El debate en reestructuración cognitiva: análisis de los mecanismos terapéuticos de cambio clínico

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Psicología, Departamento de Psicología Biológica y de la Salud.Fecha de lectura: 01-07-2019Esta tesis tiene embargado el acceso al texto completo hasta el 01-01-202

Dificultades en la intervención psicológica de un caso clínico complejo de ansiedad y obsesiones: la importancia del análisis funcional

El análisis de casos derivado de la práctica clínica contribuye al avance de intervenciones eficaces, especialmente, cuando se exponen casos complejos y las dificultades que surgen en su tratamiento. Con este objetivo, se presenta el caso de un varón de 26 años con problemas de ansiedad y obsesiones que interfieren significativamente en su funcionamiento diario. Se enfatiza el empleo del análisis funcional como elemento clave en la toma de decisiones sobre el plan de intervención e indispensable para garantizar el éxito en aquellos casos complejos. Se expone la intervención realizada centrándose en el tratamiento de los problemas más interferentes: la conducta de andar y hablar solo durante largos períodos temporales y las comprobaciones sociales. Los resultados muestran una reducción de las principales conductas problema a través de diferentes indicadores de cambio clínico: autorregistros, puntuaciones en inventario sobre obsesiones, consumo de psicofármacos e informe verbal del cliente. Se discuten los principales factores que contribuyeron al éxito del tratamiento y se ponen de manifiesto las limitaciones que conlleva un estudio de casoCase analysis derived from clinical practice contributes to the advancement of effective interventions, particularly when are shown complex cases and the difficulties in their treatment are discussed. To this aim, it is described the case of a 26 years old male with anxiety and obsessions that interfere significantly with daily functioning. The use of functional analysis is emphasized as a key element in making decision on the intervention plan and essential to ensure success in complex cases. It expounds the psychological treatment focusing in the treatment of the most interferer problems: behavior walking and talking alone for long periods of time and social checks. The results shows a major reduction in problem behaviors through several clinical indicators of change: self-registration, scores of inventory obsessions, psychopharmacological dose and verbal report by the client. The main factors that contributed to success of the treatment are discussed and reveal the limitations that entails a case stud

The therapist's rule-like verbalizations throughout the clinical process

Se ha reconocido la importancia de las reglas del cliente para explicar un problema psicológico y para lograr superarlo. Sin embargo, no se ha incidido en el papel que podrían tener las reglas del terapeuta en el proceso clínico. Como un primer paso para poder dar una respuesta al respecto, en este estudio realizamos un análisis morfológico de las verbalizaciones en forma de regla emitidas por el terapeuta a lo largo del proceso clínico con el fin de identificar un patrón de emisión de este tipo de verbalizaciones que cambie de acuerdo con los distintos momentos de la terapia. Se analizaron las verbalizaciones en forma de regla emitidas por 9 terapeutas a lo largo de 19 casos clínicos (92 sesiones). Las verbalizaciones se codificaron de acuerdo con un Sistema de Categorización de las Reglas del Terapeuta (SISC-REGLAS-T). Los resultados mostraron diferencias entre el tipo de verbalizaciones en forma de regla y el objetivo que el terapeuta persigue alcanzar en los distintos momentos de la terapia. Estos resultados pueden ayudar a comprender cómo el terapeuta utiliza las verbalizaciones en forma de reglas, lo que contribuye al esclarecimiento del papel de las reglas que emite el terapeuta para conseguir el cambio clínicoIt has been pointed out the importance of the rules to explain and to treat psychological problems. However it hasn’t emphasize the role that the therapist’s rules could have in clinical process. As a first step to give an answer, we realize a morphological analysis of verbalizationlike-rule emitted by the therapist throughout the clinical process with the aim to identify a patron of emission of this kind of verbalization that changes according to different moments of therapy. This study analyzed the verbalization-like-rules emitted by 9 therapists over 19 clinical cases (92 sessions). The verbalizations were coded according to a system of categorization of the Rules Therapist (SISC-RULES-T). The results showed differences between the type of verbalizations-like-rules and target the therapist aims to achieve at different times of therapy. These results may help to understand how the therapist uses this kind of verbalizations, helping to clarify the functional role of rules issued by the therapist for clinical chang

Applying cognitive restructuring in therapy: the clinical reality in Spain

Cognitive restructuring is one of the most widely used techniques among psychologists of different orientations. However, there is a lack of clarity in what concerns its precise definition, functioning, effectiveness and components. Objective. To obtain precise information on how psychotherapists use cognitive restructuring in their clinical practice in Spain. Method. Survey study conducted following a descriptive quantitative methodology, with a cross-sectional design and a non-random sampling method. 320 psychotherapists responded to a questionnaire, created ad hoc, on cognitive restructuring. Results. Cognitive restructuring is widely used by therapists with different levels of experience, training and following different psychotherapeutic approaches. Furthermore, it is applied to address a wide variety of psychological problems. There exist relevant differences in the use of the technique depending on the therapists’ level of experience. Conclusions. This study has shown, for the first time, how cognitive restructuring is applied in daily clinical practice. The main implications of these results are discussed, and new lines of inquiry are propose

Estudio epidemiológico sobre cefaleas en población universitaria española

Headaches represent a major socio-sanitary problem due to its high global prevalence and the important implications that they have on quality of life. Stress is an essential factor in the development and maintenance of headaches, a problem frequently encountered in university students. This study analyzes the prevalence, frequency, duration, intensity, diagnosis, medication and distribution of headaches as well as other epidemiological characteristics related to perceived disability and coping strategies. A sample of 458 participants formed by 306 students from the Autonoma University of Madrid (UAM) and 152 people not related to that university completed the "Online Headaches Epidemiological Inquest" created ad hoc for this study. We found a high percentage of people who presented headaches frequently (between 5 and 20 times per month) and were not diagnosed (63.2%). The results are compared with data obtained from other populations and their impact and implications are discussed. The need to implement psychological and multidisciplinary prevention and treatment programs is highlighted.Las cefaleas representan un problema socio-sanitario de grandes dimensiones dada su elevada prevalencia a nivel mundial y las importantes implicaciones que tiene en la calidad de vida. El estrés es un factor esencial en el desarrollo y mantenimiento de las cefaleas, problema que se presenta con frecuencia en estudiantes universitarios. En este estudio se analizan la prevalencia, frecuencia, duración, intensidad, diagnóstico, medicación y distribución de las cefaleas así como otras características epidemiológicas relacionadas con la incapacidad percibida y las estrategias de afrontamiento. Una muestra de 458 participantes compuesta por 306 estudiantes de la Universidad Autónoma de Madrid (UAM) y 152 personas ajenas a dicha universidad, completaron la Encuesta epidemiológica de cefaleas online, creada ad hoc para este estudio. Se encontró un elevado porcentaje de personas que presentan cefaleas frecuentemente (entre 5 y 20 veces al mes) y no están diagnosticadas (63,2%). Se comparan los resultados con datos obtenidos en otras poblaciones y se discute su impacto e implicaciones. Se resalta la necesidad de implementar programas de prevención y tratamiento psicológicos y multidisciplinares

Verbal behavior analysis of expert and inexperienced therapists applying the socratic method

The Socratic method, as an eminently verbal procedure, will be analyzed from a behavioral perspective in order to clarify how verbal conditioning works within. This work compares the verbalizations that expert and inexperienced therapists emit during Socratic method to find out which and why certain therapist verbalizations are most successful in changing client responses. The sample consisted of 113 Socratic method fragments from 18 cases, analyzed by observational methodology. The expert therapists had more than 6 years of experience, the inexperienced less than 2. Experts had fewer failure Socratic method fragments, but there were no differences in successful ones. The way of questioning had a different pattern: Inexperienced therapists suggested more the response, experts used more didactic verbalizations; also, experts used the aversive component more and contingently. The creation of guidelines based on functional description of verbal interaction and the need for novice psychologists training are some implications of these result

What works in the socratic debate? an analysis of verbal behaviour interaction during cognitive restructuring

Background: Cognitive restructuring is one of the most complex application procedures in psychotherapy. It is widely used by psychologists of different orientations. However, the guidelines on how to apply it do not usually have empirical evidence and there is a lack of knowledge about the mechanisms of change that explain it. Aims: The analysis of verbalizations that therapists emit during the Socratic method could help to better understand the functioning and the strategies of effective debates. Method. In this study, specific verbal interaction sequences were analyzed using observational methodology. The sample consisted of 113 Socratic questioning fragments belonging to 18 clinical cases, treated by behavioral therapists. Results: Among other findings, it was found that using questioning together with certain previous verbalizations directed the client's response better and those successful debates were characterized by using the aversive component in a frequent and contingent way. Conclusion: This study shows the most effective way to establish such interaction in the Socratic method, which entails relevant practical applications in therap

Características de la asistencia psicológica en el contexto universitario: la Clínica Universitaria de la UAM

En el presente estudio se describe la tipología, las características sociodemográficas de los clientes y los tratamientos psicológicos aplicados en la Clínica Universitaria del CPA-UAM. La muestra está formada por 309 clientes, de los cuáles 255 finalizan el tratamiento. La mayoría de los clientes obtienen alta terapéutica (65,1%), con una duración de 17 sesiones de media. Los problemas clínicos más frecuentes son ansiedad (36,8%) y bajo estado de ánimo (13,3%). El tratamiento, realizado por psicólogos inexpertos bajo supervisión, logra una mejoría media significativa del nivel de funcionamiento de los clientes (28,26 puntos más en el EEAG, escala de 0-100) y una valoración media muy alta del éxito en el tratamiento por los clientes y los psicólogos (9,49 y 9,02 escala de 0-10, respectivamente). En conjunto, se discuten las implicaciones relativas a la práctica y la investigación clínica, y se destaca el papel de las clínicas universitarias como nexo entre ambos campos de la Psicología.The current study describe the typology, sociodemographic characteristics and psychological treatments applied in the CPA-UAM University Clinic. The sample is made of 309 cases, of which 255 completed the treatment. The majority of clients who started psychological treatment (65.1%) received the therapeutic release, after receiving 17 sessions on average. The most frequent clinical problems are anxiety (36.8%) and low mood (13.3%). Treatments are applied by inexperienced psychologists under supervision. On average, there is significant improvement in the functioning level of clients (28.26 points more in the EEAG, scale of 0-100) and the treatment is evaluated as very satisfactory by clients and psychologists (9.49 and 9.02, scale of 0-10, respectively). Finally, the implications for practice and clinical research are discussed, and the role of university clinics as a link between both fields of psychology is highlighted.Sin financiaciónNo data 2018UE

Impact of COVID-19 lockdown measures on Spanish people with chronic pain : an online study survey

The corona virus disease 2019 (COVID-19) pandemic is one of the most important healthcare and societal challenges to have emerged in the last century. It may have effects on both physical and psychosocial health, but studies considering the impact on vulnerable populations, such as people with chronic pain, are needed. In this cross-sectional study, an online survey of relevant chronic pain domains, coping strategies, triggers and potential related variables was answered by 502 Spanish individuals with chronic pain. Participants were mainly women (88%) with longstanding chronic pain and moderate to high pain intensity and disability. The perception of pain aggravation and the most pain-related outcomes were observed. Contextual variables such as job insecurity, worries about the future, people cohabiting, being close to someone who had passed away, or being potentially infected with COVID-19 were related to worse outcomes. More than half the participants altered their pain management style (e.g., increased medication intake) and several changes occurred with respect to pain triggers (cognitions, feelings of insecurity and loneliness, and sleeping problems were more frequently reported as triggers during lockdown). Our preliminary results highlight the negative effects of lockdown on patients with chronic pain as well as the need to make available cost-effective and remotely accessible healthcare resources for counteracting them