Effectiveness of Brief Systemic Therapy versus Cognitive Behavioral Therapy in routine clinical practice / Efectividad de la Terapia Sistémica Breve versus la Terapia Cognitivo-Conductual en la práctica clínica rutinaria

BACKGROUND: Combining strategies and techniques from different therapeutic approaches is a common procedure in routine mental health practice. It has been claimed that the integration of systemic brief therapies offers useful psychotherapeutic alternatives, especially in our overloaded public mental health services. However, this claim has rarely been put to the test, and comparison with well-established empirically-based treatments has been scarce. METHOD: Of 419 patients referred to an Adult Ambulatory Mental Health Service, 212 were allocated to Cognitive-Behavioral Therapy (CBT), and 207 to an integrative Brief Systemic Therapy (BST). Follow-up assessments of patients' status took place between one and three years later. RESULTS: Both therapy models were found to be equivalent in their percentage of therapeutic discharges, drop-outs, relapses and in the use of other mental health services during the follow-up period. Although both treatments were cost-efficient, BST was not briefer than CBT. The between-group equivalence was also confirmed, analyzing the data by psychiatric diagnosis.CONCLUSIONS: This study provides some preliminary data that suggest that BST might be an effective and efficient treatment in public mental health practice, comparable to well-established treatments like CBT

ANTECEDENTES: la combinación de estrategias y técnicas de diferentes modelos psicoterapéuticos es un procedimiento común en la práctica habitual en salud mental. Se ha propuesto que la integración de terapias sistémicas breves ofrece alternativas psicoterapéuticas útiles, especialmente en nuestros sobrecargados servicios públicos de salud mental. Sin embargo, esta afirmación apenas ha sido investigada y la comparación con tratamientos empíricamente validados ha sido escasa. MÉTODO: de 419 pacientes adultos remitidos a un Servicio Ambulatorio de Salud Mental, 212 fueron asignados a Terapia Cognitivo-Conductual (TCC) y 207 a una Terapia Sistémica Breve integrativa (TSB). Las evaluaciones del estado de los pacientes tuvieron lugar entre uno y tres años más tarde. RESULTADOS: ambos modelos terapéuticos resultaron equivalentes en términos de sus porcentajes de altas terapéuticas, abandonos, recaídas y uso de otros servicios de salud mental durante el tiempo de seguimiento. Aunque ambos tratamientos fueron coste-eficientes, la TSB no fue más breve que la TCC. La equivalencia entre grupos fue también confirmada analizando los datos según los diagnósticos psiquiátricos. CONCLUSIONES: este estudio aporta datos preliminares que sugieren que la TSB podría ser un tratamiento efectivo y eficiente en servicios públicos de salud mental, comparables con otros tratamientos bien establecidos como la TCC

Effectiveness of Brief Systemic Therapy versus Cognitive Behavioral Therapy in routine clinical practice.

BACKGROUND: Combining strategies and techniques from different therapeutic approaches is a common procedure in routine mental health practice. It has been claimed that the integration of systemic brief therapies offers useful psychotherapeutic alternatives, especially in our overloaded public mental health services. However, this claim has rarely been put to the test, and comparison with well-established empirically-based treatments has been scarce. METHOD: Of 419 patients referred to an Adult Ambulatory Mental Health Service, 212 were allocated to Cognitive-Behavioral Therapy (CBT), and 207 to an integrative Brief Systemic Therapy (BST). Follow-up assessments of patients’ status took place between one and three years later. RESULTS: Both therapy models were found to be equivalent in their percentage of therapeutic discharges, drop-outs, relapses and in the use of other mental health services during the follow-up period. Although both treatments were cost-efficient, BST was not briefer than CBT. The between-group equivalence was also confirmed, analyzing the data by psychiatric diagnosis. CONCLUSIONS: This study provides some preliminary data that suggest that BST might be an effective and efficient treatment in public mental health practice, comparable to well-established treatments like CBT.

Estudio piloto: "Programa de soporte a la vinculación hacia dispositivos socio-sanitarios y formativo-laborales, para pacientes esquizofrénicos" / No disponible

Introducción: este estudio piloto pretende evaluar la eficacia de un programa multimodal y multi-terapéutico, dirigido principalmente a fomentar la adherencia hacia dispositivos de rehabilitación vocacional y soporte al empleo, así como dispositivos socia-sanitarios ambulatorios en salud mental. Aglutina algunos de los principales elementos terapéuticos señalados por la literatura científica (Pfammatter, Junghan et al. 2006), aplicándose tanto a los pacientes como a sus familiares simultáneamente. Material y método: 2 grupos terapéuticos fueron reclutados: el grupo de pacientes estaba compuesto por 8 pacientes con esquizofrenia, quienes asistieron a 16 sesiones (semanales); el grupo familiar incluía 8 de sus allegados, acudiendo a 6 sesiones. Ambos grupos se desarrollaron paralelamente (durante 5 meses). Resultados: todos los 8 participantes (asistencia media = 85,19%) completaron el grupo. No se consignó ningún ingreso hospitalario ni cambio de tratamiento farmacológico. Se detectaron mejoras en la asistencia hacia actividades de ocio y sociales, formativas, así como en varias escalas de la SFS (Tabla 1). Sin embargo, ningún cambio significativo a nivel clínico fue detectado en trabajo, Escala GAF y el uso de servicios en salud mental comunitarios. Conclusiones: Esta Aproximación terapéutica multimodal piloto mejora parcialmente el funcionamiento social en pacientes con esquizofrenia, manteniéndose esta mejora a los 6 meses de la intervención

Introduction: This pilot study pretends to test the efficacy of a multimodal therapy program, primarily aimed at fostering the adherence to work, vocational and ambulatory mental heath services. It encompasses the key therapeutic elements signalled on scientific literature (Pfammatter, Junghan et al. 2006), and applied to both patients and their families at the same time. Material and Methods: 2 therapeutic groups were recruited: Patients group was composed for 8 schizophrenic patients who underwent 16 sessions (weakly); the family group included 8 of their relatives, who took 6 sessions. Both groups were executed in parallel and at the same time (over 5 months). Results: All 8 patients finished the group (assistance mean = 85,19%). No hospital entrances and significant pharmacology treatment changes were reported. Improvements in assistance to leisure and social activities, formative activities and several SFS scales (table 1) were detected. Nonetheless, no significant clinical improvement were detected in work, GAF scale, and the use of communitarian health services. Conclusions: This pilot multimodal therapeutic approach partially improves social functioning in schizophrenic patients, for more than 6 months