La psicología basada en la evidencia y el diseño y evaluación de tratamientos psicológicos eficaces

Evidence-based psychology is a methodological model that expects to legitimize treatments and theories on the basis of the empirical proof that backs up their results. Nowadays, psychological treatments that fulfill the requirements derived from this system are admitted as treatments of choice by the majority of public and private health services. The purpose of this essay is to review the criteria for the design and assessment of treatment guides as applied by the two most relevant institutions in this field, the American Psychological Association (APA) and the National Institute for Health and Clinical Excellence (NICE), by setting out and comparing the updated lists of effective psychological treatments, by disorders. We conclude with an exposition of some of the positive and negative aspects of this system, and offer suggestions for its improvement, focusing on a future adaptation for psychological problems (not for disorders) and in other fields (education, social interventions).La psicología basada en la evidencia es un modelo metodológico que pretende legitimar tratamientos y teorías que presenten pruebas empíricas que respalden sus resultados. Actualmente los tratamientos psicológicos que cumplen los requisitos derivados de este sistema son admitidos como tratamientos de elección en la mayoría de servicios públicos y privados de salud. El presente artículo pretende revisar los criterios para el diseño y evaluación de guías de tratamiento de las dos instituciones más relevantes en este ámbito, la American Psychological Association (APA) y el National Institute for Health and Clinical Excellence (NICE), exponiendo y comparando los listados actualizados de tratamientos psicológicos eficaces por trastornos. Concluimos señalando algunos de los aspectos positivos y negativos de este enfoque y realizando algunas propuestas de mejora, centrando nuestra atención en la futura adaptación para intervenciones con problemas psicológicos (no trastornos) y en otros ámbitos (educativo, intervención social).

Procedimiento para la enseñanza de la discriminación entre derecha e izquierda. Estudio de caso para un niño con deficiencia visual y discapacidad intelectual

El objetivo del estudio era la enseñanza de la discriminación entre derecha e izquierda a un niño de 7 años con deficiencia visual y discapacidad intelectual. Se abordó la enseñanza desde la perspectiva del análisis de los estímulos implicados en las discriminaciones. El programa de aprendizaje consistió en la enseñanza explícita de una discriminación simple, que incluyó un estímulo, una respuesta y una consecuencia y se probó (test) la transferencia a la discriminación condicional que incluyó dos estímulos, una respuesta y una consecuencia. Los resultados pusieron de manifiesto la transferencia del aprendizaje sin un entrenamiento explícito. El aprendizaje fue mantenido a los seis meses de seguimiento. El procedimiento descrito puede ser un método fácil de aplicar, que reduce el esfuerzo de los participantes.The aim of the research was the teaching of the discrimination between right and lelf in a seven-year-old child with visual impairment and intellectual disability. The teaching was approached from the perspective of the analysis of the stimuli implied in the discriminations. The learning procedure consisted of the explicit teaching of the simple discrimination which included a stimulus, an answer and a consequence testing the transfer to the condicional discrimination that included two stimuli, an answer and a consequence. The results showed the transfer of the learning without an explicit training. The learning was maintained during the six months of the follow-up. The procedure discribed can be a method, easy to apply, that reduces the effort of the participants

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

Interpretation, emotional reactions and daily life implications of hallucination-like experiences in clinical and nonclinical populations

Background: Research on Hallucination-Like Experiences (HLEs) has not yet explored whether people without psychosis who have HLEs attribute the same level of significance to them. This signifi cance includes whether or not the HLEs elicit similar emotional reactions in people with and without psychosis, or if the HLEs occur in same context between the two groups. The objective of this study was to compare the characteristics of these experiences in a non-clinical group and a clinical group of patients with schizophrenia and schizophrenia spectrum disorders. Method: Both groups were evaluated to determine the prevalence of HLEs. After the evaluation, they were interviewed about the characteristics of these experiences. Results: Both groups sought to actively eliminate the HLEs, could identify the presence of a trigger factor, and experienced little perceived control. However, HLEs elicited more anxiety, discomfort and interference in daily life in the clinical group than in the nonclinical group. Furthermore, the clinical group members defi ned their hallucinations more negatively and were reported to have experienced them under stressful events. Conclusions: These findings suggest that the two experiences are not entirely equivalent, especially when taking into account the emotional reaction produced by these experiences and the meaning people attach to them.Interpretación, reacción emocional e implicaciones en la vida diaria de experiencias de tipo alucinatorias en población clínica y no clínica. Antecedentes: la investigación en Experiencias de Tipo Alucinatorias (HLEs en inglés) aún no ha explorado si las personas sin psicosis que las experimentan les atribuyen el mismo signifi cado, si estas provocan las mismas reacciones emocionales o si ocurren en los mismos contextos que en la psicosis. El objetivo de este estudio fue comparar las características de estas experiencias entre un grupo no clínico y un grupo clínico de pacientes con esquizofrenia y trastornos del espectro esquizofrénico. Método: ambos grupos fueron evaluados para determinar la prevalencia de las HLEs, después de lo cual fueron entrevistados sobre las características de estas experiencias. Resultados: ambos grupos buscan activamente eliminar estas experiencias; pueden identificar la presencia de un factor desencadenante, y poco control percibido. Sin embargo, las HLEs provocaron más ansiedad, malestar e interferencia en la vida diaria en el grupo clínico que en el grupo no clínico. Además, el grupo clínico definió sus HLEs como más negativas y experimentadas bajo situaciones estresantes. Conclusiones: estos resultados sugieren que las experiencias de ambos grupos no son completamente equivalentes, especialmente cuando se toman en cuenta las reacciones emocionales producidas por estas experiencias y el significado que las personas les atribuyen

Mapping bridges between anxiety, depression, and somatic symptoms in primary care patients: a network perspective

In primary care centers, emotional disorders (EDs; depression, anxiety, and somatoform disorders) frequently appear to be associated. However, there is no previous information on the key (bridge) symptoms that maintain comorbidity. The current study aimed to identify symptoms that may play a linking role in bridging comorbidity among EDs from a network analysis perspective. A sample of adult primary care patients (N = 1704) with symptoms of EDs was assessed using the Patient Health Questionnaire (PHQ). Network analysis was applied to examine the network structure, communities, expected influence, and bridge symptoms between depressive, anxiety, and somatic symptoms. Sad mood and low energy were the most central symptoms. Furthermore, low energy, fainting spells, sad mood, and restlessness were detected as prominent bridge symptoms between anxiety, depression, and somatic symptoms. These bridge symptoms could be therapeutic targets for early intervention and prevent the development of comorbidity among EDs. The results of this research highlight the importance of symptom-specific functional properties for the activation of communities within EDs, providing new insights on a complex phenomenon such as comorbidity

Emotion Regulation as a Moderator of Outcomes of Transdiagnostic Group Cognitive-Behavioral Therapy for Emotional Disorders

The aim of this study was to examine the potential moderating effect of baseline emotion regulation skills¿cognitive reappraisal and expressive suppression¿on the relation- ship between treatment allocation and treatment outcomes in primary care patients with emotional symptoms. A total of 631 participants completed scales to evaluate emotion regulation, anxiety, depression, functioning, and quality of life (QOL). The moderation analysis was carried out using the SPSS PROCESS macro, version 3.5. Expressive suppression was a significant moderator in the relationship between treatment allocation and treatment outcomes in terms of symptoms of anxiety (b = 0.530, p = .026), depression (b = 0.812, p = .004), and QOL (b = 0.156, p = .048). Cognitive reappraisal acted as a moderator only in terms of QOL (b = 0.217, p = .028). The findings of this study show that participants with higher scores of expres- sive suppression benefited more from the addition of trans- diagnostic cognitive-behavioral therapy to treatment as usual (TAU) in terms of anxiety and depressive symptoms, and QOL. Individuals with higher levels of cognitive reappraisal obtained a greater benefit in terms of QOL from the addition of psychological treatment to TAU. These results underscore the relevant role that emotion regulation skills play in the outcomes of psychological therapy for emotional symptoms

Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: the results of the PsicAP randomized controlled trial

Background. Emotional disorders are highly prevalent in primary care. We aimed to determine whether a transdiagnostic psychological therapy plus treatment-as-usual (TAU) is more efficacious than TAU alone in primary care adult patients. Methods. A randomized, two-arm, single-blind clinical trial was conducted in 22 primary care centres in Spain. A total of 1061 adult patients with emotional disorders were enrolled. The transdiagnostic protocol (n = 527) consisted of seven 90-min sessions (8–10 patients) delivered over a 12–14-week period. TAU (n = 534) consisted of regular consultations with a general practitioner. Primary outcome measures were self-reported symptoms of anxiety, depression, and somatizations. Secondary outcome measures were functioning and quality of life. Patients were assessed at baseline, post-treatment, and at 3, 6, and 12 months. Intention-to-treat and per-protocol analyses were performed. Results. Post-treatment primary outcomes were significantly better in the transdiagnostic group compared to TAU (anxiety: p 0.80) in favour of the transdiagnostic group after treatment and at the 12-month follow-up. Conclusions. Adding a brief transdiagnostic psychological intervention to TAU may significantly improve outcomes in emotional disorders treated in primary care. Trial Registration, isrctn.org identifier: ISRCTN5843708

Factor structure and measurement invariance across various demographic groups and over time for the phq-9 in primary care patients in spain

The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA) was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance were conducted to determine the extent to which the factor structure is comparable across various demo- graphic groups (i.e., gender, age, marital status, level of education, and employment situa- tion) and over time. Both one-factor and two-factor re-specified models met all the pre- established fit criteria. However, because the factors identified in the two-factor model were highly correlated (r = .86), the one-factor model was preferred for its parsimony. Multi-group CFA indicated measurement invariance across different demographic groups and across time. The present findings suggest that physicians in Spain can use the PHQ-9 to obtain a global score for depression severity in different demographic groups and to reliably monitor changes over time in the primary care setting

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