Personal Construct Therapy vs Cognitive Behavioral Therapy in the Treatment of Depression in Women with Fibromyalgia: Study Protocol for a Multicenter Randomized Controlled Trial

Background: Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia. Methods and Analysis: This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3- 5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions

A non-DNA-binding activity for the ATHB4 transcription factor in the control of vegetation proximity

Altres ajuts: Generalitat de Catalunya through the CERCA ProgramIn plants, perception of vegetation proximity by phytochrome photoreceptors activates a transcriptional network that implements a set of responses to adapt to plant competition, including elongation of stems or hypocotyls. In Arabidopsis thaliana, the homeodomain-leucine zipper (HD-Zip) transcription factor ARABIDOPSIS THALIANA HOMEOBOX 4 (ATHB4) regulates this and other responses, such as leaf polarity. To better understand the shade regulatory transcriptional network, we have carried out structure-function analyses of ATHB4 by overexpressing a series of truncated and mutated forms and analyzing three different responses: hypocotyl response to shade, transcriptional activity and leaf polarity. Our results indicated that ATHB4 has two physically separated molecular activities: that performed by HD-Zip, which is involved in binding to DNA-regulatory elements, and that performed by the ETHYLENE-RESPONSIVE ELEMENT BINDING FACTOR-associated amphiphilic repression (EAR)-containing N-terminal region, which is involved in protein-protein interaction. Whereas both activities are required to regulate leaf polarity, DNA-binding activity is not required for the regulation of the seedling responses to plant proximity, which indicates that ATHB4 works as a transcriptional cofactor in the regulation of this response. These findings suggest that transcription factors might employ alternative mechanisms of action to regulate different developmental processes

Tratamientos psicológicos empíricamente apoyados para adultos: Una revisión selectiva

Antecedentes: los tratamientos psicológicos han mostrado su eficacia, efectividad y eficiencia para el abordaje de los trastornos mentales; no obstante, considerando el conocimiento científico generado en los últimos años, no se dispone de trabajos de actualización en español sobre cuáles son los tratamientos psicológicos con respaldo empírico. El objetivo fue realizar una revisión selectiva de los principales tratamientos psicológicos empíricamente apoyados para el abordaje de trastornos mentales en personas adultas. Método: se recogen niveles de evidencia y grados de recomendación en función de los criterios propuestos por el Sistema Nacional de Salud de España (en las Guías de Práctica Clínica) para diferentes trastornos psicológicos. Resultados: los resultados sugieren que los tratamientos psicológicos disponen de apoyo empírico para el abordaje de un amplio elenco de trastornos psicológicos. El grado de apoyo empírico oscila de bajo a alto en función del trastorno psicológico analizado. La revisión sugiere que ciertos campos de intervención necesitan una mayor investigación. Conclusiones: a partir de esta revisión selectiva, los profesionales de la psicología podrán disponer de información rigurosa y actualizada que les permita tomar decisiones informadas a la hora de implementar aquellos procedimientos psicoterapéuticos empíricamente fundamentados en función de las características de las personas que demandan ayuda. Background: Psychological treatments have shown their efficacy, effectiveness, and efficiency in dealing with mental disorders. However, considering the scientific knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically supported psychological treatments. The main goal was to carry out a selective review of the main empirically supported psychological treatments for mental disorders in adults. Method: Levels of evidence and degrees of recommendation were collected based on the criteria proposed by the Spanish National Health System (Clinical Practice Guidelines) for different psychological disorders. Results: The results indicate that psychological treatments have empirical support for the approach to a wide range of psychological disorders. These levels of empirical evidence gathered range from low to high depending on the psychological disorder analysed. The review indicates the existence of certain fields of intervention that need further investigation. Conclusions: Based on this selective review, psychology professionals will be able to have rigorous, up-to-date information that allows them to make informed decisions when implementing empirically based psychotherapeutic procedures based on the characteristics of the people who require help

Percepció Interpersonal en les Parelles, Qualitat de la Relació i llur Influència en l’Èxit de la Teràpia Sistèmica de la Depressió

[cat] En l'estudi de les relacions humanes ha augmentat l'interès en els processos interpersonals degut a les seves implicacions en la qualitat de la relació de parella i en la salut mental dels cònjuges. La percepció interpersonal sembla un bon candidat per estudiar aquestes relacions, doncs es troba en la base de processos com la construcció de la identitat, la comunicació i la interacció. A més, en parelles on un dels membres pateix un trastorn mental com la depressió, pot ser un dels factors que afecten els símptomes i el seu tractament amb teràpia de parella. No obstant, aquest darrer aspecte ha estat poc estudiat, existeix una literatura poc cohesionada en aquest àmbit i els mètodes emprats per a la seva avaluació compten amb limitacions per captar-ne la seva complexitat. La present investigació té com objectiu aprofundir i ampliar el coneixement del paper de la percepció interpersonal en les relacions romàntiques mitjançant els significats personals de cada parella. Amb aquesta finalitat s’han dut a terme tres estudis. A l’estudi 1 s’elabora una tècnica, la Graella de Parella, que pretén captar els processos de percepció interpersonal únics de cada relació mitjançant els constructes personals de la parella i les percepcions i metapercepcions d’elements com el jo, la parella, el jo ideal i la parella ideal. S’il·lustra el seu desenvolupament i anàlisi mitjançant un cas exemple i s’utilitza com a instrument principal en els estudis posteriors. A l’estudi 2 s'explora la relació entre la percepció interpersonal i la qualitat de la relació mitjançant una mostra comunitària de 26 parelles heterosexuals. S'aplica el mètode d’anàlisi diàdic Actor-Partner Interdependence Model per avaluar la relació predictiva entre aquestes variables i per estudiar l’efecte del gènere i el temps de la relació en aquesta associació. A l’estudi 3, en una mostra clínica de 13 parelles en les quals un dels membres pateix depressió major, s’exploren els canvis en la percepció interpersonal i la qualitat de la relació que realitzen després d’una teràpia sistèmica de parella, tenint en compte la disminució dels símptomes dels pacients deprimits. Els resultats d’aquests estudis emfatitzen la importància de tenir en compte la visió d’ambdós membres de la parella. En l’anàlisi diàdica de l’estudi 2 s’han obtingut més resultats significatius en els efectes de parella que en els efectes d’actor indicant que com ens percep la parella (més que com la percebem a ella) té un paper rellevant en la satisfacció conjugal. A l’estudi 3, els canvis en la percepció interpersonal que han realitzat els cònjuges també han tingut un paper fonamental en la disminució dels símptomes dels pacients amb depressió. En conjunt, s’ha observat que quan la parella té una visió positiva de l’altre cònjuge i valida les seves construccions interpersonals millora el funcionament de la relació. Els resultats en els efectes condicionals del temps de la relació han mostrat que les parelles que porten més temps perceben millor qualitat en la relació quan construeixen la realitat de manera semblant, mentre que els cònjuges de les parelles noves obtenen resultats més diversos. No s’han obtingut diferències de gènere a l’hora de construir-se a sí mateix i a l’altra, però si s’han observat tendències que assenyalen que la variància de la qualitat de la relació dels homes està més explicada per la percepció interpersonal que la de les dones. Així mateix, el fet que les dones tinguin una visió positiva de la parella i de sí mateixes podria ser un indicador d’una bona qualitat de la relació per ambdós cònjuges. Pel que fa a la teràpia sistèmica de parella, s’ha observat que més de la meitat dels pacients han realitzat un canvi clínicament significatiu en la reducció dels símptomes, sobretot aquells que tenien una bona qualitat de la relació a l’inici de la teràpia. Mitjançant la grandària de l’efecte s’ha observat que aquests pacients i les seves parelles han realitzat canvis rellevants en la percepció interpersonal com millorar l’autoestima del pacient, que el cònjuge no deprimit tingui una visió positiva de la parella, sentir-se comprès i construir-se de forma semblant, aspectes que podrien contribuir a identificar els mecanismes de canvi d’aquesta teràpia. Finalment, el conjunt d’informació obtinguda mitjanant la Graella de Parella posa de manifest que pot ser un instrument útil tant per la investigació com per la pràctica clínica. Les aportacions d’aquesta tesi poden contribuir a cohesionar i millorar l’estudi de la percepció interpersonal en les parelles, a ampliar el coneixement respecte la qualitat i el funcionament de les relacions de parella, i a promoure aplicacions pràctiques per a la intervenció terapèutica en parelles i depressió.[eng] In the study of human relationships interest in interpersonal processes is increasing because of its implications for the quality of the couple’s relationship and for their mental health. Interpersonal perception seems to be very relevant for the study of human relationships because its central role in processes such as identity construction, communication and interaction. Moreover, when one partner is suffering a mental disorder such as depression, interpersonal perception could influence her or his symptoms and their treatment with couple’s therapy. However, on this we still have insufficient studies, the existing literature of interpersonal perception in couples is not well integrated, and the methodology to study the complexity of interpersonal perception has several limitations. The aim of this research was to delve into the knowledge of the role of interpersonal perception in romantic relationships by focusing on the personal meanings of each couple. For this purpose, we conducted three studies. The aim of Study 1 was to present a dyadic assessment tool, the Couple’s Grid, which was created to explore the phenomenological world of couples. We began with the main personal constructs of each partner (as elicited in their repertory grids) and, then, assessed simple perception of self and partner, their ideals, and also the metaperception of the partner’s view. This study describes the development and analysis of the Couple’s Grid with a case illustration. The following studies used this technique to obtain interpersonal perception measures. Study 2 employed the Actor-Partner Interdependence Model to analyse the bidirectional effects of partners’ observations. It explored the impact of interpersonal perception on the quality of relationship in a community sample of 26 heterosexual couples considering also the role of gender and the length of the relationship. In study 3, a sample of 13 couples with one member who was suffering depression were assessed before and after undergoing manualized systemic couple therapy. Results of interpersonal perception and dyadic adjustment were compared as a function of the extent of change in depressive symptoms occurred during the therapy process. The main results highlight the importance of considering the point of view of both partners in the study of couple’s relationships. Dyadic analysis in study 2, showed more significant results in partner effects than actor effects indicating that partner’s perception (more than one’s own perceptions) played a relevant role in relationship satisfaction. In study 3, partner’s perception also played an important role in patient’s depressive symptoms reduction. Taken together, results showed that each partner’s positive view of her or his partner and partners’ mutual validation of their interpersonal constructs enhanced the relationship functioning. Results on conditional effects of length of relationship displayed that, in long-term relationships, there was a tendency to perceive similarity between self and partner’s constructions, and that it seemed beneficial for the quality of the relationship, while short-term relationships yielded heterogeneous results. No gender differences were found in the way partners construed self and partner. However, interpersonal perception explained more variance in men’s quality of relationship than in women’s. Besides, women’s positive view of self and their partners could be an indicator of relationship satisfaction for both partners. In study 3, systemic couple therapy improved symptomatology of more than half of the patients of the sample, especially those with a better relationship quality at the beginning of therapy. Effect sizes showed that these couples underwent relevant changes in interpersonal perception such as increasing patients’ self-esteem, improving partners’ positive views of patient, feeling understood and construing their self in a similar way, which could contribute to identify mechanisms of change in couple’s therapy. Finally, the amount of information collected with the Couple’s Grid revealed that it could be a useful technique for both research and clinical uses. This thesis might contribute to integrate and improve the study of interpersonal perception in couples, to expand the knowledge of the quality and functioning of couple’s relationships, and to promote practical applications for therapeutic interventions with couples, especially in depression

Personal construct therapy vs cognitive behavioral therapy in the treatment of depression in women with fibromyalgia : study protocol for a multicenter randomized controlled trial

Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia. This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3-5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions

Proceedings Of The 23Rd Paediatric Rheumatology European Society Congress: Part Two

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