Terapia Dialéctica Conductual: aplicaciones clínicas y evidencia empírica

La Terapia Dialéctica Conductual (TDC) es un tratamiento desarrollado para pacientes con Trastorno Límite de la Personalidad (TLP). En la TDC se combinan técnicas de terapia de la conducta con principios de aceptación de la realidad derivados del Zen y de la filosofía dialéctica. La TDC es una terapia multi-modal que incluye 4 componentes: terapia individual, entrenamiento grupal en habilidades, soporte telefónico y un grupo de consulta para los terapeutas. Como lo demuestran distintos ensayos clínicos controlados y aleatorizados, la TDC es hoy en día el único tratamiento para el TLP que ha sido suficientemente investigado como para considerarse basado en la evidencia. La TDC también ha sido adaptada para el tratamiento de otras patologías vinculadas a la disregulación emocional, lo que ha contribuido a ampliar su aplicación a otras poblaciones clínicas. En este sentido, el entrenamiento en habilidades también se aplica como componente único de tratamiento, acumulando cada vez más evidencia en relación a su eficacia. En el presente artículo se exponen los principios básicos de la terapia y se realiza una revisión de sus aplicaciones clínicas y así como de la evidencia empírica disponible hasta el momentoDialectical Behavior Therapy (DBT) is a treatment developed for patients with borderline personality disorder diagnosis (BPD). DBT combines behavior therapy with reality acceptance principles derived from Zen and dialectical philosophy. DBT is a multi-modal treatment with 4 components: individual therapy, skills training, phone consultation and consultation team for therapists. Today, there are several randomized controlled clinical trials proving enough evidence as to consider that DBT is an empirically based treatment for BPD. DBT has also been adapted for the treatment of other clinical populations characterized by emotional dysregulation. The skills training component of the therapy has begin to be used as a standalone treatmentent and evidence in regard to its efficacy is still growing. In this article we resume the principles and structure of DBT and review its clinical applications and empirical dat

Early and delayed BPD diagnosis and its relationship to long-term remission in adulthood

Objective: To study long-term remission of borderline personality disorder (BPD) differentially by age of BPD diagnosis detectio

The Effectiveness of Mindfulness-Based Cognitive Therapy in Primary Care and the Role of Depression Severity and Treatment Attendance

Altres ajuts: Acord transformatiu CRUE-CSICEvidence suggests the efficacy of mindfulness-based cognitive therapy (MBCT) to prevent depression relapse and decrease depressive symptoms during the acute phase. However, the effectiveness of MBCT in real-world heterogeneous samples treated in clinical health settings, including primary care, has received little attention. This study had two aims: (1) to evaluate the effectiveness of MBCT delivered in primary care considering pre-treatment depression scores and (2) to explore the role of participants' characteristics on symptom improvement. Data were obtained from 433 individuals who received MBCT. Participants completed the Personality Inventory for ICD-11 (PiCD) pretreatment and the Beck Depression Inventory (BDI-II) pre- and post-treatment. Sixty percent presented moderate-to-severe depression according to scores on the BDI-II, 18.1% presented mild depression, and 21.7% were in the non-depressed range. The severity of pre-treatment depressive symptoms was associated with outcomes. Most individuals who lacked depressive symptoms at baseline remained in the non-clinical range after the treatment. Those in the severe group benefited the most from the intervention, since 35.6% were considered recovered. Rates of deterioration ranged from 2.1 to 2.7%, depending on the depression-baseline scores. Depression severity at the entrance, attendance, and age, but not personality traits, appear to be related to symptom improvement. According to our results, MBCT can be effectively and safely delivered in primary care

Meditation practice is associated with a values-oriented life: the mediating role of decentering and mindfulness

Clarification of personal values and meditation practice has been associated in most meditation traditions and in academic texts. Both values-related behavior and meditation practice increases well-being, but their relationship has not been well studied. It has been suggested that values, together with self-regulation, psychological flexibility, and exposure, are key mechanisms of action in mindfulness. The aims of this study were to explore the association between meditation and values and to examine the processes involved in this relation. A sample of 235 meditation-naïve participants and 274 subjects with varying levels of experience in meditation practice completed an online assessment protocol composed of Five Facets of Mindfulness Questionnaire (FFMQ), Decentering Questionnaire (EQ), Valued Living Questionnaire (VLQ), and Engagement with Life Scale (ELS). Results revealed that daily meditators were more consistent, aware, and life-fulfilled about their values; moreover, these measures correlated with the mindfulness process and decentering. The relation between meditation practice and values-related behavior (assessed by the VLQ) was mediated by decentering. The association between meditation practice and Valued Living and Life Fulfillment (measured by the ELS) was mediated by the decentering, describing, and nonjudging dimensions of mindfulness. The findings in this study support the relation between meditation and personal values, mediated by the decentering, describing, and non-judging facets of mindfulness

Psychometric properties of the spanish version of the nonattachment scale (NAS) and its relationship with mindfulness, decentering, and mental health

Abstract Nonattachment is a Buddhism-rooted construct, which can be defined as the relative absence of fixation on ideas, images, or sensory objects, as well as an absence of internal pressure to get, hold, avoid, or change circumstances or experiences. The present study was aimed at exploring the psychometric properties of the Spanish version of the Nonattachment Scale (NAS) and at delimitating the relationship between the NAS and measures of mindfulness, decentering, and negative emotional symptoms. Pooling the NAS data from Spanish meditators (n = 335) and nonmeditators (n = 270), we performed an exploratory factor analysis and then estimated the fit of two competing models (one-factor model vs. one-factor model + method effects) via confirmatory factor analysis. Data analyses showed that the Spanish version of the NAS is unifactorial in nature and has excellent internal consistency. As expected, high (positive) significant correlations were found between NAS and mindfulness and decentering measures, as well as high significant (negative) relations between NAS and depression, anxiety, and stress scores. Positive relations were also observed between NAS and variables of meditation practice. Large differences among the meditative, nonmeditative, and clinical groups (n = 39 patients with borderline personality disorder) were observed regarding NAS scores. Scores on the NAS were significant predictors of negative emotional symptoms (depression, anxiety, and stress) and, especially, resilience. Furthermore, NAS provided a unique contribution in the regression models, going beyond mindfulness facets and decentering. In conclusion, the Spanish version of the NAS is a psychometrically sound instrument with a promising future in the field of mindfulness and meditation research and in clinical setting

Physical health, health care utilization and long-term quality of life in remitted and non-remitted bpd patients: A 10-year follow-up study in a spanish sample

Objectives: 1. To describe the prevalence of physical illnesses and use of medical resources in remitted and non-remitted BPD patients at 10 years. 2. To study the impact of current physical health and BPD remission on QOL in the long-term

Validation of the Spanish version of the borderline symptom list, short form (BSL-23)

Background: The Borderline Symptom List-23 (BSL-23) is a reliable and valid self-report instrument for assessing Borderline Personality Disorder (BPD) severity. The psychometric properties of the original version have proven to be adequate. The aim of the present study was to validate the Spanish language version of the BSL-23. Methods: The BSL-23 was administered to 240 subjects with BPD diagnosis. Factor structure, reliability, test-retest stability, convergent validity, and sensitivity to change were analyzed. Results: The Spanish version of the BSL-23 replicates the one-factor structure of the original version. The scale has high reliability (Cronbach's alpha=.949), as well as good test-retest stability, which was checked in a subsample (n=74; r=.734; p<.01). The Spanish BSL-23 shows moderate to high correlations with depressive symptomatology, state and trait anxiety, hostility and impulsivity scores and BPD measures. The Spanish BSL-23 is able to discriminate among different levels of BPD severity and shows satisfactory sensitivity to change after treatment, which was verified by assessing change before and after 12 group sessions of Dialectical Behavioral Therapy in a subgroup of 31 subjects. Conclusions: Similar to the original BSL-23, the Spanish BSL-23 is a reliable and valid instrument for assessing BPD severity and sensitivity to change

La Terapia Dialéctico Conductual para el tratamiento del Trastorno Límite de la Personalidad

La Terapia Dial&eacute;ctico Conductual (TDC) ha sido creada por la Dra. Marsha Linehan, para el tratamiento de pacientes con intentos suicidas recurrentes y diagn&oacute;stico de Trastorno Limite de la Personalidad (TLP). Es un modelo terap&eacute;utico perteneciente a la &ldquo;tercera ola&rdquo; en psicoterapias cognitivas, puesto que se basa en las ciencias del comportamiento e incluye elementos de Mindfulness y de la filosof&iacute;a dial&eacute;ctica. En la actualidad la TDC es el tratamiento con mayor evidencia emp&iacute;rica para el TLP, demostrando ser efectiva en la reducci&oacute;n de varios problemas asociados a este trastorno, como ser: autolesiones, intentos de autoeliminaci&oacute;n, ideaci&oacute;n suicida, desesperanza, depresi&oacute;n y comportamientos asociados a la bulimia. El objetivo de este art&iacute;culo es desarrollar los fundamentos&nbsp; te&oacute;ricos y conceptuales b&aacute;sicos sobre los que se construye la&nbsp; TDC,&nbsp; y exponer sus principales directrices de tratamiento. Tambi&eacute;n se establecen las principales diferencias con la terapia cognitivo &ndash; conductual standard.&nbsp

Disregulación emocional y mindfulness en el trastorno límite de la personalidad: características y tratamiento

Los objetivos principales de esta tesis fueron estudiar la disregulación emocional y los déficits en mindfulness en pacientes con trastorno límite de la personalidad (TLP) y explorar los efectos de una intervención en mindfulness sobre la clínica característica del trastorno. Para ello se realizaron cuatro estudios (dos de caracterización del trastorno y dos de intervención en mindfulness). En el Estudio 1 se encontró que los pacientes con TLP, en comparación con controles sanos (CS), presentaron una mayor intensidad basal de emociones negativas, pero no una mayor reactividad emocional ante estímulos inductores de emociones discretas (ira, miedo, asco, tristeza). Sin embargo, sí se observaron diferencias entre grupos (TLP vs. CS) en relación a los estímulos relacionados con la clínica del trastorno (abandono, rechazo y dependencia emocional), para los cuales se encontró una reactividad emocional mayor a nivel subjetivo (pero no fisiológico) en el grupo de TLP. Resultados del Estudio 2 sugieren que algunas experiencias traumáticas infantiles, especialmente, el hecho de haber sufrido abuso sexual, se relacionan con déficits en algunas facetas del mindfulness (i.e., “actuación consciente” y “no-juzgar”). A pesar de esta asociación, parecería ser qué los rasgos temperamentales, especialmente el neuroticismo y la impulsividad, tienen una mayor influencia sobre los déficits en mindfulness que las experiencias traumáticas infantiles. Los Estudios 3 y 4 indican que una intervención en mindfulness de 10 semanas de duración fue más eficaz que una intervención control (i.e., entrenamiento en efectividad interpersonal), provocando una disminución de la severidad del trastorno y un aumento de la capacidad de decentering y de otras facetas del mindfulness. Además, el entrenamiento en mindfulness parecería ser eficaz para mejorar algunos aspectos relacionados con la impulsividad, como la tolerancia a las recompensas demoradas o modificar la percepción temporal. En conjunto, los resultados de esta tesis contribuyen a incrementar el conocimiento en relación a la sintomatología nuclear del trastorno y aportan conocimiento en relación a la eficacia del mindfulness como tratamiento para el TLP.The aims of this dissertation were twofold. The first objective was to study emotional dysregulation and mindfulness deficits in borderline personality disorder (BPD) and the second was to explore the effects of a mindfulness-based intervention on the core characteristics of BPD. To achieve those aims, four studies were carried out (two of them were dedicated to explore the characteristics of the disorder and the other two were focused on investigating the impact of mindfulness training). Findings of Study 1 showed that BPD patients – when compared to healthy controls (HC) – presented more intense negative emotions at baseline. BPD subjects presented no subjective heightened reactivity to film-fragments eliciting discrete emotions (anger, fear, disgust and sadness). However, differences between groups (BPD vs. HC) were observed in regard to BPD-related stimulus (abandonment, rejection and emotional dependence), BPD participants exhibited a more heightened subjective reactivity (but not in physiological variables) than HC. Results from Study 2 suggested that early traumatic experiences, especially sexual abuse, are related to deficits in some mindfulness facets (i.e., “acting with awareness” and “non-judging”) in BPD participants. In spite of this association, the results of this study seem to indicate that temperamental traits, specifically neuroticism and impulsivity, have a greater impact on mindfulness deficits than traumatic experiences. Finally, Studies 3 and 4 indicate that a 10-week mindfulness training is efficacious for diminishing BPD’s severity and increasing decentering and other mindfulness facets, when compared to a control intervention (i.e., interpersonal effectiveness training). In addition, mindfulness training seems to have a positive impact on some impulsivity-related variables (Study 4), increasing the tolerance for delayed rewards and modifying temporal perception. Overall, the present results contribute to the knowledge in regard to BPD’s core symptoms and provide evidence on the efficacy of mindfulness training for BPD