Adherence to Oral Contraception in Young Women: Beliefs, Locus of Control, and Psychological Reactance.

BACKGROUND: There is a high dropout rate of oral contraceptive pills (OCP), mainly due to a lack of adherence to treatment. The aim of this study was to identify the psychological processes and attitudes toward medication involved in adherence to OCP, depending on the prescription, to avoid unintended pregnancies (AUP) or gynecological problems (GP). METHODS: This cross-sectional study was conducted by asking 689 young women in the fertile period, mean age 23.41 (SD = 5.90), to complete questionnaires related to attitudes, beliefs, psychological reactance, locus of control, and adherence to contraceptive medication. Descriptive analyses and a binary logistic regression were performed. RESULTS: The results confirmed that different beliefs and psychological processes were involved in adherence to oral contraception, based on women's reasons for taking contraceptive medication. More psychological processes were involved in non-adherence in the AUP group than in the GP group. Psychological reactance contributed most to explaining non-adherence in women who used the OCP to prevent unintended pregnancies. Conversely, women with gynecological problems reported difficulties in adherence, mainly due to their beliefs about contraceptive pills. CONCLUSIONS: These findings indicate that attitudes toward medication and psychological processes can play an important role in adherence to OCP, including reasons for using the pill. Identifying the psychological factors and beliefs linked with contraception could guide health professionals to provide counseling to women, thus increasing their adherence to medication and maximizing their health and well-being.

Cambios en la actividad cerebral asociados a la terapia de exposición cognitivo-conductual para fobias específicas: búsqueda de los mecanismos subyacentes / Changes in brain activity associated with cognitive-behavioral exposure therapy for specific phobias: searching for underlying mechanisms

INTRODUCCIÓN: La evidencia disponible recoge resultados consistentes sobre cambios cerebrales morfológicos y funcionales producidos por el tratamiento psicológico. La terapia cognitivo-conductual (TCC) de exposición es actualmente el tratamiento psicológico más eficaz para las fobias. OBJETIVOS: Explorar los cambios cerebrales y autoinformados en pacientes con fobias específicas a animales pequeños sometidos a un programa de TCC de exposición y comprobar si el programa consiguió que estos pacientes procesaran los estímulos temidos de manera similar a las personas no fóbicas. Sujetos y métodos. La muestra estuvo compuesta por 32 adultos, de los que 16 (5 hombres y 11 mujeres; edad media: 38,08 años) tenían un diagnóstico de fobia específica a animales pequeños y 16 (4 hombres y 12 mujeres; edad media: 21,81 años) no tenían dicho diagnóstico. Se utilizó un diseño univariado de tratamiento antes-después. Las puntuaciones del grupo sin fobia en autoinformes y activación cerebral se compararon con las puntuaciones del grupo con fobia posteriores al tratamiento. RESULTADOS: Los datos muestran cambios significativos en la actividad cerebral y mejoras en las medidas autoinformadas debido a la aplicación de la TCC a la fobia específica. Tras recibir TCC, los participantes mostraron una mayor activación en puntos del precúneo. Además, comparado con los participantes sin fobia, los pacientes fóbicos mantenían las respuestas defensivas y de miedo ante los estímulos fóbicos. CONCLUSIONES: El precúneo parece ser un regulador que reorganiza el procesamiento de los estímulos fóbicos. Puede implicar que la TCC de exposición, además, activa mecanismos de aceptación, autoconciencia y autoeficacia

INTRODUCTION. The current evidence collected consistent results about morphological and functional brain changes produced by psychological treatment. Exposure cognitive-behavioral therapy (CBT) is currently the most effective psychological treatment for phobias. AIMS. To explore the brain activation and self-reported changes in patients with specific phobias to small animals who underwent a CBT exposure program and to prove if the CBT program made phobic patients process feared stimuli similarly to non-phobic persons. SUBJECTS AND METHODS. The sample consisted of 32 adults, of which 16 (5 males and 11 females; mean age: 38.08) had specific phobia to small animals and 16 (4 males and 12 females; mean age: 21.81) had no phobias. A univariate before-and-after treatment design were used. In addition, the scores of the non-phobic group in self-reports and brain activity were compared with the post-treatment scores of the phobic group. RESULTS. Data show significant changes in brain activity, and improvements in self-reported measures because of applying CBT to specific phobias. As a highlight, participants showed a greater activation in points of the precuneus after receiving CBT. Also, when compared with non-phobic participants, phobic patients still remain with both fear and defensive responses to phobic stimuli. CONCLUSIONS. The precuneus seems to be a regulator that reorganizes the processing of phobic stimuli. It can imply as CBT/ exposure also active acceptance, self-awareness, and self-efficacy mechanisms

Verbal Emotional Disclosure of Traumatic Experiences in Adolescents: The Role of Social Risk Factors.

It is well-known that traumatic events and adverse life situations are very important in both physical and psychological health. Prevalence studies suggested that adolescents experience at least one potentially traumatic event before reaching age 18. The paradigm of research centered on expressive writing has evidenced the beneficial effects that the emotional disclosure of previous traumas produces on physical health and psychological adjustment. The aims of the study are threefold: determining the prevalence of adverse or traumatic events; examining the extent to which psychopathological symptoms developed in those exposed to traumatic events; and exploring an verbal emotional disclosure (VED) paradigm in which variations on time spent talking about traumatic experiences to others resulted in a reduction of the psychological impact of trauma in a sample of Spanish adolescents. 422 volunteer adolescents participated, 226 boys and 192 girls, from 10 to 19 years old, all of them living in Tenerife. The mean age was 14.8 years (SD = 1.83). All of them completed the instruments used to assess the psychological impact of traumatic experiences and VED. The main results indicated that 77% of the participants had suffered a traumatic situation. The participants who have been exposed to traumatic events scored significantly higher in measures of post-traumatic stress, disorder, intrusive thoughts, avoidance behaviors, anxiety and depression, compared to those without trauma. Furthermore, results show a decrease in symptomatology scores as a function of time spent disclosing emotional experiences to others, particularly when disclosure occurred several times. In conclusion, stressful events or traumatic experiences and their concomitant emotional effects are highly prevalent in adolescents, and repeated VED to others appears to ameliorate their impact. VED shows greater therapeutic benefits when adolescents narrate the experience on several occasions and in an extensive way.

El uso combinado de la exposición a realidad virtual en el tratamiento de la agorafobia / The combined use of virtual reality exposure in the treatment of agoraphobia

Introducción. Este estudio compara la eficacia diferencia de tres grupos de tratamiento para la agorafobia: paroxetina en combinación con terapia cognitivo-conductual, paroxetina en combinación con terapia cognitivo-conductual y exposición de realidad virtual, y un grupo sólo con paroxetina. Metodología. Fueron seleccionados 99 pacientes con agorafobia. Ambos grupos de tratamiento combinado recibieron 11 sesiones de terapia cognitivo-conductual y uno de los grupos también fue expuesto a 4 sesiones de tratamiento de realidad virtual. Los tratamientos se aplicaron en sesiones individuales una vez a la semana durante 3 meses. Resultados. Los tres grupos de tratamiento mostraron mejoras estadísticamente significativas. En algunas de las medidas, los grupos de tratamiento combinado mostraron mayores mejoras y el grupo tratado con la exposición de realidad virtual mostró una mayor capacidad de enfrentar los estímulos fóbicos. Conclusiones. Los tratamientos que combinaron terapia psicofarmacológica y psicológica mostraron una mayor eficacia. Aunque el uso de las nuevas tecnologías dio lugar a una mejoría mayor, siguen existiendo problemas relacionados con la adherencia al tratamiento

Introduction. This study compares the differential efficacy of three groups of treatments for agoraphobia: paroxetine combined with cognitive-behavioral therapy, paroxetine combined with cognitive-behavioral therapy and virtual reality exposure, and a group with only paroxetine. Methodology. 99 patients with agoraphobia were finally selected. Both combined treatment groups received 11 sessions of cognitive-behavioral therapy, and one of the groups was also exposed to 4 sessions of virtual reality treatment. Treatments were applied in individual sessions once a week for 3 months. Results. The three treatment groups showed statistically significant improvements. In some measures, combined treatment groups showed greater improvements. The virtual reality exposure group showed greater improvement confronting phobic stimuli. Conclusions. Treatments combining psychopharmacological and psychological therapy showed greater efficacy. Although the use of new technologies led to greater improvement, treatment adherence problems still remain

The combined use of virtual reality exposure in the treatment of agoraphobia.

INTRODUCTION: This study compares the differential efficacy of three groups of treatments for agoraphobia: paroxetine combined with cognitive-behavioral therapy, paroxetine combined with cognitive-behavioral therapy and virtual reality exposure, and a group with only paroxetine. METHODOLOGY: 99 patients with agoraphobia were finally selected. Both combined treatment groups received 11 sessions of cognitive-behavioral therapy, and one of the groups was also exposed to 4 sessions of virtual reality treatment. Treatments were applied in individual sessions once a week for 3 months. RESULTS: The three treatment groups showed statistically significant improvements. In some measures, combined treatment groups showed greater improvements. The virtual reality exposure group showed greater improvement confronting phobic stimuli. CONCLUSIONS: Treatments combining psychopharmacological and psychological therapy showed greater efficacy. Although the use of new technologies led to greater improvement, treatment adherence problems still remain.

Gender differences in psychological distress in Spain.

BACKGROUND AND AIMS: Epidemiological and community-based surveys consistently report gender differences in mental health. This study examines gender differences in psychological distress by analyzing the relevance of stress, coping styles, social support and the time use. METHODS: Psychological tests were administered to a convenience sample of 1,337 men and 1,251 women from the Spanish general population, aged between 18 and 65 and with different socio-demographic characteristics, although both the women and men groups had similar age and educational levels. RESULTS: Women had more psychological distress than men. Although psychological distress in the women and men groups have some common correlates such as more stress, more emotional and less rational coping and less social support, we find some gender differences. Work role dissatisfaction was more associated with distress in the men than in the women group. In addition, women's distress was associated with more daily time devoted to childcare and less to activities they enjoy, and men's distress was associated with more time devoted to housework and less to physical exercise. CONCLUSIONS: Social roles traditionally attributed to women and men - and the differences in the use of time that such roles entail - are relevant in gender differences in psychological distress.

[The prediction of the level of depression by cognitive, behavioral, and temperamental variables in a six-month time interval]. / La predicción del nivel de depresión por variables cognitivas, conductuales y temperamentales en un intervalo de seis meses.

Several models have been proposed to explain the depressive phenomenon, such as the theory of dysfunctional attitudes, the hopelessness theory, the behavioral model of activity level, or temperamental models. This article presents data about the role of those models in the prediction of the level of depression in a sample of 414 college students, assessed over a temporal interval of six months. Dysfunctional attitudes, attributional styles, the level of activity, and the five-factors of personality were assessed. The BDI-II was the depression level measure. The results showed that these variables predict depression levels, but with low coefficients. The dimensions of Need of Achievement (a dysfunctional attitude) and Neuroticism had particularly greater weight in the prediction, but only Neuroticism seems to behave like a vulnerability element. Attributional styles did not contribute significantly to the prediction of depression. Activity level lost its predictive role during the 6-month interval. These results are discussed according to the role of the proposed models and the need for a deeper explanation of the variance of depression scores.

Agorafobia (con o sin pánico) y conductas de afrontamiento desadaptativas. Estudio empírico. Segunda parte

resumen está disponible en el texto completo

Abstract: This paper is focused in the coping strategies used by patients with an agoraphobic disorder (AD) when they are forced to confront phobic situations. Traditionally, the coping strategies considered were those used by agoraphobia patients to reduce anxiety and psychological distress: the avoidance behavior (to avoid the phobic stimuli) and the escape behavior (when the phobic stimulus is present). Additionally, behaviors used to try to avoid negative physiological responses similar to those occurring in an anxiety crisis (interoceptive avoidance) are also included. A fourth group of behaviors has received less attention: coping strategies that partially allow agoraphobia patients to confront and resist the presence of phobic stimuli. These are stimuli that they need to or are forced to confront. These partial coping strategies (often rituals behaviors) are behaviors to which patients assign a value in decreasing the anxiety to tolerable levels until they are able to confront and resist the phobic scenes (even partially). These behaviors play a non-adaptative role because they difficult the development of adaptative self-control strategies, interfere with daily living conditions, and support the disorder providing an initial and immediate relief of psychological distress. We prefer to name all these strategies non-adaptative coping behaviors. Despite the relevance of these partial coping strategies in the development and consolidation of agoraphobia, their empiric study has been infrequent (especially when compared to the study of both avoidance and escape behaviors). In that sense, with the present study we try to provide data about the following issues: 1) to know how frequently AP' use non-adaptative coping behaviors compared with a group of patients with other disorders. 2) The differential use of behavioral patterns by agoraphobic patients (AP): avoidance behaviors, interoceptive avoidance, escape behaviors, and, especially, the partial coping strategies. 3) The role of partial coping strategies in the evaluation of therapeutic outcome, according to the clinician opinion. The empirical study was designed in two stages: First, the elaboration of a scale to measure coping strategies of phobic stimuli. For that purpose, we took into account literature on the topic, observational data and clinical histories of patients with agoraphobia. The result was a scale (CAD scale) composed by 87 overt behavior items, and 52 covert behavior items. All of these items allowed for the formation of four behavioural patterns, grouping items according to their functions in coping with phobic stimuli: 1) avoidance behavioral pattern; 2) interoceptive avoidance pattern; 3) escape behavioral pattern; and 4) partial coping behavioral pattern. Second stage: The application of the CAD scale to a clinical simple. A group of psychologists and psychiatrists (from a local mental health service unit) were requested to administrate the scale to their patients, with their informed consent. The final sample (n = 235) was as follows: 40 with agoraphobic disorder (30 women and 10 men); 30 with panic disorder (18 women and 12 men); 30 mixed with anxious-depressive disorder (25 women and 5 men); 40 with depressive disorders (32 women and 8 men); 25 with psychotic disorders (10 women and 15 men). A matched group without any clinical disorders was added later (N = 70, 49 women and 21 men). After analysing the results related to the use of non-adaptative coping behaviors, these may be summarized as follows: In gene ral, the group which used less the CAD strategies was the non-clinical group. The patients with agoraphobia were the ones who used the CAD strategies in a more significant level, compared with both the non-clinical group and the groups with other disorders. This includes the use of partial coping behaviors. Results were similar both to CAD overt strategies and covert strategies. Comparing the differential use of CAD strategies by patients with agoraphobia, results show a more significant use of avoidance behaviors (especially in overt behavior form), followed by escape behaviors. Interoceptive avoidance was the third CAD more frequently used. Partial coping behaviors were less used in contrast with other CAD strategies. According to therapist judgments with respect to the relationship between the use of coping strategies and the therapeutic progress evaluation, the AP sample was divided into two groups: positive progress and non-positive progress (negative, unstable or no progress). The positive progress group shows a significant lower use of avoidance behaviors, interoceptive avoidance, and escape behaviors, but only in the overt behavior form. There were no significant effects for partial coping behavior. In other words, a positive evolution in PA was joined by a decrease in avoidance overt behaviors, interoceptive overt avoidance, and escape overt behaviors, but there were no changes in the use of both cognitive coping strategies and partial coping behaviors. Our findings confirm that CAD strategies are more used by AP. Partial coping behaviours are included among these. It was a well-known fact (and previous data supported it), that agoraphobia patients tended to use more both avoidance and escape strategies as procedures which relieved them from anxiety and psychological distress. But, also, there were few data about the role of strategies allowing AP to confront and resist the phobic scenes: the partial coping behaviors. Our data provide information about this kind of coping. Results support that it is more frequently used by agoraphobia patients. This is true when comparing it with patients with other disorders, and, obviously, in contrast with the normal population. But the use of partial coping behaviors is not commonly compared with "more traditional" behaviors such as avoidance or escape behaviors. It may be said that people with agoraphobia choose to avoid or to escape from phobic situations as the best way for them to reduce anxiety. But there is a group of phobic situations an agoraphobic patient must confront on some occasions (attending a medical service, buying something, etc.). These few occasions represent an opportunity to use partial coping strategies. The limited use of these strategies may be due to the fact that other strategies reduce anxiety in a more effective way. In that sense, they may be considered as behaviors having a low frequency of occurrence and a high intensity. We especially appreciate findings about the role of partial coping strategies in the therapeutic progress when a clinician emits judgments about the improvement of agoraphobia patients. These judgments are linked to a decrease of several non- adaptative overt strategies, but there is no change in cognitive coping strategies and neither in partial coping behaviors. These may be interpretated as imprecise therapist judgments, but also as the role played by this kind of strategies in the latent maintenance of agoraphobic responses. Finally, this paper discusses these results according to the counter-therapeutic role of partial coping strategies, and the need to consider them as a target objective in treatment process.

Agorafobia (con o sin pánico) y conductas de afrontamiento desadaptativas. Primera parte

resumen está disponible en el texto completo

Abstract: The present paper examines the role of a type of coping strategy used by patients with agoraphobic disorders (AD) when they confront phobic stimuli. This strategy consists in a group of overt behaviors and thoughts (ritual behaviors, frequently) which allow agoraphobic patients (AP) to resist the presence of phobic scenes. Those behaviors function like a partial coping in the sense that they allow initially to confront the phobic stimuli, but later they transform themselves in non-adaptative coping behaviors that limit the therapeutic efficiency. The agoraphobic disorder (AD), with or without panic attack (CIE-10, F 40), is considered the more complex phobia and which produces the highest level of disability. Besides, this phobia, contrary to social or specific phobias, has a pervasive tendency (panphobia), reaching each time more situations and stimuli. The essential clinical aspects include anxiety, sensitivity, emotional responses of fear-anxiety-panic and shame, anticipatory responses, catastrophic thoughts, and avoidance and escape behaviors toward phobic scenes. There is an important volume of research about those clinical aspects. But there are only a few studies about the coping strategies used by AP when they need to resist a phobic situation. Traditionally, coping strategies considered were those used by AP to reduce anxiety and psychological distress: the avoidance behavior (to avoid the phobic stimuli) and the escape behavior (when the phobic stimulus is present). Additionally, it also includes behaviors targeted to avoid the negative physiological responses similar to those occurring in an anxiety crisis (interoceptive avoidance). Nevertheless, some experts have reported that AP used some other coping strategies that allowed them to accomplish partial and temporary confrontations toward phobic elements (elements that they needed to confront). In that sense, some authors have proposed other strategies beyond avoidance and escape behaviors, including those partial coping behaviors in the repertories used by agoraphobic patients. So, there are several classifications that take into account these behaviors, but under different terms: Distractions (thoughts or conducts that relieve anxiety in the presence of phobic stimuli). Calming strategies (behaviors that they use when they need to confront a phobic scenario). Searchingfor company (looking for the company of a relative, friend or pet). Safety behaviors or safety signs (behaviors adopted to limit the level of distress as a consequence of feeling "caught" in a phobic situation). Counter-phobic objects (objects or persons to which patients assign the ability to diminish the distress in the case of crisis). Different experts have denominated these strategies "defensive mechanisms", "useless coping strategies", "partial coping strategies" or "non-adaptative coping behaviors". This kind of behaviors and thoughts can be useful in the short-term, but in the long term they favor the continuity of anxiety and the avoidance cycle. These partial coping strategies allow patients with agoraphobia to confront and to resist the presence of the phobic stimuli, but this is done with a high cost, since the confrontations are only partial (they confront the phobic scenarios in certain contexts and with certain characteristics) and temporary, generalizing the use of these strategies to future confrontations. These strategies provide a certain apparent validity: the person is capable to resist the phobic element (that is not possible with both avoidance and escape strategies). Nevertheless, the information provided by these behaviors acts as a reinforcing mechanism and acquires by itself a value of discriminative stimulus about the circumstances in which are possible for confronting the phobic scenes. The role of these behaviors and thoughts in the development of agoraphobia in a chronic disorder is also evident. In this sense, they play a non-adaptative role. These strategies turn to be the unique ways to confront (some part of) phobic stimuli. Then, they generate a high degree of interference with both adaptive behaviors and thoughts that must be dominant in the therapeutic process. Finally, the partial coping strategies pass from being a resource that allows them to resist the phobic stimuli, to a therapeutic aim that clinicians must reduce and eliminate. Taking into account the state of the question, we propose in this paper a new classification of non-adaptative coping strategies used by agoraphobic patients, for including the partial coping strategies. The parameters for constructing a new taxonomy are three: (i) the coping strategies must be grouped according to its function role (i.e., to avoid anxiety and negative physiological responses, to reduce anxiety if it appears, to confront the stimuli with the lower level of distress). So, we prefer the term behavioral patterns, like a group of behaviors and thoughts which rule similar functions. (ii) The classification has to attend to the nature of behaviors, differentiating between overt (manifest) and covert (cognitive) behaviors. This distinction is elemental from an applied point of view. (iii) The third element is to identify the non-adaptative character of the confrontation behaviors, because they incapacitate and interfere in the normal development of the daily life. Additionally, a terminology question: there is several concepts that are being used in an indistinct manner, such as behavioral patterns, strategies or, even, styles. According to what the agoraphobic patients do (in an overt or covert way), we prefer the term behavior, in the sense that this term emphasizes what the people do (and not what they believe o what they would like to do). According to those three parameters, we propose four behavioral patterns. These behavioral patterns have two versions: overt and covert behavior. The components of each pattern share similar functions and they cover all of those strategies that can be used for persons with agoraphobia for coping with the different phobic scenes. The four behavioral patterns are as follow: Avoidance behaviors. This pattern includes all of those behaviors and thoughts that the agoraphobic patients do to avoid the phobic stimuli. Its function consists in to prevent the anxiety and psychological distress by means of avoidance of phobic elements. Interoceptive avoidance. This pattern refers to all behaviors and thoughts that try to avoid the interoceptive signs (negative physiological responses) similar to those that occur during an agoraphobic crisis. Its function consists to prevent physiological negative states by means of avoidance of those behaviors that can generate those states and can be interpreted like the beginning of a crisis. Escape behaviors. This group of behaviors refers to all behaviors and thoughts that are used to remove the patients from a phobic scene. So, its function consists in to reduce and to eliminate the anxiety states by means to run away from the phobic stimuli. Partial coping behaviors. Finally, this fourth behavioral pattern includes all of those strategies that allow AP to resist the presence of phobic elements. This resistance is doing according to some contexts and according to certain characteristics of those elements. The strategies consist on behaviors and thoughts, such as safety signs, distractions, or rituals that reduce the anxiety to tolerable levels. Its function consists to provide several resources that allow to a person with agoraphobia to cope with a phobic situation. Usually, the anxiety does not disappear, but the psychological distress does not reach disability levels. Frequently, the patients carry out these strategies because they are forced or need it. This approach is discussed according to the utility to take into account these four behavioral patterns, and not only the avoidance and escape behaviors. An special consideration have the partial coping strategies in the extent in which these behavior may suppose a false therapeutic progress, at the time that they turn into a resistant element that interferes with the therapeutic resources.