Single application of the unified protocol in university students of the Balearic Islands: a pilot study

Despite the proven evidence of the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders (ED), there is no study using the UP to treat ED in a Spanish clinical sample of university students. The objective of this study has been to determine the clinical utility of UP in this population. The project consisted of a pilot study of an open treatment outcome study without a control group, carried out in the psychological care service of the University of the Balearic Islands. UP was applied in individual face to face format to 17 participants with a diagnosis of ED. After the intervention, only two participants maintained their diagnosis. Except for one participant, all had a statistically significant reduction in depressive and anxious symptoms, with moderate-large effect sizes (Cohen's r = 0.48-0.62). These results are encouraging and are consistent with the evidence to date. We believe that UP could be a clinically useful treatment alternative for university psychological services

Relaciones entre la sensibilidad a la ansiedad y el miedo a volar en avión

En el presente estudio se analizan las relaciones entra la sensibilidad a la ansiedad (SA), uno de los elementos centrales del modelo de expectativa de Reiss (1980, 1991), que la señalan como un importante factor de riesgo para los trastornos de ansiedad, y el miedo a volar en avión. Las fobias específicas son el único trastorno de ansiedad en el que, hasta el momento, no se han encontrado evidencias claras de que SA presente niveles más elevados de los que aparecen en muestras de sujetos no ansiosos. La relación SA y miedo a volar en avión fue analizada en una muestra no clínica de 523 sujetos, evaluados con el «Índice de Sensibilidad a la Ansiedad» (ASI). Se encontró una SA elevada en los sujetos con miedo a volar y que una mayor intensidad del miedo estaba asociada con una mayor SA. La mayoría de ítems del ASI servían para discriminar entre sujetos con y sin miedo a volar. La SA estaba relacionada con variables de la intensidad del miedo a volar y con las expectativas de peligro. No se hallaron diferencias en SA al clasificar los sujetos con miedo a volar según el componente principal de su miedo. Se aportan datos descriptivos y psicométricos sobre la versión catalana del ASIIn this paper we analyze the relationship between anxiety sensitivity (AS) and fear of flying. AS is one of the key elements of Reiss' expectancy model and it is seen as an important risk factor for anxiety disorders. So far, specific phobias are the only anxiety disorder in which no clear evidence of a high AS has been found, as compared to non-anxious people,. The role of anxiety sensitivity was examined for the fear of flying in a non clinical sample of 523 subjects who were assessed with the Anxiety Sensitivity Index (ASI). An elevated AS was found among the subjects with fear of flying and a higher intensity of the fear of flying was associated with a higher AS. Most of the items of the ASI were useful in discriminating fearful from non fearful subjects. AS was related to variables of both severity of the fear and danger expectancies. No differences in AS were found when the fearful subjects were classified according to the principal component of their fear. Descriptive and psychometric data on the Catalan version of the ASI are reporte

Predictores de resultado terapéutico en el miedo a volar en avión

En el presente estudio se analizaron los predictores de resultado terapéutico de 31 sujetos que fueron tratados con un programa de exposición asistida por ordenador. Los predictores evaluados incluyeron variables demográficas, características clínicas del miedo a volar, otras variables psicopatológicas y variables relacionadas con el tratamiento. El miedo a la inestabilidad y el miedo a las alturas estaban asociados con un peor resultado post-tratamiento. La intensidad del miedo a la inestabilidad era el mejor predictor del miedo a volar post-tratamiento. En el seguimiento a un año la intensidad del miedo a volar post-tratamiento era el mejor predictor de la intensidad del miedo a volar autoinformado. No se encontraron predictores de volar/no volar en el seguimiento.In this study treatment outcome predictors were analyzed in a sample of 31 subjects with fear of flying who were treated with a computer-assisted exposure treatment. Predictors including demographic variables, clinical characteristics of fear of flying, other psychopathological variables, and treatment variables were assessed. Fear of unstability and fear of heights were associated with a worse treatment result. Severity of the fear of unstability was the best outcome predictor at post-treatment. At one year follow-up, post-treatment fear of flying severity was the best predictor of subsequent self-reported fear of flying. No predictors were found for flying/not flying during the follow-u

Una revisión de los estudios retrospectivos sobre el origen de las fobias específicas

En el presente trabajo se ha llevado a cabo una revisión de los estudios retrospectivos sobre el origen de las fobias específicas aparecidos en los últimos veinte años. El análisis se realiza atendiendo a las categorías de fobia específica propuestas por el DSM-IV y según hayan sido realizados con sujetos clínicos o análogos. La clasificación, según las categorías propuestas en el DSM-IV, demuestra que existen diferencias en cuanto a las vías de adquisición en los distintos tipos de miedo fóbico. Las experiencias directas de condicionamiento son la vía principal de adquisición en todos los tipos de fobia específica, excepto las del tipo entorno natural, cuando se analizan muestras clínicas. En los estudios con análogos resulta más difícil esta- blecer conclusiones. Destaca la aparición de importantes diferencias entre estudios en función de los instrumentos de evaluación utilizadosThis paper reviews the retrospective studies about the origin of specific phobias published in the last twenty years. The analysis is performed according to the categories of specific phobia put forward by the DSM-IV and on whether they have been carried out on clinical or analogue subjects. The classification according to the DSM-IV categories shows that there are differences regarding the ways of acquisition of different kinds of phobic fear. Direct conditioning experiences are the most important way of acquisition in all the types of specific phobia, except the ones of natural environment type when clinical samples are analyzed. It is more difficult to get to a conclusion in the case of studies with analogues. It also stands out the emergence of significant differences between the studies depending on the assessment methods which have been use

Prevalencia, dimensiones y vías de adquisición en el miedo a volar en avión

In this study we examined the prevalence, components and ways of acquisition of fear of flying in a sample of 523 subjects from the general population. Subjects were given several questionnaires to determine intensity and history of the fear. Sixty-nine subjects (13 %) were fearful flyers and an additional 14 % suffered important distress when flying but were not phobics. The main component of the fear of flying was the fear of having an accident (22%) followed by the fear of not having control of the situation. Anyway, most of the subjects attributed their fear to more than one component. Regarding the ways of acquisition, in more than a 50 % from the subjects the fear onset was not associated with any clear trigger. Our results suggest that fear of flying cannot be regarded as a unitary fear. Nosologic and treatment implications are discussed.El objetivo de este trabajo es el de presentar los resultados más destacados de un estudio epidemiológico sobre el miedo a volar en avión en una muestra de 523 personas de la población general. Sesenta y nueve sujetos, lo que supone un 13,19% de la muestra estudiada, puede considerarse que presentan dicha alteración. Un 14,42% de las personas estudiadas también manifiestan niveles de malestar significativos al viajar en avión aunque no puedan considerarse fóbicas. Respecto a las dimensiones del miedo, el motivo principal de temor es el de sufrir un accidente (22%), seguido por el miedo a no tener control de la situación (13,6%). Lo más habitual de todos modos, es que los sujetos con miedo indiquen diversos componentes como los responsables principales de su miedo a volar en avión (45,8%). Estos resultados apuntan que el miedo a volar en avión no puede considerarse un miedo unitario. En cuanto a la instauración del trastorno más del cincuenta por ciento de los casos no se relacionan con ningún desencadenante claro de su inicio. Se discuten las implicaciones nosológicas y de indicación de tratamiento a partir de estos datos

An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial

Background: Flying phobia (FP) is a common and disabling mental disorder. Although in vivo exposure is the treatment of choice, it is linked to a number of limitations in its implementation. Particularly important, is the limited access to the feared stimulus (i.e., plane). Moreover, the economic cost of in vivo exposure should be specially considered as well as the difficulty of applying the exposure technique in an appropriate way; controlling important variables such as the duration of the exposure or the number of sessions. ICTs could help to reduce these limitations. Computer-assisted treatments have remarkable advantages in treating FP. Furthermore, they can be delivered through the Internet, increasing their advantages and reaching more people in need. The Internet has been established as an effective way to treat a wide range of mental disorders. However, as far as we know, no controlled studies exist on FP treatment via the Internet. This study aims to evaluate the efficacy of an Internetbased treatment for FP (NO-FEAR Airlines) versus a waiting list control group. Secondary objectives will be to explore two ways of delivering NO-FEAR Airlines, with or without therapist guidance, and study the patients’ acceptance of the program. This paper presents the study protocol. Methods/design: The study is a randomized controlled trial. A minimum of 57 participants will be randomly assigned to three conditions: a) NO-FEAR Airlines totally self-applied, b) NO-FEAR Airlines with therapist guidance, or c) a waiting list control group (6 weeks). Primary outcomes measures will be the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes will be included to assess other relevant clinical measures, such as the Fear and Avoidance Scales, Clinician Severity Scale, and Patient’s Improvement scale. Analyses of post-treatment flights will be conducted. Treatment acceptance and preference measures will also be included. Intention-to-treat and per protocol analyses will be conducted. Discussion: An Internet-based treatment for FP could have considerable advantages in managing in vivo exposure limitations, specifically in terms of access to treatment, acceptance, adherence, and the cost-effectiveness of the intervention. This is the first randomized controlled trial to study this issue. Trial registration: Clinicaltrials.gov: NCT02298478. Trial registration date 3 November 2014.Funding for the study was provided by grants: Ministerio de Economía y Competitividad (Spain) (Plan Nacional I + D + I. PSI2013-41783-R); Red de Excelencia (PSI2014-56303-REDT) PROMOSAM: Research in processes, mechanisms and psychological treatments for mental health promotion from the Ministerio de Economía y Competitividad (2014); a PhD grant from Generalitat Valenciana (VALi + d) (ACIF/2014/320), and CIBER: CIBER Fisiopatología de la Obesidad y Nutrición is an initiative of ISCIII

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

Retos de la investigación psicológica en salud mental

The magnitude and impact of mental disorders does not correspond to the resources devoted to research and attention. Although we have made significant progress in their understanding and the efficacy of the psychological treatments, we are still far from an optimal situation. This paper focuses on one of the major issues which we consider fundamental challenges and needs in this area, the increase in research focusing on psychopathology, especially on the mechanisms and processes that explain and maintain mental disorders, as a key point for the design and development of new psychological interventions for the prevention, treatment, and promotion of mental health. The aim is to promote discussion among all stakeholders and debate on those lines we think as a priority.La magnitud y el impacto que suponen los trastornos mentales no se corresponden con los recursos que se dedican a su investigación y atención. Aunque hemos avanzado notablemente en su comprensión y en la eficacia de los tratamientos psicológicos que intentan paliarlos, estamos aún lejos de la situación óptima. Este trabajo se centra en uno de los retos y una de las necesidades que consideramos fundamentales, el incremento de la investigación focalizada en psicopatología, especialmente sobre los mecanismos y procesos que explican y mantienen estos problemas, como eje básico para el desarrollo de nuevas intervenciones psicológicas, tanto para la prevención como para el tratamiento y promoción de la salud mental. El objetivo es promover la discusión entre los agentes implicados y reflexionar sobre las líneas de trabajo que creemos prioritarias.Este trabajo ha sido financiado por el Ministerio Español de Economía y Competitividad (MINECO), a través de la Red de Excelencia PROMOSAM financiada por el MINECO (PSI2014-56303-REDT)

Challenges in the development of psychological interventions and care practice in mental health

Aunque hemos avanzado notablemente en el desarrollo de recursos preventivos y especialmente, en la eficacia de los tratamientos psicológicos que intentan paliar los trastornos mentales, estamos aún lejos de la situación óptima. Este trabajo se centra en dos grandes cuestiones que consideramos retos y necesidades fundamentales en este ámbito: (a) la necesidad de mejorar y extender la prevención, la intervención temprana y la promoción de la salud mental y (b) la necesidad de una mayor divulgación de los tratamientos psicológicos eficaces, el desarrollo de nuevas intervenciones y la mayor comprensión de los mecanismos de acción de los tratamientos psicológicos. El objetivo es promover la discusión entre los agentes implicados y reflexionar sobre las líneas de trabajo que creemos prioritariasAlthough we have made significant progress in the development of preventive tools and especially in the efficacy of the psychological treatments, we are still far from an optimal situation. This paper focuses on two major issues which we consider fundamental challenges and urges in this area: (a) the need for improving and spreading prevention, early intervention, and the promotion of mental health and (b) the need for greater dissemination of effective psychological treatments, the development of new interventions and greater understanding of the mechanisms of action of psychological treatments. The aim is to promote discussion among all stakeholders and debate on those lines we think as priorityEste trabajo ha sido financiado por el Ministerio Español de Economía y Competitividad (MINECO), a través de la Red de Excelencia PROMOSAM financiada por el MINECO (PSI2014-56303-REDT

Changes in heart rate variability of flight phobics during a paced breathing task and exposure to fearful stimuli

The aim of this experiment was to explore changes in the vagally mediated heart rate variability (HRV) of flight phobics during exposure to feared stimuli. A paced breathing task was included to control for respiration effects. Sixty-one flight phobics (40 women) with a mean age of 39.07 years (SD = 11.24) participated in the study. The root mean of the squared successive interbeat intervals differences (RMSSD) was taken as the time domain measure of HRV. High frequency (HF: 0.15-0.4 Hz) and low frequency (LF: 0.04-0.15 Hz) band power was calculated on the ECG recordings obtained during free breathing baseline (BL), paced breathing (PB), and exposure (E) to fearful stimuli. Heart rate unexpectedly increased from BL to PB, and decreased from PB to E, while no differences were found between BL and E. No changes in the RMSSD were seen across conditions. HF band power increased, as expected, from BL to PB, and a significant decrease was found from PB to E. LF band power, as well as the LF/HF ratio, increased from BL to E. Discussion focuses on (a) the role of the parasympathetic and the sympathetic nervous systems in fear-related situations, and (b) the effects of paced breathing in preparing the system to cope with threatEn este estudio se analizan los cambios en la variabilidad de la tasa cardíaca (HRV) relacionada con el sistema vagal en sujetos fóbicos durante la exposición a estímulos temidos. Se ha introducido una tarea de respiración pautada para controlar los efectos de la misma en la medida de la HRV. Han participado en el estudio 61 pacientes con fobia a volar (40 mujeres) con una edad media de 39,07 años (SD =11,24). Como medida de la HRV en el dominio del tiempo se ha tomado la RMSSD (media cuadrática de las diferencias de los intervalos RR sucesivos). Se ha calculado la potencia espectral en las bandas de alta (HF: 0.15-0.4 Hz) y de baja frecuencia (LF: 0.04-0.15 Hz) sobre los registros de ECG obtenidos durante una línea base sin respiración controlada (BL), una fase de respiración pautada (PB) y la exposición (E) a estímulos temidos. La tasa cardíaca aumentó de forma inesperada de BL a PB, disminuyó de PB a E, y no se obtuvieron diferencias entre BL y E. No se observaron cambios en RMSSD entre las tres condiciones. La potencia espectral de HF aumentó, como se esperaba, de BL a PB, y disminuyó de forma significativa de PB a E. La potencia espectral de LF, así como la relación LF/HF, aumentó de BL a E. La discusión se centra en (a) el papel de los sistemas simpático y parasimpático en las situaciones de miedo, y (b) los efectos de la respiración pautada en la preparación del sistema para afrontar estímulos temido