Internet-Based Self-Help Program for the Treatment of Fear of Public Speaking: A Case Study.

This article discusses the development of the first totally self-administered online CBT program for the treatment of a specific social phobia (fear of public speaking) called talk to me. The online program includes three parts. The assessment protocol gives the patient information about the problem, including impairment, severity, and the degree of fear and avoidance regarding the main feared situations. The structured treatment protocol ensures that the patient does not skip any steps in the treatment. The treatment protocol is a CBT program that provides exposure to the feared situation using videos of real audiences. Finally, the control protocol assesses treatment efficacy, not only at posttreatment, but also at every intermediate step. In this work we describe talk to Me and its practical application through a case study

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Un estudio controlado que compara un tratamiento autoadministrado vía internet para el miedo a hablar en público vs. El mismo tratamiento administrado por el terapeuta

Los tratamientos cognitivo-comportamentales han demostrado su eficacia en el tratamiento de los trastornos de ansiedad. Pese a que estos programas se consideran el tratamiento de elección para dichos trastornos, no están exentos de limitaciones como la necesidad de que el terapeuta esté presente a lo largo de todo el proceso terapéutico, la dificultad de recibir terapia en áreas rurales o tener que soportar largas listas de espera en la sanidad pública. Estas limitaciones propician la aparición de formas alternativas de administrar terapia como son los programas de autoayuda y la utilización de las nuevas tecnologías para el tratamiento. Los ordenadores e Internet ofrecen posibilidades atractivas en el campo de la autoayuda y las nuevas tecnologías (Landau, 2001), de hecho existen algunos programas autoadministrados vía Internet que han demostrado su eficacia en el tratamiento de trastornos de ansiedad (ver Carlbring y Anderson, 2006 para una revisión). Nuestro grupo de investigación ha diseñado y puesto a prueba en un estudio de caso y dos series de casos un programa de tratamiento autoadministrado vía Internet para el miedo a hablar en público (Botella, Hofmann y Moscovitz, 2004; Botella et al., 2007; Guillén, 2001). El programa se llama "Háblame" y está formado por: a) Un protocolo de evaluación que da información al paciente acerca de su problema y recoge información respecto a la interferencia y gravedad de éste, y el grado de miedo y evitación ante situaciones de hablar en público.b) Un protocolo de tratamiento estructurado, organizado en bloques separados, en el que el paciente avanza a medida que supera los distintos bloques. De este modo el programa se asegura de que el paciente lleva a cabo las tareas planteadas en cada parte. El protocolo de tratamiento es un programa cognitivo-comportamental que contiene un componente de psicoeducación, un componente de reestructuración cognitiva y un componente de exposición, en este último el participante se expone a las situaciones sociales temidas mediante vídeos de audiencias reales. c) Un protocolo control, el cual evalúa la eficacia del tratamiento, tanto durante como al final de éste.El presente trabajo es un estudio controlado en el que un total de ciento veintinueve participantes diagnosticados de fobia social según criterios DSM-IV (APA, 2000) fueron asignados aleatoriamente a una de las siguientes condiciones experimentales: 1) un tratamiento autoadministrado vía Internet llamado "Háblame"; 2) el mismo tratamiento administrado por un terapeuta; 3) un grupo control lista de espera. Los resultados mostraron que "Háblame" fue igual de eficaz que el mismo programa de tratamiento administrado por un terapeuta y además ambos tratamientos fueron más eficaces que el grupo control lista de espera en medidas clínicas relevantes. Los resultados obtenidos se mantuvieron en los seguimientos a los 3 y los 6 meses. Además los participantes informaron estar satisfechos y confiar en "Háblame". Por lo tanto, "Háblame" es un programa efectivo que puede ayudar a incrementar el número de fóbicos sociales que se benefician de la terapia cognitivo-comportamental. En este sentido, la terapia cognitivo-comportamental administrada vía Internet es una línea de investigación prometedora que puede ayudar a mejorar el binomio coste-beneficio en el tratamiento de los trastornos psicológicos

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women