Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial / Terapias Cognitivo-Conductual y de Constructos Personales para la depresión en mujeres con fibromialgia: un estudio controlado aleatorizado

ResumenAntecedentes/Objetivo: La fibromialgia es un trastorno de dolor crónico que los síntomas depresivos agravan. El objetivo de este estudio es probar la eficacia de la Terapia de Cons-tructos Personales (TCP), aproximación que enfatiza las características identitarias y los significados personales como foco de la intervención, para el tratamiento de síntomas de-presivos en mujeres con fibromialgia. Método: Comparamos la TCP con la Terapia Cognitivo-Conductual (TCC) en un ensayo multicéntrico paralelo aleatorizado. Mujeres con fibromial-gia y síntomas depresivos (n = 106) fueron aleatorizadas a TCC (n = 55) o TCP (n = 51), en formato individual y modular para ajustarse a las necesidades de las pacientes. Los datos se analizaron usando modelos lineales de efectos mixtos. Resultados: Ambas condiciones redu-jeron significativamente los síntomas depresivos sin encontrarse diferencias significativas después del tratamiento (β= -0,47, t = -0,49, p = 0,63) ni en el seguimiento (β= -1,12, t = -1,09, p = 0,28). Resultados similares se encontraron para la ansiedad, el impacto de la fi-bromialgia, la distribución del cambio clínicamente significativo para los síntomas depresi-vos y el dolor. Conclusiones: la TCP y TCC parecerían ser igualmente efectivas para el trata-miento de los síntomas depresivos, postulando la TCP como una alternativa de tratamiento.

AbstractBackground/Objective:Fibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia. Method: We compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (n = 106) were randomly allocated to CBT (n = 55) or PCT (n = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models. Results: Participants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (β= -0.47, t = -0.49, p = .63) and at follow-up (β= -1.12, t = -1.09, p = .28). Results were similar between groups for anxiety, fibromyalgia’s impact, and the distribution of clinically significant changes in depressive symptoms and pain. Conclusions: PCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.

Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial.

Background/Objective: Fibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia. Method: We compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (n = 106) were randomly allocated to CBT (n = 55) or PCT (n = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models. Results: Participants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (ß = -0.47, t = -0.49, p = .63) and at follow-up (ß = -1.12, t = -1.09, p = .28). Results were similar between conditions for anxiety, fibromyalgia's impact, and the distribution of clinically significant changes in depressive symptoms and pain. Conclusions: PCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.

Antecedentes/Objetivo: La fibromialgia es un trastorno de dolor crónico que los síntomas depresivos agravan. El objetivo del estudio es probar la eficacia de la Terapia de Constructos Personales (TCP), aproximación que enfatiza las características identitarias y los significados personales como foco de la intervención, para el tratamiento de síntomas depresivos en mujeres con fibromialgia. Método: Comparamos la TCP con la Terapia Cognitivo-Conductual (TCC) en un ensayo multicéntrico paralelo aleatorizado. Mujeres con fibromialgia y síntomas depresivos (n = 106) fueron aleatorizadas a TCC (n = 55) o TCP (n = 51), en formato individual y modular para ajustarse a las necesidades de las pacientes. Los datos se analizaron usando modelos lineales de efectos mixtos. Resultados: Ambas condiciones redujeron significativamente los síntomas depresivos sin encontrarse diferencias significativas después del tratamiento (ß = -0,47, t = -0,49, p = 0,63) ni en el seguimiento (ß = -1,12, t = -1,09, p = 0,28). Resultados similares se encontraron para la ansiedad, el impacto de la fibromialgia, la distribución del cambio clínicamente significativo para los síntomas depresivos y el dolor. Conclusiones: La TCP y la TCC parecerían ser igualmente efectivas para el tratamiento de los síntomas depresivos, postulando la TCP como una alternativa de tratamiento.

Personal Construct Therapy vs Cognitive Behavioral Therapy in the Treatment of Depression in Women with Fibromyalgia: Study Protocol for a Multicenter Randomized Controlled Trial.

Background: Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia. METHODS AND ANALYSIS: This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3-5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02711020.

Perceived needs and health-related quality of life in people with schizophrenia and metabolic syndrome: a "real-world" study.

BACKGROUND: The complexity of schizophrenia lies in the combination of psychiatric, somatic and social needs requiring care. The aim of the study was to compare perceived needs between groups with absence/presence of metabolic syndrome (MetS) and to analyze the relationship between needs, health-related quality of life (HRQoL) and MetS in people with schizophrenia or schizoaffective disorder. METHODS: A "real-world" cross-sectional study was set up with a comprehensive framework including the following, needs for care (Camberwell Assessment of Need Interview [CAN]), HRQoL (Euro Qol-5D Questionnaire), sociodemographic data, lifestyle habits, psychopathology (Positive And Negative Syndrome Scale [PANSS]), global functioning (Global Assessment of Functioning Scale [GAF]), anthropometric measurements and blood test results were assessed for an outpatient sample (n = 60). RESULTS: The mean number of needs (given by CAN) was identified for both groups. Patients with MetS rated a higher number of needs compared to the group without this condition. Mobility problems (given by EQ-5D) were negatively associated with the number of total and unmet needs. For participants with MetS, HRQoL was related to the number of needs and unmet needs. For people with MetS, positive symptomatology score (given by PANSS) was related to the number of needs and met needs and general symptomatology was associated with total, met and unmet needs. For individuals without MetS, the global functioning score (given by GAF) was significantly inversely related with total, met and unmet needs. CONCLUSIONS: Needs and HRQoL, as well as general symptomatology, were related only in patients with MetS. This has implications for treatment planning at the individual and organizational levels. An analysis of both physical and mental needs could provide a starting point for the extension of facilities in the health care system in order to reach the goal of improving quality of life.

Psychometric properties of the Spanish version of the Clinical Outcomes in Routine Evaluation - Outcome Measure.

OBJECTIVE: The objective of this paper is to assess the reliability and validity of the Spanish translation of the Clinical Outcomes in Routine Evaluation - Outcome Measure, a 34-item self-report questionnaire that measures the client's status in the domains of Subjective well-being, Problems/Symptoms, Life functioning, and Risk. METHOD: Six hundred and forty-four adult participants were included in two samples: the clinical sample (n=192) from different mental health and primary care centers; and the nonclinical sample (n=452), which included a student and a community sample. RESULTS: The questionnaire showed good acceptability and internal consistency, appropriate test-retest reliability, and acceptable convergent validity. Strong differentiation between clinical and nonclinical samples was found. As expected, the Risk domain had different characteristics than other domains, but all findings were comparable with the UK referential data. Cutoff scores were calculated for clinical significant change assessment. CONCLUSION: The Spanish version of the Clinical Outcomes in Routine Evaluation - Outcome Measure showed acceptable psychometric properties, providing support for using the questionnaire for monitoring the progress of Spanish-speaking psychotherapy clients.

A DILEMMA-FOCUSED INTERVENTION FOR DEPRESSION: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL WITH A 3-MONTH FOLLOW-UP.

BACKGROUND: Since long ago it has been asserted that internal conflicts are relevant to the understanding and treatment of mental disorders, but little research has been conducted to support the claim. The aim of this study was to test the differential efficacy of group cognitive behavioral therapy (CBT) plus an intervention focused on the dilemma(s) detected for each patient versus group individual CBT plus individual CBT for treating depression. A comparative controlled trial with a 3-month follow-up was conducted. METHODS: One hundred twenty-eight adults meeting criteria for MDD and/or dysthymia, presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct, assessed by the repertory grid technique) and who had completed seven sessions of group CBT were randomly assigned to eight sessions of individual manualized CBT or dilemma-focused therapy (DFT). The Beck Depression Inventory-II was administered at baseline, at the end of therapy and after 3 months' follow-up. RESULTS: Multilevel mixed effects modeling yielded no significant differences between CBT and DFT with the intention-to-treat sample. Equivalent effect sizes, remission, and response rates were found with completers as well. In combination with group CBT, both individual CBT and DFT significantly reduced depressive symptoms. CONCLUSIONS: Both conditions obtained comparable results to those in the literature. Thus, the superiority of the adjunctive DFT was not demonstrated. Working with dilemmas can be seen as a promising additional target in the psychotherapy of depression, but further research is still required.

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence.Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression. DESIGN: A therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions). METHOD: Participants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used. DISCUSSION: We expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression. TRIAL REGISTRATION: ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Metabolic syndrome and health-related quality of life in patients with schizophrenia.

The association of metabolic syndrome (MetS) with health-related quality of life (HRQol) in schizophrenia is poorly documented. The relationship between MetS, HRQol and global functioning were examined. For this goal, 76 individuals with schizophrenia and schizoaffective disorder (DSM-IV criteria) were interviewed to obtain sociodemographic data, lifestyle habits, psychopathology (PANSS scale), global functioning (GAF scale), sef-reported quality of life (EQ-5D scale) and the anthropometric measures and blood test results. MetS was defined by the NCEP (2005) criteria. The prevalence of MetS was 36.8%. MetS was directly associated with personal background of dyslipidaemia and diabetes mellitus. Subjects with MetS had greater weight, BMI, waist, blood pressure, triglycerides, fasting glucose and a lower HDL-cholesterol. The MetS is also associated with age, inactive employment status and better self-care. The EQ VAS (visual analogue scale) of EQ-5D shows that subjects with MetS who practice physical activity indicates a better subjctive perception of health, which remarks the necessity of improving healthy lifestyle and an interdisciplinary treatment of the MetS. There is no association between global functioning and HRQol. This is the first study which investigates the relationship between MetS, HRQol and GAF in individuals with schizophrenia in the European context.

Síndrome metabólico y calidad de vida relacionada con la salud en pacientes con esquizofrenia / Metabolic syndrome and health-related quality of life in patients with schizophrenia

La asociación entre el síndrome metabólico (SMet) y la calidad de vida relacionada con salud (CVRS) en individuos con esquizofrenia está poco documentada. Los objetivos fueron estudiar la relación entre SMet, CVRS y funcionamiento global. Fueron evaluados 76 individuos con esquizofrenia y trastorno esquizoafectivo (según criterios DSM-IV) y se registraron también sus características sociodemográficas, estilo de vida, sintomatología psicótica (PANSS), funcionamiento global (GAF), escala de CVRS subjetiva (EQ-5D), medidas antropométricas y análisis de sangre. El SMet fue evaluado según criterios del NCEP (2005). La prevalencia del SMet es de un 36,8%. Se evidenció una asociación directa entre SMet y antecedentes personales de dislipemia y de diabetes mellitus. Los sujetos con SMet presentan mayor peso, IMC, PAb, PA, Trigliceridos y glucosa y menor tasa de HDL-colesterol. También la presencia de SMet está asociada con la edad, con la inactividad laboral y con un mejor “autocuidado”. La EQ VAS (escala análogo-visual) de la EQ-5D muestra que los sujetos con SMet que practican actividad física refieren una mejor autopercepción de salud, lo que refuerza la importancia de promover hábitos saludables y el tratamiento del SMet desde una perspectiva interdisciplinar. No se ha encontrado asociación entre el funcionamiento global y la CVRS. Este es el primer estudio que investiga la asociación entre SMet, CVRSy GAF en sujetos con esquizofrenia en el contexto europeo (AU)

The association of metabolic syndrome (MetS) with health-related quality of life (HRQol) in schizophrenia is poorly documented. The relationship between MetS, HR Qoland global functioning were examined. For this goal, 76individuals with schizophrenia and schizoaffective disorder (DSM-IV criteria) were interviewed to obtain sociodemographic data, lifestyle habits, psychopathology (PANSS scale), global functioning (GAF scale), sef-reported quality of life (EQ-5D scale) and the anthropometric measures and blood test results. MetS was defined by the NCEP (2005) criteria. The prevalence of MetS was 36.8%.MetS was directly associated with personal background of dyslipidaemia and diabetes mellitus. Subjects with MetS had greater weight, BMI, waist, blood pressure, triglycerides, fasting glucose and a lower HDL-cholesterol. The MetS is also associated with age, inactive employment status and better self-care. The EQ VAS (visual analogue scale) of EQ-5Dshows that subjects with MetS who practice physical activity indicates a better subjetive perception of health, which remarks the necessity of improving healthy lifestyle and an interdisciplinary treatment of the MetS. There is no association between global functioning and HRQol. This is the first study which investigates the relationship between MetS, HRQol and GAF in individuals with schizophrenia in the European context (AU)

Anatomía de una confusión: error diagnóstico de patología paranoide en víctimas de mobbing: [revisión] / Anatomy of a misunderstanding: wrong diagnosis of paranoid pathology in victims of mobbing: [review] / Anatomia de uma confusão: erro diagnóstico de patologia paranoide em vítimas de mobbing: [revisião]

CONTEXTO: Diversas investigaciones subrayan el alto riesgo de error diagnóstico de trastorno delirante y trastorno paranoide de la personalidad entre víctimas de mobbing o acoso psicológico en el trabajo (APT). OBJETIVO: Analizar hasta qué punto los síntomas asociados con el mobbing son confundidos con criterios de dos nosologías del espectro paranoide (trastorno delirante y trastorno paranoide de la personalidad). MÉTODOS: Se realiza una revisión bibliográfica desde 1990 hasta Junio de 2009 en PubMed y SciELO. RESULTADOS: La identificación de síntomas del espectro paranoide en las víctimas de mobbing no resulta consistente con la literatura que, en cambio, indica una fuerte presencia de síntomas del espectro del estrés postraumático (hasta el 92 por ciento), aunque no se cumpla el criterio A1 de esta nosología. Se apuntan algunas causas del error diagnóstico, tales como la tendencia a confundir hipervigilancia (criterio D4 del trastorno por estrés postraumático en el DSM-IV-TR) con ideación paranoide, la existencia de un perfil defensivo en las víctimas de APT y la falta de reconocimiento por parte de los clínicos del impacto estresante y traumatizante del mobbing. CONCLUSIÓN: Se requieren investigaciones longitudinales y mixtas (cualitativos/cuantitativos) para establecer criterios robustos de diagnóstico diferencial entre las manifestaciones clínicas asociadas al mobbing y los síntomas paranoides.

CONTEXTO: Diversos estudos evidenciam o alto risco de erro diagnóstico de transtorno delirante e transtorno da personalidade paranoide entre as vítimas de mobbing ou assédio psicológico no trabalho (APT). OBJETIVO: Analisar a associação dos sintomas atribuídos ao mobbing com os critérios de duas nosologias do grupo paranoide (transtorno delirante e transtorno da personalidade paranoide). MÉTODOS: Realiza-se uma revisão bibliográfica de 1990 a junho de 2009 em PubMed e SciELO. RESULTADOS: A identificação de sintomas paranoides em vítimas de mobbing não é congruente com a literatura científica. Por outro lado, evidencia-se uma forte presença de sintomas vinculados ao estresse pós-traumático (até 92 por cento), ainda que não apresente o critério A1 dessa patologia. Algumas causas de erro diagnóstico seriam a tendência a confundir a hipervigilância (critério D4 do transtorno de estresse pós-traumático do DSM-IV-TR) com ideação paranoide, a existência de um perfil defensivo nas vítimas de APT e o desconhecimento do impacto estressante e traumatizante do mobbing pelos clínicos. CONCLUSÃO: São necessários estudos longitudinais e com metodologias mistas (qualitativas/quantitativas) para estabelecer critérios sólidos de diagnóstico diferencial entre as manifestações clínicas atribuídas ao mobbing e os sintomas paranoides.

BACKGROUND: Several studies point out the high risk of misdiagnosing delusional disorder and paranoid personality disorder in victims of mobbing or workplace harassment (WPH). OBJECTIVE: To analyze the extent to which the symptoms attributable to mobbing are misidentified with criteria for two paranoid spectrum nosologies (delusional disorder and paranoid personality disorder). METHODS: Literature review of PubMed and SciELO from 1990 to June 2009. RESULTS: The identification of paranoid spectrum symptoms in victims of mobbing is not consistent with the literature, which, by contrast, shows a notable presence of symptoms in the post-traumatic stress spectrum (as much as 92 percent), although they do not meet the A1 criterion for this nosology. Some of the causes of wrong diagnosis are noted, such as a tendency to confuse hypervigilance (D4 criterion for post-traumatic stress disorder in DSM-IV-TR) with paranoid ideation, the existence of a defensive profile in victims of WPH, and lack of recognition on the part of clinicians of the stressful and traumatizing impact of mobbing. DISCUSSION: Longitudinal and mixed methodology (qualitative and quantitative) studies are necessary in order to establish robust differential diagnosis criteria that clearly distinguish the clinical manifestations attributable to workplace harassment from paranoid spectrum symptoms.