Narrativas, Mindfulness y diálogo colaborativo

En las últimas décadas asistimos a un interés creciente por la integración de Mindfulness en psicoterapia. En este texto se revisan brevemente los resultados de los programas más difundidos, que, desde diferentes escuelas, han incluido Mindfulness como un factor clave para el cambio. En base a las pocas diferencias de resultado que los diferentes programas psicoterapéuticos tienen entre sí, se ofrece una reflexión sobre las áreas de convergencia entre Mindfulness y las corrientes narrativas como marco potencial para los factores comunes y la integración en psicoterapia.In recent decades we have witnessed a growing interest in the integration of Mindfulness in psychotherapy. This text briefly reviews the results of the most widespread programs, which, from different schools, have included Mindfulness as a key factor for change. Based on the few differences in the results of the different psychotherapeutic programs, a reflection is offered on the areas of convergence between Mindfulness and narrative currents as a potential framework for common factors and integration in psychotherap

Effectiveness of a mental health stepped-care programme for healthcare workers with psychological distress in crisis settings: a multicentre randomised controlled trial

Background Evidence-based mental health interventions to support healthcare workers (HCWs) in crisis settings are scarce. Objective To evaluate the capacity of a mental health intervention in reducing anxiety and depression symptoms in HCWs, relative to enhanced care as usual (eCAU), amidst the COVID-19 pandemic. Methods We conducted an analyst-blind, parallel, multicentre, randomised controlled trial. We recruited HCWs with psychological distress from Madrid and Catalonia (Spain). The intervention arm received a stepped-care programme consisting of two WHO-developed interventions adapted for HCWs: Doing What Matters in Times of Stress (DWM) and Problem Management Plus (PM+). Each intervention lasted 5 weeks and was delivered remotely by non-specialist mental health providers. HCWs reporting psychological distress after DWM completion were invited to continue to PM+. The primary endpoint was self-reported anxiety/depression symptoms (Patient Health Questionnaire-Anxiety and Depression Scale) at week 21. Findings Between 3 November 2021 and 31 March 2022, 115 participants were randomised to stepped care and 117 to eCAU (86% women, mean age 37.5). The intervention showed a greater decrease in anxiety/depression symptoms compared with eCAU at the primary endpoint (baseline-adjusted difference 4.4, 95% CI 2.1 to 6.7; standardised effect size 0.8, 95% CI 0.4 to 1.2). No serious adverse events occurred. Conclusions Brief stepped-care psychological interventions reduce anxiety and depression during a period of stress among HCWs. Clinical implications Our results can inform policies and actions to protect the mental health of HCWs during major health crises and are potentially rapidly replicable in other settings where workers are affected by global emergencies

The interplay between functioning problems and symptoms in first episode of psychosis: an approach from network analysis

The relationship between psychotic symptoms and global measures of functioning has been widely studied. No previous study has assessed so far the interplay between specific clinical symptoms and particular areas of functioning in first-episode psychosis (FEP) using network analysis methods. A total of 191 patients with FEP (age 24.45 ± 6.28 years, 64.9% male) participating in an observational and longitudinal study (AGES-CM) comprised the study sample. Functioning problems were assessed with the WHO Disability Assessment Schedule (WHODAS), whereas the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Network analysis were conducted with the aim of analysing the patterns of relationships between the different dimensions of functioning and PANSS symptoms and factors at baseline. According to our results, the most important nodes were “conceptual disorganization”, “emotional withdrawal”, “lack of spontaneity and flow of conversation”, “delusions”, “unusual thought content”, “dealing with strangers” and “poor rapport”. Our findings suggest that these symptoms and functioning dimensions should be prioritized in the clinical assessment and management of patients with FEP. These areas may also become targets of future early intervention strategies, so as to improve quality of life in this populationThis work was supported by the Madrid Regional Government (R&D activities in Biomedicine (grant number S2017/BMD-3740 - AGES-CM 2-CM)) and Structural Funds of the European Union. Ana Izquierdo’s work is supported by the PFIS predoctoral program (FI17/00138) from the Instituto de Salud Carlos III (Spain) and co-funded by the European Union (ERDF/ESF, "A way to make Europe”/ “Investing in your future”) and The Biomedical Research Foundation of La Princesa University Hospital. Angela Ib´a˜nez thanks the support of CIBERSAM and of the Spanish Ministry of Science, Innovation and Universities. Instituto de Salud Carlos III (PI16/00834 and PI19/01295) co-financed by ERDF Funds from the European Commission. Covadonga M. Díaz-Caneja holds a Juan Rod´es Grant from Instituto de Salud Carlos III (JR19/00024). Celso Arango was supported by the Spanish Ministry of Science and Innovation. Instituto de Salud Carlos III (SAM16PE07CP1, PI16/02012, PI19/ 024), co-financed by ERDF Funds from the European Commission, “A way of making Europe”, CIBERSAM. Madrid Regional Government (B2017/BMD-3740 AGES-CM-2), European Union Structural Funds. European Union Seventh Framework Program under grant agreements FP7-4-HEALTH-2009-2.2.1-2-241909 (Project EU-GEI), FP7- HEALTH- 2013-2.2.1-2-603196 (Project PSYSCAN) and FP7- HEALTH-2013- 2.2.1-2-602478 (Project METSY); and European Union H2020 Program under the Innovative Medicines Initiative 2 Joint Undertaking (grant agreement No 115916, Project PRISM, and grant agreement No 777394, Project AIMS-2-TRIALS), Fundaci´on Familia Alonso, Fundaci´on Alicia Koplowitz and Fundaci´on Mutua Madrile˜n

Narrativas, Mindfulness y diálogo colaborativo

En las últimas décadas asistimos a un interés creciente por la integración de Mindfulnessen psicoterapia. En este texto se revisan brevemente los resultados de los programas más difundidos, que, desde diferentes escuelas, han incluido Mindfulness como un factor clave para el cambio. En base a las pocas diferencias de resultado que los diferentes programas psicoterapéuticos tienen entre sí, se ofrece una reflexión sobre las áreas de convergencia entre Mindfulness y las corrientes narrativas como marco potencial para los factores comunes y la integración en psicoterapia.In recent decades we have witnessed a growing interest in the integration of Mindfulness in psychotherapy. This text briefly reviews the results of the most widespread programs,which, from different schools, have included Mindfulness as a key factor for change. Based on the few differences in the results of the different psychotherapeutic programs, a reflection is offered on the areas of convergence between Mindfulness and narrative currents as a potential framework for common factors and integration in psychotherapy

Intervenciones basadas en Mindfulness y compasión en dolor crónico

Durante el procesamiento del dolor crónico intervienen múltiples áreas cerebrales, produciendo cambios tanto estructurales como funcionales; esto, en ocasiones, puede dar como resultado una mala adaptación al mismo. El dolor activa el sistema de alerta, aumenta el miedo, la ansiedad, el estrés y la atención dirigida al mismo. Además,ante la amenaza,puede activar nuestro sistema de apego,aumentando la inseguridad y la indefensión. Más allá de la nocicepción, el dolor es un fenómeno difícil de entender que comprende dimensiones sensoriales/discriminativas, afectivas/motivacionales y cognitivas/evaluativas. Las Intervenciones Basadas en Mindfulness trabajan tanto con con los aspectos corporales como con los cognitivo-emocionales del dolor, de modo que puede permitir el desacoplamiento de redes neuronales que habitualmente se activan juntas. Las sensaciones desagradables se hacen más tolerables si pueden vivirse “momento a momento”. Promueve la aceptación de la experiencia, el desapego de los eventos mentales (des-identificación de los mismos), reduce el estado de hiperalerta hacia el dolor, y promueve una actitud proactiva de autocuidado y de buscar el alivio del sufrimiento.Multiple brain areas participate during chronic pain processing, generating functional and structural brain changes that sometimes may produce a maladaptive coping with pain. Pain activates warning system, increases fear, anxiety, stress and attention to itself. Moreover, pain can activate attachment system because of the perceived threat, increasing feelings of insecurity and helplessness. Beyond nociception, pain is a difficult phenomenon to describe that it is composed of sensory/discriminative, affective/motivational and cognitive/evaluative dimensions. Mindfulness-Based Interventions work with body and cognitive/emotional aspects of pain, so that body sensations can be “disengaged” of the cognitive/evaluative aspects of pain experience. Unpleasant sensationsbecome more endurable if they can be experienced in a “moment to moment” way. Mindfulness promotes acceptance of experience, defusing of mental events, it also reduces hypervigilance to pain and promotes a proactive attitude toward self-care and relief of inner and other’s suffering

Mindfulness y compasión en el Sistema Nacional de Salud

En las últimas décadas se ha producido un interés creciente por las intervenciones basadas en mindfulness en contextos de salud. Nuestro grupo de trabajo, con profesionales de la red de salud mental de los hospitales públicos Príncipe de Asturias, en Alcalá de Henares (Madrid), y La Paz, en Madrid, se ha centrado principalmente en las psicoterapias ofertadas desde el sistema nacional de salud, integrando elementos de mindfulness desde el año 2010, tanto en el trabajo con los pacientes como en el modo de entender la práctica de la psicoterapia. Mindfulness es un proceso psicológico central para cambiar la forma en que nos relacionamos no sólo con problemas existenciales cotidianos (enfermedad, pérdidas, muerte) sino también con problemas de salud mental como las ideas suicidas, la depresión crónica o los síntomas psicóticos, que generan importante malestar emocional. En este trabajo revisamos la experiencia de la introducción del mindfulness en la atención a los pacientes en los servicios de salud mental correspondientes a estos dos hospitales de Madrid y, además,en el cuidado de los profesionales y en la formación de especialistas.In recent decades there has been a growing interest in mindfulness-based interventions in health contexts. Our working group, with professionals from the mental health network of the Prince of Asturias public hospitals, in Alcalá de Henares (Madrid), and La Paz, in Madrid, has focused mainly on psychotherapies offered from the National Health Service, integrating elements of mindfulness since 2010, both in the work with patients and in the way of understanding the practice of psychotherapy. Mindfulness is a central psychological process to change the way we relate not only to everyday existential problems (illness, loss, death) but also to mental health problems such as suicidal ideas, chronic depression or psychotic symptoms, which generate important emotional discomfort. In this work we review the experience of the introduction of mindfulness in the care to patients in the Mental Health Service corresponding to these two hospitals in Madrid and, in addition, in the care of professionals and in the training of specialists

Adverse childhood experiences and cognition: A cross-sectional study in Xhosa people living with schizophrenia and matched medical controls

Background: Adverse childhood experiences (ACEs) are associated with impaired cognitive function in adult life in the general population as well as in people living with schizophrenia (PLS). Research on cognitive function in PLS in low- and middle-income countries (LMIC) is, however, limited. The objectives of this study were to investigate the association between ACE types and various cognitive domains in a sample of PLS and matched medical controls, and to determine the moderating effect of group membership (PLS vs. medical controls) on these associations, in the South African setting. Methods: Participants (n PLS = 520; n medical controls = 832) completed the Childhood Trauma QuestionnaireShort Form, the Structured Clinical Interview for DSM-IV (SCID-I), and the University of Pennsylvania Computerized Neurocognitive Battery (PennCNB). An efficiency or speed score was used to assess performance across 9 cognitive domains. The association between exposure to different ACE types and 9 cognitive domains was examined using partial correlations and multiple linear regression models, adjusting for sex, age and education years. Finally, potential moderating effects of group membership (PLS vs. medical controls) on the association between ACEs and cognitive domains were tested. Results: In the entire sample, emotional and physical abuse predicted worse performance on sensorimotor and emotion identification domains. Also, emotional abuse was negatively associated with motor function, physical abuse was negatively associated with spatial processing, and physical neglect was negatively associated with face memory and emotion identification. In contrast, emotional neglect was related to better performance on abstraction and mental flexibility. No moderating effect of group membership was found on any of these associations. Conclusion: Exposure to ACEs was associated with social and non -social cognition in adulthood, although the magnitude of these relationships was small and similar between PLS and matched medical controls. The nature of these associations differed across ACE subtype, suggesting the need for a nuanced approach to studying a range of mechanisms that may underlie different associations. However, a number of ACE subtypes were associated with worse performance on emotional identification, indicating that some underlying mechanisms may have more transversal impact. These findings contribute to the sparse body of literature on ACEs and cognition in PLS in LMIC.National Institute of Mental Health (NIMH: Grant number U01MH125053; SAX study, grant number: 5UO1MH096754)Instituto de Salud Carlos III (PI19/00941 SURVIVE)Co-funded by the European Union (COV20/00988, PI17/00768)Fundación Española de Psiquiatría y Salud MentalThis work was also support by Erasmus, 4Alianza Universidades and the European UnionInstituto de Salud Carlos III and co-funded by the European Regional Development Fund (CD22/00061).7.3 Q1 JCR 20221.831 Q1 SJR 2023No data IDR 2022UE

Evidence for a causal-mechanistic role for positive appraisal style in stress resilience

Stress resilience is the maintenance of mental health despite adversity. We have predicted that a tendency to appraise stressors in a realistic to slightly unrealistically positive fashion (positive appraisal style, PAS) is prospectively associated with more resilient outcomes; that PAS is a proximal and integrative resilience factor, mediating the pro-resilience effects of other protective factors (e.g., social support); and that PAS is modifiable, with changes in PAS leading to corresponding changes in resilience. In two independent observational samples (N=132 and N=1034), we find PAS to predict resilience over three and more years and to mediate the positive effects of social support. Analyzing the effects of a multi-component intervention (N=232) that targets a broad set of resilience factors, we find that the intervention increases PAS and that this prospectively mediates the intervention-induced increases in resilience. This establishes PAS as a proximal and plastic resilience factor with likely causal effects on resilience

The interplay between functioning problems and symptoms in first episode of psychosis: An approach from network analysis

The relationship between psychotic symptoms and global measures of functioning has been widely studied. No previous study has assessed so far the interplay between specific clinical symptoms and particular areas of functioning in first-episode psychosis (FEP) using network analysis methods. A total of 191 patients with FEP (age 24.45 ± 6.28 years, 64.9% male) participating in an observational and longitudinal study (AGES-CM) comprised the study sample. Functioning problems were assessed with the WHO Disability Assessment Schedule (WHODAS), whereas the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Network analysis were conducted with the aim of analysing the patterns of relationships between the different dimensions of functioning and PANSS symptoms and factors at baseline. According to our results, the most important nodes were “conceptual disorganization”, “emotional withdrawal”, “lack of spontaneity and flow of conversation”, “delusions”, “unusual thought content”, “dealing with strangers” and “poor rapport”. Our findings suggest that these symptoms and functioning dimensions should be prioritized in the clinical assessment and management of patients with FEP. These areas may also become targets of future early intervention strategies, so as to improve quality of life in this population.Depto. de Psicobiología y Metodología en Ciencias del ComportamientoFac. de PsicologíaTRUEpu