Implementation of an Ecological Momentary Assessment (EMA) in Naturalistic Psychotherapy Settings: Qualitative Insights from Patients, Therapists, and Supervisors Perspectives.

Ecological momentary assessment (EMA) allows measuring intra-individual processes moment by moment, identifying and modeling, in a naturalistic way, individual levels and changes in different psychological processes. However, active EMA requires a high degree of adherence, as it implies a significant burden for patients. Moreover, there is still no consensus on standardized procedures for implementation. There have been few results in detecting desirable characteristics for the design and implementation of an EMA device. Studies that address these issues from the perspectives of participants in psychotherapeutic processes are needed. To analyze the perspectives of patients, therapists and supervisors on the implementation of an EMA device in a psychotherapeutic treatment for depression. The sample will include eight patients, eleven therapists and five supervisors, taken from a research project that implemented an EMA system for monitoring the dynamics of affectivity at the beginning of psychotherapies for depression. Semi-structured interviews specific to each group are being conducted and analyzed from a qualitative approach based on consensual qualitative research (CQR). Participants reported having a positive evaluation of the study's informational resources and implementation. Difficulties were expressed in responding in the morning hours and the importance of having a customized EMA that is tailored to the needs of the patients was expressed. Furthermore, patients and therapists agreed that the impact of the use of the monitoring system on treatment was neutral or positive. In contrast, patients considered the EMA to be positive for their daily life.

Efficacy of a self-applied online program to promote resilience and coping skills in university students in four Spanish-speaking countries: study protocol for a randomized controlled trial.

BACKGROUND: There is evidence of a high prevalence of depression and anxiety in university students. Therefore, college time is a key period where prevention of mental disorders through interventions that promote resilience and mental health can be relevant. Currently, there are interventions available, but these are insufficient for those who need them. Online interventions are tools that can facilitate global accessibility and are easy for young people to use. CORE (Cultivating Our Resilience) is a self-administered online program, based on Ryff's psychological well-being model, to promote resilience and coping skills in university students at risk of developing symptoms of depression or anxiety. The objective is to evaluate the effectiveness of this intervention protocol in comparison with an active control condition targeting healthy lifestyle, and a waiting list control condition. The study will be conducted in four populations of Spanish-speaking university students (Spain, Argentina, Colombia, and Mexico). METHODS: The study design is a randomized controlled trial (RCT). At least 324 university students will be randomly assigned to three conditions: 1) CORE, a 6-week training program to improve resilience; 2) HLP, a 6-week training to promote a healthy lifestyle; and 3) WL, waiting list control condition. The primary outcome measure will be the Connor-Davidson resilience scale. Additionally, measures of anxiety, depression, quality of life and socio-demographic variables (age, sex, incomes, marital status, among others) will be collected. Participants will be evaluated at pre-treatment, after each module, 6 weeks after allocation, and at 3-month follow-up. Intention-to-treat and per-protocol analyses will be performed. DISCUSSION: The results of this study will contribute to research on Internet-administered interventions and the implementation of a protocol that includes a series of components designed to improve resilience and coping skills, increase psychological well-being, and prevent depression and anxiety disorders in Spanish-speaking university students. In addition, avenues will be opened up for new research on the effectiveness of these interventions focused on the prevention and promotion of mental health in Spanish-speaking countries. TRIAL REGISTRATION: Registered at ClinicalTrials.gov NCT03903978 on April 2, 2019.

Predicción de comportamientos suicidas y autolesiones no suicidas en adolescentes argentinos / Prediction of suicidal behaviors and non suicidal sel-injury in Argentinian adolescents

Actualmente uno de los debates centrales en el campo de la suicidología refiere a si los comportamientos suicidas y las autolesiones no suicidas (NSSI) representan clusters diferentes o un continuum en el espectro autodestructivo. Si se las considerara entidades nosológicas separadas debiera ser factible identificar características diferenciales entre ellas de manera que, por ejemplo, fuera posible predecir en qué casos de NSSI sería más probable que un adolescente cometiera un intento suicida. Este estudio se propuso establecer la capacidad predictiva de habilidades emocionales e interpersonales para ambos tipos de comportamientos. Para ello se administraron el Inventario de Orientaciones Suicidas ISO-30, la Escala Rasgo de Metaconocimientos sobre Estados Emocionales TMMS-24 y las escalas Recursos Sociales de las Escalas de Recursos Psicológicos a 510 adolescentes escolarizados de la ciudad de Mar del Plata, Argentina. Se seleccionaron 81 casos con autolesiones no suicidas (Grupo NSSI) y 61 con ideaciones suicidas (Grupo IS). Los resultados muestran que los modelos de regresión obtenidos para cada grupo son diferentes. El ajuste general del modelo del Grupo IS resultó adecuado (χ² = 10.54; p = .22), los coeficientes de determinación revelan una capacidad explicativa que da cuenta de entre un 25 y 46% de la varianza total y la variable de mayor peso en el modelo fue la Incapacidad para Pedir Ayuda. En cambio el modelo del grupo NSSI mostró un pobre ajuste y solamente quedaron incluidas las variables emocionales. Se discuten los resultados según consecuencias aplicadas y futuras líneas de investigación.

Currently, one of the central debates in the field of suicidology refers to whether suicidal behavior and non suicidal self-injury (NSSI) represent different clusters or a continuum in the self-harm spectrum. The first approach, which runs in the same line than DSM-5, defines the NSSI as self-inflected injuries on any surface the own body with the goal of releasing negative thought or feelings, as a reaction to an interpersonal conflict, aiming at the achievement of a positive affective state, clearly understanding that in any case these injuries could cause death. The second approach states that the non-suicidal qualification represents a restriction and is potentially dangerous, given the close link between NSSI and suicidal behavior. If they were separate nosological entities it should be possible to identify differential features in each one. Literature focused on the study of pathological variables, suggest that it seems to be a difference of degree rather than qualitative since adolescents showing suicidal behaviors report more severe psychopathological symptoms, more depression, more hopelessness and loneliness, many family conflicts, and finding less reasons to stay alive compared to those who only exhibit NSSI. These data, somehow, offer support to both approaches. Following this debate, this study aimed at establishing the predictive value of emotional and interpersonal skills as inde-pendent variables for both types of behaviors. The selection of these variables was based on previous research findings, which provide robust evidence regarding the huge difficulties showed by adolescents with suicidal behaviors and NSSI in emotional expression and regulation. As for of interpersonal variables, diverse studies offer consistent results about the low perception of social support, the presence of intense feeling of loneliness and alienation, as well as the communication difficulties manifested by adolescents with suicidal behaviors. Based on this background, the hypothesis states that such difficulties with emotional skills will be useful predictors for both groups, only showing differences of degree. This way, adolescents with NSSI will show fewer difficulties in this aspect than the suicidal ideation group; mean while difficulties in interpersonal skills will arise as predictors only for the suicidal ideation group. The Inventory for Suicidal Orientations, the Trait Meta-Mood Scale and the Social Resources Scales from the Psychological Resources Scales were used to examine to 510 adolescent students from the city of Mar del Plata, Argentina. From the total sample, 142 participants were selected and separated into two groups. Suicidal Ideation Group -IS- (82% females, M = 16.16; SD = 1.11) accomplished at least one of the following criteria for high suicidal risk with active suicidal ideation: a) total score of ISO-30 ≥ 45; b) score ≥ 2 in the item #30 of the ISO-30 scale, "If my problems get worst, I will kill myself"; c) score≥ 1 in item 30 and total score ≥ 37 (P 84) in ISO-30, or d) explicit information on ideation and/or suicidal attempt in responses to personal data survey. The other group -NSSI- was composed of 81 cases (71.6% females, M = 16.35; SD =1.13) according to the following criteria: (a) having reported self-injury thoughts and/or committing self-injuries; (b) not achieving any of the 4 criteria established for the suicidal ideation group. Results identified different regression models for each group. The overall fit showed for IS-Group model was adequate (χ²= 10.54; p =.22). As for coefficients of determination reported, 25 to 46% of the total variance was explained, and the inability to ask for help played a major role within predictive variables. Instead, the model for the NSSI Group achieved a poor fit, including only emotional variables, as hypothesized. Results and further research lines are discussed.

Why Do Young Hispanic Women Take Sexual Risks? Psychological and Cultural Factors for HIV Prevention.

Young Hispanic women have been particularly affected by HIV. For this reason, we analyzed the influence of cognitive factors, dispositional variables, and gender culture on the HIV risks of two groups of Hispanic women. Young Argentinian and Spanish women (N = 342) completed the AIDS Prevention Questionnaire, the Spanish version of the Sexual Compulsivity Scale, and the Spanish version of the Sexual Sensation Seeking Scale in order to evaluate knowledge of HIV transmission, HIV, and condom use; self-efficacy; safe-sex intention and safe sex; as well as Sexual Sensation Seeking and Sexual Compulsivity traits. Our findings support a different pattern of HIV risk based on gender inequality, although self-efficacy and sexual sensation seeking seem to have been the main important predictors of unsafe sex and HIV risk. Social and psychological factors should be considered to design HIV prevention strategies aimed at young Hispanic women.

Executive functions and Cognitive Reappraisal ability: the relationship in children / Funciones ejecutivas y regulación de la emoción: evidencia de su relación en niños

Resumen La habilidad de reevaluación cognitiva (HRC) es una estrategia de regulación emocional que implica resignificar un evento para cambiar su efecto emocional. En los niños, esta habilidad permite disminuir experiencias emocionales negativas y se ha mostrado como un factor de protección frente a la ansiedad y depresión. Sin embargo, aún resta conocer los factores que contribuyen a explicar las diferencias individuales en esta habilidad. Uno de estos factores son las funciones ejecutivas, ya que contribuyen al control cognitivo de la emoción. El objetivo de este trabajo fue analizar el rol de las funciones ejecutivas en la HRC. Se evaluaron 100 niños de 9 a 12 años (M = 10.49; DS = 1.10) en memoria de trabajo, flexibilidad cognitiva espontánea, inhibición y HRC mediante la tarea de amplitud oral (Batería AWMA), prueba de fluidez verbal semántica (Batería ENI) y la tarea de identificación de reevaluaciones cognitivas (TIRC) elaborada para este estudio. Los datos se analizaron mediante regresión lineal múltiple. Los resultados mostraron que las funciones ejecutivas predecían la HRC, es decir, los niños que tuvieron mejor desempeño en funcionamiento ejecutivo mostraron mayor HRC. Se espera que estos resultados permitan profundizar el conocimiento de los procesos implicados en el control cognitivo de la emoción.

Abstract The Cognitive Reappraisal Ability (CRA) is an emotional regulation strategy that involves giving a new meaning to an event in order to change the emotional response. In children, this skill helps reduce negative emotional experiences and has proven to be a protective factor against anxiety and depression. However, there's still the need to understand the factors that may influence on the individual differences in the CRA. One of these factors is executive functions, since they contribute to the cognitive control of emotion. The aim of this study was to analyze the role of executive functions in the CRA. We evaluated 100 children whose ages ranged from 9 to 12 years (M=10,49; DS=1,10) on their working memory capacity, spontaneous cognitive flexibility, inhibition and CRA using a Verbal Span Task (AWMA) , Verbal Fluency Task (ENI Battery) and a Cognitive Reappraisal Task CRT, which was designed for this research. Data set was analyzed by linear regression analysis. The results showed executive functions preceded CRA, i.e. children who performed better in executive functioning showed higher CRA. It is expected that these results permit a deeper understanding of the processes involved in cognitive control of emotion.

Neuroticism and Depression in Children: The Role of Cognitive Emotion Regulation Strategies.

This study's general objective was to analyze whether different types of cognitive emotion regulation strategies (CERS), namely adaptive strategies-specifically positive refocusing and positive reappraisal-and maladaptive strategies-self-blame, catastrophizing, and rumination-mediated the neuroticism-depression relationship in children 9-12 years old, and whether gender and school transition moderated the relationships proposed. A self-reporting measure was administered to 315 children to evaluate said variables. The resulting data were analyzed using structural equations. The study verified that maladaptive CERS partially mediated neuroticism's relationship with depression, while adaptive CERS, though negatively associated with depression, did not show a mediating effect on this relationship. The results provide evidence of the mediating function of maladaptive CERS on the neuroticism-depression relationship. Gender and school transition did not moderate the relationships proposed. Because, by their very nature, these strategies are modifiable, these results constitute an important finding that can be transferred to the design and content of child mental health prevention and promotion programs.

Presentación de una guía para la observación y clasificación de la conducta verbal de los Terapeutas / Presentation of an observation and classification guide of therapists' verbal behavior

El artículo presenta una guía de observación y clasificación de la conducta verbal de los terapeutas, la Guía de Observación de Terapeutas Aiglé (GOTA-v). Se revisan los estudios sobre la variable del terapeuta, especialmente el Estilo Personal y sus procedimientos de evaluación. Este nuevo instrumento fue aplicado a la transcripción de 44 sesiones de 12 terapeutas de Argentina con diferente orientación teórico-técnica y distinto grado de experiencia (bajo, medio y alto). Se delimitaron los textos de las sesiones en unidades de análisis y se clasificaron esas unidades con categorías pertenecientes a tres clases de actos de habla: Preguntas, afirmaciones e indicaciones. Se calculó el índice de acuerdo inter jueces de Kappa para cada clase. Se discuten los alcances y limitaciones del instrumento y sus posibilidades para la investigación en psicoterapia.

The article presents an observation and classification guide of therapists' verbal behavior, the Aiglé Therapists Observation Guide (ATOG-v). Studies on the therapist variables together with the assessment procedures are revisited. This new instrument was applied to the transcription of 44 sessions of 12 therapists in Argentina with different theoretical-technical orientation and different levels of experience (low, moderate and high). The session texts were delimited into analysis units and these units were classified with categories pertaining three types of speech acts: questions, statements and indications. The Kappa inter-judges index was applied for each class. The scope and limitations of the instrument and its possibilities for psychotherapy research are presented.

[The educational component in an integrated approach to bronchial asthma]. / El componente educativo en el abordaje integral del asma bronquial.

Bronchial asthma is an inflammatory chronic disease of the respiratory tract whose prevalence is increasing worldwide. Since there is no curative treatment available, the principal objective of every approach is to control the disease and to improve the quality of life of patients. Over the last few decades, intervention programs supplementing conventional medical treatments have been tested and implemented. The majority of such programs consist of educational interventions or include some type of educational component. In this study, we attempted to determine the characteristics and the impact of educational interventions on asthma by means of the following: a) an updated review of the various educational interventions developed and implemented for asthma patients; b) the identification of aspects that are common to all of these interventions; and c) the analysis of the findings in the literature regarding the impact that these interventions have on the health and quality of life of patients. We conclude that educational interventions are effective in improving the health and quality of life of asthma patients, as well as in reducing the use and costs of health resources. These findings indicate the importance of including an educational component as part of an integrated approach to this population. Likewise, the inherent complexity of the educational process highlights the importance of a complementary joint effort including various health professionals.

El componente educativo en el abordaje integral del asma bronquial / The educational component in an integrated approach to bronchial asthma

El asma bronquial es una enfermedad inflamatoria crónica de las vías respiratorias cuya prevalencia está aumentando en el mundo. Actualmente no se dispone de un tratamiento curativo, y el objetivo principal de todo abordaje es el control de la enfermedad y la optimización de la calidad de vida de los pacientes. En este sentido, durante las últimas décadas se han estado implementando y evaluando programas de intervención complementarios a los tratamientos médicos convencionales. Gran parte de éstos consisten en intervenciones educativas o incluyen algún tipo de componente educativo. El objetivo del presente trabajo fue analizar las características y el impacto de las intervenciones educativas en el asma, a través de: a) revisión actualizada sobre los diferentes tipos de intervenciones educativas desarrolladas e implementadas para el asma; b) identificación de aspectos comunes a todas estas intervenciones; c) análisis de los hallazgos de la investigación referidos a su impacto sobre la salud y la calidad de vida de los pacientes. Se concluye que las intervenciones educativas son efectivas para mejorar la salud y la calidad de vida de los pacientes con asma, y para reducir el uso y el costo de recursos sanitarios. Estos hallazgos señalan la importancia de incluir el componente educativo como parte esencial del abordaje integral de esta población clínica. Asimismo, la complejidad inherente al proceso educativo pone de manifiesto la necesidad del trabajo conjunto y complementario entre diferentes profesionales de la salud.

Bronchial asthma is an inflammatory chronic disease of the respiratory tract whose prevalence is increasing worldwide. Since there is no curative treatment available, the principal objective of every approach is to control the disease and to improve the quality of life of patients. Over the last few decades, intervention programs supplementing conventional medical treatments have been tested and implemented. The majority of such programs consist of educational interventions or include some type of educational component. In this study, we attempted to determine the characteristics and the impact of educational interventions on asthma by means of the following: a) an updated review of the various educational interventions developed and implemented for asthma patients; b) the identification of aspects that are common to all of these interventions; and c) the analysis of the findings in the literature regarding the impact that these interventions have on the health and quality of life of patients. We conclude that educational interventions are effective in improving the health and quality of life of asthma patients, as well as in reducing the use and costs of health resources. These findings indicate the importance of including an educational component as part of an integrated approach to this population. Likewise, the inherent complexity of the educational process highlights the importance of a complementary joint effort including various health professionals.

Evaluación del estilo personal del terapeuta: presentación de una versión abreviada del cuestionario EPT-C / Assessment of personal style of the therapist: presentation of a brief versión of the PST-questionnaire

El Estilo Personal del Terapeuta (EPT) se conceptualiza como un constructo multidimensional que está presente en todo proceso terapéutico. El objetivo principal de este trabajo es presentar una versión abreviada del cuestionario EPT-C y proporcionar nuevas pruebas sobre la validez de este instrumento como herramienta para la evaluación del constructo. Se administró el EPT-C a una muestra de 461 psicoterapeutas argentinos. Se analizó la validez de constructo del cuestionario mediante Análisis Factorial Confirmatorio, se estudió la relación entre la versión breve y la original, y se evaluó la capacidad del instrumento para discriminar a los diferentes grupos de terapeutas en variables de relevancia para el proceso y los resultados de la psicoterapia. Los resultados indicaron un buen ajuste entre el modelo de medida pentafactorial del EPT-C y las dimensiones del constructo teórico. El cuestionario EPT-C aporta una medida sensible para detectar diferencias entre grupos de terapeutas a partir de varias características de los mismos.

The PST is conceptualized as a multidimensional construct which is present throughout the therapeutic pro-cess. The aim of this work is to present a brief version of the PST-Questionnaire and to give new evidence about the validity of the instrument to evaluate it. The PST-Q was administered to a sample of 461 argentine therapists. A confirmatory factor analysis was applied, and it was studied the relationship between the brief and original version. It was assessed its capacity to discriminate the differences between groups of therapists. The results indicated a good fit between the model of pentafactorial measure PST-Q and the dimensions of the theoretical construct. The PST-Q gives a measure to detect differences between groups of therapists.

Asma bronquial hoy: una perspectiva psicosocial / Bronchial asthma today: a psychosocial perspective

El asma bronquial es una enfermedad inflamatoria crónica de las vías aéreas respiratorias, cuya prevalencia está aumentando en todo el mundo. Este trabajo tiene por objetivo: a) presentar una revisión actualizada del estado del conocimiento a nivel nacional e internacional sobre asma bronquial y factores psicosociales; y b) analizar los hallazgos de la investigación empírica en el tema, particularmente los relacionados con las variables psicosociales involucradas en el desencadenamiento, evolución, modulación y mantenimiento de la enfermedad. Para este último objetivo se consideraron las publicaciones indexadas en bases de datos oficiales (LILACS, MEDLINE, PsyARTICLES, PsyBOOKS y PsycINFO) durante el período enero de 1995 y julio de 2005. Se concluye que la consideración de variables psicosociales -como las aquí reseñadas- en las tareas de evaluación y abordaje del asma bronquial como complemento del tratamiento médico constituye un aporte significativo para el mejoramiento de la calidad de vida de estos pacientes.