22 research outputs found
Vulnerabilidad cognitiva a la hipocondr铆a: intrusiones, valoraciones y creencias disfuncionales/ Cognitive vulnerability to hypochondriasis: intrusions, appraisals and dysfunctional beliefs
La hipocondr铆a es un trastorno caracterizado por el miedo o la creencia de padecer una enfermedad grave a partir de la interpretaci贸n negativa de los signos y s铆ntomas corporales. La confirmaci贸n por parte de un m茅dico, despu茅s de una evaluaci贸n exhaustiva, de que el paciente no padece una enfermedad m茅dica, no tiene como resultado una tranquilizaci贸n segura y duradera. Por lo general, las personas que presentan hipocondr铆a pueden experimentar una reducci贸n de la ansiedad despu茅s de visitar al m茅dico, pero esta reducci贸n dura solo horas o d铆as. Cuando se presenta otro s铆ntoma, la ansiedad reaparece y el ciclo de preocupaci贸n hipocondr铆aca se reanuda. Adem谩s, la hipocondr铆a se puede manifestar de diferentes maneras. Algunos pacientes tienen numerosos pensamientos intrusos y sensaciones durante el d铆a que los llevan a consultar con la familia, amigos, internet o diferentes especialistas m茅dicos para asegurarse de que no est谩n gravemente enfermos o para identificar el curso de la enfermedad. Y, otros pacientes, por el contrario, evitan a los proveedores de servicios de salud y cualquier referencia a la enfermedad en su vida diaria, para que no aumente la ansiedad que buscan reprimir. La hipocondr铆a se ha conceptualizado tambi茅n, desde los modelos cognitivos, como la forma m谩s extrema de ansiedad por la salud.
Las propuestas cognitivo-conductuales de la hipocondr铆a y las investigaciones recientes en torno a este trastorno han sugerido diferentes variables cognitivas como posibles factores de riesgo para el desarrollo y mantenimiento del problema. Entre ellos, destacan: los pensamientos intrusos sobre los posibles peligros para la salud (PIEs), las valoraciones/interpretaciones y creencias disfuncionales asociadas a estos pensamientos, y los supuestos o creencias disfuncionales sobre la salud/enfermedad. Aunque todas estas variables se han se帽alado, en la literatura cient铆fica, como factores de vulnerabilidad hac铆a la hipocondr铆a, no existen apenas estudios en los que se analice su papel en la g茅nesis y evoluci贸n del trastorno, y los resultados obtenidos tampoco son del todo concluyentes. Por todo ello, la presente Tesis tiene como finalidad clarificar el rol que juegan los pensamientos intrusos, las valoraciones/interpretaciones y las creencias disfuncionales (sobre los pensamientos y sobre la salud/enfermedad) en la hipocondr铆a y la ansiedad por la salud.
El estudio preliminar proporcion贸 un instrumento fiable y v谩lido para evaluar la ansiedad por la salud en adultos de habla hispana, el Inventario Breve de Ansiedad por la Salud (SHAI). El Estudio 1 explor贸 la presencia y caracter铆sticas de los PIEs en la poblaci贸n general, y a trav茅s de este estudio se ha proporcionado un nuevo instrumento de autoinforme, el Inventario de Pensamientos Intrusos sobre la Enfermedad (INPIE), para evaluar los PIEs. El estudio 2 examin贸 las diferencias entre los pacientes con hipocondr铆a y los participantes de la comunidad en la recurrencia con la que se experimentaban PIEs y las consecuencias derivadas de su experimentaci贸n. Los estudios 2 y 3 tambi茅n evaluaron el papel de las valoraciones y creencias disfuncionales asociadas a los PIEs. El estudio 4 analiz贸 la importancia del contexto familiar en la adopci贸n de supuestos o creencias disfuncionales sobre la salud/enfermedad y los pensamientos. Los resultados muestran que (1) el SHAI es un instrumento de autoinforme apropiado para medir la ansiedad por la salud en la poblaci贸n adulta de habla hispana; (2) el INPIE es un cuestionario de autoinforme adecuado para evaluar la frecuencia de los PIEs, as铆 como las valoraciones y estrategias de control asociadas a estos pensamientos; (3) los PIEs son un fen贸meno universal y dimensional; (4) las valoraciones/interpretaciones y creencias disfuncionales asociadas a los PIEs juegan un papel significativo en la escalada de los pensamientos intrusos normales y sus consecuencias funcionales a los s铆ntomas cl铆nicos relacionados con la ansiedad por la salud, y (5) los supuestos o creencias disfuncionales sobre la salud/enfermedad y los pensamientos pueden adquirirse en el seno familiar. Estos resultados tienen implicaciones cl铆nicas sustanciales, ya que la comprensi贸n del funcionamiento y las caracter铆sticas de algunos de los elementos clave para la g茅nesis y el desarrollo de la hipocondr铆a y la ansiedad para la salud puede mejorar y actualizar los protocolos de tratamiento para estos pacientes.Hypochondriasis is a disorder characterized by the fear or belief of suffering from a serious illness based on the negative interpretation of bodily signs and symptoms. After a thorough evaluation, confirmation by a physician that the patient does not have a medical condition does not result in safe and lasting reassurance. Generally, people with hypochondriasis may experience a reduction in anxiety after a visit to the doctor, but this reduction lasts only hours or days. When another symptom occurs, anxiety reappears, and the cycle of hypochondriacal worry resumes. In addition, hypochondriasis can manifest itself in different ways. Some patients have numerous intrusive thoughts and sensations during the day that lead them to consult family, friends, the Internet, or different medical specialists to make sure they are not seriously ill or to identify the course of the disease. Other patients, on the other hand, avoid health care providers and any reference to the disease in their daily lives, so that the anxiety they seek to suppress does not increase. Hypochondriasis has also been conceptualized in cognitive models as an extreme form of health anxiety.
Cognitive-behavioral proposals of hypochondriasis and health anxiety and recent research on this disorder have suggested different cognitive variables as possible risk factors for the development and maintenance of the problem. They include intrusive thoughts about possible health hazards (illness-ITs), the dysfunctional appraisals/interpretations and beliefs associated with these thoughts, and dysfunctional assumptions or beliefs about health/illness. Although these variables have been pointed out in the literature as vulnerability factors for hypochondriasis and health anxiety, there are hardly any studies analyzing their role in the genesis and development of the disorder, and the results obtained are not entirely conclusive either. The purpose of this thesis is to clarify the role played by these variables in hypochondriasis and health anxiety. The preliminary study provided a reliable and valid instrument to evaluate health anxiety in Spanish-speaking adults, the Short Health Anxiety Inventory (SHAI). Study 1 explored the presence and characteristics of illness-ITs in the general population, and through this study, a new self-report instrument has been provided, the Illness Intrusive Thoughts Inventory (INPIE), to evaluate illness-ITs. Study 2 examined differences between patients with hypochondriasis and community participants in the recurrence of illness-ITs and the consequences of experiencing them. Studies 2 and 3 also evaluated the role of dysfunctional appraisals and beliefs about illness-ITs. Study 4 analyzed the importance of the family context in the adoption of dysfunctional beliefs about health/illness and thoughts. The results show that (1) the SHAI is an appropriate self-report instrument to measure health anxiety in the Spanish-speaking adult population; (2) the INPIE is an adequate self-report questionnaire to assess the frequency of illness-ITs, as well as the appraisals and control strategies associated with these thoughts; (3) illness-ITs are a universal and dimensional phenomenon; (4) dysfunctional appraisals/interpretations and beliefs about illness-ITs play a significant role in the escalation from normal intrusive cognitions and their associated consequences to clinical health anxiety-related symptoms; and (5) dysfunctional assumptions or beliefs about health/illness and thoughts can be acquired within the family. These results have substantial clinical implications because understanding the functioning and characteristics of some of the key elements in the genesis and development of hypochondriasis and health anxiety may improve and update the treatment protocols for these patients
The relationship between obsessions and the self: Feared and actual self-descriptions in a clinical obsessive-compulsive disorder sample
Cognitive models of obsessive-compulsive disorder (OCD) posit the relevance of the self in OCD, although the nature of this association is still unclear. We aimed to explore actual and feared selves and its association with obsessions and intrusions in a group of OCD patients. A group of 58 patients with OCD identified their most upsetting obsession and intrusion (non-clinical obsession) experienced in the past 3 months. These cognitions were classified as either moral-based or autogenous (obsessions n = 32; intrusions n = 26) or non-moral-based or reactive, depending on their content. Next, patients described their actual self and their feared self, that is, the person they feared being or becoming, and whether they believed these descriptions were associated with their obsessions/intrusions. Results indicate that individuals with OCD described themselves as insecure, anxious and fearful, but also as good and nice. They particularly feared a selfish, aggressive, bad, liar, coward, insecure and arrogant self. Two-thirds of the patients believed that their obsessions said something about their actual self (65.52%) and that their obsessions brought them closer to the person they do not want to be (62.06%). A third of patients believed their intrusions said something about their actual self (actual self: 30.35%; feared self: 25%), which was a significantly lower percentage than for obsessions. These associations existed independent from the content of the obsession and/or intrusion, although patients with obsessions with moral-based contents more often tended to believe that their obsessions brought them closer to the person they do not want to be. Results suggest the relevance of the real and feared selves in the maintenance of obsessions
Mental health stigma in Spanish university students
Knowledge about mental health problems and previous contact are key variables in the fight against stigma. The aims of the study were: (1) to explore the level of stigma associated with mental disorders in students of different university degrees, and (2) to analyze the evolution of stigma in psychology students. Two groups completed the Attribution Questionnaire (AQ-27). Group 1 consisted of 392 first-year students of the different degrees evaluated (Mage= 18.59 years, SD= 1.29, 60% female), and group 2 consisted of 152 third-year Psychology undergraduates (Mage= 24.35 years, SD= 8.97, 73.4% female). Group 1 students with previous contact with mental disorders showed fewer stigmatizing attitudes. Differences were observed according to grade level. Group 2 showed lower levels of stigma throughout the academic year. The results support the effectiveness that mental health education and awareness-raising interventions through contact with people with mental health problems can have in reducing stigma
Programa de prevenci贸n e intervenci贸n en habilidades psicosociales y emocionales para adolescentes institucionalizados en un programa de autonom铆a y emancipaci贸n
El objetivo de este estudio fue llevar a cabo un programa de prevenci贸n-intervenci贸n en el desarrollo de habilidades psicosociales y de gesti贸n emocional en adolescentes institucionalizados, pr贸ximos a la mayor铆a de edad, en un programa de autonom铆a y emancipaci贸n. Para ello se realizaron 8 sesiones semanales, divididas en dos bloques: emocional y social, abarcando desde aprendizaje de las emociones, autoestima y reestructuraci贸n cognitiva, hasta asertividad, resoluci贸n de problemas y relaciones amorosas. Los instrumentos empleados fueron el cuestionario CHASO, el cuestionario ERQ-CA y el test de autoestima de Rosenberg. Los resultados demostraron la eficacia del programa y su mantenimiento, principalmente en el desarrollo de habilidades sociales y regulaci贸n emocional, en la autoestima tambi茅n se demostr贸 una mejor铆a.<br /
Teachers' Knowledge and Stigmatizing Attitudes Associated With Obsessive-Compulsive Disorder: Effectiveness of a Brief Educational Intervention
Because children and adolescents are vulnerable to developing obsessive-compulsive disorder (OCD), classroom teachers play an important role in the early identification and intervention in students with OCD. The present study aims to explore the recognition of OCD, general knowledge about this disorder, implications in the classroom, and stigmatizing attitudes among teachers, as well as the effectiveness of a brief educational intervention about OCD. Participants (n = 95; mean age = 43. 29 years old; 64.3% female) were primary and secondary school teachers who were randomly assigned to an experimental group or a control group. All of them completed a set of self-report questionnaires, read an educational fact sheet (either about OCD in the experimental group or about a healthy diet in the control group), and again completed the questionnaires. Results show that prior to the intervention, most of the teachers identified the contamination and order OCD symptoms described in a vignette as specific to OCD (82.1%) and would recommend talking about the problem (98.9%) and seeking help (94.7%). However, only a few (36.8%) knew about the most effective OCD treatments or identified compulsions as a main OCD symptom (33%). Moreover, only about half of the teachers correctly identified OCD's possible interference in classroom routines, such as delays to achieve perfection or concentration problems, and strategies for dealing with OCD, such as continuing with the class rhythm. Stigma levels were from low to moderate. After the brief educational intervention, participants in the experimental group increased their knowledge about OCD, improved their strategies for managing a student with OCD symptoms, and had fewer stigmatizing attitudes associated with pity (p < 0.05). These changes were not observed in the control group. We can conclude that this brief and easy-to-administer intervention is an effective educational intervention to significantly improve teachers' knowledge and attitudes, at least in the short-term. These results are especially relevant because OCD is associated with high interference and long delays in seeking treatment, and teachers have a unique opportunity to help with prevention, early identification, and recommending an adequate intervention for OCD
ComunicaTEA: Programa de intervenci贸n para mejorar las habilidades sociales en ni帽os con Trastorno del Espectro Autista: comunicaci贸n e interacci贸n social
Introducci贸n: El Trastorno del Espectro Autista implica alteraciones y deficiencias en la comunicaci贸n social y en la conducta prosocial de los pacientes a los que se les diagnostica, siendo m谩s importante abordar estas deficiencias en la infancia.Objetivo: El objetivo del presente trabajo es desarrollar un programa de intervenci贸n para mejorar la conducta prosocial de los ni帽os con TEA, y conseguir mejorar su interacci贸n y comunicaci贸n social.M茅todo: La muestra del estudio se compone de 10 ni帽os/as que tengan entre 6 y 11 a帽os de edad con diagn贸stico de TEA. El instrumento de evaluaci贸n que se utilizar谩 ser谩 la Social Responsiveness Scale.Resultados: Se espera que el programa propuesto mejore la conciencia social, la cognici贸n social, la comunicaci贸n social y la motivaci贸n social.Discusi贸n: Es importante atender a las dificultades en la conducta prosocial en el TEA, dado su impacto en la calidad de vida de los pacientes.<br /
Cuando el TOC es el producto y la narrativa su mejor representante
Introducci贸n: Seg煤n el modelo inferencial para el Trastorno Obsesivo-Compulsivo (TOC), la confusi贸n inferencial da lugar a la narrativa TOC, o discurso interno que el paciente construy a trav茅s de la confusi贸n inferencial y cuya funci贸n principal es dar credibilidad y fuerza a la duda obsesiva. Por tanto, cuanto m谩s elaborada sea dicha narrativa, m谩s cre铆ble parecer谩 la obsesi贸n. Las narrativas TOC y las narrativas de las intrusiones (dudas no cl铆nicas) compartir铆an herramientas de razonamiento generales pero adem谩s, las narrativas que subyacen a las obsesiones presentar铆an unas herramientas de razonamiento espec铆ficas del TOC. Los objetivos de este estudio fueron: (1) analizar el nivel de confusi贸n inferencial en poblaci贸n cl铆nica con diagn贸stico de TOC; (2) explorar y comparar las narrativas que subyacen a las obsesiones e intrusiones; (3) explorar si existe una asociaci贸n entre las caracter铆sticas de las narrativas y el nivel de confusi贸n inferencial. M茅todo: 68 pacientes con diagn贸stico de TOC completaron una serie de autoinformes entre los que se evalu贸 su nivel de confusi贸n inferencial (Cuestionario de confusi贸n inferencial-versi贸n extendida), as铆 mismo se les realiz贸 una entrevista semiestructurada en la que se recogieron textualmente las narrativas correspondientes a su obsesi贸n m谩s molesta y una intrusi贸n (duda no cl铆nica). Posteriormente se analiz贸 la extensi贸n de las mismas, y las herramientas de razonamiento subyacentes a las mismas. Resultados:Los resultados mostraron que los niveles de confusi贸n inferencial son significativamente mayores en poblaci贸n cl铆nica(M=132.04, SD=26.62; N=60)que lo observado en otros estudios con poblaci贸n general; tambi茅n se observ贸 una diferencia significativa en cuanto al nivel de elaboraci贸n de las narrativas, siendo las narrativas TOC (M (SD) de palabras empleadas= 31,37 (16,07)) significativamente m谩s extensas que las narrativas asociadas a las intrusiones (M (SD) de palabras empleadas= 16,91(10,63))(t(65)=5,82, p<,0001; d de Cohen=1,06). Sin embargo, y contrariamente a lo esperado, no hubo diferencias significativas en cuanto al uso de las herramientas de razonamiento espec铆ficas del TOC entre las narrativas TOC y aquellas existentes tras las intrusiones.Tambi茅n se observ贸 que a mayor nivel de confusi贸n inferencial, mayor era el nivel de elaboraci贸n en las narrativas de las intrusiones pero no se encontr贸 dicha relaci贸n en las narrativas TOC. Conclusiones: Los resultados sugieren que las obsesiones se sustentan en narrativas m谩s elaboradas, por lo que podr铆an ser un factor relevante en el origen y mantenimiento de las obsesiones, pudiendo ser un factor diferencial entre obsesiones e intrusiones. Sin embargo se requiere una mayor investigaci贸n sobre el 谩rea antes de poder establecer conclusiones.Agradecimientos: Ministerio de Ciencia e Innovaci贸n y Agencia Estatal de Investigaci贸n [RTI2018-098349-B-I00] y cofinanciado con fondos FEDER de la UE
Is context a crucial factor in distinguishing between intrusions and obsessions in patients with obsessive-compulsive disorder?
Objective Some cognitive models of obsessive鈥恈ompulsive disorder (OCD) posit that intrusions exist on a continuum with obsessions; others consider that they may be unrelated phenomena that differ in the context where they occur. We aimed to examine and compare, at two different moments, the context of the occurrence of intrusions and obsessions. Method Sixty鈥恊ight patients with OCD completed an interview appraising their most upsetting obsession and intrusion. Results At their onset, the obsessions/intrusions were associated with experiencing negative emotional states and life events, and they were more likely to appear in 'inappropriate' contexts. The context of the obsessions/intrusions differed the last time they were experienced. Autogenous obsessions/intrusions occurred more frequently in contexts with an indirect link. Conclusions The context distinguishes between intrusions and obsessions, not when they emerge, but when the obsession is already established. The results support that there is a continuum or progression from intrusions to obsessions
Contenidos obsesivos, miedo a la enfermedad y asco
Recently, studies on the associations between obsessive-compulsive disorder (OCD) and the emotion of disgust have shown some inconsistencies, which might be due to the differential role of disgust propensity and sensitivity, the influence of other variables, or the heterogeneity of OCD contents. This study examines the relationships among disgust propensity and sensitivity, fear of illness, and different OCD contents in university students (N = 114). Disgust propensity was the most relevant variable in predicting Doubt/checking contents (19% of explained variance - EV), and fear of illness and disgust sensitivity were the most relevant variables predicting Contamination (EV: 21% and 8%, respectively), and Superstitious contents (EV: 21% and 24%, respectively). Results suggest the need to consider the disgust and fear of illness dimensions in the conceptualization, assessment and treatment programs of OCD.Los estudios recientes sobre la relaci贸n entre el trastorno obsesivo-compulsivo (TOC) y la emoci贸n de asco han revelado algunas inconsistencias, que podr铆an deberse al papel diferencial que tienen la propensi贸n y la sensibilidad al asco, a la influencia de terceras variables, o a la heterogeneidad del TOC. Este trabajo analiza la relaci贸n entre propensi贸n y sensibilidad al asco, miedo a la enfermedad, y diferentes contenidos TOC en estudiantes universitarios (N = 114). La propensi贸n al asco resulta ser la variable m谩s importante en la predicci贸n de los contenidos de Dudas/comprobaci贸n (19% varianza explicada, VE), y el miedo a la enfermedad y la sensibilidad al asco lo son respecto a los contenidos de Limpieza/contaminaci贸n (21% y 8% VE, respectivamente) y Superstici贸n (21% y 24% VE, respectivamente). Los resultados indican la necesidad de considerar las dimensiones del asco y el miedo a la enfermedad en la conceptualizaci贸n, evaluaci贸n y tratamiento del TOC
Enhancing mental health literacy in obsessive-compulsive disorder and reducing stigma via smartphone: A randomized controlled trial protocol
Background Obsessive-compulsive disorder (OCD) is a disabling disorder that can be successfully treated. However, individuals with OCD do not seek or delay seeking treatment. This delay may be explained by poor mental health literacy and stigmatizing attitudes toward OCD in community. In order to work on these variables, a gamified mental health mobile application (app) called esTOCma has been developed. The purpose of this study is to describe the protocol for a study to test the efficacy of esTOCma, increasing mental health literacy and help-seeking intention, reducing the stigmatizing attitudes and social distance suffered by people with OCD, as well as the distress associated with obsessive-compulsive symptoms. Methods A randomized controlled trial with a crossover design with two conditions (immediate-use App group versus delayed-use App group) will be conducted on a non-clinical adult sample of the community of a minimum size of 200 participants. Participants in the immediate-use App group will start using the app at baseline until completion (10 days); whereas participants in the delayed-use App group will wait 10 days, and then start using the app until completion (10 days). The outcomes will be measured at four assessment points (baseline; 10 days from baseline; and 20 days from baseline; and after 3 months). The following instruments will be administered: Attribution Questionnaire, General Help-Seeking Questionnaire, Social Distance Scale, Mental Health Literacy, Psychoeducation Questionnaire, Social Desirability Scale, Single-Item Self-esteem Scale, and Obsessive-Compulsive Inventory-Revised. Discussion This protocol presents the first study to describe a randomized control trial of a mental health app focused on changing mental health literacy, stigmatizing attitudes, social distance and help-seeking intention associated with OCD. An app intervention of these characteristics is especially relevant nowadays as the COVID-19 pandemic has increased obsessive-compulsive symptoms and severity. An improvement in general knowledge about OCD and a reduction in stigma could be associated with earlier OCD detection and an increase in help-seeking intention, which could result in greater wellbeing. Moreover, normalizing intrusions and knowledge about the cognitive OCD model could serve as a protective variable in vulnerable individuals