Cognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a non-counteractive ...approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT.
A total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects.
According to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22).
Although using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression.
ClinicalTrials.gov; ID: NCT01542957.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Training programmes for clinical psychologists should include evidence-based teaching methods that enable trainees to learn therapeutic skills. Here we compared the perceived utility of role-playing ...vs. peer counselling. In peer counselling, one student recounts a personal experience to the other, who thus has the opportunity to act as the therapist in relation to a real situation. Given that sharing such personal experiences may provoke discomfort in students, we also examined this aspect.
Trainees (n=202) were given both role-play and peer counselling activities as a way of practising empathy and active listening. After completing the skills training programme they completed a questionnaire to assess the extent to which each method had helped them to develop their self-awareness and to acquire these therapeutic skills.
In general, peer counselling was considered more useful than role-playing for enhancing self-awareness and personal growth, as well as for learning these professional skills. Regarding the discomfort experienced by students, our data suggest that any initial reluctance to share personal experiences is outweighed by the personal and professional benefits obtained.
Our results indicate that experiential learning involving emotionally charged situations is an effective way of teaching therapeutic skills to clinical and health psychology trainees.
The Tonic Immobility Scale has been only studied in abuse and/or sexual assault survivors, but tonic immobility (TI) also occurs after other types of traumatic events. Consequently, we modified the ...scale for this purpose and studied its factor structure, internal consistency, and convergent, discriminant and criterion validity in 392 university students, most of whom had suffered one or more traumatic events of various kinds. The Fear subscale of the Modified Tonic Immobility Scale (MTIS) showed very low internal consistency, and must be eliminated or reformulated. Discrimination indices of items 5 and 8 were very low, and these items must be reformulated or removed. After removing the five previous items, the shortened version of the MTIS had a one-factor structure, although model fit was not completely satisfactory. This scale showed acceptable levels of reliability, convergent validity with post-traumatic symptomatology, discriminant validity with measures of depression and anxiety, and criterion validity differentiating between groups that had and had not experienced traumatic events. The psychometric properties of the shortened version of the MTIS should be studied further. It may also be advisable to add new items of TI in order to establish whether this is a construct with more than one dimension.
This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations.
Systematic searches ...were conducted in Medline, PsycINFO, PsycArticles, PubMed and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period ≥ 5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied.
Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome.
Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.
To clarify what is actually measured by the trait version of the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970), we conducted a confirmatory factor analysis of various ...models and evaluated convergent and discriminant validity. The best fit was obtained with both a bifactor model, comprising 2 specific factors plus a general factor, and a 1-construct, 2-method model. The total score and the 2 method subscales of the STAI trait version were more strongly correlated with depression than with anxiety. In the bifactor model with 2 specific factors, the depression subscale showed stronger correlations with measures of depression than with measures of anxiety. The correlation of the hypothetical anxiety subscale with measures of depression was equivalent to or higher than its correlation with measures of anxiety. These results suggest that the questionnaire does not strictly evaluate anxiety but, rather, negative affect.
Celotno besedilo
Dostopno za:
BFBNIB, DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Se presenta el caso de una mujer de 27 años que consultó por ataques de pánico que comenzaron año y medio antes de acudir a terapia y que se agudizaron en el mes previo a la consulta. Tras cuatro ...sesiones de evaluación y una entrevista con una amiga se consideró que se trataba de un trastorno de ansiedad social. Los ataques eran desencadenados por situaciones sociales y la paciente temía vomitar delante de otros y ser evaluada negativamente. Se aplicó a lo largo de 21 sesiones un tratamiento cognitivo-conductual que incluyó autorregistros, entrenamiento en respiración controlada, entrenamiento en atención, reestructuración cognitiva, autoexposición en vivo y entrenamiento en asertividad respecto a su pareja, ya que había sintomatología ansiosa asociada con las discusiones y maltrato por parte de su compañero. Las puntuaciones obtenidas en las escalas administradas a lo largo del proceso indicaron una mejora progresiva y clínicamente significativa. Las razones principales que pueden haber contribuido al éxito terapéutico son la motivación para el cambio, la sólida alianza terapéutica establecida, la aceptación y aplicación constante de la técnica de exposición y el entrenamiento asertivo respecto a la pareja.
Se presenta el caso de una familia de cuatro miembros en la cual, a partir de un ictus sufrido por la madre tres años atrás, se produjo un cambio de roles y la aparición de conflictos familiares. ...Tras la evaluación, la familia aceptó que los problemas no eran solo de la madre, sino que implicaban una dinámica familiar disfuncional. La terapia fue aplicada a lo largo de 24 sesiones y algunos breves contactos individuales paralelos, e incluyó fomento de la empatía, entrenamiento en habilidades de comunicación, negociación y resolución de problemas, reestructuración cognitiva y potenciación del afecto positivo y de actividades agradables conjuntas. Según la familia y las terapeutas, se consiguieron en gran medida los objetivos propuestos, lo cual vino refrendado por diversos cuestionarios. Las mejoras se mantuvieron en el seguimiento a los 10 meses. Los buenos resultados podrían ser explicados por la gran motivación de la familia para el cambio, la buena relación terapéutica y la aplicación de técnicas con apoyo empírico
Se presenta el caso de una mujer de 36 años que solicitó ayuda por la presencia de crisis de angustia. Tras la evaluación se consideró que el foco central del problema era la presencia de ansiedad y ...preocupaciones de carácter excesivo y persistente. Se realizaron 43 sesiones de tratamiento cognitivo-conductual, dos de ellas con el marido. Se abordaron las crisis de angustia mediante psicoeducación, entrenamiento en respiración controlada y restructuración cognitiva; y las preocupaciones excesivas mediante control de estímulos, reestructuración cognitiva, entrenamiento en resolución de problemas, experimentos conductuales y exposición imaginal. Los informes de la paciente y los cuestionarios indicaron una mejora clínicamente significativa, en la que, creemos, los experimentos conductuales y la exposición imaginal jugaron un papel muy importante.
The main goal of the study is to explore the relationship between coping styles and vulnerability to eating disorders in a sample of adolescent girls, according to their age. The sample comprises ...1396 girls, aged 13 to 18, who completed the Eating Disorders Inventory-3 (EDI-3) and the Adolescent Coping Scale (ACS). The regression analysis shows that the coping strategy most closely linked to the likelihood of developing an ED in all age groups is Intropunitive Avoidance. The scales of the Intropunitive Avoidance dimension that have the most explanatory power are Tension Reduction and Self-Blame. Girls aged 13 and 17 are identified as the highest risk groups. Physical and social changes are proposed as the hypothetical explanation for the difference between age groups. Emphasis is placed on the need for specific prevention programs for adolescents, particularly those at high risk.
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