Programa de tratamiento integrativo para la fibromialgia: estudio preliminar

One of the most prevalent chronic pain syndromes in the hospital and outpatient rheumatologyclinic is fibromyalgia (FM). The current psychological treatment programs that havebeen developed for patients suffering from FM are based on Cognitive Behavioral Therapy(CBT). Many of these treatments have shown efficacy in isolation in empirical studiesin laboratory settings. Therefore, it is necessary to test the effectiveness of these treatmentprograms in natural settings such as a Mental Health Unit (USM). For the presentstudy, an intervention program has been developed, applied at a USM, aimed not only atreducing pain but also at providing the patient with tools to achieve better acceptance ofit, increase their positive emotions and their quality of life, therefore addressing better theproblem of pain.A pilot study was conducted to assess the preliminary efficacy of a psychological treatmentprogram that integrates CBT techniques along with positive psychology, acceptance,mindfulness and hypnosis tools (which have shown evidence in the treatment of chronicpain). The study involved 5 patients (4 women and 1 man) who received an 8 sessionprogram. Post- treatment results indicate that patients significantly increased their levelsof pain acceptance, self-pity, and quality of life. There is also an improvement in moodaccompanied by a reduction in pain interference.Our work provides preliminary data that support the usefulness of including new componentswhen addressing FM.Uno de los síndromes de dolor crónico más prevalente en la consulta hospitalaria y ambulatoriade reumatología es la fibromialgia (FM). Los programas de tratamiento psicológicosactuales que se han desarrollado para los pacientes que sufren FM están basadosen la Terapia Cognitivo Conductual (TCC). Muchos de estos tratamientos han mostradoeficacia de forma aislada en estudios empíricos en entornos de laboratorio. Por esto, esnecesario probar la eficacia de estos programas de tratamiento en entornos naturalescomo es el caso de una Unidad de Salud Mental (USM). Para el presente estudio seha desarrollado un programa de intervención, aplicado en una USM, dirigido no sólo ala reducción del dolor sino también a dotar al paciente de herramientas para lograr unamejor aceptación del mismo, aumentar sus emociones positivas y su calidad de vida,afrontando así de mejor manera el problema del dolor.Se realizó un estudio piloto con el fin de valorar la eficacia preliminar de un programa detratamiento psicológico que integra técnicas de la TCC junto con herramientas de psicologíapositiva, aceptación, mindfulness e hipnosis (que han mostrado evidencia en eltratamiento del dolor crónico). En el estudio participaron 5 pacientes (4 mujeres y 1 hombre)que recibieron dicho programa en 8 sesiones. Los resultados en el post-tratamientoindicaron que los pacientes aumentaron de manera significativa sus niveles de aceptacióndel dolor, auto-compasión y calidad de vida. Se observa también una mejora en elestado de ánimo acompañada de una reducción en la interferencia del dolor.Nuestro trabajo aporta datos preliminares que apoyan la utilidad de incluir nuevos componentesa la hora de abordar la F

La regulación emocional en los trastornos emocionales, una piedra nodal para los abordajes transdiagnósticos: una revisión de la literatura

II Jornades d’Investigació per als Estudiants de Ciències de la Salut Facultat de Ciències de la SalutIntroducción: La regulación emocional se ha convertido en un tema de creciente interés, tanto a nivel de investigación básica (Tamir, 2011) como en diversos ámbitos aplicados, fundamentalmente el clínico (Aldao, Nolan-Hoeksema y Schweizer, 2010). Si bien la regulación emocional ha sido estudiada en un amplio conjunto de entidades psicopatológicas, una importante proporción de los desarrollos están vinculados con los trastornos emocionales. En ese sentido, la producción exponencial en relación a la regulación emocional en depresión y ansiedad requiere de notables esfuerzos teóricos para integrar los resultados empíricos. Este trabajo se propone presentar una integración de los principales aportes de la regulación emocional en el campo de los trastornos emocionales, enfatizando su importancia para los abordajes transdiagnósticos. Con dicho objetivo se ha realizado una revisión de la literatura a través de una búsqueda ascendente (ancestry approach). Método: Se utiliza el modelo de regulación emocional propuesto por Gross (1998) para organizar la siguiente revisión, con las innovaciones que aporta la revisión extendida de dicho modelo (Sheppes, Suri y Gross, 2015). Resultados: A través del análisis de la bibliografía se destaca la predominancia del estudio de estrategias de regulación emocional individuales y encubiertas tales como la supresión, la reevaluación, la aceptación o la rumiación. Se plantean los desafíos futuros en el campo de estudio de la regulación emocional en la psicopatología.Introducction: Emotion regulation has become a topic of increasing interest, both at the level of basic research (Tamir, 2011) and applied fields, mainly clinical (Aldao, Nolan- Hoeksema y Schweizer, 2010). While emotional regulation has been studied in a wide range of psychopathological entities, a significant proportion of the developments are linked to emotional disorders. In that sense, the exponential production in relation efforts to integrate the existing empirical findings. This work aims to present an integration of the main contributions of emotion regulation in the field of emotional disorders, emphasizing its importance for transdiagnostic approaches. With this objective a review of the literature through an ancestry approach was carried out. Method: The emotion regulation model proposed by Gross (1998) is taken to organize the next revision, linking the content to some of the innovations provided by the extended model (Sheppes, Suri y Gross, 2015). Results: In the light of the findings a prevalence of individual and covert strategies of emotion regulation such as suppression, reappraisal, acceptance or rumination stands out. Future prospects of the field of emotion regulation are considered

Prácticas de PS1034: Evaluación e Intervención Clínica

Departament de Psicologia Bàsica, Clínica i Psicobiologia . Codi assignatura: PS103

Upregulating Positive Affectivity in the Transdiagnostic Treatment of Emotional Disorders: A Randomized Pilot Study

Transdiagnostic cognitive-behavioral therapy for emotional disorders (ED) has proven to be effective. However, current transdiagnostic treatment protocols address only the regulation of negative affectivity, and they do not include treatment components to more directly target the regulation of positive affectivity. In this study, we propose to evaluate the preliminary efficacy and acceptability of a transdiagnostic treatment protocol for ED that includes, as an innovative feature, a specific treatment component to directly upregulate positive affectivity based on positive psychology interventions. A total of 24 participants were randomized to either a transdiagnostic treatment protocol (n = 12) or a transdiagnostic treatment protocol with an additional component designed to regulate positive affectivity (n = 12). Participants completed measures of anxiety, depression, positive and negative affectivity, and quality of life, as well as treatment acceptability at pre- and posttreatment and at the 3-month follow-up. Both interventions led to improvements in all measures at posttreatment, and these outcomes were maintained at the 3-month follow-up, with large effect sizes for all measures. The effect sizes for positive affect were larger in the condition that included the component to upregulate positive affectivity. Attrition rate was low, and both treatment protocols were well accepted by participants. The results obtained in this study indicate the feasibility of testing the treatment protocol in a larger, randomized, controlled trial, and they suggest the potential of including treatment components for directly upregulating positive affectivity in future research on transdiagnostic treatment protocols for ED

Standard dialectical behavioral therapy for bipolar I disorder: a case study with two year follow-up

Este trabajo tiene como objetivo analizar la efectividad de la terapia conductual dialéctica (DBT) en un individuo diagnosticado de trastorno bipolar I después de un año de tratamiento y un seguimiento realizado dos años después del tratamiento. El paciente sufría de un trastorno de larga evolución que había recibido numerosos tratamientos psicológicos y psiquiátricos antes de comenzar el programa DBT. Los resultados indicaron que la DBT fue efectiva ya que hubo una disminución en los síntomas clínicos más relevantes, como el número de episodios afectivos y el número de ingresos en la sala de emergencias, así como un aumento en la regulación del afecto y la adherencia a la farmacoterapia. La mejora también se reflejó en el nivel de rendimiento general. Los resultados se mantuvieron a los 2 años de seguimiento. Estos hallazgos respaldan la conveniencia de utilizar estrategias destinadas a mejorar la regulación emocional y el comportamiento, de acuerdo con otros estudios que demuestran la eficacia de DBT en el tratamiento de individuos que presentan una desregulación de la emoción generalizada.This work aims to analyze the effectiveness of dialectical behavior therapy (DBT) in an individual diagnosed of bipolar disorder I after a year of treatment and a follow-up conducted two years after the treatment. The patient was suffering from a disorder of long evolution having received numerous psychological and psychiatric treatments before starting the DBT program. The results indicated that DBT was effective as there was a decrease in the most relevant clinical symptoms, such as the number of mood episodes and the number of emergency room admissions, as well as an increase in the regulation of affect and adherence to pharmacotherapy. The improvement was also reflected in the level of overall performance. The outcomes were maintained at 2-year follow-up. These findings support the convenience of using strategies aimed to improve emotion and behavioral regulation in line with other studies demonstrating the efficacy of DBT in the treatment of individuals presenting pervasive emotion dysregulation

Cognitive-Behavioural therapy and interpersonal psychotherapy for the treatment of post-natal depression: a narrative review

BACKGROUND: Post-natal Depression (PND) is a depressive disorder that causes significant distress or impairment on different levels in the individual's life and their families. There is already evidence of the efficacy of psychological treatments for PND. We conducted a narrative review and researched the literature for identifying systematic reviews and studies for the best psychological treatments of PND, and examined what parameters made those treatments successful. METHODS: We searched 4 electronic databases. We included reviews and randomised controlled clinical trials for our research. We excluded other types of studies such as case studies and cohort studies. We followed a specific search strategy with specific terms and a selection process. We identified risk of bias in reviews and studies, and identified their limitations. We synthesized the data based on particular information, including: name of the authors, location, research type, target, population, delivery, outcome measures, participants, control groups, types of intervention, components of treatments, providers, experimental conditions amongst others. RESULTS: We found 6 reviews and 15 studies which met our inclusion criteria focusing on Cognitive Behavioural Therapy (CBT) for PND. Among the main findings we found that CBT can be delivered on an individual basis or within a group. It can be effective in the short-term, or up to six months post-intervention. CBT can be delivered by professionals or experts, but can also be practiced by non-experts. We found 7 components of CBT, including psychoeducation, cognitive restructuring, and goal setting. We also researched whether virtual reality (VR) has ever been used for the treatment of PND, and found that it has not. CONCLUSION: From our review, we have concluded that CBT is an effective treatment for PND. We have explored the utility of VR as a possible therapeutic modality for PND and have decided to run a pilot feasibility study as a next step, which will act as the foundational guide for a clinical trial at a later stage

Positive and Negative Affect Schedule (PANAS): psychometric properties of the online Spanish version in a clinical sample with emotional disorders

Background: The Positive and Negative Affect Schedule (PANAS) is the most widely and frequently used scale to assess positive and negative affect. The PANAS has been validated in several languages, and it has shown excellent psychometric properties in the general population and some clinical samples, such as forensic samples, substance users, and adult women with fibromyalgia. Nevertheless, the psychometric properties of the scale have not yet been examined in clinical samples with anxiety, depressive, and adjustment disorders. In addition, the proliferation of Internet-based treatments has led to the development of a wide range of assessments conducted online with digital versions of pen and paper self-report questionnaires. However, no validations have been carried out to analyze the psychometric properties of the online version of the PANAS. The present study investigates the psychometric properties of the online Spanish version of the PANAS in a clinical sample of individuals with emotional disorders. Methods: The sample was composed of 595 Spanish adult volunteers with a diagnosis of depressive disorder (n = 237), anxiety disorder (n = 284), or adjustment disorder (n = 74). Factor structure, construct validity, internal consistency, and sensitivity to change were analyzed. Results: Confirmatory factor analysis yielded a latent structure of two independent factors, consistent with previous validations of the instrument. The analyses showed adequate convergent and discriminant validity, good internal consistency as well as sensitivity to change. Conclusions: Overall, the results obtained in this study show that the online version of the PANAS has adequate psychometric properties for the assessment of positive and negative affect in a Spanish clinical population

Dialectical behavioural therapy for oppositional defiant disorder in adolescents: a case series

Aplicación de la terapia dialéctica comportamental al trastorno negativista desafiante en adolescentes: una serie de casos. Antecedentes: el trastorno negativista desafiante (TND) se caracteriza por un patrón consistente de conductas oposicionistas hacia las figura de autoridad, irritabilidad y dificultades de regulación emocional. El TND en adolescentes presenta sintomatología común con el trastorno límite de la personalidad (TLP). Un programa de tratamiento que se ha mostrado eficaz para el tratamiento de trastornos caracterizados por dificultades graves en la regulación emocional como el TLP es la terapia dialéctica comportamental (DBT). El objetivo de este trabajo es mostrar una serie de casos en los que se aplica la DBT a dos adolescentes diagnosticadas de TND, con comorbilidad psiquiátrica y conductas parasuicidas. Método: se aplicó el programa de entrenamiento en habilidades de la DBT y sesiones de terapia individual. Resultados: los resultados indican una disminución de las conductas impulsivas, desadaptativas de regulación del afecto, autolesiones, ingresos hospitalarios, síntomas depresivos y de la ira. También se produjo una mejora del estado de ánimo y el afecto positivo. Conclusión: estos resultados sugieren que la DBT puede ser una alternativa para el tratamiento del TND en adolescentes con comorbilidad psiquiátrica y conductas parasuicidas.Background: Oppositional defiant disorder (ODD) is characterised as a recurrent pattern of defiant behaviour towards authority figures, irritability and difficulties in regulating emotions. ODD in adolescents presents similar symptomatology to borderline personality disorder (BPD). A treatment programme that has been shown to be effective for treating problems related to emotion dysregulation such as BPD is dialectical behavioural therapy (DBT). The aim of this article is to outline a case series in which we applied DBT to two adolescents diagnosed with ODD, in addition to psychiatric comorbidity and parasuicidal behaviours. Method: We applied a training programme of 24 sessions in DBT skills, along with individual therapy. Results: The results showed a decrease in impulsive behaviours, maladaptive behaviours to regulate affect, self-mutilation behaviour, number of hospitalisations, anger and depressive symptoms. The data also showed an increase in positive emotions. Conclusion: These results suggest that DBT can be an alternative for the treatment of ODD in adolescents with psychiatric comorbidity and parasuicidal behaviours

Individual differences and health in chronic pain: are sex-differences relevant?

Background: Because psychological variables are known to intercorrelate, the goal of this investigation was to compare the unique association between several well-established psychological constructs in pain research and pain-related outcomes. Sex differences are considered because pain is experienced differently across sex groups. Methods: Participants were 456 consecutive chronic pain patients attending a tertiary pain clinic (mean age = 58.4 years, SD = 14.8, 63.6% women). The study design was cross-sectional. Psychological constructs included personality (NEO-Five Factor Inventory), irrational thinking (General Attitudes and Beliefs Scale), and coping (Social Problem Solving Inventory). Outcomes were pain severity and interference (Brief Pain Inventory) and physical, general, and mental health status (Short Form-36). To decide whether the bivariate analyses and the two-block, multivariate linear regressions for each study outcome (block 1 = age, sex, and pain severity; block 2 = psychological variables) should be conducted with the whole sample or split by sex, we first explored whether sex moderated the relationship between psychological variables and outcomes. An alpha level of 0.001 was set to reduce the risk of type I errors due to multiple comparisons. Results: The moderation analyses indicated no sex differences in the association between psychological variables and study outcomes (all interaction terms p > .05). Thus, further analyses were calculated with the whole sample. Specifically, the bivariate analyses revealed that psychological constructs were intercorrelated in the expected direction and mostly correlated with mental health and overall perceived health status. In the regressions, when controlling for age, sex, and pain severity, psychological factors as a block significantly increased the explained variance of physical functioning (ΔR2 = .037, p < .001), general health (ΔR2 = .138, p < .001), and mental health (ΔR2 = .362, p < .001). However, unique associations were only obtained for mental health and neuroticism (β = − 0.30, p < .001) and a negative problem orientation (β = − 0.26, p < .001). Conclusions: There is redundancy in the relationship between psychological variables and pain-related outcomes and the strength of this association is highest for mental health status. The association between psychological characteristics and health outcomes was comparable for men and women, which suggests that the same therapeutic targets could be selected in psychological interventions of pain patients irrespective of sex

Calidad de vida en fibromialgia: Influencia de factores físicos y psicológicos

El objetivo de este trabajo es profundizar en los factores físicos y psicológicos que influyen en la calidad de vida (CV) de los pacientes con fibromialgia (FM). 63 mujeres con FM y 58 mujeres sanas fueron evaluadas en distintas medidas relacionadas con CV y con factores físicos y psicológicos. Se encontró una CV percibida significativamente más baja en las pacientes comparadas con el grupo control; los análisis de correlación indicaron, por una parte, una relación inversa y significativa entre la CV percibida y la intensidad e interferencia del dolor y la fatiga, el impacto de la FM y la sintomatología psicopatológica (depresión, ideación paranoide, obsesión-compulsión y somatización); por otra parte, la función física, el rol físico, la vitalidad y la salud mental correlacionaron positiva y significativamente con CV. Los análisis de regresión señalaron dos variables físicas (interferencia del dolor en las actividades y el rol físico) y dos psicológicas (sintomatología obsesiva-compulsiva e ideación paranoide) como mejores predictores de la CV. Estos resultados indican la necesidad de abordar esta enfermedad desde un punto de vista multidisciplinar.The aim of this paper is to deepen the physical and psychological factors that influence the quality of life (QoL) of patients with fibromyalgia (FM). 63 women with FM and 58 healthy women were evaluated on several measures related to QoL and to physical and psychological symptoms. A significantly lower QoL was found in FM patients vs. the control group; the correlation analyses indicated, on the one hand, a significant inverse relationship between QoL and perceived intensity and interference of pain and fatigue, FM impact and psychopathological symptoms (depression, paranoid ideation, obsessive- compulsive and somatization); on the other hand, both physical function and physical role, vitality and mental health correlated positively and significantly with QoL. The regression analysis revealed that two physical variables (pain interference and physical role) and two psychological variables (obsessive- compulsive and paranoid ideation symptoms) presented the strongest relationship with QoL. These results indicate the need to address this syndrome from a multidisciplinary perspective