Imagen corporal y autoestima en mujeres mastectomizadas / Body image and self-esteem in women subjected to radical mastectomy

Objetivo: Estudiar la imagen corporal que construyen las pacientes diagnosticadas de cáncer de mama tras someterse a intervención quirúrgica, mastectomía radical y cirugía conservadora, tanto en lo referente a aspectos corporales relacionados directamente con la lesión como a zonas corporales no relacionadas, e investigar cómo esa imagen afecta a la autoestima centrada en lo corporal. Método: Contamos con una muestra de 23 pacientes (12 mujeres mastectomizadas y 11 con cirugía conservadora) y 24 mujeres sanas que sirvieron como grupo control. El instrumento de evaluación utilizado es la Técnica de la Rejilla Corporal. Se analizaron las diferencias entre los grupos mediante ANOVA de un factor y las pruebas no paramétricas H de Kruskal Wallis y U de Mann-Whitney. Resultados y conclusiones: Los resultados del estudio han permitido identificar qué aspectos son los más dañados en la autoestima y autoimagen de las pacientes, estableciendo que no existen diferencias significativas en la imagen corporal global y la autoestima centrada en lo corporal entre mujeres mastectomizadas y mujeres sometidas a cirugía conservadora, aunque sí en la imagen que se tiene de las zonas corporales específicamente implicadas en la cirugía. Sí se han encontrado diferencias entre estos dos grupos y el grupo de mujeres sanas en imagen corporal global y autoestima. Los resultados obtenidos permitirán identificar los aspectos de la imagen corporal más afectados en las pacientes y por tanto orientar posibles intervenciones psicológicas futuras hacia la reconstrucción adaptativa y sana de los mismos

Aim: To study the body image built by patients with breast cancer after surgery, radical mastectomy and partial mastectomy, related to body parts directly involved in surgery and not directly related to it, and to investigate how this image affects bodily self-esteem. Method: Our sample comprised 23 patients (12 had been subjected to radical mastectomy and 11 to partial mastectomy) and 24 healthy women (they served as control group). Participants were assessed with the Body Grid technique. We analyzed the differences between groups using one way ANOVA and non-parametric tests (namely, H de Kruskal Wallis and U de Mann-Whitney). Results: Our findings allowed us to identify which were the most damaged aspects about self-esteem and body image in these patients, showing that there were no significant differences in body image and bodily self-esteem between patients subjected to radical and partial mastectomy. However, we found significant differences between body parts directly involved in surgery and those not directly related to it. Finally, we found significant differences between both groups of patients and the control group regarding body image and self-esteem.Conclusions: Our results show that the Body Grid Technique is helpful to identify the most affected aspects of body image in patients subjected to mastectomy and tailor psychological treatments aimed at improving body image in these patients

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.

Un estudio naturalista sobre el cambio de los conflictos cognitivos durante la psicoterapia / A naturalistic studya bout the change of cognitive conflicts during the psychotherapy

Los autores presentan una propuesta para la operativización e investigación sobre el cambio de un tipo de conflicto cognitivo, denominado dilema implicativo (DI) en la teoría de los constructos personales. En una muestra de 87 pacientes se miden los DIs y la sintomatología al comienzo y al final de la psicoterapia. Los datos sugieren que la psicoterapia los reduce. La disminución del DIs al finalizar el proceso psicoterapeutico parece relacionada con la mejora sintomática, por lo que se estima una relación entre la presencia de DIs y la evolución de la sintomatología que debería confirmarse en estudios controlados. Asimismo, se sugiere el interés de incluir protocolos dirigidos de forma específica a trabajar con los dilemas para incrementar la eficacia de la psicoterapia para aquellos pacientes que los presenten a su inicio

The authors present a proposal to operationalize and assess the change of a type of cognitive conflict called implictaive dilema (ID) in the context of personal construct theory. In a sample of 87 patients, DIs and symptoms are assessed at the beginning andthe end of the psychotherapy process. Results suggest that psychotherapy reduces both ofthem. Moreover, the decrease of DIs seems to be related with symptom improvement, forwhat, a relation is estimated between the presence of ID and symptom reduction, a result that should be confirmed in controlled studies. Overall, these results suggest to include protocols to work with the dilemmas as a way to improve the benefits of the psychotherapy for those patients who have them (AU)

Estilo personal del terapeuta y dirección de intereses / Personal style of the therapist and direction of interest

El objetivo principal del presente estudio es profundizar en el conocimiento del EstiloPersonal del Terapeuta (EPT) y estudiar las relaciones entre diferentes funciones deeste estilo y la dirección de intereses de los terapeutas en formación. El EPT es evaluadocon el cuestionario EPT-C (Fernández Álvarez, Garcia, LoBianco y Corbella, 2003) que distingue seis funciones que permiten dibujar el perfil personal de cada terapeuta, instruccional, atencional, expresiva, operacional e involucrativa. La dirección de interés delterapeuta es evaluada a través del cuestionario DIQ (Caine, Wijesinghe y Winter, 1981),que distingue entre una dirección interna o externa. La muestra del estudio está formadapor 91 licenciados (9,9% hombres y 90,1% mujeres) que están cursando un Máster enpsicoterapia. Los resultados de los análisis indican unas correlaciones moderadas y significativas entre las funciones atencional (receptiva) y operativa (espontáneo) y la dirección de intereses (interna) de los participantes

The principal aim of the present study is to penetrate into the knowledge of the PersonalStyle of the Therapist (EPT) and to study the relations between different functions of this style and the direction of interests of the therapists in training. The EPT is evaluatedby the questionnaire EPT-C (Fernandez-Alvarez, Garcia, LoBianco, & Corbella, 2003) that distinguishes six functions that allow drawing the personal profile of every therapist instruccional, atencional, expressive, operational and involucrativa.The direction of interest of the therapist is evaluated across the questionnaire DIQ(Caine, Wijesinghe & Winter, 1981), which distinguishes between an internal or externaldirection.The sample of the study is form by 91 licentiates (9,9 % men and 90,1 % women)that are dealing a Master in psychotherapy. The results of the analyses indicate a few moderate and significant correlations between the functions attentional (receptive)and operative (spontaneously) and the internal direction of interests (AU)