Intervención basada en mindfulness a través de una app móvil para personas con cáncer colorrectal en espera de cirugía: ensayo clínico aleatorizado / Mindfulness based intervention through mobile app for colorectal cancer people awaiting surgery: A randomized clinical trial

Introducción: El cáncer colorrectal representa el tercer cáncer con mayor incidencia en ambos sexos. Un tercio de los pacientes con cáncer experimentan sintomatología ansiosa o depresiva. El objetivo de este estudio fue evaluar la eficacia de una intervención de reducción de estrés basada en mindfulness a través de una aplicación móvil (En calma en el quirófano). Método: Es un ensayo controlado, aleatorizado, con evaluador ciego y multicéntrico, que compara la eficacia de una aplicación de entrenamiento en mindfulness para móviles (rama experimental) con tratamiento habitual (rama control), en 3tiempos de medida (T0 o línea base, T1 o alta a domicilio, T2 o un mes tras cirugía). Se evaluó la sintomatología ansiosa y depresiva (HADS), la calidad de vida (WHOQOL), la escala de dolor (EVA) y la escala de satisfacción (CSQ). Resultados: Hubo un total de 270 derivaciones. Fueron analizadas 82 personas: 39 personas utilizaron la app y 43 continuaron su tratamiento habitual. No hubo cambios significativos entre grupos ni tiempos de medida. Se observó una ligera tendencia en la que el grupo experimental tuvo menos síntomas de depresión y ansiedad entre T0 y T2 (B?= −0,2; IC 95%: 8,8-9,2). Conclusiones: Nuestra población mostraba una edad media alta (65 años), niveles bajos de ansiedad y depresión, y niveles medios de calidad de vida en T0. Estos factores podrían haber interactuado y limitado la eficacia de la app. Nuevas líneas de investigación tienen que ir dirigidas a evaluar la eficacia de las apps para pacientes con enfermedades quirúrgicas en poblaciones más jóvenes. (AU)

Introduction: Colorectal cancer is the third most common cancer worldwide that occurs both in men and women. Around one-third of patients with cancer will suffer from anxiety or depression symptoms. The aim of this study was to evaluate the effectiveness of a mindfulness-based stress reduction intervention through a mobile application («en calma en el quirófano»). Method: This study is a multicenter, single-blind (evaluator), controlled, randomized trial that compares the effectiveness of a mindfulness training through a mobile application (intervention group) and treatment as usual (control group) in 3different moments (T0 or baseline, T1 or hospital discharge and T2 or one month after surgery). Hospital Anxiety and depression Scale (HADS), quality of life (WHOQOL), pain (VAS) and satisfaction (CSQ) were assessed. Results: In all, there were 270 referred patients. Among them, 39 and 43 were assigned to the intervention and control groups respectively; 82 patients were analyzed: 39 patients used the app, and 43 patients continued with the treatment as usual. There were no significant changes between groups and time. We observed a slight trend in which intervention group had less depression and anxiety symptoms since T0 and T2 (B=−0.2; 95% CI: 8.8-9.2). Conclusions: The sample of this study had a high mean age (65 years old), and low levels of anxiety and depression and medium levels of pre-surgery quality of life in baseline. These factors could have influenced limiting the effectiveness of the app. Prospective research lines should focus on evaluating the effectiveness of mobile applications for younger patients with surgical pathologies. (AU)

Mindfulness based intervention through mobile app for colorectal cancer people awaiting surgery: A randomized clinical trial.

INTRODUCTION: Colorectal cancer is the third most common cancer worldwide both in men and women. Around one-third of patients with cancer will suffer from anxiety or depression symptoms. The aim of this study was to evaluate the effectiveness of a Mindfulness-based stress reduction intervention through a mobile application ("En Calma en el Quirófano"). METHOD: This study is a multicenter, single-blind (evaluator), controlled, randomised trial that compares the effectiveness of a mindfulness training through a mobile application (intervention group) and treatment as usual (control group) in three different moments (T0 or baseline, T1 or hospital discharge and T2 or one month after surgery). Anxiety and depression symptoms (HADS), quality of life (WHOQOL), pain, (VAS) and satisfaction (CSQ) were assessed. RESULTS: In all, there were 270 referred patients. Among them, 39 and 43 were assigned to the intervention and control groups respectively. 82 patients were analyzed: 39 patients used the app, and 43 patients continued with the treatment as usual. There were no significant changes between groups and time. We observed a slight trend in which intervention group had less depression and anxiety symptoms since T0 and T2 (B = -0.2; 95% CI between 8.8 and 9.2). CONCLUSIONS: The sample of this study had a high mean age (65 years old), and low levels of anxiety and depression and medium levels of pre-surgery quality of life in baseline. These factors could have influenced limiting the effectiveness of the app. Prospective research lines should focus on evaluating the effectiveness of mobile applications for younger patients with surgical pathologies.

Mindful Self-Compassion program for chronic pain patients: A randomized controlled trial.

BACKGROUND: Although evidence-based psychological treatments for chronic pain (CP) have been demonstrated to be effective for a variety of outcomes, modest effects observed in recent reviews indicate scope for improvement. Self-compassion promotes a proactive attitude towards self-care and actively seeking relief from suffering. Consequently, more compassionate people experience better physical, psychological and interpersonal well-being. METHODS: We conducted a single-blind, randomized, controlled trial to examine the effects of a Mindful Self-Compassion program (MSC) on relevant clinical outcomes in patients with CP. Patients were randomly assigned to one of the two intervention arms: MSC or cognitive-behavioural therapy (CBT). The protocols of both intervention arms were standardized and consisted of a 150-min session once a week during 8 weeks formatted to groups of no more than 20 participants. The primary outcome was self-compassion, measured with the Self-Compassion Scale (SCS). The secondary outcomes were other pain-related scores, quality-of-life measures, and anxiety and depression scores. RESULTS: In all, 62 and 61 patients were assigned to the MSC and CBT groups, respectively. The MSC intervention was more effective than CBT for self-compassion (average treatment effect [ATE] = 0.126, p < 0.05). The secondary outcomes, pain acceptance (ATE = 5.214, p < 0.01), pain interference (ATE = -0.393, p < 0.05), catastrophizing (ATE = -2.139, p < 0.10) and anxiety (ATE = -0.902, p < 0.05), were also favoured in the experimental arm (MSC). No serious adverse events were observed. CONCLUSIONS: Mindful Self-Compassion is an appropriate therapeutic approach for CP patients and may result in greater benefits on self-compassion and emotional well-being than CBT. SIGNIFICANCE: This randomized controlled trial compares the novel intervention (MSC program) with the gold standard psychological intervention for CP (CBT). MSC improves the levels of self-compassion, a therapeutic target that is receiving attention since the last two decades, and it also improves anxiety symptoms, pain interference and pain acceptance more than what CBT does. These results provide empirical support to guide clinical work towards the promotion of self-compassion in psychotherapeutic interventions for people with CP.

Impacto emocional en pacientes y familiares durante la pandemia por COVID-19. Un duelo diferente / Emotional impact on patients and families during the COVID-19 pandemic. A different kind of bereavement

OBJETIVO: Favorecer que cada persona elabore su duelo de forma natural, prevenir factores de riesgo e identifi car a los deudos que necesiten una atención específica. MÉTODO: Estudio descriptivo. Doscientas ocho familias fueron atendidas entre el 11 de marzo y el 20 de mayo de 2020 por duelo por la COVID-19, de acuerdo con un protocolo establecido. RESULTADOS: La edad media de los fallecidos fue de 76 años. El 58 % eran hombres. Los familiares atendidos fueron hijo/a (54 %), cónyuge o pareja (20 %), hermano/a (2 %). En relación con el lugar de fallecimiento, el 41 % en plantas de hospitalización, el 27 % en Urgencias, el 22 % en la planta de cuidados paliativos y el 10 % en UCI. El tipo de atención fue en el 53 % de los casos telefónica, en el 16 % presencial, en el 12 % telefónica y presencial y en el 3 % a través de videollamada. En un 63 % de las veces se realizó apoyo, asesoramiento puntual o atención específica mientras que en el 37 % se ofreció apoyo y disponibilidad. En lo referente "despedida final", el 49 % de los familiares pudieron despedirse, el 31 % no pudo. El tipo de duelo de los familiares atendidos fue inicialmente normal en el 71 %, mientras que un 16 % fue clasificado como de riesgo. CONCLUSIONES: La información y comunicación efectiva con los familiares afectados, la formación en la muerte y el duelo de los profesionales implicados y la disponibilidad de atención psicológica se consideran de gran importancia en una situación COVID-19. La experiencia muestra que la "Atención al duelo" debe estar a disposición de la población general afectada. Una buena organización y planificación ha de incorporar protocolos de actuación y seguimiento que incluyan una adecuada valoración y atención en los diferentes niveles desde el apoyo, la prevención y la detección precoz de posibles complicaciones en el duelo, y si es necesario la intervención especializada

OBJECTIVE: To allow each individual to undergo bereavement in a natural way, to prevent risk factors, and to identify bereaved people who need specific attention. METHOD: A descriptive study. Two hundred and eight families were attended to between March 11 and May 20, 2020 for Covid-19 according to an established protocol. RESULTS: Average age of the deceased relatives was 76 years. Fifty-eight percent were men. The family members who were cared for included: son or daughter (54 %), spouse or partner (20 %), brother or sister (2 %). Regarding the place of death, 41 % were in hospitalization wards, 27 % in the emergency room, 22 % in the palliative care ward, and 10 % in the ICU. The method of care was in 53 % of cases over the telephone, in 16 % in person, and in 12 % both over the telephone and in person; in 3 % of cases it was by video call. In 63 % of cases, support, specific advice or care was provided, whereas in 37 % support and availability were offered. In terms of "final goodbye", 49 % of all family members were able to say goodbye, while 31 % were unable to do so. The type of grief observed in the family members attended to was initially considered to be normal for 71 % of cases, whereas 16 % were classified as at risk. DISCUSSION: Effective information to and communication with affected relatives; that involved professionals be trained in dealing with death and grief so as not to cause harm, as well as in palliative care; and availability of psychological care are deemed of great importance in a COVID-19 scenario. Experience shows that "bereavement care" should be available to the general affected population. Proper organization and planning must incorporate action and follow-up protocols that include adequate assessment and care at different levels, from support, prevention and early detection of possible complications of bereavement to specialist intervention when necessary

Diálogo con atención plena: integrando mindfulness y narrativas / Dialogue with full attention: integrating mindfulness and narratives

Se desarrolla una propuesta de integración de narrativas y mindfulness basándonos en la naturaleza lingüística del ser humano y su capacidad de apertura al campo de la conciencia. Se describen otros programas psicoterapéuticos en el mundo que han integrado mindfulness. Se aportan datos de investigación a nivel nacional e internacional. Se comparte la experiencia de nuestro grupo al trabajar en la clínica e investigar con esta perspectiva en la sanidad pública española. Se hace hincapié en la importancia de desarrollar programas de formación para los profesionales de la salud mental que sean rigurosos y profundos

A proposal to integrate narratives and mindfulness based on the linguistic nature of human beings and their ability of openness to the consciousness field is made. Other international psychotherapeutic programs that have integrated mindfulness into their practice are described. Research evidence from both national and international studies is provided. In this paper we share our experience working from this perspective both in research and in the clinical practice. The importance of developing rigorous and in-depth training programs for mental health professionals is pointed out