The selection of evidence-based psychological treatments. An analysis to integrate the scientific data with the assistance reality

Nowadays there is a wide variety of psychological interventions to treat mental disorders, meaning that professionals have to weigh up which one is more effective to reach the therapeutic objectives. In this sense, during the last decades, explicit criterio have been established to determine whether a treatment is effective or not. The scientific evaluation of psychological treatments began to be systematized in the mid-twentieth century, reaching its peak during the 1980s and 1990s with the appearance of numerous randomized controlled trials (RCTs) and meta-analyzes. The proliferation of quality studies led to the emergence of a series of organizations aimed to review and disseminate those treatments supported by research and made existing institutions such as the American Psychological Association (APA) also pursue that goal. Between 1995 and 1998, a task force of the Division 12 (Society of Clinical Psychology) of the APA published several reports that identified treatments with empirical support and proposed the criteria that could be used to determine if a treatment is effective. These reports were published for Psychology students to be trained in therapies with demonstrated efficacy, and to inform practicing clinical psychologists, health insurers, and the public in general, about the existence of these treatments. Possibly, the most relevant contributions of the lists of effective treatments were establishing the explicit criteria that allow assessing the quality of the evidence of the interventions and the creation of institutions acting as mediators between research and clinical practice, serving as a reference and as a source of consultation for clinicians and academics. However, the systems used to determine the evidence for each intervention vary between institutions. In fact, they usually follow different assessment criteria, which suggests that the recommendations may differ from one organization to another. In addition, despite the endeavors made by different organizations to transfer the information provided by the research to the different actors involved, numerous studies have suggested that the knowledge held by psychologists concerning evidence-based treatments (EBTs) may be limited, suggesting that there is a need for more training, dissemination and implementation of these treatments. Some of the proposals made to improve the dissemination of these treatments among applied psychologists suggest the adaptation of the interventions to real situations of application and promoting the training of these professionals in the psychological treatment from a transdiagnostic perspective. An example of this matter may consist in developing intervention protocols composed of less than 10 sessions. This treatment modality is not sufficiently represented in the recommendations of the main organizations, but it is often applied in public and private settings in an unstructured or improvised manner. Regarding the use of a transdiagnostic treatment, its implementation would benefit clinical practice, since it may allow developing treatment modules that could be used in patients with different diagnoses or problems, which may allow avoiding that psychologists have to be trained in numerous and complex specific treatments for each disorder. Under this situation several objectives have been proposed. To accomplish them, this doctoral thesis, composed of four independent but intertwined studies, was conducted. The first study gathered the recommended EBTs for mental disorders in adults by different organizations in order to determine the level of existing agreement. To that end, the recommendations proposed by Division 12 of the APA, the National Institute for Health and Care Excellence (NICE), the Cochrane Collaboration and the Australian Psychological Society (APS) were reviewed following the PRISMA methodology for systematic reviews. A total of 135 treatments for 23 mental disorders were compiled and the degree of similarity among the recommendations proposed by each organization was analyzed. Results showed that the agreement among institutions was low for most of the disorders, observing discrepancies in the evidence presented by each one of them. These discrepancies might be due to a combination of reasons: possible biases in the procedures or in the evaluation committees, different studies reviewed by each organization to recommend a certain treatment, the use of different criteria to graduate the level of evidence, and the reviews of existing evidence were conducted in different time periods. The second study shares the aims of the previous study but focused on children and adolescents. For this, following the PRISMA methodology, the same organizations reviewed in Study 1 were analyzed, with the exception that the recommendations proposed by Division 53 (Society of Clinical Child and Adolescent Psychology) of the APA were used instead of the proposed by Division 12. A total of 137 treatments for 17 mental disorders were compiled and the degree of agreement among the recommendations proposed by each organization was examined. Results were similar to those obtained in study 1. A low agreement for most of the disorders was observed, and the same discrepancies discussed above were found. The third study aimed to determine the impact that EBTs have on the clínical practice of psychologists trained in Spain. In order to achieve this objective, a retrospective single-group ex post facto study was designed. Results confirmed that the use of EBTs by psychologists is limited, highlighting cognitive-behavioral therapies above other treatments. After analyzing some possible personal variables that could explain the use of EBTs, results indicated that the type of professional accreditation and the years of clinical experience could be related to the use of EBTs. Finally, the fourth study was directed to designing a protocol of an RCT in which the efficacy of a brief therapy adaptation of the "Unified Protocol for the transdiagnostic treatment of emotional disorders" will be examined. For this, an RCT was developed with five groups (brief therapy based on the Unified Protocol; conventional psychological treatment; conventional psychological treatment plus pharmacological therapy; mínimum intervention based on basic psychoeducational information, counseling and bibliotherapy; and usual pharmacological treatment), which would be carried out in public health centers. In this way, brief therapy will be compared with other treatment modalities frequently used in the public health system. The protocol follows the recommendations for intervention trials proposed in the SPIRIT statement -Standard Protocol Item: Recommendations for Interventional Trials-, and the rules for the communication of the trials proposed in the CONSORT statement -Consolidated Standards of Reporting Trials-. The findings of this RCT will be described in future publications, since due to the time limit for the development of this doctoral thesis, only the design of the trial and the start of its implementation were proposed as a plausible goal. In conclusion, there are significant differences among the psychological treatments recommended by the organizations included in this work due to the use of different procedures to evaluate and grade the quality of the evidence. In addition, despite the effort made by these institutions to disseminate the results of scientific research among applied professionals, it has been demonstrated that the divulgation of these findings has not been sufficiently successful among Spanish psychologists. Finally, with the aim of testing an intervention that fits the realities of healthcare public services, the protocol for a brief intervention under a transdiagnostic approach has been designed to be carried out in public health centers. In the case that the results of the study were favorable, including this type of therapies would decongest the healthcare system

Aplicación de sistema de control de calidad automatizada en productos de bebidas en la industria salvadoreña, en función de la materia prima, llenado y producto final

El presente estudio parte de la importancia de conocer los beneficios que una empresa de bebidas carbonatadas de El Salvador, obtiene al aplicar a sus procesos un sistema de control de calidad automatizado, en función de la materia prima, llenado y producto final. Tomando como base en primer lugar normas de calidad nacional e internacional; que ofrezcan un producto apto para el ser humano, que produzca el menor daño al medio ambiente, y que sea un producto con una calidad indiscutible. Mediante la aplicación de Visión Artificial, Elementos de inspección de olores, consistencias, colores, entre otras variables; se pueda analizar cada uno de los productos de manera ágil y a la vez minuciosa, para que el producto que no cumpla con el estándar de calidad para su consumo y represente algún daño, pueda ser regresado al inicio del proceso o desechado. La inversión inicial al adquirir equipo para realizar las tareas de control de calidad automatizado es alta pero ese costo genera beneficios que una empresa que no lo tenga, al tener tecnología en la línea de producción se crea por ende productos con un alto grado de calidad y al ofrecer un producto con optimas características se vuelve en el preferido del consumidor y estos equipos no le permiten anormalidades al producto. Es un estudio cualitativo, en el cual se utilizó la técnica de la entrevista para la obtención de los resultados, esta entrevista se llevó a cabo a Industrias La Constancia

Diseño de intervenciones psicoeducativas para el desarrollo de habilidades sociales en niños y niñas con TEA

Material didáctico de apoyo para la docencia en asignaturas de grado relacionadas con la Prevención e intervención en Trastornos del desarrollo, Atención a Necesidades Educativas Específicas, Diferencias individuales, Psicología del Desarrollo; o en asignaturas de Máster relacionadas con el diseño o evaluación de intervenciones. Puede servir de apoyo a la dirección de Trabajos Finales de Máster y Trabajos Finales de Grado en Psicología, Educación Infantil y Educación Primaria.El presente libro recoge dos propuestas de Intervenciones psicoeducativas diseñadas para el desarrollo de habilidades sociales en niños con Trastorno del Espectro Autista. La primera de ellas se basa en el estudio de un caso de un niño de 4 años con Autismo leve y expone una propuesta de intervención individualizada diseñada en base a las características y necesidades particulares del niño en el contexto educativo. Presenta una secuencia de actividades creadas para mejorar el reconocimiento y expresión de emociones y entrenar habilidades básicas de interacción social con iguales. La segunda propuesta se basa en el estudio de un grupo de niños de 6 y 7 años de edad con Autismo leve o Síndrome de Asperger, que presentan conductas verbales disruptivas en situaciones sociales. Se diseña un modelo de intervención grupal que utiliza las historias sociales como metodología para mejorar el comportamiento social en situaciones específicas de las rutinas del aula

Diseño de intervenciones psicoeducativas para la disminución de conductas disruptivas en niños y niñas con TEA

Material didáctico de apoyo para la docencia en asignaturas de grado relacionadas con la Prevención e intervención en Trastornos del desarrollo, Atención a Necesidades Educativas Específicas, Diferencias individuales, Psicología del Desarrollo; o en asignaturas de Máster relacionadas con el diseño o evaluación de intervenciones. Puede servir de apoyo a la dirección de Trabajos Finales de Máster y Trabajos Finales de Grado en Psicología, Educación Infantil y Educación Primaria.El presente libro recoge dos propuestas de Intervenciones psicoeducativas diseñadas para la disminución de conductas disruptivas en niños con Autismo. En los capítulos iniciales se establece una descripción de las principales características del Trastorno del Espectro del Autismo (TEA) y se explica brevemente qué se entiende por conductas disruptivas en esta población. Además, se explican los modelos de intervención más frecuentemente aplicados para el abordaje de estas problemáticas en el entorno escolar y otros modelos complementarios como la musicoterapia. En los capítulos 3 y 4 se presentan las propuestas de intervención diseñadas en base al estudio de dos casos de niños con TEA que presentan conductas disruptivas en distintos contextos educativos. Se explican los objetivos específicos de la intervención, el procedimiento y actividades a llevar a cabo. Además, se expone una propuesta de evaluación, con definición de indicadores e instrumentos para valorar la eficacia de la puesta en marcha de estas estrategias

Diseño de intervenciones psicoeducativas para el desarrollo de habilidades sociales en niños y niñas con Síndrome de Down

Material didáctico de apoyo para la docencia en asignaturas de grado relacionadas con la Prevención e intervención en Trastornos del desarrollo, Atención a Necesidades Educativas Específicas, Diferencias individuales, Psicología del Desarrollo; o en asignaturas de Máster relacionadas con el diseño o evaluación de intervenciones. Puede servir de apoyo a la dirección de Trabajos Finales de Máster y Trabajos Finales de Grado en Psicología, Educación Infantil y Educación Primaria.El presente libro recoge dos propuestas de Intervenciones psicoeducativas diseñadas para el desarrollo de habilidades sociales en niños y niñas con Síndrome de Down (SD). En los capítulos iniciales se describen las características clínicas y funcionales de este Síndrome y las limitaciones que puede presentar este colectivo en el área social. A continuación, se explican los principales modelos de intervención que se aplican para el desarrollo de distintas habilidades y específicamente para el desarrollo de habilidades sociales en personas con discapacidad intelectual y Síndrome de Down. En los capítulos 3 y 4 se presentan dos estrategias de intervención orientadas al incremento de las destrezas sociales y la mejora de la interacción entre pares en el contexto del aula. La primera propuesta se basa en el estudio de un caso de una niña de 4 años con SD con dificultades sociales y problemas de aislamiento en el aula. La segunda propuesta expone una estrategia de intervención grupal. En ambos diseños se explican los objetivos específicos, procedimientos y actividades a llevar a cabo. Además, se plantean indicadores e instrumentos de evaluación para valorar los resultados obtenidos tras la puesta en marcha de las acciones propuestas

Evidence-Based Brief Psychological Treatment for Emotional Disorders in Primary and Specialized Care: Study Protocol of a Randomized Controlled Trial

Emotional Disorders (EDs) are very prevalent in Primary Care (PC). However, general practitioners (GPs) have difficulties to make the diagnosis and the treatment of this disorders that are usually treated with drugs. Brief psychological therapies may be a new option to treat EDs in a PC context. This article aims to present a study protocol to evaluate the effectiveness and the efficiency of an adaptation to brief format of the “Unified Protocol (UP) for the transdiagnostic treatment of EDs.” This is a single-blinded RCT among 165 patients with EDs. Patients will be randomly assigned to receive brief psychological treatment based on UP, conventional psychological treatment, conventional psychological treatment plus pharmacological treatment, minimum intervention based on basic psychoeducational information, or pharmacological treatment only. Outcome measure will be the following: GAD-7, STAI, PHQ-9, BDI-II, PHQ-15, PHQ-PD, and BSI-18. Assessments will be carried out by blinded raters at baseline, after the treatment and 6-month follow-up. The findings of this RCT may encourage the implementation of brief therapies in the PC context, what would lead to the decongestion of the public health system, the treatment of a greater number of people with EDs in a shorter time, the reduction of the side effects of pharmacological treatment and a possible economic savings for public purse.Clinical Trial Registration:ClinicalTrial.gov, identifier NCT03286881. Registered September 19, 2017

Caregiver Burden Domains and Their Relationship with Anxiety and Depression in the First Six Months of Cancer Diagnosis

Cancer caregiving is associated with burden and a poor psychological state. However, there is no previous information about the predictive utility of specific burden domains on anxiety and depression in the first six months after a partner’s cancer diagnosis. In a longitudinal study, 67 caregivers completed the Zarit Burden Interview (ZBI) and Hospital Anxiety and Depression Scale (HADS) at T1 (45–60 days after diagnosis) and T2 (180–200 days after diagnosis). Most of the caregivers were female (65.7%, mean age = 51.63, SD = 13.25), while patients were mostly male (56.7%). The TRIPOD checklist was applied. ZBI scores were moderate and HADS anxiety reached significant values. There were no differences in ZBI and HADS between T1 and T2. The relationship between burden, anxiety, and depression were more consistent at T2, while emotional burden at T1 were related and predicted anxiety and depression at T2. Some burden domains were related and predicted anxiety in caregivers in the first six months after partner cancer diagnosis. This information could be useful to prevent the onset of these symptoms in the first six months after diagnosis

Cost‐effectiveness and cost‐utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP‐Costs): a multicentre randomized controlled trial protocol

Background: Emotional disorders are common, and they have become more prevalent since the COVID‐19 pan‐ demic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetu‐ ate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive‐behavioural therapy (tCBT) as a cost‐effective alternative. However, it is not suitable for everyone; in some cases, one‐on‐one sessions may be more effective. The objective of the present study is to compare, in cost‐benefit terms, group and individual tCBT with the treatment usu‐ ally administered in Spanish primary care (TAU). Methods: A randomized, controlled, multicentre, and single‐blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calcu‐ late incremental cost‐effectiveness and cost‐utility ratios. Discussion: This trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped‐care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems. Trial registration: ClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021

Protocolo transdiagnóstico PsicAP de entrenamiento cognitivo-conductual en grupo para trastornos emocionales

Anxiety disorders and depression are highly prevalent today. The PsicAP clinical trial showed that adding 7 sessions of group cognitive-behavioural training with a transdiagnostic approach to the usual treatment of emotional disorders in adult primary care patients increased efficacy and cost-effectiveness in reducing symptom levels, reduced disability and improved quality of life. In this work, these 7 sessions of the PsicAP protocol of transdiagnostic treatment are described, aimed at intervening on the factors common to the different disorders: cognitive distortions and emotional regulation strategies. It is an intervention based on learning through psychoeducation, cognitive restructuring, relaxation, behavioural techniques and relapse prevention. It concludes by arguing about the usefulness of this protocol to reduce the gap between research and clinical practice, something necessary in today's societyLos trastornos de ansiedad y la depresión son altamente prevalentes en la sociedad actual. El ensayo clínico PsicAP demostró que añadir 7 sesiones de entrenamiento cognitivo-conductual en grupo con enfoque transdiagnóstico al tratamiento habitual de trastornos emocionales en pacientes adultos de atención primaria aumentó la eficacia y coste-efectividad para reducir los niveles de síntomas, redujo la discapacidad y mejoró la calidad de vida. En este trabajo se describen esas 7 sesiones del protocolo PsicAP de tratamiento transdiagnóstico, dirigido a la intervención sobre los factores comunes a los distintos trastornos: las distorsiones cognitivas y las estrategias de regulación emocional. Se trata de una intervención basada en el aprendizaje mediante psicoeducación, reestructuración cognitiva, relajación, técnicas conductuales y prevención de recaídas. Se concluye argumentando sobre la utilidad de este protocolo para reducir la brecha entre investigación y práctica clínica, algo necesario en la sociedad actua

El Conocimiento y el Uso en la Práctica Clínica de los Tratamientos Psicológicos Basados en la Evidencia

Este trabajo pretende conocer el impacto que los tratamientos basados en la evidencia (TBE) ejercen sobre la psicología aplicada, así como los factores que podrían estar relacionados con dicho impacto. La muestra estuvo compuesta por 242 psicólogos formados en España, a los que se les administró un cuestionario ad hoc constituido por preguntas que recogían información acerca de determinadas variables sociodemográficas y sobre el uso o conocimiento de los TBE para los trastornos mentales en población adulta. Los resultados señalan que, a excepción de las terapias cognitivo-conductuales, el impacto de los tratamientos basados en la evidencia es limitado, pudiendo influir en dicho impacto el tipo de acreditación profesional y los años de experiencia clínica. Los hallazgos de este estudio apoyan la idea de que los resultados de la investigación no se implementan ni consolidan del todo en los ámbitos aplicados