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.

Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies.

BACKGROUND: This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations. METHODS: Systematic searches were conducted in Medline, PsycINFO, PsycArticles, PubMed and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period ≥ 5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied. RESULTS: Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome. CONCLUSIONS: Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.

One-year follow-up of a randomized trial with a dilemma-focused intervention for depression: Exploring an alternative to problem-oriented strategies.

BACKGROUND: Cognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a non-counteractive approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT. METHOD: A total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects. FINDINGS: According to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22). INTERPRETATION: Although using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression. TRIAL REGISTRATION: ClinicalTrials.gov; ID: NCT01542957.

Adaptation and psychometric properties of the spanish version of the yp-core (Young Person's Clinical Outcomes in Routine Evaluation).

INTRODUCTION: Given the increasing prevalence of mental health problems in the general population, it is indispensable to use assessment tools aimed to assess the outcome of therapeutic interventions in order to refine the process of psychological rehabilitation. METHOD: We describe the process of adaptation into Spanish and a first psychometric study of the Young Person's- Clinical Outcomes in Routine Evaluation (YP-CORE), an instrument designed to measure the outcome in terms of general distress of therapeutic interventions in young people (11-16 years). 104 adolescents participated in the clinical and 131 in the non-clinical samples. RESULTS: Analyses showed good levels of acceptability, adequate internal consistency and acceptable test-retest stability, with moderately high correlations between administrations. In addition, the instrument yielded significant correlations with all dimensions of the Youth Self Report, the highest being between both total scores. Crucially, discriminated between clinical and non-clinical samples and showed a small effect of age but a larger effect of gender, with higher scores for females. The Principal Component Analysis replicates the original structure. Cut-off scores to calculate the reliable and clinically significant change are provided. CONCLUSIONS: These results support initial use of the instrument though there are certain limitations that indicate the need for more research with larger and more representative samples, in which the psychometric properties of the instrument should be verified.

Adaptación y propiedades psicométricas de la versión española del yp-core (Young Person's Clinical Outcomes in Routine Evaluation) / Adaptation and psychometric properties of the spanish version of the yp-core (Young Person's Clinical Outcomes in Routine Evaluation)

Introducción. Ante la creciente prevalencia de problemas de salud mental en la población general, resulta imprescindible el uso de instrumentos de evaluación destinados a evaluar el resultado de las intervenciones terapéuticas, con el fin de facilitar el proceso de rehabilitación psicológica. Metodología. Se expone el proceso de adaptación al español y un primer estudio psicométrico del Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE), un instrumento diseñado para medir el resultado de las intervenciones terapéuticas a través de la evaluación del malestar general en población infanto-juvenil (11-16 años). Para ello, se ha tenido en cuenta una muestra clínica de 104 participantes y otra no clínica de 131. Resultados. Los análisis han demostrado una buena aceptabilidad, una consistencia interna adecuada, así como una estabilidad test-retest aceptable, con correlaciones moderadamente elevadas. Además, el instrumento ha reflejado correlaciones significativas con todas las dimensiones del Youth Self Report, siendo las más elevadas entre ambas puntuaciones totales. También resulta útil a la hora de discriminar entre la población clínica y no clínica, mostrando poca influencia de la edad, pero sí del sexo, con puntuaciones más elevadas en el género femenino. El Análisis de Componentes Principales replica la estructura original. También se proporcionan los puntos de corte que servirán para calcular el cambio fiable y clínicamente significativo. Conclusiones. Los resultados expuestos permiten hacer un uso fiable del instrumento, aunque se mencionan ciertas limitaciones que sugieren la necesidad de realizar investigaciones con muestras mayores y más representativas, en las cuales se verifiquen las propiedades psicométricas del instrumento

Introduction. Given the increasing prevalence of mental health problems in the general population, it is indispensable to use assessment tools aimed to assess the outcome of therapeutic interventions in order to refine the process of psychological rehabilitation. Method. We describe the process of adaptation into Spanish and a first psychometric study of the Young Person's-Clinical Outcomes in Routine Evaluation (YP-CORE), an instrument designed to measure the outcome in terms of general distress of therapeutic interventions in young people (11-16 years). 104 adolescents participated in the clinical and 131 in the non-clinical samples. Results. Analyses showed good levels of acceptability, adequate internal consistency and acceptable test-retest stability, with moderately high correlations between administrations. In addition, the instrument yielded significant correlations with all dimensions of the Youth Self Report, the highest being between both total scores. Crucially, discriminated between clinical and non-clinical samples and showed a small effect of age but a larger effect of gender, with higher scores for females. The Principal Component Analysis replicates the original structure. Cut-off scores to calculate the reliable and clinically significant change are provided. Conclusions. These results support initial use of the instrument though there are certain limitations that indicate the need for more research with larger and more represen tative samples, in which the psychometric properties of the instrument should be verified

Long-Term Course of Borderline Personality Disorder: A Prospective 10-Year Follow-Up Study.

The aim of this prospective study was to expand previously reported evidence on the 10-year clinical and functional course of borderline personality disorder (BPD) in a Spanish sample. Participants diagnosed with BPD were assessed at baseline and at 10-year follow-up to evaluate BPD symptomatology and other relevant clinical measures, suicidal behavior, dimensional personality traits, Axis I and II comorbidity, use of mental health resources, and psychosocial functioning. At the 10-year follow up, significant improvements were observed on BPD domains, suicidal behavior, and other clinical measures. Neuroticism, impulsiveness, and aggression-hostility features trended toward normalization, whereas activity and sociability were impaired over time. Comorbidity with Axis I and personality disorders remained high. Social functioning and occupational functioning were largely unchanged. These findings confirm the tendency toward a symptomatic remission of BPD over the long term with regard to symptom criteria and characteristic dimensional traits. However, psychosocial functioning remains impaired.

Aprendizaje experiencial de habilidades terapéuticas y análisis de su utilidad en función de la personalidad / Experiential learning of therapeutic skills and analysis of their usefulness depending on the personality

Se comparó la utilidad percibida de dos métodos de entrenamiento de habilidades terapéuticas en la formación del Psicólogo General Sanitario: el asesoramiento entre iguales (el alumno que hace de cliente expone una experiencia personal, es decir, se trabaja con experiencias reales) y la representación de papeles (el alumno que hace de cliente representa un papel). Además, se evaluó el grado de incomodidad que puede suponer al alumno compartir experiencias personales íntimas, así como la relación entre la personalidad de los alumnos y la utilidad percibida de ambos métodos docentes. Los participantes, 149 alumnos del Máster en Psicología General Sanitaria de la Universidad de Barcelona, cumplimentaron el NEO-FFI y un cuestionario ad hoc sobre la metodología docente. El asesoramiento entre iguales fue considerado más útil que la representación de papeles tanto para el trabajo del autoconocimiento como para la formación como psicólogo clínico y la utilidad de ambos fue predicha principalmente por la dimensión "Responsabilidad". La incomodidad experimentada fue significativamente menor que la anticipada. Tales resultados tienen importantes implicaciones docentes para la formación de habilidades terapéuticas

The perceived utility of two training methods of therapeutic skills was compared in the training of General Health Psychologist: the peer counseling (the student who plays the client role relates a personal experience and therefore the therapist works with real experiences), and the role-playing (the student who plays the role of patient always plays a role). The degree of discomfort that sharing intimate personal experiences may involve for students was also examined, as well as the relationship between personality and utility perceived The participants, 149 students of the Master in General Health Psychology at University of Barcelona, completed the NEO-FFI and an ad hoc questionnaire to assess the teaching methodology. The peer counseling was considered more useful than role-playing to learn therapeutic skills and the utility of both was predicted mainly by the dimension of Responsibility. The discomfort experienced was significantly lower than anticipated. These results have important implications for training in therapeutic skills

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.

Coping styles and vulnerability to eating disorders in adolescent girls, by age / Estrategias de afrontamiento y vulnerabilidad a los trastornos de la conducta alimentaria, en chicas adolecentes, en función de la edad

The main goal of the study is to explore the relationship between coping styles and vulnerability to eating disorders in a sample of adolescent girls, according to their age. The sample comprises 1396 girls, aged 13 to 18, who completed the eating Disorders Inventory-3 (EDI-3) and the Adolescent Coping Scale (ACS). The regression analysis shows that the coping strategy most closely linked to the likelihood of developing an Ed in all age groups is Intropunitive Avoidance. The scales of the Intropunitive Avoidance dimension that have the most explanatory power are Tension Reduction and Self-Blame. Girls aged 13 and 17 are identified as the highest risk groups. Physical and social changes are proposed as the hypothetical explanation for the difference between age groups. Emphasis is placed on the need for specific prevention programs for adolescents, particularly those at high risk.

El objetivo principal del estudio es explorar la relación entre estilos de afrontamiento y vulnerabilidad a trastornos de alimentación en una muestra de chicas adolescentes, según su edad. La muestra está compuesta por 1396 chicas de entre 13 y 18 años, que respondieron a los cuestionarios Eating Disorders Inventory-3 (EDI-3) y el Adolescent Coping Scale (ACS). Los análisis de regresión muestran que la estrategia de afrontamiento más relacionada con el riesgo de sufrir TCA es la Huída Intropunitiva, en todas las edades. Las escalas de la dimensión Huida Intropunitiva con mayor poder explicativo son Reducción de la Tensión y Autoinculparse. Las chicas de 13 y 17 años son los grupos identificados de mayor riesgo. Los cambios físicos y sociales se presentan como una explicación hipotética para la diferencia entre grupos de edad. Se enfatiza en la necesidad de programas de prevención específicos para adolescentes, especialmente aquellos con mayor riesgo.

Predictors of tonic immobility during traumatic events / Predictores de la inmovilidad tónica ante eventos traumáticos

Tonic immobility (TI) is a possible reaction to danger that is facilitated by intense fear, physical restraint and perceived inability to escape. Other variables that could affect TI, such as the type and characteristics of traumatic events and personal characteristics have been little or no studied. The present study evaluated the power of these variables to predict TI in a sample of 273 college students who had experienced at least one traumatic event. Of the sample, 7.7% and 13.2% responded with TI according to the two stricter definitions adopted. Most of the variables were significantly associated with TI in univariate analyses. However, in a multiple regression analysis, only certain features of the events (occurrence of physical/sexual abuse, number of different types of events experienced) and certain reactions to them (perception of how traumatic were the events, severe fear response) were significant predictors of TI. Since these predictors explained only 25% of the variance, the influence of other variables -such as neuroticism, negative affectivity and perceived lack of personal control or resources to cope with traumatic events- should be investigated

La inmovilidad tónica (IT) es una posible reacción ante el peligro que es facilitada por el miedo intenso, la restricción física y la incapacidad percibida de escapar. Otras variables que podrían influir, tales como el tipo de eventos traumáticos, características de los mismos y características personales han sido poco o nada estudiadas. El presente estudio evaluó la capacidad de estas variables para predecir la IT en una muestra de 273 universitarios que habían experimentado al menos un suceso traumático. El 7.7% y el 13.2% de participantes reaccionaron con IT según las dos definiciones más estrictas adoptadas. La mayoría de las variables estuvieron significativamente asociadas con la IT en análisis univariantes. Sin embargo, en un análisis de regresión múltiple, sólo ciertas características de los eventos (ocurrencia de maltrato físico/ abuso sexual, número de tipos diferentes de eventos experimentados) y determinadas reacciones ante los mismos (percepción de lo traumáticos que fueron, respuesta de miedo intenso) fueron predictores significativos de la IT. Puesto que estos predictores sólo explicaron el 25% de la varianza, debería investigarse la influencia de otras variables, tales como el neuroticismo, la afectividad negativa y la sensación de falta de control personal o de recursos para afrontar los eventos traumáticos

Psychometric properties of the Modified Tonic Immobility Scale / Propiedades psicométricas de la Escala Modificada de Inmovilidad Tónica

The Tonic Immobility Scale has been only studied in abuse and/or sexual assault survivors, but tonic immobility (TI) also occurs after other types of traumatic events. Consequently, we modified the scale for this purpose and studied its factor structure, internal consistency, and convergent, divergent and discriminant validity in 392 university students, most of whom had suffered one or more traumatic events of various kinds. The Fear subscale of the Modified Tonic Immobility Scale (MTIS)showed very low internal consistency, and must be eliminated or reformulated. Discrimination indices of items 5 and 8 were very low, and these items must be reformulated or removed. After removing the five previous items, the shortened version of the MTIS had a one-factor structure, although model fit was not completely satisfactory. This scale showed acceptable levels of reliability, convergent validity with post-traumatic symptomatology, divergent validity with measures of depression and anxiety, and discriminant validity differentiating between groups that had and had not experienced traumatic events. The psychometric properties of the shortened version of the MTIS should be studied further. It may also be advisable to add new items of TI in order to establish whether this is a construct with more than one dimensión

La Escala de Inmovilidad Tónica ha sido estudiada sólo en víctimas de abusos y/o agresiones sexuales, pero la inmovilidad tónica (IT) puede darse ante otros eventos traumáticos. En consecuencia, nos propusimos modificar la escala con este fin y estudiar su estructura factorial y otras propiedades psicométricas (consistencia interna y validez convergente, divergente y discriminante) en 392 universitarios, la mayoría de los cuales había padecido uno o más eventos traumáticos de distintos tipos. La subescala de miedo de la Escala Modificada de Inmovilidad Tónica (EMIT) mostró una consistencia interna muy baja y debe ser eliminada o reformulada. Los índices de discriminación de los ítems 5 y 8 fueron muy bajos y dichos ítems deben ser reformulados o eliminados. Después de eliminar los cinco ítems anteriores, la versión abreviada de la EMIT tuvo una estructura unifactorial, aunque el ajuste del modelo no fue totalmente satisfactorio. Esta escala mostró niveles aceptables de fiabilidad, validez convergente con sintomatología postraumática, validez divergente con medidas de depresión y ansiedad, y validez discriminante al diferenciar entre grupos que habían experimentado o no eventos traumáticos. Las propiedades psicométricas de la versión abreviada de la EMIT deben ser más estudiadas. Puede ser aconsejable añadir nuevos ítems de IT para determinar si este es un constructo con más de una dimensión

Eventos traumáticos en universitarios de psicología y sintomatología postraumática, de depresión, ansiedad y estrés en la actualidad / Traumatic events in Psychology college students and current post-traumatic symptomatology, depression, anxiety and stress

El objetivo de este trabajo fue estudiar en universitarios de Psicología la influencia de la historia de eventos traumáticos, el tipo y características de estos y factores personales en la sintomatología postraumática, de depresión, ansiedad y estrés en la actualidad. Cuatrocientos treinta y dos universitarios contestaron un cuestionario de acontecimientos traumáticos y escalas de depresión, ansiedad, estrés y sintomatología postraumática. La sintomatología actual estuvo asociada con tener una historia de experiencias traumáticas, haber padecido maltrato/abuso/forzamiento sexual o una experiencia traumática que no se quería contar, haber experimentado más de un tipo de evento traumático o más de un evento y haber percibido como altamente traumático el peor acontecimiento experimentado. Estas tres últimas variables fueron las más importantes. Los delitos violentos no sexuales y los eventos traumáticos deliberadamente causados por otros no estuvieron asociados con una mayor sintomatología. Los resultados sugieren que la mayoría de universitarios, al igual que otras personas, muestran una gran capacidad de resiliencia ante los eventos traumáticos, aunque esta capacidad se ve más fácilmente desbordada bajo ciertas características de los eventos y la persona (AU)

The aim of this work was to study the influence of a history of traumatic events, their type and characteristics, and personal factors on current post-traumatic symptomatology, depression, anxiety and stress among college students of psychology. Four hundred thirty-two college students completed a questionnaire of traumatic events and scales of depression, anxiety, stress and posttraumatic symptomatology. Current symptomatology was associated with the following variables: having a history of traumatic events, having suffered maltreatment/abuse/rape or a traumatic experience that the person refuses to tell, having experienced more than one type of traumatic event or more than one event, and having perceived the worst event as highly traumatic. The last three were the most important variables. Non-sexual violent crimes and intentional traumatic events were not associated with increased symptomatology. Results suggest that most college students, like other people, show great resilience to traumatic events, although this ability is more easily overwhelmed given certain characteristics of the events and the person

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.

La utilidad del criterio A en el trastorno por estrés postraumático / The utility of criterion A in the posttraumatic stress disorder

El objetivo de este trabajo fue estudiar, tanto por separado como conjuntamente, la adecuación de los criterios A1 y A2 del trastorno por estrés postraumático (TEPT) propuestos en la 4ª edición revisada del Manual diagnóstico y estadístico de los trastornos mentales (DSM‑IV‑TR; APA, 2000). Cuatrocientos treinta y dos universitarios contestaron un cuestionario de eventos traumáticos y una escala de síntomas del TEPT. Al comparar los grupos que cumplían o no A2 -pero no los que cumplían o no A1 o los que cumplían o no A1+A2-, se hallaron diferencias significativas de magnitud media en sintomatología postraumática y de magnitud baja en el riesgo condicional del TEPT. Estos datos indican que el TEPT puede darse con la misma probabilidad ante eventos muy estresantes pero no traumáticos y ponen en duda la utilidad de los criterios A1 y A1+A2. Se sugiere eliminar el criterio A1 y ampliar el criterio A2, pero considerándolo un factor de riesgo en vez de un requisito diagnóstico (AU)

The aim of this paper was to study, separately and jointly, the adequacy of the A1 and A2 criteria of posttraumatic stress disorder (PTSD) as proposed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Four hundred thirty-two college students answered a questionnaire of traumatic events and a PTSD symptom scale. When comparing groups meeting or not A2 -but no groups meeting or not A1 or groups meeting or not A1+A2-, significant differences of moderate degree were found in posttraumatic symptomatology, and significant differences were also found in the conditional risk of PTSD, although the effect size was low. These data show that PTSD can occur with equal probability in response to stressful but not traumatic events, and cast doubt on the usefulness of criteria A1 and A1+A2. We suggest abolishing criterion A1 and broadening criterion A2, but considering it a risk factor rather than a diagnostic requirement

Experiencias traumáticas y trastorno por estrés postraumático en universitarios españoles / Traumatic experiences and posttraumatic stress disorder in Spanish university students

El presente estudio se propuso estudiar en universitarios la ocurrencia de diferentes eventos traumáticos y el riesgo condicional y pre-valencia actual de probable trastorno por estrés postraumático (TEPT). Cuatrocientos treinta y dos universitarios contestaron un cuestionario de eventos traumáticos y una escala de TEPT. El 60.6% de la muestra había experimentado algún evento traumático. El evento más frecuente fue la muerte violenta o inesperada de alguien cercano. Los peores eventos fueron la muerte de seres queridos y el padecimiento de violencia física o sexual. El riesgo condicional de probable TEPT fue 8.6% y la prevalencia actual, 5.2%. Estos datos son, con toda probabilidad, una sobrestimación de los verdaderos valores, debido probablemente al hecho de haber utilizado cuestionarios en vez de una entrevista estructurada, pero indican que aunque la experiencia de eventos traumáticos es frecuente, la inmensa mayoría de las personas que los padecen se sobreponen a los mismos (AU)

The aim of this study was to analyze in college students the occurrence of different traumatic events, as well as the conditional risk and current prevalence of probable posttraumatic stress disorder (PTSD). Four hundred and thirty two college students completed a questionnaire concerning traumatic experiences, as well as a scale of PTSD. Of the sample, 60.6% had experienced a traumatic event. The most common was the violent or unexpected death of loved ones. The death of loved ones and suffering from physical or sexual violence were the worst events. The conditional risk of probable PTSD was 8.6% and the current prevalence, 5.2%. These data are probably an overestimate of the true values, probably due to having used questionnaires rather than a structured interview, but indicate that although the experience of traumatic events is common, the vast majority of people exposed to these events overcome them (AU)

Familial predictors of obsessive-compulsive symptom dimensions (contamination/cleaning and symmetry/ordering) in a nonclinical sample.

INTRODUCTION: Obsessive-compulsive disorder (OCD) is a heterogeneous condition, which can be expressed as various symptom dimensions, including contamination/cleaning and symmetry/ordering. Previous research suggests that these obsessive-compulsive (OC) dimensions may show specific associations with certain traits such as disgust sensitivity and "not just right" experiences (NJREs), but whether a familial association between these variables exists is unknown. OBJECTIVES: The goal of this study was to test whether parental disgust sensitivity and NJREs predicted contamination/cleaning and symmetry/ordering respectively in the offspring. METHOD: Contamination/cleaning, symmetry/ordering, disgust sensitivity, NJREs, and negative affect were assessed in a nonclinical sample (n = 184 triads comprising 184 female undergraduates and their parents). Associations between parental and offspring variables were investigated by means of bivariate correlations and multiple regression models, controlling for relevant variables. RESULTS: Neither disgust sensitivity nor NJREs in parents were significant predictors of contamination/cleaning or symmetry/ordering in the offspring. CONCLUSIONS: Combined with previous research, our results suggest that the best familial predictors of OC symptom dimensions are the same symptom dimensions themselves.

The state-trait anxiety inventory, trait version: does it really measure anxiety?

To clarify what is actually measured by the trait version of the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970), we conducted a confirmatory factor analysis of various models and evaluated convergent and discriminant validity. The best fit was obtained with both a bifactor model, comprising 2 specific factors plus a general factor, and a 1-construct, 2-method model. The total score and the 2 method subscales of the STAI trait version were more strongly correlated with depression than with anxiety. In the bifactor model with 2 specific factors, the depression subscale showed stronger correlations with measures of depression than with measures of anxiety. The correlation of the hypothetical anxiety subscale with measures of depression was equivalent to or higher than its correlation with measures of anxiety. These results suggest that the questionnaire does not strictly evaluate anxiety but, rather, negative affect.

Dimensionality of three versions of the Eating Disorder Inventory in adolescent girls.

OBJECTIVES: To analyze the dimensionality of three versions of the Eating Disorder Inventory (EDI) in adolescent girls. METHOD: The sample comprised 738 participants. The Spanish adaptation of the EDI-2 was used. The EDI-2 contains the 64 items of EDI and has the same items as EDI-3. The dimensional structures hypothesized by Garner for the three EDI versions were assessed via a series of Confirmatory Factor Analyses (CFAs). RESULTS: The CFA did not confirm Garner's proposed structure in any of the three versions. Consequently it was decided to perform Exploratory Factor Analyses (EFA) of the EDI-2 and the EDI-3 to try to identify the underlying structure. The best theoretical and empirical fit was provided by a 7-factor structure. DISCUSSION: This article presents a shortened version of the EDI-2 which may prove more suitable for use with adolescent girls in the general population than the original questionnaire. Certain practical suggestions for optimizing the use of the different versions of the EDI are also presented.

Factorial structure and validity of the Multicultural Quality of Life Index.

PURPOSE: To study the internal structure and the convergent and divergent validity of the Multicultural Quality of Life Index (MQLI) in a Spanish sample. METHODS: The MQLI, along with another quality of life instrument--the World Health Organization Quality of Life, brief version (WHOQOL-BREF)--and the Depression, Anxiety and Stress Scales (DASS-21), was administered to 356 students, 159 people from the general population and 65 psychiatric patients. RESULTS: The value of Cronbach's a was .90. The confirmatory factor analysis showed a good fit for both the one- and two-factor structures. The overall mean score of the MQLI correlated between .61 and .78 with the domains of the WHOQOL-BREF and between -.55 and -.70 with the DASS-21 scales. CONCLUSIONS: The MQLI has high internal consistency, can be interpreted in terms of a single factor, and has an adequate convergent validity, although its absolute correlations with depression and with the WHOQOL-BREF were equally high.