El problema del mantenimiento en el tratamiento de la obesidad. Un modelo de intervención para la prevención de la recaída

A pesar de la demostrada superioridad de los tratamientos conductuales y cognitivo-conductuales para la obesidad frente a otras formas de intervención, todavía perduran dos problemas no resueltos por la terapia de conducta: 1)Las pérdidas de peso que se obtienen con estos procedimientos no son clínicamente relevantes, y 2) el peso perdido durante el tratamiento difícilmente es mantenido por periodos largos de tiempo. En el trabajo que aquí se presenta, se analiza el panorama actual en relación con los dos problemas señalados y algunas de las estrategias probadas hasta el momento para su solución. Asi mismo, se expone de forma amplia el modelo de prevención de recaída propuesto por Marlatt y Gordon (1980, 1985) así como las sugerencias que recientemente han realizado Brownell, Marlatt, Lichtenstein y Wilson (1986). Finalmente, se resalta la necesidad de cambiar el sentido de las investigaciones en el campo de la obesidad, para poder encontrar soluciones concluyentes a los problemas señalados

Tres casos clínicos desde la perspectiva de terapeutas en formación en una unidad clínica universitaria

Tres casos clínicos desde la perspectiva de terapeutas en formación en una unidad clínica universitari

Presentación Dossier

Tres casos clínicos desde la perspectiva de terapeutas en formación en una unidad clínica universitari

Tratamiento cognitivo-conductual de una persona con trastorno de ansiedad generalizada

A case of a 36-year-old woman who asked help by the presence of panic attacks is reported. After assessment, it was considered that the main problem was the presence of excessive and persistent anxiety and worries. Forty-three sessions of cognitive-behavioral treatment were conducted, two with her husband. Panic attacks were addressed with psychoeducation, training in controlled breathing and cognitive restructuring, whereas the excessive worries were addressed with stimulus control, cognitive restructuring, training in problem solving, behavioral experiments and imaginal exposure. Patient's reports and scores on questionnaires indicated a clinically significant improvement that, we believe, can be mainly attributed to behavioral experiments and imaginal exposur

Cognitive-behavioral treatment of a person with generalized anxiety disorder

Se presenta el caso de una mujer de 36 años que solicitó ayuda por la presencia de crisis de angustia. Tras la evaluación se consideró que el foco central del problema era la presencia de ansiedad y preocupaciones de carácter excesivo y persistente. Se realizaron 43 sesiones de tratamiento cognitivo-conductual, dos de ellas con el marido. Se abordaron las crisis de angustia mediante psicoeducación, entrenamiento en respiración controlada y restructuración cognitiva; y las preocupaciones excesivas mediante control de estímulos, reestructuración cognitiva, entrenamiento en resolución de problemas, experimentos conductuales y exposición imaginal. Los informes de la paciente y los cuestionarios indicaron una mejora clínicamente significativa, en la que, creemos, los experimentos conductuales y la exposición imaginal jugaron un papel muy importante.A case of a 36-year-old woman who asked help by the presence of panic attacks is reported. After assessment, it was considered that the main problem was the presence of excessive and persistent anxiety and worries. Forty-three sessions of cognitive-behavioral treatment were conducted, two with her husband. Panic attacks were addressed with psychoeducation, training in controlled breathing and cognitive restructuring, whereas the excessive worries were addressed with stimulus control, cognitive restructuring, training in problem solving, behavioral experiments and imaginal exposure. Patient’s reports and scores on questionnaires indicated a clinically significant improvement that, we believe, can be mainly attributed to behavioral experiments and imaginal exposur

Un caso de fobia social con predominio de ataques de pánico

We report a case of a 27-year-old woman with panic attacks which began one and a half year before coming to therapy and worsened in the prior month of consultation. After four assessment sessions and an interview with a friend, a diagnosis of social anxiety disorder was made. Panic attacks were triggered by social situations and the patient was afraid of vomiting in front of the others and being evaluated negatively. A cognitive-behavioral treatment was applied over 21 sessions which included self-monitoring, training in controlled breathing, attention training, cognitive restructuring, self-exposure in vivo and assertiveness training centered on her partner, since patient's anxious symptomatology was also related to the discussions and mistreatments by her companion. Scores on the scales applied along the process indicated a progressive and clinically significant improvement. The main reasons that may have contributed to therapeutic success are the motivation for change, the strong therapeutic alliance established, the acceptance and consistent application of the exposure technique, and the assertiveness training related to her partne

A case of social phobia with predominant panic attacks

Se presenta el caso de una mujer de 27 años que consultó por ataques de pánico que comenzaron año y medio antes de acudir a terapia y que se agudizaron en el mes previo a la consulta. Tras cuatro sesiones de evaluación y una entrevista con una amiga se consideró que se trataba de un trastorno de ansiedad social. Los ataques eran desencadenados por situaciones sociales y la paciente temía vomitar delante de otros y ser evaluada negativamente. Se aplicó a lo largo de 21 sesiones un tratamiento cognitivo-conductual que incluyó autorregistros, entrenamiento en respiración controlada, entrenamiento en atención, reestructuración cognitiva, autoexposición en vivo y entrenamiento en asertividad respecto a su pareja, ya que había sintomatología ansiosa asociada con las discusiones y maltrato por parte de su compañero. Las puntuaciones obtenidas en las escalas administradas a lo largo del proceso indicaron una mejora progresiva y clínicamente significativa. Las razones principales que pueden haber contribuido al éxito terapéutico son la motivación para el cambio, la sólida alianza terapéutica establecida, la aceptación y aplicación constante de la técnica de exposición y el entrenamiento asertivo respecto a la pareja.We report a case of a 27-year-old woman with panic attacks which began one and a half year before coming to therapy and worsened in the prior month of consultation. After four assessment sessions and an interview with a friend, a diagnosis of social anxiety disorder was made. Panic attacks were triggered by social situations and the patient was afraid of vomiting in front of the others and being evaluated negatively. A cognitive-behavioral treatment was applied over 21 sessions which included self-monitoring, training in controlled breathing, attention training, cognitive restructuring, self-exposure in vivo and assertiveness training centered on her partner, since patient’s anxious symptomatology was also related to the discussions and mistreatments by her companion. Scores on the scales applied along the process indicated a progressive and clinically significant improvement. The main reasons that may have contributed to therapeutic success are the motivation for change, the strong therapeutic alliance established, the acceptance and consistent application of the exposure technique, and the assertiveness training related to her partne

Terapia familiar cognitivo-conductual con cuatro adultos

The case of a family of four members is presented. Starting from a stroke suffered by the mother three years ago, there was a change of roles and the emergence of family conflicts. After assessment, the family agreed that the problems were not just something of the mother, but involved a dysfunctional family dynamics. The therapy was applied over 24 sessions plus some parallel individual brief contacts, and included development of empathy, skills training in communication, negotiation and problem solving, cognitive restructuring, and enhancement of positive affect and pleasurable activities. According to the family and therapists, the proposed objectives were largely achieved, and this was endorsed by several questionnaires. The improvements were maintained at 10-months follow-up. Good results could be explained by the large family motivation for change, good therapeutic relationship and the application of empirically supported technique

Cognitive-behavioral family therapy with four adults

Se presenta el caso de una familia de cuatro miembros en la cual, a partir de un ictus sufrido por la madre tres años atrás, se produjo un cambio de roles y la aparición de conflictos familiares. Tras la evaluación, la familia aceptó que los problemas no eran solo de la madre, sino que implicaban una dinámica familiar disfuncional. La terapia fue aplicada a lo largo de 24 sesiones y algunos breves contactos individuales paralelos, e incluyó fomento de la empatía, entrenamiento en habilidades de comunicación, negociación y resolución de problemas, reestructuración cognitiva y potenciación del afecto positivo y de actividades agradables conjuntas. Según la familia y las terapeutas, se consiguieron en gran medida los objetivos propuestos, lo cual vino refrendado por diversos cuestionarios. Las mejoras se mantuvieron en el seguimiento a los 10 meses. Los buenos resultados podrían ser explicados por la gran motivación de la familia para el cambio, la buena relación terapéutica y la aplicación de técnicas con apoyo empíricoThe case of a family of four members is presented. Starting from a stroke suffered by the mother three years ago, there was a change of roles and the emergence of family conflicts. After assessment, the family agreed that the problems were not just something of the mother, but involved a dysfunctional family dynamics. The therapy was applied over 24 sessions plus some parallel individual brief contacts, and included development of empathy, skills training in communication, negotiation and problem solving, cognitive restructuring, and enhancement of positive affect and pleasurable activities. According to the family and therapists, the proposed objectives were largely achieved, and this was endorsed by several questionnaires. The improvements were maintained at 10-months follow-up. Good results could be explained by the large family motivation for change, good therapeutic relationship and the application of empirically supported technique