Un programa de Tratamiento de corte Cognitivo-Comportamental basado en las TIC para la prevención y el tratamiento de la depresión: Descripción del programa y datos preliminares

Introducción: En el año 2020 la depresión alcanzará el segundo lugar del ranking de los DALYs (Disability Adjusted Life Years), por ello su prevención es un punto central en el Pacto Europeo para la Salud Mental y el Bienestar. Actualmente, menos del 50 % de las personas afectadas recibe el tratamiento correcto. El uso de internet facilita el acceso a los Tratamientos Basados en la Evidencia. Además, es importante desarrollar programas de prevención. Nuestro grupo ha desarrollado un programa preventivo, de corte cognitivo comportamental, auto-aplicado a través de Internet. Sonreír es Divertido combina los procedimientos eficaces para el manejo del estrés, la regulación emocional, la capacidad de afrontamiento y la resiliencia. Metodología: La muestra está compuesta por nueve participantes varones desempleados. La media de edad es de 36-33 (SD = 10–759), con un rango de 22 a 50 años. Se utilizaron: Escala general de Gravedad e Interferencia de la Ansiedad y de la Depresión, Inventario de Depresión de Beck-II y Escala Multidimensional de Estilos de Afrontamiento. Resultados: No hay diferencias estadísticamente significativas del pre al postratamiento, a excepción de la subescala de Aceptación del Brief Cope (z = –2, 27; p < ,05). En el resto de variables, las medias muestran una tendencia a la mejoría. Conclusión: Este programa puede ser útil como estrategia para la prevención, ya que, a pesar de que los participantes estaban pasando por una situación difícil, se observa una tendencia a la mejoría.In 2020, depression will reach the second place in the DALYs (Disability Adjusted Life Years), ranking, so prevention is a central point for the European Pact for Mental Health and Wellbeing. Currently, less than 50 % of those people affected receive the correct treatment. Using Internet facilitates the access to evidence-based treatments. It is also important to develop prevention programs. Our group has ellaborated a cognitive-behavioural preventive program, self-applied through the Internet. Smiling is Fun combines effective procedures for stress management, emotional regulation, coping ability and resilience. Methodology: The sample consists of nine participants. They are all unemployed men, and their mean age is 36’33 (SD = 10’759), with a range of 22-50 years. We used: Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Beck Depression Inventory II and Brief cope. Results: There aren’t statistically significant differences between pre and post-treatment, except for the Acceptance subscale of the Brief Cope (z = –2, 27, p <.05). For all other variables, means show a tendency to improve. Conclusion: This program can be useful as a prevention strategy considering that even though the participants were going through a difficult situation, there is a trend towards improvement

Virtual reality versus computer-aided exposure treatments for fear of flying

Evidence is growing that two modalities of computer-based exposure therapies—virtual reality and computer-aided psychotherapy—are effective in treating anxiety disorders, including fear of flying. However, they have not yet been directly compared. The aim of this study was to analyze the efficacy of three computer-based exposure treatments for fear of flying: virtual reality exposure therapy (VRET), computer-aided exposure with a therapist’s (CAE-T) assistance throughout exposure sessions, and self-administered computer-aided exposure (CAE-SA). A total of 60 participants with flying phobia were randomly assigned to VRET, CAE-T, or CAE-SA. Results indicate that the three interventions were effective in reducing fear of flying at posttreatment and at 1-year follow-up; furthermore, there were no significant differences between them in any of the outcome measure. Large within-group effect sizes were found for all three treatment conditions at both posttreatment and at follow-up. The results suggest that therapist involvement might be minimized during computer-based treatments and that CAE can be as effective as VRET in reducing fear of flyin

La utilización de las Tecnologías de la Información y la Comunicación (TICS) en el ámbito de los tratamientos psicológicos

Setzenes Jornades de Foment de la Investigació (Any 2011)Las nuevas tecnologías de la información y la comunicación (TICs) están demostrando utilidad en el campo de la salud. En concreto, Internet ofrece un nuevo modo de dispensar tratamientos TCC (Anderson, 2009) y ha demostrado ser una intervención eficaz y de bajo coste para los trastornos de ansiedad y los trastornos del estado de ánimo (Botella, Hoffman & Moscovitch, 2004; Botella et al., 2010; Cuijpers & Schuurmans, 2007). Una ventaja fundamental de estos programas es que reducen el tiempo de contacto entre paciente y clínico, y además llegan a pacientes que no recibirían tratamiento de otro modo (Bauer, Golkaramnay & Kordy, 2005). Las revisiones sobre el tema indican que estos tratamientos son eficaces (p.ej., Anderson, 2008, 2009; Cuijpers, et al., 2008; Spek et al., 2007). En estos momentos, las guías clínicas NICE en Inglaterra apoyan la utilización de programas como “Beating the Blues” (Cavanagh et al., 2004; Proudfoot et al., 2004) y el programa “FearFighter” (Marks, Kenwright, McDonough, et al., 2003). En Australia el grupo de Andrews ha desarrollado programas basados en Internet para diversos trastornos psicológicos (Titov et al., 2008, 2011; Andrews et al., 2010) Los resultados obtenidos hasta el momento son consistentes y prometedores, aunque aún existen una serie de problemas que hay que resolver, especialmente por lo que se refiere a la cantidad de apoyo y de ayuda que es necesario que el clínico proporcione al paciente (¿qué cantidad y qué tipo de apoyo por parte del clínico se necesita para que el programa sea eficaz ?) y las tasas de abandonos, que son más altas en los tratamientos que utilizan Internet, que en los tradicionales “cara a cara” (Anderson, 2009). El objetivo de esta comunicación es presentar una revisión de los logros obtenidos en este campo y las posibles líneas futuras que resulta necesario abordar para seguir avanzando

Effectiveness of a transdiagnostic internet-based protocol for the treatment of emotional disorders versus treatment as usual in specialized care: study protocol for a randomized controlled trial

Background Emotional disorders (depression and anxiety disorders) are highly prevalent mental health problems. Although evidence showing the effectiveness of disorder-specific treatments exists, high comorbidity rates among emotional disorders limit the utility of these protocols. This has led some researchers to focus their interest on transdiagnostic interventions, a treatment perspective that might be more widely effective across these disorders. Also, the current way of delivering treatments makes it difficult provide assistance to all of the population in need. The use of the Internet in the delivery of evidence-based treatments may help to disseminate treatments among the population. In this study, we aim to test the effectiveness of EmotionRegulation, a new transdiagnostic Internet-based protocol for unipolar mood disorders, five anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder and anxiety disorder not otherwise specified), and obsessive-compulsive disorder in comparison to treatment as usual as provided in Spanish public specialized mental health care. We will also study its potential impact on basic temperament dimensions (neuroticism/behavioral inhibition and extraversion/behavioral activation). Expectations and opinions of patients about this protocol will also be studied. Methods/Design The study is a randomized controlled trial. 200 participants recruited in specialized care will be allocated to one of two treatment conditions: a) EmotionRegulation or b) treatment as usual. Primary outcome measures will be the BAI and the BDI-II. Secondary outcomes will include a specific measure of the principal disorder, and measures of neuroticism/behavioral inhibition and extraversion/behavioral activation. Patients will be assessed at baseline, post-treatment, and 3- and 12-month follow-ups. Intention to treat and per protocol analyses will be performed. Discussion Although the effectiveness of face-to-face transdiagnostic protocols has been investigated in previous studies, the number of published transdiagnostic Internet-based programs is still quite low. To our knowledge, this is the first randomized controlled trial studying the effectiveness of a transdiagnostic Internet-based treatment for several emotional disorders in public specialized care. Combining both a transdiagnostic approach with an Internet-based therapy format may help to decrease the burden of mental disorders, reducing the difficulties associated with disorder-specific treatments and facilitating access to people in need of treatment. Strengths and limitations are discussed

How Technology Influences the Therapeutic Process: Evaluation of the Patient-Therapist Relationship in Augmented Reality Exposure Therapy and In Vivo Exposure Therapy

New technologies have slowly become a part of psychologists’ therapeutic office. However, many therapists still have doubts about the possibility of creating a good therapeutic relationship with patients in the presence of technology. Aims: This study evaluates the development of the therapeutic alliance in individuals with small animal phobia disorder who were treated with Augmented Reality Exposure Therapy or In Vivo Exposure Therapy. Method: Twenty-two participants received an intensive session of cognitive behavioural therapy in either a technology-mediated therapeutic context or in a traditional therapeutic context. Results: The results show no significant difference for the therapeutic alliance between two conditions. Conclusions: The results seem to show that technologies such as Augmented Reality do not represent a danger to negatively influence the therapeutic allianceWrzesien, M.; Bretón-López, J.; Botella, C.; Burkhardt, J.; Alcañiz Raya, ML.; Pérez-Ara, MÁ.; Riera Del Amo, A. (2013). How Technology Influences the Therapeutic Process: Evaluation of the Patient-Therapist Relationship in Augmented Reality Exposure Therapy and In Vivo Exposure Therapy. Behavioural and Cognitive Psychotherapy. 41(4):505-509. doi:10.1017/S1352465813000088S505509414Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J., Brackman, E. H., & Montgomery, G. H. (2012). The Therapeutic Relationship in E-Therapy for Mental Health: A Systematic Review. Journal of Medical Internet Research, 14(4), e110. doi:10.2196/jmir.2084Germain, V., Marchand, A., Bouchard, S., Guay, S., & Drouin, M.-S. (2010). Assessment of the Therapeutic Alliance in Face-to-Face or Videoconference Treatment for Posttraumatic Stress Disorder. Cyberpsychology, Behavior, and Social Networking, 13(1), 29-35. doi:10.1089/cyber.2009.0139Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1(3), 207-210. doi:10.1037/1040-3590.1.3.207Elvins, R., & Green, J. (2008). The conceptualization and measurement of therapeutic alliance: An empirical review. Clinical Psychology Review, 28(7), 1167-1187. doi:10.1016/j.cpr.2008.04.002Juan, M. C., Alcaniz, M., Monserrat, C., Botella, C., Banos, R. M., & Guerrero, B. (2005). Using Augmented Reality to Treat Phobias. IEEE Computer Graphics and Applications, 25(6), 31-37. doi:10.1109/mcg.2005.14

Concordancia entre la evaluación psicológica a través de internet y la evaluación tradicional aplicada por el terapeuta para la fobia a volar

The psychological evaluation through the Internet can be an effective alternative to pick user information up; however, few studies indicate that this assessment can completely replace diagnosis by a clinical. This study compares the correlation between evaluation through Internet with SIN MIEDO Airlines program and traditional therapist assessment for flying phobia. And also are analyzed data, opinions and preferences of the participants on these evaluation systems. Was made a within exploratory study with 51 participants was conducted from which high percentages of concordance was found between the two methods of evaluation. As for the opinion on the preference; both methods were highly rated although participants showed a clear preference for the traditional method used by the therapist. The results show that, in relation to specific phobias, the online evaluation allow making a diagnosis as reliable as a traditional evaluation applied by the clinician.La evaluación psicológica a través de Internet puede ser una alternativa eficaz para recoger información de los usuarios; sin embargo, hay pocos estudios que indiquen que esta evaluación pueda reemplazar completamente el diagnóstico realizado por un clínico. Este estudio compara la concordancia entre la evaluación a través de Internet con el programa SIN MIEDO Airlines y la evaluación tradicional del terapeuta para la fobia a volar. Se analizan también, datos de opinión y preferencias de los participantes acerca de estos sistemas de evaluación. Se llevó a cabo un estudio exploratorio intrasujeto con 51 participantes a partir del cual se encontraron altos porcentajes de concordancia entre los dos métodos de evaluación. En cuanto a la opinión sobre la preferencia; ambos métodos fueron bien valorados aunque los participantes mostraron una clara preferencia por el método tradicional aplicado por el terapeuta. Los resultados ponen de manifiesto que, en relación a las fobias específicas, la evaluación online parece permitir hacer un diagnóstico tan fiable como una evaluación tradicional aplicada por el clínic

Preferencias de pacientes con miedo a volar sobre tres tratamientos de exposición con ordenador

This study analyses participants' preferences regarding three computer-aided exposure treatments for fear of flying (FF): virtual reality exposure treatment assisted by a therapist (VRET), computer-aided exposure with a therapist present throughout exposure sessions (CAE-T), and self-administered computer-aided exposure (CAE-SA). Sixty participants with FF were randomly assigned to one of these treatments. At the end of a treatment, a demonstration of the other two treatment options was given and patients were asked to rate their preferences. At post-treatment, assessment data on treatment preferences were obtained from 48 participants (CAE-T n= 14; CAE-SA n= 16, and VRET n= 18). Participants favoured VRET as the most effective, the most recommended, but also they valued it as the most aversive. Attending to the specific treatment condition received by the participants, results showed that in VRET and CAE-T, participants assessed their own treatment as more preferred, more efficacious and more recommendable. Results suggest relevant features regarding the efficiency of computer-based treatments, and offer insights into improving computer-aided psychological interventions.Este estudio analiza las preferencias de los participantes sobre tres tratamientos de exposición basados en ordenador para el miedo a volar (MV): tratamiento de exposición mediante realidad virtual asistido por un terapeuta (RV), tratamiento de exposición asistido por ordenador con un terapeuta durante la exposición (CAFT-T) y tratamiento de exposición asistido por ordenador autoaplicado (CAFT-A). 60 participantes con MV fueron asignados aleatoriamente a uno de estos tratamientos. Al final del tratamiento, los participantes veían una demostración de las otras dos opciones y valoraban sus preferencias. En el post-tratamiento, la evaluación de las preferencias se obtuvo para 48 participantes (CAFT-T n= 14; CAFT-A n= 16 y RV n= 18). Los participantes valoraron la RV como la más eficaz, más recomendada, pero también como la más aversiva. Atendiendo a la condición de tratamiento recibida, en las condiciones RV y CAFT-T los participantes valoraron su propio tratamiento como el más preferido, más eficaz y más recomendable. Los resultados sugieren aspectos relevantes sobre la eficiencia de los tratamientos basados en ordenador y ofrecen ideas para mejorar las intervenciones psicológicas asistidas por ordenador.Funding for the study was provided by grants SEJ-2006-14301/PSIC, PROMETEO/2008/157 and PSI2010-17563 from the Spanish Government; Generalitat Valenciana, Conselleria de Educación Proyecto PROMETEOII/2013/003 para grupos de excelencia, and CIBER Fisiopatología de la Obesidad y Nutrición (CB06/03) is an initiative of ISC-III

An Internet-based program for depression using activity and physiological sensors: efficacy, expectations, satisfaction, and ease of use

Purpose: Computerized cognitive behavioral therapy (CCBT) has been shown to be efficacious. Moreover, CCBT can be enhanced by using physiological and activity sensors, but there is no evidence about the acceptability of all these tools. The objective of this study is to examine the efficacy, expectations, satisfaction, and ease of use of an Internet-based CCBT program for preventing depression, with and without sensors (electroencephalography, electrocardiograhpy ECG, and actigraphy), in a high-risk population (unemployed men). Patients and methods: Sixty participants at risk of depression (unemployed men) were randomly assigned to three experimental conditions: 1) intervention program (N=22), 2) intervention program plus sensors (N=19), and 3) control group (N=19). Participants completed depression, anxiety, positive and negative affect, and perceived stress measures. Furthermore, they also completed the measures for expectation, satisfaction, and the ease of use of the program. Results: Results showed that the two intervention groups improved significantly more than the control group on the clinical variables, and the improvements were greater in the group that used sensors than in the group that did not use them. Furthermore, participants in both intervention groups scored high on expectations and satisfaction with the CCBT program (with and without sensors). The mean score for usability was 88 out of 100 (standard deviation =12.32). No significant differences were found between groups on any of these variables. Conclusion: This is the first study to analyze the efficacy, expectations, satisfaction, and ease of use of an Internet-based program using physiological and activity sensors. These results suggest that an Internet program for depression with or without physiological and activity sensors is effective, satisfactory, and easy to useOPTIMI (European Union's Seventh Framework Program Personal Health Systems). 248544. Ministerio de Ciencia e Innovación. PSI2010-17563. CIBER of Physiopathology of Obesity and Nutrition, an initiative of ISCII