Burnout como inflexibilidad psicológica en profesionales sanitarios: revisión y nuevas propuestas de intervención desde una perspectiva contextual-funcional

El burnout es un fenómeno que ha sido objeto de estudio durante las últimas décadas, llegándose a cierto consenso en cuanto a las tres dimensiones que lo componen: cansancio emocional, despersonalización y sensación de ineficacia. El burnout presenta una prevalencia elevada en aquellas profesiones que conllevan un contacto continuado con el sufrimiento humano, por ejemplo profesiones sanitarias. Dada la necesidad de definir el burnout como una relación mutua entre factores ambientales y personales y la implicación del mismo en tres niveles de respuesta (cognitivo, físico, y conductual) se propone una re-definición como evitación experiencial o inflexibilidad psicológica, comportamiento encaminado a evitar los eventos privados consecuencia de las circunstancias laborales, y su abordaje a partir de una perspectiva funcional-contextual como la Terapia de Aceptación y Compromiso (ACT). En este trabajo se realiza una revisión bibliográfica no sistematizada de diferentes investigaciones correlaciónales y experimentales, que justifican la definición del burnout como inflexibilidad psicológica. Se finaliza con dos breves propuestas de intervención que tratan de solventar las carencias de trabajos previos, como la falta de sesiones de seguimiento.Burnout is a phenomenon that has been object of study during the last decades, reaching a consensus regarding the three dimensions which comprise it: emotional exhaustion, depersonalization and sense of ineffectiveness. Burnout has a high prevalence in those professions that involve continuous contact with human suffering, for example, healthcare professionals. According to the need to define burnout as a mutual relationship between environmental and personal factors, and the implication of this phenomena in three levels of response (cognitive, physical, and behavioral), we propose a definition of burnout as experiential avoidance or psychological inflexibility, behavior aimed to avoid private events presented in some work circumstances, and its approach from a functional-contextual perspective such as Acceptance and Commitment Therapy (ACT). In this paper, a non-systematized bibliographic review is carried out, presenting different correlation and experimental investigations that justify the definition of burnout as psychological inflexibility. The paper ends with two brief proposals of intervention that try to solve the limitations of previous research, such as the lack of follow-up sessions

XXVI International Conference of the Spanish Society for Comparative Psychology

Braga (Portugal), 10 - 12 de septiembre de 201

La Psicoterapia Analítica Funcional. Un recorrido desde su origen hasta la actualidad

La Psicoterapia Analítica Funcional (FAP) es una terapia de conducta de tercera generación que emplea el análisis funcional de la conducta bajo la premisa de que el comportamiento del paciente en el contexto psicoterapéutico será funcionalmente equivalente a su conducta en su entorno natural. Kohlenberg y Tsai crearon este modelo terapéutico para abordar problemas relacionales de una forma experiencial, valiéndose de la operativización de aspectos de otros modelos, tales como las dinámicas transferenciales tradicionalmente descritas en el psicoanálisis. A lo largo de las décadas, FAP ha acumulado un amplio número de publicaciones que muestran su utilidad a la hora de abordar múltiples problemas clínicos, ya sea como terapia única o complementada con otras técnicas. En los últimos años han proliferado nuevos modelos y herramientas terapéuticas con el objetivo de solventar algunas de sus limitaciones. Asimismo, se ha ampliado el uso de FAP en el análisis e intervención de otras problemáticas, así como para enriquecer la formación de nuevos terapeutas gracias a la definición de metas terapéuticas específicas.Functional Analytical Psychotherapy (FAP) is a third-generation behavior therapy that uses functional analysis of behavior under the premise that the patient’s behavior in therapy will be functionally equivalent to his behavior outside of therapy (in his life). Kohlenberg and Tsai created this therapeutic model to address relational problems in an experiential way, making use of the operationalization of aspects of other models, such as transference dynamics. Over the decades, FAP has accumulated a large number of publications that show its usefulness--as a single therapy or complemented with other techniques--when addressing multiple clinical problems. In recent years, new therapeutic models and tools have proliferated with the aim of solving current limitations, using FAP in the analysis and intervention of other problems, as well as to enrich the training of new therapists thanks to the definition of specific therapeutic goals

The challenge of community mental health interventions with patients, relatives, and health professionals during the COVID-19 pandemic: a real-world 9-month follow-up study

Epidemiology; Human behaviour; PsychologyEpidemiologia; Comportament humà; PsicologiaEpidemiología, Comportamiento humano; PsicologíaSince the beginning of the COVID-19 pandemic, the need to implement protocols that respond to the mental health demands of the population has been demonstrated. The PASMICOR programme started in March 2020, involving a total of 210 requests for treatment. Out of those subjects, the intervention was performed in 53 patients with COVID-19 without history of past psychiatric illness, 57 relatives and 60 health professionals, all of them within the area of Salamanca (Spain). Interventions were carried out by professionals of the public mental health service mostly by telephone. Depending on clinical severity, patients received basic (level I) or complex psychotherapeutic care combined with psychiatric care (level II). The majority of attended subjects were women (76.5%). Anxious-depressive symptoms were predominant, although sadness was more frequent in patients, insomnia in relatives and anxiety and fear in health professionals. 80% of the sample, particularly most of the health professionals, required a high-intensity intervention (level II). Nearly 50% of the people treated were discharged after an average of 5 interventions. Providing early care to COVID-19 patients, relatives and professionals by using community mental health resources can help to reduce the negative impact of crises, such as the pandemic, on the most affected population groups.This work has been funded by the Castilla y León Regional Health Management (Spain) file no.: GRS COVID 59/A/20 “Impacto y abordaje de salud mental en familiares y pacientes afectos de COVID y en los profesionales sanitarios” (Impact and management of mental health in relatives, patients affected by COVID and health professionals). All the authors declare that they have no conflicts of interest in this study. The funding entities had no role in the design, collection, analysis or interpretation of the data, in the process of writing the manuscript, or in the decision to publish the results

Behavioral-contextual Model of Intimate Relationships: Applicability in Psychotherapy

Behavioral-contextual Model of Intimate Relationships: Applicability in Psychotherapy. Intimate relationships matter for both human’s physical and psychological health. Although many theories have been developed to study this topic, there is no consensus about the underlying processes in human relationships. The Interpersonal Process Model, which has well-established empirical support, aims to address the development of intimate relationships describing them as observed behaviors. This has important implications in psychotherapy, especially for those approaches that understand the interpersonal patient-therapist relationship as a tool for change. That is the case of Functional Analytic Psychotherapy. In this paper we articulate a model of intimate relationships based on Interpersonal Process Model and the principles of Functional Behavioral Analysis, connecting it with previous results on the field of intimate relationships. Likewise, a discussion about its implications in psychotherapy and its utility to solve some Functional Analytic Psychotherapy’s limitations is presented

El burnout en los profesionales de salud mental: el papel de la flexibilidad psicológica, la conciencia, la valentía y el amor

El modelo predominante del burnout asume tres dimensiones: agotamiento emocional (AE), despersonalización (D) y (falta de) logro personal (LP). Hasta la fecha, enfoques conductuales-contextuales han explorado el papel de la flexibilidad psicológica en el burnout, pero no el rol de variables interpersonales como las del modelo Consciencia, valentía y amor (ACL, por sus siglas en inglés) de la psicoterapia analítica funcional. En este estudio, 269 trabajadores españoles de salud mental cumplimentaron un formulario que exploraba la contribución del ACL, más allá de la flexibilidad psicológica, para comprender el burnout. Los resultados principales muestran que la flexibilidad psicológica predice las tres dimensiones del burnout. Con respecto al modelo ACL, el amor fue el predictor más fuerte de D, después de la flexibilidad psicológica; las tres dimensiones del ACL contribuyen a predecir el LP. En este trabajo se presenta brevemente un modelo conductualcontextual que integra estos hallazgos y sus implicaciones para mejorar las intervenciones para reducir el burnout en profesionales de salud mental.The predominant model of burnout posits three dimensions: emotional exhustion (EE), depersonalization (D), and (a lack of) personal accomplishment (PA). To date, contextual behavioral approaches have explored the role of psychological flexibility within this model of burnout but has not focused on the role of interpersonal variables, such as suggested by the Awareness, Courage, and Love (ACL) model of Functional Analytic Psychotherapy. In this study, 269 Spanish mental health workers completed a questionnaire study exploring the unique contribution of ACL, over and above psychological flexibility, to understanding burnout. Results indicated that psychological flexibility predicted all three dimensions of burnout. Regarding ACL, love was the strongest predictor of D over and above psychological flexibility and all three ACL dimensions contributed to PA prediction. We briefly present a contextual-behavioral model that integrates these findings with implications for improving interventions to reduce burnout in mental health practitioners

The challenge of community mental health interventions with patients, relatives, and health professionals during the COVID-19 pandemic : a real-world 9-month follow-up study

Since the beginning of the COVID-19 pandemic, the need to implement protocols that respond to the mental health demands of the population has been demonstrated. The PASMICOR programme started in March 2020, involving a total of 210 requests for treatment. Out of those subjects, the intervention was performed in 53 patients with COVID-19 without history of past psychiatric illness, 57 relatives and 60 health professionals, all of them within the area of Salamanca (Spain). Interventions were carried out by professionals of the public mental health service mostly by telephone. Depending on clinical severity, patients received basic (level I) or complex psychotherapeutic care combined with psychiatric care (level II). The majority of attended subjects were women (76.5%). Anxious-depressive symptoms were predominant, although sadness was more frequent in patients, insomnia in relatives and anxiety and fear in health professionals. 80% of the sample, particularly most of the health professionals, required a high-intensity intervention (level II). Nearly 50% of the people treated were discharged after an average of 5 interventions. Providing early care to COVID-19 patients, relatives and professionals by using community mental health resources can help to reduce the negative impact of crises, such as the pandemic, on the most affected population group