Clinical and Theoretical Considerations of Psychoanalysts and Cognitive Behavioral Therapists Regarding Generalized Anxiety Disorder in Argentina. A Qualitative Study of the Research-Practice Gap

This paper presents two qualitative studies exploring the gap between research and practice, as related to Generalized Anxiety Disorder, by comparing the differing theoretical and clinical considerations of psychoanalysts and cognitive behavioral therapists from Buenos Aires. METHODS: In the first study, a group of ten expert Psychoanalysts and five expert Cognitive-Behavioral Therapists were asked to explicitly present their theoretical conceptualization of this disorder, based on the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. In the second study, twenty psychotherapists (ten from each theoretical orientation) were asked to listen to an audio recording of a fictional patient meeting GAD's diagnostic criteria, and to present their clinical impression about the case. Through qualitative analysis, categories were created and rated upon their frequency for both studies. RESULTS/DISCUSSION/CONCLUSION: Results showed similarities and differences in participants' theoretical and clinical conceptualizations and suggested that therapist orientations may pose differing implications and obstacles to breach the psychotherapy research-practice gap.Este artigo apresenta dois estudos qualitativos que exploram a lacuna entre investigaçao e prática, como se relaciona com ao Transtorno de Ansiedade Generalizada, comparando as diferentes consideraçoes teóricas e clínicas da psicanalistas e terapeutas cognitiva-comportamentais de Buenos Aires. MÉTODOS: No primeiro estudo, foram convidados um grupo de dez psicanalistas especializados e cinco terapeutas cognitivacomportamentais especializados para apresentar explicitamente a sua conceituaçao teórica desta desordem, com base nos critérios de diagnóstico da quinta ediçao do Manual Diagnóstico e Estatístico de Transtornos Mentais. No segundo estudo, vinte psicoterapeutas (dez de cada orientaçao teórica) foram convidados a ouvir uma gravaçao de áudio de um paciente fictício preenche os critérios diagnósticos de TAG e para apresentar sua impressao clínica sobre o caso. Através da análise qualitativa, as categorias foram criadas e avaliado após a sua frequência para ambos os estudos. RESULTADOS/DISCUSSAO/CONCLUSOES: Os resultados mostraram semelhanças e diferenças em conceituaçoes teóricas e clínicas dos participantes e sugerem que as orientaçoes do terapeuta podem representar diferentes implicaçoes e obstáculos para superar a lacuna entre pesquisa e prática da psicoterapia.Fil: Etchebarne, Ignacio. Universidad de Belgrano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Juan, Santiago. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gómez Penedo, Juan Martín. Universidad de Buenos Aires; Argentina. Universidad de Belgrano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Roussos, Andres Jorge. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Belgrano; Argentin

Inventario de Problemas Interpersonales-32 (IIP-32): Propiedades psicométricas y datos normativos en una muestra clínica de Argentina

This study analyzes the psychometric properties of the Inventory of Interpersonal Problems-32 (IIP-32), the most widely used instrument to measure relational difficulties. A sample of 2128 participants completed the IIP-32 and two additional measures of interpersonal difficulties before starting a psychotherapy treatment. To evaluate reliability, we analyzed internal consistency and item homogeneity. We analyzed the construct validity of IIP-32 through a confirmatory factor analysis and the concurrent validity through correlations between the IIP-32 and other measures of interpersonal deficits. The results of the study show excellent internal consistency and homogeneity of the items in the IIP-32. Furthermore, the results show construct validity as well as concurrent validity of the instrument. In sum, the results of this paper rank the IIP-32 as a reliable and valid instrument with important clinical implications to measure interpersonal difficulties in Argentina.Este estudio analiza las propiedades psicométricas del Inventario de Problemas Interpersonales-32 (IIP-32), la medida más utilizada para evaluar dificultades en las relaciones interpersonales. Una muestra de 2128 participantes completaron el IIP-32 y otras medidas de dificultades interpersonales antes de comenzar un tratamiento psicoterapéutico. Para evaluar la confiabilidad se analizaron medidas de consistencia interna y de homogeneidad de ítems. Se analizó la validez del constructo mediante un análisis factorial confirmatorio y la validez concurrente mediante correlaciones entre el IIP-32 y otras medidas de problemáticas interpersonales. Los resultados muestran excelentes niveles de consistencia interna y homogeneidad de ítems. A su vez, los resultados muestran la validez de constructo y validez de concurrente del instrumento. En síntesis, los resultados del trabajo posicionan al IIP-32 como un instrumento de confiabilidad y validez para estudiar dificultades interpersonales con importantes implicancias para la práctica clínica en Argentina

Propriedades psicométricas preliminares da Common Intervention Scale: um instrumento para estudar as ações de terapeutas de diferentes marcos teóricos

Objetives: This article aims to present the Scale of Common Interventions (EIC), an instrument aimed at exploring the use of psychotherapeutic interventions used by therapists of different theoretical frameworks and analyze its psychometric properties. Methodology: A non-probabilistic sample of 101 psychoanalytic and cognitive behavioral therapists completed an online version of the scale based on the last session with an adult patient. Based on this data preliminary reliability analyzes and an exploratory factor analysis was performed. Subsequently, to validate the factorial structure of the instrument, a confirmatory factor analysis was performed, based on data from a new sample of 213 therapists identified with various theoretical frameworks that completed the scale.  Results: The exploratory factor analysis suggested a first solution of three factors; as one of them did not have the minimum required items per factor, said items were excluded and a new factor analysis was generated that resulted in a two-factor solution, which explained 71.1% of the total variance. The ordinal α coefficients presented levels adequate reliability in both factors. Confirmatory factor analysis showed that all estimated standardized loads of the nine items presented parameters significant (p <0.001). Discussion: The EIC is presented as a scale, which has evidence of validity and reliability, which as a short and simple instrument can represent a valuable contribution to studies aimed at evaluating psychotherapeutic interventions in the Latin American context.Objetivos: Este artículo tiene por objetivo presentar la Escala de Intervenciones Comunes (EIC), un instrumento orientado a explorar el uso de intervenciones psicoterapéuticas utilizadas por terapeutas de distintos marcos teóricos y analizar, a su vez, sus propiedades psicométricas. Metodología: Se convocó una primera muestra no probabilística de 101 terapeutas psicoanalíticos y cognitivo-conductuales que completaron una versión online de la escala basándose en la última sesión con un paciente adulto. Sobre la base de estos datos se realizaron análisis preliminares de confiabilidad y un análisis factorial exploratorio. Posteriormente, para validar la estructura factorial del instrumento, se realizó un análisis factorial confirmatorio, a partir de los datos de una nueva muestra de 213 terapeutas identificados con diversos marcos teóricos que completaron la escala. Resultados: El análisis factorial exploratorio sugirió una primera solución de tres factores; como uno de ellos no contaba con el mínimo de ítems requerido por factor se excluyeron dichos ítems y se generó un nuevo análisis factorial que dio lugar a una solución de dos factores, que explicaron el 71,1% de la varianza total. Los coeficientes α ordinales presentaron niveles adecuados de confiabilidad en ambos factores. El análisis factorial confirmatorio, mostró que todas las cargas estandarizadas estimadas de los nueve ítems, presentaron parámetros significativos (p<0,001). Discusión: La EIC se presenta como una escala, que cuenta con evidencias de validez y confiabilidad, que por ser un instrumento breve y sencillo de administrar puede representar un aporte valioso para los estudios orientados a evaluar intervenciones psicoterapéuticas en el contexto latinoamericano.Este artigo tem como objetivo apresentar a Escala de Intervenções Comuns (EIC), um instrumento destinado a explorar o uso de intervenções psicoterapêuticas utilizado por terapeutas de diferentes referenciais teóricos e analisar, por sua vez, suas propiedades psicométrico Metodologia: Uma primeira amostra não probabilística de 101 foi convocada terapeutas comportamentais psicanalíticos e cognitivos que completaram uma versão on-line de a escala baseada na última sessão com um paciente adulto. Com base nesses dados análises preliminares de confiabilidade e uma análise fatorial exploratória foram realizadas. Posteriormente, para validar a estrutura fatorial do instrumento, foi realizada uma análise Fator confirmatório, baseado em dados de uma nova amostra de 213 terapeutas identificados com vários quadros teóricos que completaram a escala. Resultados: O análise fatorial exploratória sugeriu uma primeira solução de três fatores; como um dos eles não possuíam o mínimo necessário de itens por fator, tais itens foram excluídos e uma nova análise fatorial foi gerada que resultou em uma solução de dois fatores, que Eles explicaram 71,1% da variância total. Os coeficientes α ordinais apresentaram níveis confiabilidade adequada em ambos os fatores. A análise fatorial confirmatória mostrou que todas as cargas padronizadas estimadas dos nove itens apresentaram parámetros significativo (p <0,001). Discussão: O EIC é apresentado como uma escala, que tem evidência de validade e confiabilidade, que, como instrumento curto e simples de A administração pode representar uma contribuição valiosa para estudos que visam avaliar intervenções psicoterapêuticas no contexto latino-americano

Therapist’s perspective about alliance negotiation: An instrument’s evaluation

La negociación de alianza es la capacidad que tienen paciente y terapeuta para resolver problemas vinculares y desacuerdos en terapia. Si bien este concepto es una noción diádica, con implicancias importantes para el tratamiento, actualmente solo existe un instrumento, desde la perspectiva del paciente, que permite su medición. El objetivo de este artículo es presentar el desarrollo y el estudio de las propiedades psicométricas preliminares de la Escala de Negociación de la Alianza, versión terapeuta (ANS-T). A estos fines, se convocó una muestra de 188 terapeutas de distintas aproximaciones teóricas que completaron un conjunto inicial de ítems tentativos del ANS-T junto con el Inventario de Alianza de Trabajo (WAI, por su sigla en inglés), otra escala para medición de la alianza. Para el análisis de datos se realizó un análisis de componentes principales, se estudiaron medidas de confiabilidad como el alfa de Cronbach y correlaciones ítem-total corregidas, así como también evidencias de validez de criterio a partir de las correlaciones entre el ANS-T y la WAI. Los resultados del análisis de componentes principales sugirieron una solución unidimensional integrada por nueve ítems. Los análisis conducidos sobre la versión final de la ANS-T mostraron una adecuada consistencia interna (a = .82) y homogeneidad de sus ítems (r ítem-total corregidas: entre .34 y .66) junto con evidencias de validez de criterio (r con WAI: .51, p < .001). Las cualidades del instrumento y sus propiedades psicométricas sugieren que la ANS-T es un recurso valioso tanto para la clínica como para la investigación.Alliance negotiation is defined as the patient and therapist’s ability to solve relational problems and disagreements (in therapeutic goals and tasks) during therapy. Although this construct is essentially a dyadic notion, with important clinical implication for treatments of different theoretical frameworks, currently there is only one instrument that can measure alliance negotiation and it is only based on the patients’ perspective about therapy. The aim of this paper is to develop and examine the preliminary psychometric properties of the Alliance Negotiation Scale, therapist form. In the context of the importance attributed to analyzing relational constructs with a dyadic perspective, this instrument will not only allow to measure the perception of alliance negotiation from therapist’s point of view, but also it will provide the necessary information to have a dyadic measurement of alliance negotiation by using both the original Alliance Negotiation Scale and the Alliance Negotiation Scale, therapist form in the same cases. With this purpose, a sample of 188 therapists from different theoretical frameworks completed an initial pool of twenty four preliminary items of the Alliance Negotiation Scale, therapist form. All the items of Alliance Negotiation Scale, therapist form, were developed based on the original Alliance Negotiation Scale, adapted to be completed by the therapist, and scored in a seven point Likert scale ranging from 1 (Never) to 7 (Always). The sample of therapist also completed the Working Alliance Inventory, therapist from, a widely spread standard measure of therapeutic alliance. For both instruments we asked the therapist to answer the measures thinking about a patient they have recently treated. To avoid a bias in patients’ selection and ceiling effects in alliance scores, half of the sample of therapists was randomized to use as a reference a patient they considered easy, while the other half was asked to select a difficult patient. For data analyzes we first ran a principal component analysis in order to find the best factorial solution for the items and to establish the construct validity of the scale. Based on that factorial solution we analyzed the internal consistency of the final version of the Alliance Negotiation Scale, therapist form, using Cronbach’s alphas coefficients and item’s homogeneity using adjusted itemtotal correlations. Finally, to test for criterion validity we explored the associations between the Alliance Negotiation Scale, therapist form, and the Working Alliance Inventory, therapist from, using Pearson’s correlations. The principal component analysis suggested a one-dimensional solution integrated by nine items, explaining a 42.16 % of the total variance. All the items in this solution had factorial weights above .40. Furthermore, the analysis of reliability on this version of the scale showed an adequate internal consistency (Cronbach’s a = .82). The adjusted item-total correlations presented also evidences of homogeneity (r’s range: between .34 and .66), suggesting that all the items explores different aspects from a common construct, without being redundant. Finally, the correlations between the Alliance Negotiation Scale, therapist form, and the Working Alliance Inventory, therapist from, presented evidences of criterion validity (r with WAI: .51, p < .001). This result showed an association between the measures but also indicate that they do not measure the exact some construct. The specific characteristics and properties of the Working Alliance Inventory, therapist from, presented in this paper, suggested that this measure represents an important contribution both for clinical practice and research. Future studies will need to further explore and confirm the psychometric properties of the Working Alliance Inventory, therapist from, and analyze its application for dyadic measures of the therapeutic alliance negotiation in psychotherapy.Fil: Gómez Penedo, Juan Martín. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentina. Universidad de Belgrano; ArgentinaFil: Doran, Jennifer M.. The New School University; Estados Unidos. University of Yale; Estados UnidosFil: Roussos, Andres Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Belgrano; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; Argentin

Inventario de Problemas Interpersonales-32 (IIP-32): Propiedades psicométricas y datos normativos en una muestra clínica de Argentina

This study analyzes the psychometric properties of the Inventory of Interpersonal Problems-32 (IIP-32), the most widely used instrument to measure relational difficulties. A sample of 2128 participants completed the IIP-32 and two additional measures of interpersonal difficulties before starting a psychotherapy treatment. To evaluate reliability, we analyzed internal consistency and item homogeneity. We analyzed the construct validity of IIP-32 through a confirmatory factor analysis and the concurrent validity through correlations between the IIP-32 and other measures of interpersonal deficits. The results of the study show excellent internal consistency and homogeneity of the items in the IIP-32. Furthermore, the results show construct validity as well as concurrent validity of the instrument. In sum, the results of this paper rank the IIP-32 as a reliable and valid instrument with important clinical implications to measure interpersonal difficulties in Argentina.Este estudio analiza las propiedades psicométricas del Inventario de Problemas Interpersonales-32 (IIP-32), la medida más utilizada para evaluar dificultades en las relaciones interpersonales. Una muestra de 2128 participantes completaron el IIP-32 y otras medidas de dificultades interpersonales antes de comenzar un tratamiento psicoterapéutico. Para evaluar la confiabilidad se analizaron medidas de consistencia interna y de homogeneidad de ítems. Se analizó la validez del constructo mediante un análisis factorial confirmatorio y la validez concurrente mediante correlaciones entre el IIP-32 y otras medidas de problemáticas interpersonales. Los resultados muestran excelentes niveles de consistencia interna y homogeneidad de ítems. A su vez, los resultados muestran la validez de constructo y validez de concurrente del instrumento. En síntesis, los resultados del trabajo posicionan al IIP-32 como un instrumento de confiabilidad y validez para estudiar dificultades interpersonales con importantes implicancias para la práctica clínica en Argentina

La aplicación de modelos lineales jerárquicos para el estudio de la eficacia en psicoterapia

Hierarchical Linear Models (HLM) represents a valuable statistical tool for psychotherapy research, given that they allow dealing with the usual dependency presented in its data. These methods are useful to estimate change, disaggregate sources of variations, and analyze the effect of different level predictors. Considering that, these analyses required a highly sophisticated technical knowledge that might remain inaccessible for many researchers, the aim of this paper is to present a guide on how to understand, apply, and report HLM for psychotherapy effects research. To illustrate how to apply HLM, we have drawn on a naturalistic clinical dataset. Disseminating these methods in the Latin-America might represent a meaningful contribution both for research and practice, improving the soundness of clinical studies and helping to develop a more robust knowledge that might leads to greater process and outcome in psychotherapy.Los modelos lineales jerárquicos (HLM) representan una estrategia estadística fundamental para la investigación en psicoterapia, ya que permiten superar la dependencia de las observaciones que habitualmente se presenta en sus datos. Estos métodos son útiles para estimar el cambio, desagregar fuentes de variación y analizar efectos de predictores de distintos niveles de jerarquía. Debido a que la aplicación de estos métodos requiere de un alto grado de conocimiento técnico, aún inaccesible para muchos investigadores, el objetivo de este trabajo es presentar una guía para entender, aplicar y reportar los HLM para estudiar los efectos de la psicoterapia. Para ilustrar cómo aplicar y reportar los HLM hemos utilizado una base de datos clínica real. Diseminar estos métodos en Latinoamérica puede representar una contribución tanto para la investigación como para la práctica, mejorando la solidez de los estudios clínicos y desarrollando un conocimiento robusto para optimizar los procesos y resultados en psicoterapia

Improvements in pain coping predict treatment success among patients with chronic primary pain.

OBJECTIVE Given the increasing incidence and prevalence of chronic pain, effective treatments for chronic pain are needed. This study aimed to investigate the role of cognitive and behavioral pain coping regarding the prediction of treatment outcomes among inpatients with chronic primary pain participating in an interdisciplinary multimodal treatment program. METHODS At intake and discharge, 500 patients with chronic primary pain completed questionnaires on pain intensity, pain interference, psychological distress, and pain processing. RESULTS Patients' symptoms, cognitive and behavioral pain coping improved significantly after treatment. Similarly, separate cognitive and behaviroal coping skills improved significantly after treatment. Hierarchical linear models revealed no significant associations of pain coping with reductions in pain intensity. Whereas the overall level and improvements in cognitive pain coping predicted reductions in pain interference and psychological distress, the overall level and improvements in behavioral pain coping were associated with reductions in pain interference alone. DISCUSSION Since pain coping seems to influence both pain interference and psychological distress, improving cognitive and behavioral pain coping during an interdisciplinary multimodal pain treatment seems to be a key component in the successful treatment of inpatients with chronic primary pain, enabling them to function better physically and mentally despite their chronic pain. Clinically, it might be worth fostering and exercising cognitive restructuring as well as action planning in treatment to reduce both pain interference and psychological distress levels post-treatment. In addition, practicing relaxation techniques might help reduce pain interference post-treatment, whereas making experiences of personal competence might help reduce psychological distress post-treatment

How Treatment Motivation Predicts Favorable Outcomes in Interdisciplinary Multimodal Pain Treatment Among Patients with Chronic Primary Pain.

As motivation for psychological treatment at intake has been shown to predict favorable outcomes after an inpatient stay, this study aimed to further characterize the different components of psychological treatment motivation that predict favorable treatment outcomes. 294 inpatients with chronic primary pain participating in an interdisciplinary multimodal pain treatment in a tertiary psychosomatic university clinic completed a battery of psychological questionnaires at intake and discharge. Treatment motivation was assessed at intake using the scales of the FPTM-23 questionnaire, while pain intensity, pain interference, anxiety, and depression were assessed both at intake and discharge. After treatment, pain intensity, pain interference, anxiety, and depression were significantly reduced. While higher levels on the FPTM-23 scale of suffering predicted smaller decreases in anxiety after treatment, higher scores on the scale of hope, i.e., lower levels of hopelessness, predicted lower levels of pain interference, anxiety, and depression after treatment. None of the scales of treatment motivation predicted pain intensity levels after treatment. Above and beyond providing symptom relief, reducing hopelessness and fostering hope regarding the treatment process and outcome might help clinicians treat patients with chronic primary pain more effectively

Adaptación y validación de la Escala de Dificultades en la Regulación Emocional en adultos del Área Metropolitana de Buenos Aires

La desregulación emocional (de) fue identificada como uno de los principales procesos involucrados en el surgimiento y mantenimiento de los trastornos emocionales. A su vez, los trastornos emocionales son los más prevalentes mundialmente, volviendo a la de un objeto de estudio de gran relevancia. El presente trabajo consiste en la adaptación y validación de la Escala de Dificultades en la Regulación Emocional (Difficulties in Emotion Regulation Scale, ders) (Gratz & Roemer, 2004), para ser usada en población general del Área Metropolitana de Buenos Aires. Se realizó un estudio transversal con 315 participantes entre 18 y 65 años. La consistencia interna resultó adecuada (α = 0.936; ω = 0.938). Se llevó a cabo un análisis factorial confirmatorio mediante el paquete Lavaan, quedando la escala conformada por 30 ítems que se ajustan a las seis dimensiones originales. También se presenta evidencia de validez convergente y discriminante, la capacidad de discriminación de los ítems, diferencias por sexo y edad, y valores normativos para adultos del Área Metropolitana de Buenos Aires. La adaptación al español de la ders representa una herramienta válida y confiable para medir distintos aspectos del proceso de regulación emocional

Rupturas en la alianza terapéutica y su asociación con cambio y abandonos tempranos en psicoterapia

Con el objetivo de estudiar los procesos de rupturas en la alianza terapéutica y su vínculo con los cambios terapéuticos y abandonos tempranos en psicoterapia.&nbsp;Se analizaron quince pacientes de psicoterapia diagnosticados con trastornos emocionales y divididos en tres grupos, cada uno con cinco participantes: pacientes que abandonaron, que presentaron mejorías clínicas y que no presentaron mejorías. Las primeras cuatro sesiones de los participantes fueron analizadas por cuatro jueces usando el Sistema de Ranqueo y Resolución de Rupturas-Argentina mediante un método consensual. Posteriormente se analizaron patrones diferenciales de rupturas y resoluciones en los grupos.&nbsp;Se observó un promedio de 1,18 (DE= 1,74) rupturas por sesión, encontrando una proporción equitativa de rupturas de retirada (54,72%) y confrontación (45,28%). El grupo de los pacientes que mejoraron presentó mayor tasa de rupturas resueltas (ratio= 0,50) que el grupo de pacientes sin cambio (ratio= 0,30). No se observaron diferencias entre las rupturas del grupo de abandono y los otros dos grupos. Los&nbsp;resultados&nbsp;sugieren que las rupturas en la alianza no implican una amenaza en sí mismo a los tratamientos (en términos de proceso temprano y de abandonos). Sin embargo, la resolución de dichas rupturas podría favorecer mejores respuestas tempranas.&nbsp