The Adventures of Fundi Intervention Based on the Cognitive and Emotional Processing in Attention Deficit Hyperactive Disorder Patients

As expected, the training, Adventures of Fundi, was useful to intervene in ADHD behavioral dysfunction based on both the PASS cognitive processing and self-confidence emotional processing. The success is in terms of better cognitive processing and better behavior. The better cognitive processing is mainly in planning and not so much in attention (Table 1). PASS planning and selective attention join the executive function. It is well known that a better executive function is associated with a better behavior, therefore, we can expect improved behavior in an ADHD sample. The remedial procedure involves inductive learning and an emotional communication technique promoting self-confidence that can, at least in part, explain the results. The effectiveness of inductive learning has been previously and sufficiently demonstrated^2,6,8.

On the other hand, moods, even positive ones, interfere with the central cognitive tasks (memorizing complex materials, detecting contradictions in texts, etc.). Arguments must be focused on finding how the improvement in self-confidence happens. Self-confidence is the result of subtracting safe-confident experiences from unsafe-unconfident experiences throughout life. The safe experiences throughout life determine the confidence. The improvement in executive function and the inductive learning provide a safe-confident experience, but the more innovative point is that the Ericksonian indirect communication metaphor is a powerful tool to generate self-confidence, communicating well-being unconsciously^{16,17,18,19,20,21} rather than consciously. Much of the behavior consists precisely in the automatic functioning. Self-confidence is the key point to improve cognition (and learning) and emotion and consequently behavior. Therefore, we can expect better ADHD behavior.

We are developing a rationale for supporting the effectiveness of this technique as a procedure for promoting self-confidence. Supporting evidence is being reported to measure emotion (well-being and discomfort) objectively, in terms of behavioral and physiological changes. Not only emotional response can be objectively studied, like body language, facial expressions, tone of voice, etc., but also psychophysiological responses can also be studied such as, skin conductance, heart rate, and so on⁵⁸. The role of body language in expressing unconscious processing and implicit (unconscious) decision well described in previously published literatures^7,44.

Many body expressions tell us about cognition and emotion. For instance, eyes down and to the left or to the right show body sensations; eyes level and to the left or to the right show successive processing; eyes up and to the left or to the right show simultaneous processing, etc. Other examples of informative body expressions are as follows: shoulders relaxed and drooped and breathing deeply in the abdominal area (as in breathing from the diaphragm) depicts tranquility and relaxation. In contrast, wrinkled forehead and/or contracted jaw and/or shoulders thrown back and/or shallow breathing in the chest and/or a fixed grin show tension and concentration among other expression: unusual posture, rigid body, rocking back and forth or side to side, leaning to one side, head turns, facial expression (mouth and eyebrows), startled look, big grin on the face, eye contact, yawning, specific hand movements, particular words or phrases, voice quality and pitch, tempo (rhythmic, choppy), volume, tone, inflection, speed, and so on.

This technique is based on the cognitive and emotional unconscious processing for diagnosis and treatment. In contrast, almost all cognitive psychology and remediation is based on the self-report of what they perceive, think, remember, and feel. That is, they seem to rely on self-reports of what subjects report. This way, emotion is viewed as a product of cognitive construction such that the factors that differentiate the emotions are the cognitive attributions that people make about their emotions.

In last decade, neuroscience studies have reaffirmed the unconscious mind. This technique is based on the unconscious mind for cognitive and emotional diagnosis and treatment. For instance, people can recognize an image they have seen before even when they have been unaware of having seen it²¹. About 40 ms is the time it takes to form an opinion of a stranger, which is a shorter time than a blink. However, it is enough time to observe what the subject's face and body language is doing such that the brain-mind can interpret it unconsciously if its facial features and body language inspire confidence or danger³⁶.

A step further is to focus on cognitively unsound uses of reasoning. We base decisions on the availability of justificatory reasons^42,43. Conscious reasoning is applied to rationalize more than anything else⁵⁹. This process is supported by neuroimaging studies. One of them²³ concludes that the brain might cheat when learning or behaving, building memorized answers to respond to similar questions. Thoughts and impulses simply arise in consciousness without will or intent. Which is all to say, we are not in any relevant sense the conscious authors of our mental lives, nor the actions that flow from them. Therefore, the self-verbal report is questionable. Another example, the verbally reported strategy to perform a task may not be the one the child used, according to the observable eye movements of the child^{1,6,7,8,14,15}. Likewise, a self-verbal-report of positive view (overconfidence) of oneself is not necessarily a reliable indicator of self-confidence; on the contrary, it could be the opposite^7,14,15. Humans reason rather poorly, as reported by Mercier and Sperber (2011)⁴³, irrational biases in decision making^37,39,40. It is about intuitive-unconscious inference^42,43. This is in sharp contrast to the classical view that pro and con reasoning is the most reliable way to arrive at sound decisions^{17,18,19,40,58,59}.

Following Kahneman^{37,39,40,60,61}, we have a dual-process system of decision-making: automatic linked to emotion (gut reaction) and deliberative linked to rational calculation. However, following Greene^62,63, “the response to footbridge has an emotional charge that is missing in the allegedly more rational response to switch.” Brain imaging studies link the emotional ventromedial prefrontal cortex with “footbridge” decision whereas the “switch-type” response is linked with the cognitive-rational dorsolateral prefrontal cortex. On the other hand, injury studies of the ventromedial prefrontal cortex show that this injury predisposes approval of pushing the fat man off the bridge. The LeDoux studies¹³ showed that the temporal amygdala responses to danger before the cortex (thinking brain). More importantly, the response of the cortex did not modify the earlier response of the amygdala. This fact is entirely consistent with the thinking cortex, putting into action thoughts that justify the response to danger (cognitive bias).

To go one step further, we must elaborate on the anticipatory unconscious processing. This processing (unconscious before conscious decision processing) has been studied, not only, in the field of neuroscience^{22,23,24,25,26,27,28,29,30,31,32,33,34,35}. Brain studies on the pre-decision period^{22,23,24,25,26,27,28,29,30,31,32,33,34,35} have found neural activity representing the upcoming choice. As Soon et al. reported (2013)³¹, a decision can be encoded in brain activity of the prefrontal and parietal cortex up to 10 s before it enters awareness.

As previously reported for practical applications⁷, techniques that are used in this type of communication include the use of metaphors, indirect questions, hypothetical phrases, introductory phrases, ambiguous terms, saturation of channels of information, melodramatic expression or confusion, post-trance amnesia, silence, dissociation, paradox, false alternative options, and prescription of the symptom. These communicative techniques involve extreme attention focalization (trance state) on what is being said and done by the therapist. Attention cannot be focused on other thoughts associated with bad feeling because of the known limited attention span. All this happens unconsciously.

In particular⁶⁴, the metaphor is an indirect method of verbal and nonverbal communication and it is the basis of Ericksonian hypnosis^44,65. This method of communication is an educational and psychotherapeutic proven procedure^{45,46,47,48,49,50,51,52,53}. The metaphor involves a cognitive effect while conveying an idea – thought (message), but also, and more importantly, produces an analgesic-reassuring effect because of a distraction work linked to focused attention, taking into account that the attention span is limited. In other words, a highly focused attention on getting the meaning of the metaphor in action (Ericksonian hypnosis effect) restricts other cognitive processing (thoughts) and the associated memorized painful feeling (discomfort). It causes an analgesic effect. This analgesic effect is the key to avoid resistance to the communication. If so, interpersonal communication requires to fit this principle to be more effective. On the other hand, there is evidence that the metaphor uses a communication based more on tangible-concrete knowledge rather than abstract knowledge, which makes the message (knowledge) more easily processed and far transferred.

In contrast, most procedures to intervene are based on gaining conscious control of thought and action, but we must assume that implicit emotions are less subject to conscious self-regulation. It is intended to help people learn how to cope with otherwise threatening and debilitating emotional situations, assuming one can strengthen the willpower with practice. Not only does this seem too simplistic, but it sidesteps the core problem of self-control: what is controlling what? The consequence of this is to give cognitive psychology a fuller, richer understanding of how the mind operates. This will inevitably have some implications for clinical work on learning and behavioral disorders and ADHD in particular. The only way to do this is to get clinicians to collaborate with experimental psychologists to produce methodologically adequate clinical studies.

In conclusion, the Adventures of Fundi was able to improve PASS cognitive processing planning and attention and also achieved remission⁶⁶ in manifestations of ADHD. This result should be attributed to the administration of the whole procedure. It took place using inductive learning and indirect communication (metaphorical Ericksonian hypnosis). Taking into account that the main effect of indirect communication is an effective emotional empathic communication (sensitive effect on self-confidence), we must deduce that other factors, non-cognitive, must be taken into account to maximize the benefit of cognitive and behavioral remediation. Likewise, we must summarize that the critical step within the protocol is the indirect communication, the technique has no significant limitations and its future applications are any dysfunction linked to executive dysfunction.

Some limitations deserve to be highlighted. Further research is required—at behavioral, cognitive, and physiological levels—to delineate the components of goal-directed behavior. The presence of the effect does not actually always provide support for the model. It is still needed to check that individual results hold up. The empirical point is now well established. We caution that the evidence for this proposition is consistent and, in some way, convincing, but maybe inadequately supported by the research so far.