values above 0.95 in all the dimensions studied
This instrument aims to detect temporary patterns at the start
development and end of the offensive sequences and shares with the REOFUT the importance of the dimension related to the type of attack
which was divided into categories such as rapid attack
as it is a tool based on notational analysis and therefore on the observation
interpretation and recording of events that take place during the game
It may not reflect the total complexity and criteria that the offensive play actions represent
this instrument is fundamentally based on the study of the offensive moment
Although it consists of numerous criteria to describe the different moments of the action of open offensive play
which consists of different moments such as the beginning
it is not considered an instrument of ideal observation for the study of offensive set pieces
which are actions that have different technical and tactical characteristics to open game situations
It would be fantastic to have a single and simple tool to analyze all types of action that are in a game
but given the diversity of actions that occur in football
to analyze the tactical behavior of the team with a single instrument appears almost impossible
this instrument has important practical applications
the REOFUT tool can be used for researchers to analyze
predict and compare collective offensive performance
soccer coaches and match analysts of all levels can use the theoretical framework of REOFUT to evaluate and register the offensive performance of their teams throughout the season
analyzing the tactical progress and using this information for adjusting and improving the coaching process
the optimal inter and intra-reliability levels obtained in this work are high enough as for suggesting that REOFUT could be an adequate tool for analyzing offensive play actions and their performance in soccer
JG-R was responsible for the review of the literature and the drafting of the manuscript
and contributed to the analysis and the method section
All authors approved the submitted version of the manuscript
The authors gratefully acknowledge the support of the two Spanish Government subprojects: Integration ways between qualitative and quantitative data
and synthesis review as main axis for an innovative future in physical activity and sports research (PGC2018-098742-B-C31) (Ministerio de Ciencia
Programa Estatal de Generaci&#x00F3;n de Conocimiento y Fortalecimiento Cient&#x00ED;fico y Tecnol&#x00F3;gico del Sistema I+D+i)
and Mixed method approach on performance analysis (in training and competition) in elite and academy sport (PGC2018-098742-B-C33) (Ministerio de Ciencia
that are part of the coordinated project New approach of research in physical activity and sport from mixed methods perspective (NARPAS_MM) (SPGC201800X098742CV0)
The authors also gratefully acknowledge the support of the two Spanish Government projects (Ministerio de Econom&#x00ED;a y Competitividad): (1) La actividad f&#x00ED;sica y el deporte como potenciadores del estilo de vida saludable: Evaluaci&#x00F3;n del comportamiento deportivo desde metodolog&#x00ED;as no intrusivas (Grant Nos
UE) and (2) Avances metodol&#x00F3;gicos y tecnol&#x00F3;gicos en el estudio observacional del comportamiento deportivo (PSI2015-71947-REDP
Tecnolog&#x00ED;a i aplicaci&#x00F3; multim&#x00E8;dia i digital als dissenys observacionals (Grant No
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Tudela-Desantes A and Anguera MT (2019) &#x201C;REOFUT&#x201D; as an Observation Tool for Tactical Analysis on Offensive Performance in Soccer: Mixed Method Perspective
Copyright &#x00A9; 2019 Aranda, Gonz&#x00E1;lez-R&#x00F3;denas, L&#x00F3;pez-Bondia, Aranda-Malav&#x00E9;s, Tudela-Desantes and Anguera. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
*Correspondence: Joaqu&#x00ED;n Gonz&#x00E1;lez-R&#x00F3;denas, <a id="encmail">am9hcXVpbmdvbnphbGV6cm9kZW5hc0BnbWFpbC5jb20=</a>; Ignacio L&#x00F3;pez-Bondia, <a id="encmail">aWdsb2JvbkBnbWFpbC5jb20=</a>; Rodrigo Aranda-Malav&#x00E9;s, <a id="encmail">cm9kcmlnby5hcmFuZGFAdXYuZXM=</a>; Andr&#x00E9;s Tudela-Desantes, <a id="encmail">YW5kcmVzLnR1ZGVsYUB1di5lcw==</a>
Volume 8 - 2017 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2017.01188">https://doi.org/10.3389/fpsyg.2017.01188</a>
Group psychotherapy is a useful clinical practice for adolescents with mental health issues
Groups typically consist of young people of similar ages but with different personalities
and this results in a complex communication network
The goal of group psychoanalytic psychotherapy is to improve participants&#x00027; mentalization abilities
facilitating interactions between peers and their therapist in a safe
The main aim of this study was to analyze conversation turn-taking between a lead therapist
and six adolescents over the course of 24 treatment sessions divided into four blocks over 8 months
We employed a mixed-methods design based on systematic observation
which we consider to be a mixed method itself
as the qualitative data collected in the initial observation phase is transformed into quantitative data and subsequently interpreted qualitatively with the aid of clinical vignettes
The choice of methodology is justified as we used an ad-hoc observation instrument combining a field format and a category system
Interobserver agreement was analyzed quantitatively by Cohen&#x00027;s kappa using the free QSEQ5 software program
Once we had confirmed the reliability of the data
these were analyzed by polar coordinate analysis
which is a powerful data reduction technique that provides a vector representation of relationships between categories
The results show significant relationships between the therapist and (1) the activation of turn-taking by the participants and the co-therapist and silence and (2) conversation-facilitating interventions and interventions designed to improve mentalization abilities
Detailed analysis of questions demonstrating interest in others showed how the communication changed from radial interactions stemming from the therapist at the beginning of therapy to circular interactions half way through
Repetition was found to be a powerful conversation facilitator
The results also illustrate the role of the therapist
who (1) did not facilitate interventions by all participants equally
(2) encouraged turn-taking from more inhibited members of the group
(3) stimulated conversation from the early stages of therapy
and (4) favored mentalization toward the end
polar coordinate analysis produces easy-to-interpret results in the form of vector maps
they showed how the children shifted from paranoid-schizoid functioning to depressive functioning over the course of therapy
They concluded that psychotherapy was beneficial in latency-aged children
as it provided them with the opportunity to observe and try to attach meaning to the interactions of other people
to initiate contact and to help and be helped in a safe environment
Such experiences improve individuals&#x00027; ability to recognize and observe mental states in both themselves and others and to develop empathy
In this article, we describe the results of a study based on systematic observation, which we consider to be a mixed method in itself (<a href="#B4">Anguera and Hern&#x000E1;ndez-Mendo, 2016</a>)
The study consisted of systematically observing video-recordings of adolescent group therapy sessions over a period of several months
The observation produced a large set of qualitative conversational data
subsequently analyzed quantitatively via polar coordinate analysis to detect changes in behaviors over the course of therapy
The aim of the group therapy analyzed was to promote autonomy and maturity through interactions between peers and their therapist in a safe, containing environment (<a href="#B72">Torras de Be&#x000E0;, 2013</a>)
Group sessions of this type produce complex communication networks
Participants are typically young people of similar ages with different personalities who have difficulty relating to others and often perform poorly at school
Psychodynamic interventions have been described as &#x0201C;conversation therapies,&#x0201D; as the relationship between the person seeking treatment and the therapist forms the basis of the therapy (<a href="#B46">Malmberg and Fenton, 2008</a>)
We studied group communication as a conversation in which we analyzed turn-taking (who) and content (what)
<a href="#B35">Foulkes (1986)</a> described two roles for group analysis leaders
or conductors: a role as dynamic-administrator and a role as analyst-interpreter
The function of the first is to set up the group
and containing environment designed to increase participation
and the ability to put into words everything they are understanding
interventions by a therapist largely seek to (a) facilitate conversation and (b) promote mentalization
and understanding about oneself and one&#x00027;s relationships with others
while DYN interventions correspond to either the therapist or the participants over the course of the sessions
it diverges outwards toward the participants from the formal leader of the group
with participants spontaneously intervening and demonstrating interest in each other
This shift in the direction of communication is an indicator of the group process
and our aim was to objectively analyze this process by studying the therapist&#x00027;s interventions
The main aim of this study was to apply polar coordinate analysis to analyze conversation turn-taking and DYN and MNT interventions in a group therapy program involving a lead therapist
The program consisted of 24 group sessions
There are eight possible study designs in observational methodology (<a href="#B19">Blanco-Villase&#x000F1;or et al., 2003</a>; <a href="#B64">S&#x000E1;nchez-Algarra and Anguera, 2013</a>)
The design used in this study was N/F/M (nomothetic/follow-up/multidimensional)
It was nomothetic because we conducted a parallel analysis of the therapist
follow-up because we performed both intersessional analyses (24 successive sessions) and intrasessional analyses (sequential recording of all behaviors from the start to finish of each session)
and multidimensional because the ad-hoc observation instrument contained various dimensions selected on the basis of the theoretical framework and our experience
The systematic observation was non-participative and the behaviors were highly perceivable
The inclusion criteria were (a) an age of 12&#x02013;15 years and (b) recommendation for group therapy following diagnostic evaluation at the Mental Health Center
The exclusion criteria were (a) anticipated difficulty attending all the therapy sessions and (b) contraindication for group therapy
assisted by a co-therapist who participated as an observer
Both were clinical psychologists trained in group psychoanalytic psychotherapy
the participants were informed that they were being filmed
Informed consent was also obtained from the parents of the minors
In systematic observation (<a href="#B3">Anguera, 2003</a>; <a href="#B64">S&#x000E1;nchez-Algarra and Anguera, 2013</a>)
a distinction is made between recording instruments (i.e.
those used to record or code data) and observation instruments (purposed-designed instruments to analyze a given subject)
The group sessions were recorded using two video cameras, two microphones, two video units, and two screens comprising a closed-circuit television system. The dataset was built in the software program GSEQ5, v.5.1 (<a href="#B15">Bakeman and Quera, 2011</a>) using an initial transcription of the video content
A total of 30,436 multievents were coded in our study
The 15 dimensions included in the observation instrument are Facilitating of conversation, Reflective function, Expressivity, Defensive expressions, Dislike, Ordering, Humor, Confrontation, Exclamation, Degradation of vocal behavior, Whispering, Touching, Noise, Surrounding noise, and Silence (Table <a href="#T2">2</a>). Each of these dimensions was broken down to build a category system that fulfilled the requirements of exhaustivity and mutual exclusivity (<a href="#B3">Anguera, 2003</a>)
Dimensions and category systems in the observation instrument for therapists and patients
It should be noted that some dimensions gave rise to a single category, but given their conceptual relevance, we considered it important to include them as dimensions in the instrument. The dimensions and categories are shown in Table <a href="#T2">2</a>
The parents of the six adolescents were notified that their children had been proposed for group therapy after a diagnostic evaluation period
they all agreed to participate in a parallel group led by another therapist
All the sessions were video-recorded and transcribed in full
Thirty sessions were held but due to technical difficulties with the recording
24 sessions were included in the final analysis
The sessions were grouped into four periods spanning an 8-month period
the level of agreement was &#x0201C;almost perfect&#x0201D;
with kappa values ranging between 0.86 and 0.93 for all the sessions
a technique used to reveal behavioral patterns based on occurrence of behaviors after (prospective) or before (retrospective) a given behavior (as the focal behavior is known in lag sequential analysis)
The technique is based on calculating conditional and unconditional probabilities (based
on matched frequencies and simple frequencies) for each of the time lags considered
1987) based on the concept of genuine retrospectivity
This modified technique has been used on multiple occasions in the past two decades and was employed in the current study
Polar coordinate analysis integrates the prospective and retrospective perspectives with the help of a vectorial map that contains four quadrants in which the prospective and retrospective Zsum values are plotted along the X and Y axis, respectively. Each target behavior analysis thus can be located in one of the four quadrants depending on the combination of negative/positive signs (Table <a href="#T3">3</a>)
Polar coordinate analysis results corresponding to interventions by the therapist (T) as the focal behavior and interventions by the participants (G D JM F L M)
Polar coordinate analysis uses the prospective and retrospective Zsum values for each conditional behavior to calculate the length and angle of the corresponding vector
thus allowing these to be graphically represented
The length of the vector is &#x0221A;(Zsum2Prospective&#43;Zsum2Retrospective)
The meanings of the different quadrants are shown in Figure <a href="#F1">1</a>
Characteristics of the quadrants in which the vectors are located according to the activation (&#43;) or inhibition (&#x02013;) sign carried by the Prospective and Retrospective Zsum values
Quadrants I and III are symmetrical in terms of the relationship they depict between the focal behavior and the different conditional behaviors they contain
Quadrant I (&#43;&#43;) indicates mutual activation while quadrant III (&#x02212;) indicates mutual inhibition
Quadrant II (&#x02212;&#43;) indicates that the focal behavior inhibits but at the same time is activated by the conditional behaviors
while quadrant IV (&#43;&#x02212;) indicates the opposite (i.e.
the focal behavior activates and is inhibited by the corresponding conditional behaviors)
The polar coordinate analysis for this study was performed in HOISAN v. 1.6.3.2 (<a href="#B38">Hern&#x000E1;ndez-Mendo et al., 2012</a>)
which contains all the necessary modules and also produces partial results for adjusted residuals and z values in addition to analytical parameters and polar coordinate maps
The analysis was conducted by exporting the data file from GSEQ5 to HOISAN
he used it to study turn-taking in conversation
we describe the relationships detected between interventions by the therapist and the group participants using polar coordinate analysis
The focal behavior was intervention by the therapist (T) and the conditional behaviors were interventions by the participants (G
and silence (Q) in the four blocks of sessions spanning 8 weeks
The graphs in Figure <a href="#F2">2</a> show the vectors representing turn-taking by the participants and the co-therapist and silence
some of the vectors are located in the mutual inhibition quadrant (quadrant III) while others are located in the mutual activation quadrant (quadrant I)
On analyzing the four blocks of sessions grouped by time
it can clearly be seen that the turn-taking behavior by D
that of the co-therapist and silence remained stable
Vectors corresponding to interventions by the therapist (T) as the focal behavior and interventions by the participants (G
Session blocks 1-2-3-4 (from left to right)
the focal behavior was intervention by the therapist (T) and the conditional behaviors were the DYN categories FF
The majority of results in this case were also significant (Table <a href="#T4">4</a>)
Polar coordinate analysis results with interventions by the therapist (T) as the focal behavior and DYN categories (broken down) and MNT as conditional behaviors
The graphs in Figure <a href="#F3">3</a> show the vectors for the different relationships distributed among the four quadrants
On examining the figures by blocks of time
it can be seen that the vectors tend to form clusters
with the majority located in the mutual activation quadrant (quadrant I) by the end of the therapy
Note that the length of the radius for repetition (RP) and the quadrant in which it was located (quadrant I) remained stable over the four periods
Vectors corresponding to interventions by the therapist (T) as the focal behavior and conversationfacilitating DYN categories (FF
QV) and the mentalizing or reflective function MNT category as conditional behaviors
Below we discuss the significance of the relationships detected by polar coordinate analysis in five sections
We also illustrate our findings with clinical vignettes containing coded transcripts of the interventions
However, not all interactions are the same. Gabriel and Lucy, for example, spontaneously take turns in these early sessions (Table <a href="#T6">6</a>)
Lucy raises conflicts about herself that interest everyone (Table <a href="#T7">7</a>)
John M is a reserved person with anxiety problems. He has difficulty intervening and when he does, he often mumbles, says very little, and adheres to what has just been said (Table <a href="#T8">8</a>)
The co-therapist and the therapist was mutually activated (quadrant 1). The co-therapist&#x00027;s interventions reflect her role of interfering as little as possible in the group dynamics. They complement those of the main therapist. Together, they form a team and create and maintain a safe environment (Shechtman 2007; <a href="#B72">Torras de Be&#x000E0;, 2013</a>; <a href="#B45">Malekoff, 2014</a>)
The therapist generates silence but also breaks it (quadrant 1)
The examples below show how the adolescents fall silent when faced with difficult issues, such as verbalizing why they are in the group or talking about their relationship with their parents or their concerns about sexuality (Tables <a href="#T10">10</a>&#x02013;<a href="#T12">12</a>)
The different strategies for facilitating conversation (FF
and QV) showed varying patterns of change over the course of therapy but converged at the end
Repetition (RP) was the most powerful strategy
as it activated conversation from the start of the therapy program
The next most powerful strategies were phatic function (FF) and greetings (FO)
The transcripts of the sessions show that in the early sessions
it was the therapist who verbally greeted the adolescents (by saying hello and goodbye)
few of them responded and the others returned the greeting or made a non-verbal gesture
This behavior changes after the first block
indicating an increase in reciprocity between the therapist and the participants
The appearance of QA (questions directed at others) in the second half of the therapy is, in our opinion, a highly significant indicator of the group process. It tells us that the communication is no longer radial and that the adolescents have achieved one of the most important benefits of group therapy, which is showing interest in others (<a href="#B76">Yalom, 2005</a>) in the presence of the therapist (<a href="#B72">Torras de Be&#x000E0;, 2013</a>)
Bringing back a central topic of conversation (RT) and suggesting looking at this in greater depth was only done by the therapist
At the end of therapy, all the categories in the DYN dimension except RT are located in the mutually activating quadrant. This supports the idea that the communication strategies used by the therapist were adopted by the participants, enabling them to talk more autonomously and facilitating their personal growth (<a href="#B76">Yalom, 2005</a>; <a href="#B72">Torras de Be&#x000E0;, 2013</a>)
Polar coordinate analysis provides a new approach for gaining insights into dialogue in group pyschotherapy
The results show that the technique provides a novel means of analyzing the role of the therapist and describing her conversational style
The therapist proved to be an expert in creating a communicative environment that allowed the adolescents to grow
She employed four core strategies: (1) she did not facilitate communication equally for all participants
(2) she encouraged turn-taking by the more inhibited members of the group
(3) she stimulated conversation from the early stages of therapy
and (4) she promoted mentalization toward the end of therapy
Observational methodology and polar coordinate analysis could prove to be of great value for detecting changes in psychotherapy models based on spoken conversation
MA performed the method section and polar coordinate analysis
Both authors have participated in the writing of the article
This study was supported by the Catalan government under grant number 2014 SGR 1088 for the project Grup de recerca comunicaci&#x000F3; i salut (COMSAL) and Grup de recerca i innovaci&#x000F3; en dissenys (GRID) and under Grant number 2014 SGR 971 for the project Tecnologia i aplicaci&#x000F3; multimedia i digital als dissenys observacionals
We also gratefully acknowledge the support of the Spanish government (Ministerio de Econom&#x000ED;a y Competitvidad) within the Projects Avances metodol&#x000F3;gicos y tecnol&#x000F3;gicos en el estudio observacional del comportamiento deportivo [Grant PSI2015-71947-REDT; MINECO/FEDER
we also acknowledge the support of Ramon Llull University (PGRiD of FPCEE Blanquerna) and University of Barcelona (Vice-Chancellorship of Doctorate and Research Promotion)
We thank all those at the Center for Child and Adolescent Mental Health of the Eul&#x000E0;lia Torras de Be&#x000E0; Foundation in Barcelona
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Citation: Arias-Pujol E and Anguera MT (2017) Observation of Interactions in Adolescent Group Therapy: A Mixed Methods Study
Received: 13 January 2017; Accepted: 29 June 2017; Published: 24 July 2017
Copyright &#x000A9; 2017 Arias-Pujol and Anguera. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
provided the original author(s) or licensor are credited and that the original publication in this journal is cited
*Correspondence: Eul&#x000E0;lia Arias-Pujol, <a id="encmail">ZXVsYWxpYWFwQGJsYW5xdWVybmEudXJsLmVkdQ==</a>
Possessing two X chromosomes is a double-edged sword
Females are better at fighting off infection than males
but they are also more susceptible to many autoimmune conditions
A new study published in Proceedings of the National Academy of Sciences and led by researchers from the University of Pennsylvania now offers the first mechanistic explanation for why this is the case
an assistant professor in the Department of Biomedical Studies at Penn's School of Veterinary Medicine
a mechanism that serves to balance gene dosage between males and females by inhibiting gene expression on one of a female's two X chromosomes
an RNA molecule essential for the inactivation process
as well as other markers of X chromosome inactivation
thus making X inactivation incomplete in these cells
That incomplete activation was present in lymphocytes in all females
but lupus patients also had unique expression patterns of key immunity-related genes and unusual patterns of Xist RNA localization
suggesting an underlying explanation for the disease condition
"There just seems to be something about lymphocytes," Anguera said
"The silencing of the X chromosome doesn't seem to be as tight in them as it is in other cell types."
Anguera's coauthors on the paper were lead author Jianle Wang
Kramer of the Department of Biochemistry and Biophysics in Penn's Perelman School of Medicine; and Arindam Basu of Pennsylvania State University
The study had its origins in Anguera's postdoctoral research
which focused on X inactivation in pluripotent stem cells
In particular she examined the role of Xist
a long non-coding RNA molecule that is known to initiate X inactivation and maintain it by residing with the inactivated X chromosome
which also acquires small-molecule tags called heterochromatic modifications
stem cells lose both Xist expression and the modifications that normally reside on the inactive X
the cells would start to become partially reactivated
growing rapidly and beginning to resemble cancer cells
She began to wonder whether certain diseases might arise from improper maintenance of X inactivation
notably autoimmune conditions such as lupus; 85 percent of lupus patients are women
"What caught my attention about autoimmunity and specifically lupus," Anguera said
"was that there were genes on the X chromosome that were immunity related and that had been shown to have higher expression levels in lupus patients."
the Penn researchers examined lymphocytes donated by healthy human females as well as "naïve," or unstimulated T and B cells from female mice
unlike in other cell types where Xist is associated tightly with the inactive X chromosome
female lymphocytes lacked this Xist "cloud," even though the cell still contained expected levels of Xist
This suggested that Xist was failing to properly migrate to the inactive X to silence it
When the research team activated the human T and B cells
simulating how these cells would respond when presented with a pathogen
Yet the naïve and stimulated lymphocytes all had similar quantities of Xist
"What was really striking to us was that this wasn't due to a difference in the amount of Xist
There is a ton of Xist RNA in these cells," Anguera said
"It's just not getting to the inactive X chromosome in the naïve lymphocytes."
Further examinations of the inactive X in lymphocytes found that it lacked the heterochromatic marks found on the inactive X in other cell types
The findings that even healthy females had such unusual maintenance of the inactive X in their lymphocytes was entirely unexpected
"Our hypothesis was that the lupus samples were going to be dysregulated and the healthy females would be fine," Montserrat said
"So it was really shocking to us that lymphocytes in normal females lacked these markers of X inactivation as well."
To see if this lack of heterochromatic marks and Xist
both of which normally block gene expression on the inactive X
the researchers looked at immunity-related genes on the X chromosome to see if there was one or two copies being expressed
They found that about 3 to 5 percent of female lymphocytes expressed two copies of these genes
as well as two copies of a gene unrelated to immunity
No male lymphocytes showed this same two-copy expression
the researchers found that certain regions of the X chromosome in human female B cells
including regions that contain immunity-related genes
were expressed at higher levels than male cells
Because Xist in the female lymphocytes was present but simply wasn't localizing to the proper place on the inactive X
the research team took a closer look at two proteins
that are known  to bind with Xist and possibly play a role in moving it back to the inactive X after lymphocytes are stimulated
Using human T cells in culture as well as mice lacking one of these genes
the two proteins did help move Xist back to the inactive X chromosome in activated lymphocytes
Though it was clear that female lymphocytes were different from males' in their patterns of Xist localization
the team wanted to know whether lupus patients had additional unusual features of X inactivation that might explain their disease
Using lymphocyte samples from both pediatric lupus patients and healthy children of similar ages
the team found more Xist mis-localization in lupus patients and some evidence that they were more likely than healthy people to have two copies of immunity-related genes
The researchers also noted that the region of the X chromosome containing Xist showed the biggest differences in expression when comparing lupus to healthy patients
is that all females may have a subpopulation of lymphocytes with incomplete X inactivation; in healthy individuals
but that subpopulation may take over in patients with autoimmune conditions
Anguera's team is performing additional studies using primary samples from lupus patients as well as samples from a mouse model of lupus
While the current study was done on immortalized cells from lupus patients
Anguera is hopeful the researchers will obtain a clearer picture of how Xist patterns differ using primary cells
The team is also embarking on a study of another female-biased autoimmune disease
which has an even more extreme female bias than lupus
to see if similar X inactivation patterns are present
If the findings hold up across different autoimmune diseases
it's possible that the characteristic patterns of Xist localization could be used as a disease biomarker
The work was supported by the McCabe Research Foundation
Lupus Foundation and National Institutes of Health (GM07229)
Proceedings of the National Academy of Sciences
<a href="http://dx.doi.org/10.1073/pnas.1520113113" target="_blank">10.1073/pnas.1520113113 </a>
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Copyright © 2025 by the American Association for the Advancement of Science (AAAS)
Volume 9 - 2018 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2018.01416">https://doi.org/10.3389/fpsyg.2018.01416</a>
Advances in the study of non-verbal behavior and communication have generated a need for movement transcription systems capable of incorporating continuous developments in visual and computer technology
Our research team has been working on the construction of a common morphokinetic alphabet (CMA) for the systematic observation of daily life activities
was designed to create a system for describing and analyzing body motion expression
we describe an idiosyncratic application of Noam Chomsky&#x2019;s phrase marker grammar to the morphokinetic phrase
the objective being to establish the grammatical rules and basic order of the symbol string according to a relational tree formed by the breakdown of the syntactic components identified as structuring the visual description of movement
Criteria for using the CMA as a coding system and a free transcription system are proposed
after two decades of successive technological advances
the hurdle once posed by frame-by-frame transcription has now been totally overcome
thus ensuring high degrees of precision when obtaining data
we sought to develop a notational grammar of body movement which we call the Common Morphokinetic Alphabet (CMA)
The term &#x201C;morphokinetic&#x201D; is defined as a temporally demonstrable change in properties and spatial design of body motion form
By &#x201C;common&#x201D; we understand two things: (1) the notation system can be communicated and learned
as a balance is sought between clarity and precision and (2) the notation system shares the logic of meaning
which emerges from the writing of movement in the notational systems reviewed according to the choreographic model
the concept of &#x201C;alphabet&#x201D; denotes the conventional and discretional nature of the tokens and connotes the material condition sine qua non required to develop a notational system governed by grammatical rules
In previous publications (<a href="#B43">Izquierdo and Anguera, 2001</a>; <a href="#B5">Anguera and Izquierdo, 2006</a>; <a href="#B42">Izquierdo, 2010</a>) we have mapped out the different facets of this theoretical and methodological proposal that forms part of the movement observation process within the field of psychology (<a href="#B18">Chinellato et al., 2015</a>; <a href="#B17">Casta&#x00F1;er et al., 2016</a>; <a href="#B4">Anguera et al., 2017</a>)
Now our aim is to present the CMA grammar and the criteria for its use in systematic observation studies
The following sections address the theoretical and methodological basis of the CMA notation
the grammatical formalization of the morphokinetic description
the general criteria for use in the coding format and as a free transcription system
the possibilities offered by this notational system
Advances in the study of non-verbal behavior and communication have led to the need for suitable systems for transcribing movement that are capable of incorporating continuous developments in visual and computer technology (<a href="#B7">Archer, 1991</a>; <a href="#B2">Anguera, 2003</a>; <a href="#B16">Blanco-Villase&#x00F1;or et al., 2003</a>; <a href="#B58">Portell et al., 2015a</a>,<a href="#B59">b</a>)
The CMA aims to code the visual form of body movement by describing it as a configuration sculpted in space-time
Each new configuration perceived by the observer implies a demonstrable change with respect to the immediately previous one
The change in configuration includes total or partial mobility of the body and relative stillness with respect to the following position
the initial position can be maintained as a basic reference point for subsequent changes
In terms of the spatial description of body movement a determining feature is that the body has a large number of degrees of freedom when executing movements. Bearing in mind this principle, CMA notation of spatial points is geared toward what is specific about the spatial design of a movement in accordance with the objective of the observation (<a href="#B36">Frey and Pool, 1976</a>)
Given that body space is located in space/setting, CMA notation considers the movements through space that we can make with our body and the relationship between the use of space and overall body positions, that is, physical postures (standing, sitting, kneeling, lying down, etc.) and the postural movements produced by a form of established behavior (<a href="#B53">Mehrabian, 1969</a>; <a href="#B8">Argyle, 1973</a>; <a href="#B60">Poyatos, 1986</a>)
From a methodological perspective the CMA has notable potential in that it is able to objectify behavioral units at the micro level due to the way it breaks up the stream of behavior (<a href="#B21">Condon and Ogston, 1970</a>)
and this gives it important analytic properties for subsequent empirical processing
The first part of the analytic process consists of transforming the kinesic reality of human movement into units of behavior that are later turned into data with the aid of an observation instrument developed ad hoc; these data must be suitably managed before being analyzed
a task for which there are various approaches
Thus there are four stages that are necessary from a methodological point of view and that provide the CMA with its required consistency
(1) The creation of molecular units (<a style="color:gray" href="#B66">Schegloff, 2000</a>) is a prior condition in the development of an observation instrument (<a style="color:gray" href="#B5">Anguera and Izquierdo, 2006</a>)
demarcating the unit of behavior is clearly linked to the specific setting of objectives
in the event that four criteria have been proposed:
following the way in which music is written
corresponding to synchrony or concurrence of behaviors
This proposal was found to fit perfectly with that resulting from the data management obtained when recording by means of field formats
Chomsky referred to generative grammar as &#x201C;a system of rules that in some explicit and well-defined way assigns structural descriptions to sentences&#x201D; (<a href="#B20">Chomsky, 1965</a>
The function of these rules is to specify whether the minimum terminal units of syntactic function comprise well-formed strings (phrase markers)
Triple structural information of the phrase marker: tree diagram
Branch generation of the terminal string for a given grammar
the first question requires us to name and identify the bodily form of movement: part of the body + figure
The second question must be answered by specifying spatial and temporal references with respect to position (overall physical posture
or any other aspect related to the maintenance of overall physical posture)
orientation (position in the movement plane
and the duration of movements and their structure in time
The final question (How has it changed?) involves identifying the contextual factors which may affect the form of movement and classifying the specific mode of the motor action
considered as invariant at least within the same observation session
include the situation where the activity takes place
the baseline body and psychosocial conditions of the person (or persons) in movement
and the acquired habituation in executing the movements (i.e.
The qualities perceived for specific movements
including styles related to culture or social status that are not selected by the situation
are the aspects that classify the idiosyncratic differences observed in the execution of specific movements
Syntactic components of the morphokinetic grammar K
&#x2018;Every morning&#x2019; > DG: it is context [Det]: temporal reference;
&#x2018;[my father]&#x2019; > DG: it is context [Det]: personal reference with a social basis: family relationship;
&#x2018;attended mass&#x2019; > DG: it is context [Det]: religious activity: selects the repertoire of action;
&#x2018;[all the time&#x2217;]&#x2019; > reader&#x2019;s inference > NG: it is time [T]: duration of the whole body figure;
&#x2018;with both knees&#x2019; = [kneeling] > NG: it is form [F]: body part + figure;
&#x2018;[kneeling] on the floor&#x2019; > NG: it is position [P]: location in physical space;
&#x2018;his hands together&#x2019; > NG: it is form [F]: part of the body + figure;
&#x2018;pointing upwards at chest level&#x2019; > NG: it is orientation [O]: vertical axis
&#x2018;his hat on top of them&#x2019; > NG: it is form [F]: supporting object;
&#x2018;(&#x2026;) on top (&#x2026;)&#x2019; > NG: it is orientation [O]: height scale;
&#x2018;his hat on top of them&#x2019; DG > it is modal [M]: it is form: familiar/strange emphasis
This exercise is merely an initial approach to the adaptation of structural symbols to the morphokinetic information expressed in a word or group of words
Continuing with the &#x201C;phrase-structure&#x201D; analogy
let us consider a simple example of syncopated verbal-morphokinetic description (the order follows the conventional above-cited written text): &#x201C;every morning
(The commas separate the word symbols; note that there are symbols composed of several words)
Representation of (1) using labeled square brackets (K is the initial symbol. Vid Figure <a href="#F2">2</a>):
Assuming that this formalizatiwic entities
the branch rewriting rules of the grammar K are:
The &#x201C;base mold&#x201D; of grammar K is acceptable within the restrictive framework imposed by our interpretation of the structural components of the morphokinetic description
the formalization of the systematization carried out here is characterized by the negligible abstraction of the categorical notions
and in concert a clear application effect on the grammatical ordering of the symbolized morphokinetic expressions
the analogical attitude (as if) indicates that we have defined an intermediate space between the branching rules of phrase marker grammar and the rules of action
The proposed formal method for determining the hidden structure of &#x201C;natural&#x201D; morphokinetic expressions provides a syntax that orders the symbols of the morphokinetic alphabet: F &#x2229; S (P
each element of the terminal string is a member of K in NG &#x2229; DG
&#x201C;smoothly&#x201D; is a member of K in DG &#x2229; M
The formalized syntax of the morphokinetic phrase serves as a guide not only when the movement image is observed live or through the viewing of photographs
or video but also when working with written texts
The grammar K channels the search for answers
to the three basic questions: &#x201C;What has moved?&#x201D; &#x201C;What has changed?&#x201D; and &#x201C;How has it changed?&#x201D;
One way of optimizing the structural categories is to link them to the movement behavior criteria established in the field formats
The folder of each structural category can be displayed in as many sub-folders as necessary
Each folder contains complementary or alternative codes and
there are open options and specific catalogs (in accordance with the morphokinetic protocol created) so that the observer/analyst of movement selects
the codes that describe the image of the observed movement
This procedure can be carried out relatively easily using a database
CMA selection of symbols (#) for free transcription
Example 1: Analysis of the shape of the torso at the current moment in code 2_2 (Table <a href="#T2">2</a>)
Example 2: Analysis of the sequence of positions of large head movements with or without speech in code 2_2. See Table <a href="#T3">3</a>
When the aim is to prepare the simplified schema for the data collection work that will subsequently be carried out, the CMA functions as a free transcription system. In the context, it is necessary to economically transcribe the movement action for their analysis (Table <a href="#T4">4</a>)
Free transcription also converts the kinesics present in written natural language into movement scores
One example is the compound and sequential gesture described by <a href="#B45">Kendon (1987</a>, p. 85) &#x2013; &#x201C;[action context and speech:&#x2026;]. In this gesture he placed his two extended index fingers side by side and then extended both arms away from himself and upwards in the direction of the door&#x201D;. It is transcribed as follows (Table <a href="#T5">5</a>):
Labanotation) is compatible with our grammar
Any of these transcriptions can be converted to a decimal coding system or translated to the CMA vocabulary (alphanumeric and word symbols)
achieving an accurate reproduction of the motor action
The process of observing human movement depends on how morphokinetic changes are perceived and described. The CMA notation system simplifies, organizes, and restructures (<a href="#B24">Dittmann, 1987</a>) the morphokinetic changes in the psychological space of the observer/analyst as distinct descriptive phrases or movement configurations
Changes in the body figure are demarcated by the variables of space and time
and the identification is completed through the inclusion of words that mark the context of activity and classify the movement&#x2019;s linguistic space
Grammatical formalization is a way of forming acceptable symbol strings in accordance with the properties assigned to the syntactic component
The grammar has been developed here on the basis of phrase marker grammar
regardless of the size of the morphokinetic unit being considered
must be able to be analyzed as a basic expression: the visual form of the movement described provides information about
and time and the particular execution of the motor action
Without doubt the most delicate question related to precision concerns the selection of movements and their description with respect to the reference framework adopted: body parts/space-time and other attributes
the CMA may be useful for several basic reasons set out in this article: (1) it gives structure to the processes of identifying
and analyzing raw data in the form of time function (video record); (2) it offers an open and flexible coding format that is compatible with the solutions offered by other notational systems for transcribing body movement; (3) it meets the frequent need to combine molar and molecular units in the same recording as if it were a zoom
without losing the unitary view of the whole body under consideration; (4) it allows the computerized management of visual notations; (5) it combines the principles of synchrony and diachrony of movement behavior
which enables advanced analytic techniques (time-series
etc.) to be applied to the matrix of reliable data; and (6) it performs an appreciable function as a transcription system in situations involving direct observation and when working with the kinesics of written texts
The CMA is designed as a basic framework for developing specific coding schemes of body movement in a social context
the next step will be to build a guide for recording and coding movement behaviors in each area of study
Further research is required on the applications of the CMA in order to assess its potential and scope
It is expected that new initiatives will provide additional evidence about the versatility of the system and assurances regarding the reliability of the trials carried out by different researchers who are committed to the grammatical principles of the morphokinetic observation on which the CMA is based: simplified coding
CI developed the project &#x2018;Common Morphokinetic Alphabet&#x2019; (CMA) under supervision of MTA
Both authors reviewed the literature and discussed the references included in the proposal of a grammatical framework of body movement for observing and coding morphokinetic records in systematic observation studies
MTA incorporated the four stages that structure the process of systematic observation
CI designed the path followed in the conceptual analysis of the problem of movement notation
We gratefully acknowledge the support of the Spanish government (Ministerio de Econom&#x00ED;a y Competitividad) within the Projects Avances Metodol&#x00F3;gicos y Tecnol&#x00F3;gicos en el Estudio Observacional del Comportamiento Deportivo (Grant PSI2015-71947-REDT; MINECO/FEDER
and La Actividad F&#x00ED;sica y el Deporte Como Potenciadores del Estilo de Vida Saludable: Evaluaci&#x00F3;n del Comportamiento Deportivo Desde Metodolog&#x00ED;as no Intrusivas (Grant DEP2015-66069-P; MINECO/FEDER
We gratefully acknowledge the support of the Generalitat de Catalunya Research Group (GRUP DE RECERCA E INNOVACI&#x00D3; EN DISSENYS [GRID])
Tecnolog&#x00ED;a i Aplicaci&#x00F3; Multimedia i Digital als Dissenys Observacionals (Grant 2017 SGR 1405)
MTA acknowledge the support of University of Barcelona (Vice-Chancellorship of Doctorate and Research Promotion)
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Citation: Izquierdo C and Anguera MT (2018) Movement Notation Revisited: Syntax of the Common Morphokinetic Alphabet (CMA) System
Copyright &#x00A9; 2018 Izquierdo and Anguera. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
*Correspondence: Conrad Izquierdo, <a id="encmail">Y29ucmFkLml6cXVpZXJkb0B1YWIuY2F0</a> M. Teresa Anguera, <a id="encmail">dGFuZ3VlcmFAdWIuZWR1</a>
The Senate of the University of Las Palmas de Gran Canaria (ULPGC) approved on Thursday the <a href="https://www.ulpgc.es/noticia/2024/01/25/claustro-aprueba-nombramiento-13-nuevas-doctoras-honoris-causa-ulpgc">appointment of 13 new Honorary Doctorates</a>, whose investiture ceremony is scheduled to take place on 5 March.&nbsp;
Among them is Dr M. Teresa Anguera Argilaga who was proposed by the Faculty of Education Sciences and the Department of Psychology, Sociology and Social Work.&nbsp;
The UB emeritus lecturer Maria Teresa Anguera received an honorary doctorate this Friday, April 29, at the University of La Laguna. During the ceremony, Carmen Rosa Sánchez López, tenured lecturer from the Department of Clinical Psychology, Psychobiology and Methodology of La Laguna, pronounced Angueraʼs laudation.   
Volume 5 - 2020 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/feduc.2020.00050">https://doi.org/10.3389/feduc.2020.00050</a>
This article is part of the Research TopicThe Importance of Academic Training in Emotional Intelligence for Teachers<a class="Link Link--linkType Link--maincolor Link--medium Link--icon Link--chevronRight Link--right" aria-label="View all 5 articles" href="https://www.frontiersin.org/research-topics/9646/the-importance-of-academic-training-in-emotional-intelligence-for-teachers/magazine" target="_self" data-event="customLink-linkType-a_viewAll5Articles">View all 5 articles</a>
Teachers who present high emotional skills and knowledge of strategies to mediate the conflicts generated in the classroom
are able to exercise a better management of both the teaching tasks that correspond to them and to establish an emotionally nutritive and productive educational climate for the students
under an integrative conceptual revision methodology
the theories and models that consider individual
as well as emotional elements that underlie people&#x2019;s behavior
All this within interpersonal relationships and in the different areas of action; in order to synthesize the results of each
establishing points of agreement and complementarity that serve to be adapted to the educational field
Educational mediation and emotional regulation are two constructs that have been previously studied separately
but not in a complementary way between them
The presentation of these conceptual discussions suggests the formulation of new theoretical proposals
aimed at improving interpersonal relationships
the environment and dynamics of teaching&#x2013;learning
focusing efforts on the teachers&#x2019; collective
we propose the elaboration of a conceptual model aimed at the development of tools and resources for teachers
to improve the management of conflicts that arise in the context of the classroom
Other empirical studies (<a href="#B34">Folger, 2008</a>; <a href="#B84">Moral and P&#x00E9;rez, 2010</a>; <a href="#B18">Carrasco et al., 2016</a>; <a href="#B44">Garc&#x00ED;a-Raga et al., 2016</a>
have indicated that the use of conflict mediation in the educational field is perceived as very positive for teachers
its impact on conflict resolution and the prevention of serious and violent situations; it has also been highlighted the resistances that many educational institutions have to adopt this tool as part of their resources for the construction of a culture of institutional peace
Finally, different investigations (<a href="#B99">Ruiz de Alegr&#x00ED;a et al., 2009</a>; <a href="#B20">Casta&#x00F1;o and Le&#x00F3;n del Barco, 2010</a>; <a href="#B74">Mart&#x00ED;nez et al., 2011</a>; <a href="#B69">Limonero et al., 2012</a>) have shown the close relationship that exists between coping strategies and the management of significant emotional situations for people
high or low emotional intelligence and resilience
This model can be contrasted with systematic review studies or descriptive non-experimental studies
where the systematic observation record is used
through which conflicts can be observed and recorded as they occur in their natural context
This proposal integrates the constructs conflict mediation
emotional regulation and coping strategies under an Integrated Circular Model of Conflict (ICMC)
whose particularity is to be able to feedback from the teachers&#x2019; own experiences
from knowledge facilitators-transmitters to reflective-practical ones
who analyze everyday educational situations
making continuous adjustments to improve the teaching-learning process
The mediation of conflicts implies the application of established principles and techniques aimed at resolving differences that arise between parties, without the need to apply sanctions or punitive measures, which have shown little to no effectiveness (<a href="#B102">S&#x00E1;nchez Ruiz, 2016</a>)
aimed at the prevention of structural violence
whose results evidenced the need to elaborate
apply and evaluate more programs of this type
since they not only collaborate in the resolution of the arised conflictive situations
but also encourage the involvement of the different actors in the educational environment
who perceive mediation as a strategy that encourages change and transformation of interpersonal relationships
The decrease in conflicts is noticeable in the educational centers that have applied mediation processes, where one of the factors indicated as determining for the success of the application of these processes, is the active participation of both the management team of the educational center and the teachers (<a href="#B18">Carrasco et al., 2016</a>)
of a culture of peace achieved through initiatives of conflict mediation processes in education
should not only be a matter of learning and application for the student
but the adults should also be affected by the educational function of the processes of mediation
if you really want to deepen the democratization of educational institutions with the use of mediation
the entire educational community must be guided
since they are all part of the relational dynamics and everyone is prone to get involved in conflict situations
although its members occupy different and unequal positions in the same institution and their rights and duties are regulated by means of different regulations
Emotional regulation, which refers to a process which people use to manage the emotions they experience, when they happen and how they are experienced and expressed is indispensable in order to adapt to social dynamics, trying to maintain good physical, psycho-emotional health, as well as healthy and productive interpersonal relationships. According to the Extended Process Model of Emotional Regulation proposed by <a href="#B50">Gross (2015)</a>
it is indicated that the emergence of emotions -and other affective states- occur as a result of a series of evaluations that individuals perform
and also including the contexts of personal interrelation
the need to analyze the behaviors of the people involved in a conflict is evident
to understand when they use coping strategies focused on the intrapersonal effect of emotional experience
directed at the impact of affection on their own conflict behavior
and when they focus on the interpersonal effect of emotional experience
in the impact of affection on the behavior of others
The fact of observing and identifying the coping strategies used by the students and by the teachers themselves
in their &#x201C;pure state&#x201D; (in situ
prompt and direct tactics and mechanisms to better manage conflicts that arise in the classroom
the ICMC is made up of three phases that include conflict analysis
theoretical and practical review and application in situ for the handling that teachers do of conflict situations that arise in the natural context of action
the self-knowledge acquired by people who have a tendency to attend their own mood
is involved in the development of greater regulatory capacity and
a greater adaptation capacity for interpersonal relationships
It coincides in some points with the proposal of the integrated conflict model (Caram&#x00E9;s et al.
in trying to balance the positions of both parties involved in the conflict
they can work more focused on the reestablishment of the relationship than in the result obtained in the mediation
proposes an analysis of the conflict and the coping strategies of those involved
The ICMC has two particular characteristics that aim to complete some gaps detected in these models; on the one hand, it is a dynamic model (<a href="#F1">Diagram 1</a>) that feeds on the experiences of teachers and makes adjustments according to the needs of each educational institution
This represents a differential point of other models and programs that present pre-established and equal training for all educational centers
The consideration of the differences existing in each educational institution
if they have mediation programs already established in the center
are factors that should be considered so that the implementation of the program or model has a greater chance of causing a significant and lasting impact over time
it represents a point of identification and involvement of teachers within the model
since it is being built and fed back from their experiences
Dynamic diagram of the Integrated Circular Model of Conflict (ICMC)
the relationship between conflict mediation
and its application in the field of education is analyzed
A mediation process must consider the emotional aspects that influence the creation of the conflict, for example, negative emotions, such as anger, can trigger conflicts or even episodes of violence if they are not properly regulated (<a href="#B33">Filella et al., 2018</a>)
Conceptual summary of the Integrated Circular Model of Conflict Theories
To address this interaction, knowledge is required to generate resolution and prevention tools for the accelerated growth of conflicts experienced by educational institutions in many countries around the world (<a href="#B33">Filella et al., 2018</a>)
contemplating the different factors involved
This study proposes a model aimed at facilitating the development of resources for teachers that allow them to improve the management of the different conflict situations that arise in the context of the classroom
This dynamic model aims to complete gaps detected in other previously developed models
integrating elements that allow a synergy of actions aimed at stimulating the cognitive
in a more complete way than what is provided by each element separately
Carrying out constant evaluations of daily tasks and including teachers as main protagonists
since it allows them to expand their functions
not only acting as transmitters of knowledge
but also as generators of information aimed at developing research which will result in improvements in their own functions
taking advantage of their experiences to enrich the teaching&#x2013;learning processes
recognizing the importance of the research&#x2013;practice&#x2013;research relationship
in addition to representing an applied advantage over other previous models and programs
allows to produce new theories related to educational dynamics and the importance of teacher participation
which supports and in turn enables a more rigorous empirical development
A door is left open for the application of this model with the objective of obtaining empirical results that demonstrate its strengths and weaknesses
improving the weak aspects for future research
Given the evidence of studies that analyze these constructs separately
we conclude the following; it is necessary to create a model that integrates the most important aspects
development and regulation of conflicts in education
emotional regulation and coping strategies
analyze and synthesize the aspects that link some elements with others to develop exercises
implement them and evaluate them in a way that generates cognitive
which makes it possible to improve the management that teachers make of the conflicts that arise in the classroom
which turns this model into a pioneering proposal
which aims to make a contribution to solve this need of lack of knowledge
To ensure that teachers solve the training gaps that they show when they face conflicts in the educational field, one of the first aspects that must be worked with them is the direct modification of their emotional experiences through cognitive reevaluations (<a href="#B8">Becker et al., 2015</a>)
Cognitive reevaluation plays a very important role in regulating emotions and
future studies could consider how this intervention should be designed to promote effective and adaptive cognitive reevaluation strategies in teachers so that they can benefit emotionally
Finally, with the strengthening of these three elements: conflict mediation, emotional regulation and coping strategies, teachers enable the reduction of behavioral problems in the classroom, with fewer interruptions between classmates, and with more involved and participatory students in educational issues (<a href="#B53">Hauser, 2019</a>)
Although this study provides evidence linking particular characteristics of each of the central elements
which can be complemented to develop a conceptual model that responds to the growing number of conflicts that arise in schools
its conclusions are limited in several ways
Prospective studies are required to validate the complementarity of these elements in a single conceptual model and should serve as a basis for future adjustments to the model
Finally, since previous research has shown the link between the emotions of teachers and the motivation of students (<a href="#B37">Frenzel et al., 2009a</a>; <a href="#B108">Ursu et al., 2009</a>; <a href="#B64">Kunter et al., 2013</a>)
it is suggested to future research to analyze whether there is a direct involvement between cognitive reevaluation and the level of motivation of students and teachers; that is
if cognitive reevaluation can stimulate nociceptive neurons that in turn promote the motivational states of people
and responsible for the literature review and the drafting of this manuscript
MA revised the manuscript and approved it for publication
PB gratefully thanks to Universidad Estatal a Distancia de Costa Rica (UNED) the support of an academic grant (Acuerdo COBI No 7661)
PB and IA also acknowledge the support of University of Barcelona (Vice-Chancellorship of Doctorate and Research Promotion)
IA thanks also the support from Grup de Recerca en Psicologia Social
Ambiental i Organitzacional 2017 SGR 00564 (PSICOSAO)
MA gratefully acknowledges the support of a Spanish government subproject Integration ways between qualitative and quantitative data
Innovaci&#x00F3;n y Universidades/Agencia Estatal de Investigaci&#x00F3;n/Fondo Europeo de Desarrollo Regional)
MA thanks the support of the Generalitat de Catalunya Research Group
Tecnolog&#x00ED;a i Aplicaci&#x00F3; Multimedia i Digital als Dissenys Observacionals (Grant number 2017 SGR 1405)
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Copyright &#x00A9; 2020 Bonilla R., Armadans and Anguera. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
*Correspondence: Pedro Bonilla R., <a id="encmail">cGJvbmlsbGFAdW5lZC5hYy5jcg==</a>; <a id="encmail">cGVkcm8uYm9uaWxsYTVAaG90bWFpbC5jb20=</a>
Volume 10 - 2019 | <a class="ArticleLayoutHeader__info__doi" href="https://doi.org/10.3389/fpsyg.2019.01832">https://doi.org/10.3389/fpsyg.2019.01832</a>
A child diagnosed with autism may have a negative psychological and behavioral impact on their siblings
whose participation in a group with children in the same situation is a preventive measure
Our group study was conducted by two therapists (T1 and T2) assigned to co-therapy (CT) work
Both therapists shared the theoretical bases and understanding of the group and the needs of the individual subjects
and complemented each other in terms of the direction of their interventions
given that shared impressions and continuous exchanges that integrate countertransference aspects are essential to successful co-therapy
The objectives of this study were as follows: (a) to detect patterns of clarification
and interpretation interventions by T1 and T2 in the group; and (b) to detect patterns of clarification
confrontation and interpretation interventions considering T1 and T2 as the only focal subject of the CT
Design was mixed-methods based on systematic observation
for which we developed a qualitative ad hoc instrument that combined a field format and a categorizing system
Interobserver agreement was analyzed quantitatively using Cohen&#x2019;s kappa and Krippendorf&#x2019;s canonical concordance
lag sequential analysis using GSEQ5 software was performed to search for behavior patterns
The results show (a) different behavior patterns in the clarification
and interpretation interventions by T1 and T2; and (b) different behavior patterns when T1 and T2 are considered as the focal subject (CT)
Our study offers a new perspective on the impact of therapist interventions on participants in this kind of group
children with ASD-Sibs had significantly poorer &#x2013; albeit small in magnitude &#x2013; outcomes
specifically in their internalization of behavioral problems
No significant results were obtained for adaptation
In this study we were especially interested in observing how the two therapists related and interacted as co-therapists with each other and with the children
because of the complexity of the interactions
the group phenomenon and the co-therapy relationship
specifically on the interventions and complementarity of the co-therapy relationship
The training of the therapists is the solid foundation that ensures the studied group become therapeutic. Since the group in question is not a self-help group or a group with a specific requirement, but rather resembles a parent or family group, we may define it as a support group. Support groups, in contrast with ad hoc crisis intervention groups, are designed to offer emotional support to persons sharing a common problem or handicap (<a href="#B73">Scheidlinger, 2005</a>)
But unlike a standard support group working on the subject that links it
our intervention group reinforces individual and group work so that the therapeutic work is self-validated
Also relevant here is Scheidlinger&#x2019;s idea of the mother-group, which refers to an aspect of identification with the group entity that connotes a covert wish of group members to restore a state of unconflicted well-being, characteristic of an earlier tie to the mother (<a href="#B72">Scheidlinger, 1974</a>)
This longing for a return to that relationship and its unequivocally positive need-gratifying elements is brought directly to bear in and by the group
The main objective of our research was to study the interaction of therapists and children using a mixed methods framework, an approach that has acquired a certain tradition in recent years (<a href="#B14">Arias-Pujol and Anguera, 2017</a>; <a href="#B36">Del Giacco et al., 2019</a>), in accordance with the Guidelines for Reporting Evaluations Based on Observational Methodology (<a href="#B65">Portell et al., 2015</a>)
we wanted to identify the existence of possible patterns of behavior in the communicative interactions between children and therapists (a) in turn-taking and (b) breaking down interventions involving clarification (I1)
and interpretation (I3) for therapist 1 (T1) and therapist 2 (T2) separately and for the two therapists as a single focal subject (co-therapists
The observational methodology offers eight types of observational designs (<a href="#B5">Anguera et al., 2011</a>; <a href="#B71">S&#x00E1;nchez-Algarra and Anguera, 2013</a>; <a href="#B7">Anguera and Hern&#x00E1;ndez, 2015</a>) based on three criteria: the number of participants (idiographic or nomothetic)
the continuity of the recording (one moment or follow-up) and the number of criteria observed (unidimensional or multidimensional)
it was nomothetic (N) because we studied six subjects (two therapists and four children)
it consisted of follow-up (F) because we transcribed six consecutive and multidimensional group sessions
and it was multidimensional (M) because we coded different dimensions of the observed behaviors with concurrent and event-base data from quadrant II of the systematic observation design
The six participants were two women therapists (T1
T2) and four children aged 6&#x2013;9 years old (P1
The therapists are clinical psychologists with decades of experience with groups and with autism from a psychoanalytical perspective
inclusion criteria were (a) age 6&#x2013;9 years
Exclusion criteria were a diagnosis of pervasive developmental disorder (PDD) and attendance at psychotherapy
The therapists requested the permission of the parents to include their children in the group
The setting is a 1-h monthly meeting over 2 years
the therapists send a reminder letter to the children&#x2019;s home regarding the upcoming session
one with colored plasticine and the other with two foldable wooden figures of families (father
The group&#x2019;s activities focus mostly on the wooden dolls and the plasticine
and the plasticine figures made by the children are kept
with some becoming like persons in the group
At the family level, there are three meetings with parents, two in groups (one each before and after the main sessions) and an individual meeting (<a href="#B41">Fieschi et al., 2011</a>; <a href="#B83">Venturella et al., 2014</a>)
the participants were informed that they were being filmed and parents signed a written informed consent
authorizing the participation of their children in this research
the reason for filming was explained to the subjects
along with the privacy and confidentiality conditions regarding session content
an observer (a psychologist in training) sat at a distance from the table where the group&#x2019;s conversation was taking place and took notes
We used both observation and recording instruments
Our ad hoc observation instrument, following observational methodology canons (<a href="#B71">S&#x00E1;nchez-Algarra and Anguera, 2013</a>; <a href="#B65">Portell et al., 2015</a>), combined field format with category systems (<a href="#B8">Anguera and Izquierdo, 2006</a>; <a href="#B9">Anguera et al., 2007</a>) and was structured according to the dimensions identified from the conceptual framework
A system of categories was built from the dimensions
which was hierarchical in some of the dimensions (i.e.
macro-categories that unfolded into categories)
This instrument was designed to fulfill exhaustiveness and mutual exclusivity requirements for each of the category systems
all verbal/vocal expressions by the children and the therapists were first transcribed in full
Their analysis resulted in an instrument of 27 codes in four dimensions: (1) turn-taking
was divided into two macro-categories: therapists and children
which considered the participatory interactions in each turn
was distributed in five macro-categories: body
The ASD-Sibs dimension &#x2013; the common element among the participating children &#x2013; reflected all comments regarding the sibling with autism
play reflected the techniques used to foster interaction and expression within the group
<a href="#F2">Figure 2</a> depicts the observation instrument with the dimensions along with a description of the macro-categories and codes (the number of the codes does not reflect range or quantity)
We focused on the intervention macro-category (the group dimension) and on specific communications between therapists in relation to the emotional field of the children. To better exemplify the data analyzed below, <a href="#F3">Figure 3</a> shows fragments of text that could potentially represent the intervention macro-category (indicated in dark gray)
Used as the recording instrument &#x2013; to ensure maximum accuracy in data collection &#x2013; was a video camera
To minimize the reactivity bias of the participants
the camera was positioned discreetly at a high viewing angle in the room
we used recordings of six sessions from the first year with the group
but excluded three of these as not being fully audible
All sessions were video-recorded and subsequently transcribed in full
For the transcribed conversations between the children and the therapists
intervention turns were considered as the units of analysis
which were assigned the codes reflecting each dimension from the observation instrument
Data quality control was implemented to ensure that codes were correctly assigned. Three observers, previously trained using the approach described by <a href="#B4">Anguera (2003)</a>
resulting in a Krippendorf&#x2019;s alpha (&#x03B1;) value of 96% (with values above 80% indicating reliable data)
These values indicate that the categories were well defined and had good consistency
with the fact that the system was highly concordant guaranteeing the reliability of the material encoded for subsequent analysis
In our study we applied it to an analysis of concurrent and event-based quadrant II data. For our analysis, we used GSEQ v.5.1 software (<a href="#B19">Bakeman and Quera, 2011</a>)
in which an algorithm compares the unconditional and conditional probabilities of behavioral occurrences (in our case
prospectively and retrospectively) in the form of frequencies of transition to a criterion behavior
established according to the objectives of the study
Since the study refers to communication processes
we separately considered the intervention turns of the therapists (T1 and T2) and of the grouped children (children) as the criterion and conditional behaviors
we separately considered the criterion behavior of each therapist for the three forms of intervention
and used the remaining codes as the conditional behaviors
the co-therapy (CT) macro-category was taken as the criterion behavior for the three intervention forms (CTI1
CTI3) and the remaining codes were taken as the conditional behaviors
Example of adjusted values (RSAJ) obtained for turn-taking between T1
Our results are described in four sections: the first reflects turn-taking between the therapists and the children
while the remaining three reflect behavior patterns in relation to use of clarification
and interpretation by each therapist separately (T1 and T2) and then together in co-therapy (CT)
The analysis yielded ten distinct interactive behavior patterns between lags &#x2212;1 and +1 responding to the question: what precedes and what succeeds therapeutic interventions
This first set of patterns with arrows, as shown in <a href="#F4">Figure 4</a>
point to clear symmetry and reciprocity between T1
This suggests that communication in the group is fluid and that each person is stimulated by the others to participate
Results for significant behavior patterns corresponding to turn-taking by therapists T1 and T2 and child participants P1
The second set of results, depicted in <a href="#F5">Figure 5</a>
we see how the clarification intervention by T1 arises after the same kind of intervention by T2 or after a brief response by one of the children (P2 B1)
These interventions generate short responses (B1
Results in the form of behavior patterns for interactions between turn-taking interventions by therapist T1 as the focal subject
and turn-taking by therapist T2 and child participants P1
The use pattern of confrontation by T1 is this time much more complex
T1 confrontations follow T2 interpretation interventions (T2 I3) or involuntary behaviors
and lead to clarification (I1) and confrontation (I2) interventions by T2
we see that P1 stimulates T1 with brief interventions (B1) or follow-ups to the conversation (R3)
and S2) and verbal follow-ups to the conversation (R3)
one of the children (P2) responds with non-verbal approval gestures (C3)
The pattern also reflects the possibility of a response in the form of silence (S1) or of a comment regarding the game (M1)
we also see that these follow interpretation interventions (I3) or laughs (S3) by T2 and
generate confrontation (I2) and interpretation (I3) interventions
short answers (R1) and comments regarding the game (M1) by P3 or involuntary reflexes
such as coughs or sneezes (S2) by P4 prior to the interpretation by T1
the interpretation generates brief expressions of disagreement or doubt (B2) in two of the children (P1 and P4) and interruptions (R2) by another child (P3)
<a href="#F6">Figure 6</a> shows an example of a communicative behavior pattern in the use of confrontation by T1
This third set of results, depicted in <a href="#F7">Figure 7</a>
is even more complex that the previous set
In the first pattern we see how the clarification intervention (I1) by T2 follows the clarification intervention (I2) by T1 or a brief response (B1)
non-verbal response (C3) or coughing or sneezing (S2) by the children (P2
T2 clarification interventions generate coughing or sneezing (P2 S2)
very short responses or verbal agreement (P3 B1)
Results in the form of behavior patterns for interactions between turn-taking interventions by therapist T2 as the focal subject
and turn-taking by therapist T1 and child participants P1
these follow interpretation or laughter by T1
A priori of the confrontation intervention
the children (P1) briefly express agreement (B1) or doubt (B2)
or express their collaboration with the conversation (P3)
The confrontational interventions by T2 generate short responses
coughing or sneezing by P4 or silence in the whole group
the interpretations of T2 arise from brief expressions of gratitude or collaborative interventions by one child (P1)
interruptions by another child (P4) and a non-verbal response by yet another child that stimulates laughter (P2)
The interpretations of T2 stimulate interpretation (I3) or confrontation (I2) interventions
and also coughing or sneezing (S2) by T1 and laughter or other sounds reflecting humor in P2
<a href="#F8">Figure 8</a> shows an example of a communicative behavior pattern in the use of clarification by T2
This final set of results shows that when T1 and T2 are grouped together (i.e., CT), communicative patterns are simplified somewhat, as shown in <a href="#F9">Figure 9</a>
The first detected pattern is clarification interventions following repeated questions by one child (P1 R1) or laughter or other sounds reflecting humor by the therapists
generating brief assent (B1) or doubt (B2) interventions in another child (P3) or interruptions (R2) or interventions that foster progress (R3) in yet another child (P4)
Results in the form of behavior patterns for interactions between turn-taking interventions by the therapists together (CT) as the focal subject
confrontation interventions arise after non-verbal responses by P2 or brief interventions expressing doubt or disagreement by two of the children (P1
CT interpretation interventions arise after laughter or other sounds reflecting humor in one of the children or the therapists (P3
or brief interventions expressing doubt or disagreement (B2) by one of the children (P3) or interruptions (by P4)
These interpretations generate other brief interventions expressing doubt or disagreement (P1
CT) or other confrontation interventions by the therapists (CT)
<a href="#F10">Figure 10</a> shows an example of a communicative behavior pattern in CT use of confrontation
The intervention macro-category was designed as a resource and as a means of communication for psychoanalytical therapists T1 and T2
interventions introduce new variables and new emotional experiences and help to develop new mental models
The changes seen in the children were the result of the attitudes and verbal interventions of the therapists
In the group, both therapists perform clarification after a brief communication (body or sound). As the therapists do not introduce feelings or ideas that the children have not expressed, these continue with a similar discourse in the form of a brief response, some sound or silence, followed by manipulation of the material. Given its simplicity and neutrality, this intervention generates confidence and helps improve connections between participants (<a href="#B32">Coderch, 2009</a>)
Confrontation arises when thoughts are explored in depth (<a href="#B39">Ferro and Civitarese, 2016</a>)
this type of intervention occurs after brief
as well as after responses of a more relational nature
Since the therapist highlights omitted aspects
in some cases accompanied by manipulation of the material
by a brief communication (body or sound) and
The fact that the main objective may be to facilitate the transition from clarification to interpretation would explain a downward tendency during the group session
Confrontation helps children overcome their difficulties in expressing themselves. It also facilitates clarification and interpretation interventions (<a href="#B57">Lichtenberg, 2016</a>)
Interpretation is a basic psychoanalytic instrument
To interpret is to explain the unconscious meaning of statements to patients
interpretation interventions are also represented after brief
they add to the sequence of material and play
through which therapists inform children of unconscious mental processes that direct and condition their relationships with others
Subsequent responses are usually given by the therapists themselves or
The therapist&#x2019;s efforts focus on bringing the patient to an understanding of how to balance their inner fantasies with influences from the external world
The emergence of behavioral patterns of silence or of responses that reflect collaboration or dissatisfaction in the children in response to the interventions of the therapists is consistent with results obtained in previous research on the role of the psychoanalytic therapist in group sessions (<a href="#B12">Arias-Pujol and Anguera, 2004</a>, <a href="#B13">2005</a>) and in individual sessions (<a href="#B15">Arias-Pujol et al., 2015</a>)
In our sequential analysis it was found that T1 activates clarification and confrontation interventions by T2 but does not follow up on these interventions
The opposite happens in the interpretation interventions
where T1 does not activate T2 interventions
T2 activates all the three types of interventions by T1 and follows up on confrontation and interpretation interventions
Both therapists are women. T1 (the older therapist) seems to assume a greater role in containment, tolerance, and follow-up. The younger T2 seems to play a role that is more activating, verbal and available (<a href="#B53">Kosch and Reiner, 1984</a>)
therapeutic interventions present significant sequences in the response patterns that precede and succeed them
more global than the analysis of individual relationships within the group
is characterized by more general aspects and issues reflecting the group as a whole
it can be observed that in the CT clarification intervention
P1 is hidden in previous analyses of this category
the leadership of the other children is obscured
While the subsequent responses are similar to those of the therapists in isolation
there is no room for the silence represented above
the two protagonists of separate interventions by the therapists stand out
but therapists conceal what the other children express and leave silence evident
Interpretation implies deeper intervention. The co-therapeutic result helps protect the children, since previous and subsequent follow-ups to the interpretation intervention take place between the therapists themselves (<a href="#B24">Blum, 2016</a>)
T2 activates T1&#x2019;s interpretation and follows up
and T1 activates T2&#x2019;s interpretation and follows up
as a powerful force of identification and connection for the group as a whole
there is no differentiation of functions other than those determined by the personal and professional characteristics of each therapist; however
alternating between different functions means they participate in the transference process
analyzing the profiles of the therapeutic partners (co-therapists) draws attention to children and responses not observed in the individual analyses of each therapist&#x2019;s interventions
In addition to our sequential study of the interventions, we were able to observe parallels and interwoven relationships for the two therapists, who complement each other in the direction in which their interventions are intended. Basic aspects of co-therapy include shared impressions, continuous exchanges and integrated countertransference aspects (<a href="#B28">Cabr&#x00E9;, 2002</a>). As noted by <a href="#B73">Scheidlinger (2005)</a>
most group therapists tend to adhere to a pluralistic-integrative orientation that appears to be suited to the complexity of individual and group-level manifestations
A limitation of our study is the fact that results cannot be generalized
both in terms of the number of sessions and the variety of attitudes
the group should be considered as a unique case analyzed in depth in terms of individual processes
it would be of great interest to broaden the theoretical foundations of co-therapy
other groups may benefit from the developed ad hoc instrument and so evolve to new lines of research
This study was carried out in accordance with the recommendations of &#x201C;Comit&#x00E8; d&#x2019;&#x00C8;tica de la Recerca (CER-URL)&#x201D; with written informed consent from all subjects
All subjects gave written informed consent in accordance with the Declaration of Helsinki
The protocol was approved by the &#x201C;Comit&#x00E8; d&#x2019;&#x00C8;tica de la Recerca (CER-URL).&#x201D;
MV developed the project and performed the sequential analysis
VC and XC contributed to the documenting and writing of the manuscript
This research was supported by the Catalan government under Grant 2017 SGR 876 awarded to the project Grup de Recerca de Parella i Fam&#x00ED;lia (GRPF)
Elena Fieschi and N&#x00FA;ria Farr&#x00E9;s
We also thank the children in the group and their families
We also gratefully acknowledge the support of Ramon Llull University (PGRiD of FPCEE Blanquerna)
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Copyright &#x00A9; 2019 Venturella, Carbonell, Cabr&#x00E9; and Arias-Pujol. This is an open-access article distributed under the terms of the <a rel="license" href="http://creativecommons.org/licenses/by/4.0/" target="_blank">Creative Commons Attribution License (CC BY)</a>
*Correspondence: Mariella Venturella, <a id="encmail">dmVudHVyZWxsYS5tYXJpZWxsYUBnbWFpbC5jb20=</a>
Marc Guiu has become the latest sensation from La Masia to make his debut with the men's first team
but did you know that he started playing football at a supporters' club
Marc began playing with the Penya Barcelonista de Sant Celoni
where they still have photographs of his time there and are very proud to have had him from a very young age
But he is not the only player recently being called up to the first team who comes from a supporters' club
who currently plays for U19A and kicked his first balls at the Penya Barcelonista Anguera
the FC Barcelona penya is very proud indeed of the progress being made by their former player:
Primera convocatòria amb el Primer Equip del FC Barcelona en competició oficial de l'Héctor Fort, el nostre ex-jugador en categories inferiors, en la victòria contra l'Athletic Club 😍No podem estar més orgullosos de tu! Segueix el teu camí amb treball i el sacrifici Héctor 💛 <a href="https://t.co/83MWPN1g19">pic.twitter.com/83MWPN1g19</a>
<a href="https://www.marca.com/" title="Ir a la versi&oacute;n completa de MARCA.com en castellano">Versi&oacute;n en castellano</a>
After 32 years with the first team and 36 at the club
Send to multiple recipients separating emails with a comma 
the Barcelona kitman Jos� Mar�a 'Txema' Corbella - who has become something of an institution at the club - has been told that he will leave his job with the first team in the next few days and will either be moved to another position or can accept an offer of early retirement
Corbella learned of the news when he returned from his holidays
He received a letter from the human resources department and for several hours it appeared that the club had sacked him
Barcelona insist that it was a club decision that in no way consists of him being fired &ndash; rather he will be given another position and receive the same benefits
the kitman has been given the option of early retirement
Corbella joined the Barcelona first team in 1982 on the very day that Diego Armando Maradona also joined the outfit
replacing another of the club's legendary kitmen
It is more of a sentimental than a professional decision
because Corbella is a character who has an excellent relationship with the first team players
and "the president" &ndash; as they call him &ndash; has taken part in some of the many celebrations at the Nou Camp after winning titles
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