Queridos Residentes, Cuidaos: una Guía Para Sobrevivir a la Psicología Clínica / Dear Trainees, Take Care of Yourselves: A Guide to Surviving Clinical Psychology

La residencia en psicología clínica es un proceso que pondrá al límite la capacidad de adaptación de los residentes,especialmente si no gozan de la supervisión y el soporte institucional adecuados. Conscientes de esta situación, estetrabajo pretende normalizar la complejidad que supone formarse como psicólogo clínico en España, poniendo unénfasis especial en los primeros pasos como residente en el Sistema Nacional de Salud y en los desafíos personalesque ello implica. Asimismo, persigue incrementar la sensibilidad sobre la necesidad de medidas que permitan a losresidentes sobrevivir a la psicología clínica. Por ende, se discute el estado del arte sobre el concepto de autocuidadodentro del campo de la psicología clínica y la psicoterapia desde la perspectiva de que especialistas mejor formadospodrán mejorar el Sistema Nacional de Salud y la atención a la salud mental de los más vulnerables.(AU)

The training system in clinical psychology in Spain is a process that will test the adaptability of trainees to thelimit, especially if they do not have adequate supervision and institutional support. Aware of this issue, this paperaims to normalize the complexity of training as a clinical psychologist in Spain, placing special emphasis on thefirst steps as a trainee in the National Health System and on the personal challenges involved. Moreover, it seeksto increase sensitivity and awareness about the importance of establishing measures that enable trainees to surviveclinical psychology. Therefore, the state of the art on the topic of self-care within the field of clinical psychologyand psychotherapy is discussed from the perspective that better trained specialists will improve the National HealthSystem and mental health care for the most vulnerable people.(AU)

La reorganización de un servicio comunitario de salud mental infantil y juvenil ante la pandemia de covid-19 / The reorganization of a community mental health center for children and youth due to the covid-19 pandemic

La crisis sanitaria causada por la COVID-19 ha forzado una reorganización de los servicios de salud mental. El presente artículo describe una propuesta de reorganización aplicada en una unidad de salud mental infanto-juvenil (atención ambulatoria y comunitaria). Se exponen las estrategias concretas de intervención desarrolladas en las distintas fases de la pandemia según las medidas de restricción sanitarias y los distintos niveles de intervención requeridos (prevención, atención primaria y atención especializada). Además, se compara el número de visitas hechas durante el periodo de Marzo-Julio de 2020 con el mismo periodo en 2019. Concluimos que se ha producido una rápida adaptación del marco asistencial presencial a la metodología telemática mediante una reorganización flexible. Sin embargo, la disminución de la asistencia presencial y la cancelación de grupos terapéuticos han incrementado la presión asistencial notablemente. Se ha observado un incremento de conductas autolíticas y de problemas relacionados con la conducta alimentaria que deberán ser investigados en futuros estudios. (AU)

The heath crisis caused by COVID-19 has required a reorganization of mental health centers. This article describes the reorganization proposal that was applied in a child and adolescent mental health unit (outpatient and community care). The specific intervention strategies developed in the different phases of the pandemic are presented according to the sanitary restriction measures and the different levels of intervention required (prevention, primary care, and specialized care). In addition, the number of visits made during March-July 2020 is compared to the same period in 2019. We conclude that there has been a rapid adaptation from the face-to-face care framework to atelematic approach through a flexible reorganization. However, the decrease in face-to-face assistance and the cancellation of therapeutic groups have significantly increased the pressure of care. A rise in autolytic behaviors and eating pathologies has been observed that should be investigated in future studies. (AU)

[Evidence-Based Psychological Treatments for Adults: A Selective Review]

Evidence-Based Psychological Treatments for Adults: A Selective Review. BACKGROUND: Psychological treatments have shown their efficacy, effectiveness, and efficiency in dealing with mental disorders. However, considering the scientific knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically supported psychological treatments. The main goal was to carry out a selective review of the main empirically supported psychological treatments for mental disorders in adults. METHOD: Levels of evidence and degrees of recommendation were collected based on the criteria proposed by the Spanish National Health System (Clinical Practice Guidelines) for different psychological disorders. RESULTS: The results indicate that psychological treatments have empirical support for the approach to a wide range of psychological disorders. These levels of empirical evidence gathered range from low to high depending on the psychological disorder analysed. The review indicates the existence of certain fields of intervention that need further investigation. CONCLUSIONS: Based on this selective review, psychology professionals will be able to have rigorous, up-to-date information that allows them to make informed decisions when implementing empirically based psychotherapeutic procedures based on the characteristics of the people who require help.

The relationship with the voices as a dialogical experience: The role of self-focused attention and dissociation.

OBJECTIVE: The purpose of this article was to study the relationship of self-focused attention and dissociation with the dialogical relationship persons diagnosed with psychosis have with their voices. METHOD: The DAIMON Scale was applied to 62 persons diagnosed with psychosis to measure the dialogical relationship with their voices, and the Cambridge depersonalization scale, the Tellegen absorption scale, and the self-focused attention scale. RESULTS: The results showed that the dialogical relationship with the voices was associated with high levels of self-focused attention (private and public), depersonalization, and absorption. It was also found that absorption mediated significantly between public self-focused attention and the dialogical relationship with the voices. CONCLUSIONS: The role of dissociation and self-focused attention in forming the dialogical relationship a person with psychosis has with the voices is discussed and approaches to treatment are suggested.

Childhood memories of threatening experiences and submissiveness and its relationship to hallucination proneness and ideas of reference: The mediating role of dissociation.

Recent studies have emphasized the importance of childhood memories of threatening experiences and submissiveness in a diversity of psychological disorders. The purpose of this work was to study their specific relationship with hallucination proneness and ideas of reference in healthy subjects. The ELES scale for measuring memory of adverse childhood experiences, the DES-II scale for measuring dissociation, the LSHS-R scale for measuring hallucination proneness, and the REF for ideas of reference were applied to a sample of 472 subjects. A positive association was found between childhood memories of adverse experiences and hallucination proneness and ideas of reference, on one hand, and dissociation on the other. A mediation analysis showed that dissociation was a mediator between the memory of adverse childhood experiences and hallucination proneness on one hand, and ideas of reference on the other. When the role of mediator of the types of dissociative experiences was studied, it was found that absorption and depersonalization mediated between adverse experiences and hallucination proneness. However, this mediating effect was not found between adverse experiences and ideas of reference. The relationship between these last two variables was direct. The results suggest that childhood memories of adverse experiences are a relevant factor in understanding hallucination proneness and ideas of reference. Similarly, dissociation is a specific mediator between adverse childhood experiences and hallucination proneness.

Behavior Problems Inventory (BPI): Psychometric characteristics of an instrument for routine assessment of persons with psychoses and related disorders.

This study explores the psychometric characteristics of the Behavior Problems Inventory (BPI), an instrument for routine clinical assessment of behavior problems in outpatients with psychosis based on information provided by key family informants. Six hundred and twenty-one patients diagnosed with psychosis and bipolar affective disorder (ICD-10 F20-F31) attended at Community Mental Health Units were evaluated in routine reviews using the BPI and the Social Functioning Scale (SFS). Twenty-five subjects were simultaneously administered the Social Behavior Schedule (SBS) and 28 were again administered the BPI eight weeks later. The instrument shows adequate psychometric characteristics with high internal consistency and robust temporal reliability, as well as satisfactory concurrent and construct validity. Factor analysis identified three factors: Underactivity/Social Withdrawal, Active Problems and Lack of Impulse Control, with adequate saturation of the items on each of the factors. The BPI is easy to apply, reliable and valid, takes up little of valuable clinical time, allowing routine assessment in public service contexts for persons diagnosed with psychosis and bipolar affective disorder for whom key family informants are available.

Relationship between behavioural problems and use of mental health services in patients with severe mental illness and the mediating role of the perceived burden of care.

Mental health models proposed for predicting more use of mental health resources by patients with severe mental illness are including a wider variety of predictor variables, but there are still many more remaining to be explored for a complete model. The purpose of this study was to enquire into the relationship between two variables, behaviour problems and burden of care, and the use of mental health resources in patients with severe mental illness. Our hypothesis was that perceived burden of care mediates between behaviour problems of patients with serious mental illness and the use of mental health resources. The Behaviour Problem Inventory, which was filled out by the main caregiver, was used to evaluate 179 patients cared for in a community mental health unit. They also answered a questionnaire on perceived family burden. A structural equation analysis was done to test our hypothesis. The results showed that both the behaviour problems and perceived burden of care are good predictors of the use of mental health resources, where perceived burden of care mediates between behaviour problems and use of resources. These variables seem to be relevant for inclusion in complete models for predicting use of mental health resources.

Predictors in use of mental health resources: The role of behaviour problems in patients with severe mental illness.

BACKGROUND: In recent years, more variables are being included in the use of mental health resource prediction models. Some studies have shown that how well the patient can function is important for this prediction. However, the relevance of a variable as important as behaviour problems has scarcely been explored. AIM: This study attempted to evaluate the effect of behaviour problems in patients with severe mental illness on the use of mental health resources. METHOD: A total of 185 patients at a Community Mental Health Unit were evaluated using the Behaviour Problem Inventory. Later, a bivariate logistic regression was done to identify what behaviour problems could be specific predictors of use of mental health resources. RESULTS: The results showed that the general index of behaviour problems predicts both use of hospitalization resources and outpatient attention. Underactivity/social withdrawal is the best predictor of all the different areas. CONCLUSION: These results confirm the role of behaviour problems as predictors of the use of mental health resources in individuals with a severe mental illness.

Spanish adaptation of the Varieties of Inner Speech Questionnaire (VISQ). Study of the relationship between inner speech, dissociation, and hallucination proneness / Adaptación al español del Varieties of Inner Speech Questionnaire (VIQS). Estudio de la relación entre diálogo interno, disociación y propensión a las alucinaciones

Inner speech is a familiar experience for us but, in general, few systematic studies have been done on the subject. Recent studies have included this phenomenon in the development of auditory hallucinations. The purpose of this article is to propose and validate the Spanish version of the Varieties of Inner Speech Questionnaire (VISQ), to which we have added a new factor called Dialogues with Self-Positions in Inner Speech. It is further intended to test the relationship between this scale, dissociation, and proneness to hallucinations. For this purpose, 318 students completed the VISQ, plus a dissociation scale and another one for hallucination proneness. The results show the scale's good psychometric reliability and validity. Dissociation was found to mediate between the VISQ scale and hallucination proneness. The implications for hallucination models and future lines of research are discussed

El habla interna [inner speech] es una experiencia familiar para nosotros pero que ha sido en general poco estudiada de manera sistemática. Recientes estudios han incluido este fenómeno en el desarrollo de las alucinaciones auditivas. En el presente artículo se pretende revisar y validar la escala Varieties of Inner Speech Questionnaire (VISQ) en castellano, añadiendo además una quinta escala denominada Posiciones del Yo en el Lenguaje Interno. Además, se pretende comprobar la relación entre las diferentes escalas, la disociación y la propensión a las alucinaciones verbales. Para ello 318 estudiantes completaron la VISQ-R más una medida de disociación y otra de propensión a las alucinaciones. Los resultados muestran unas buenas propiedades psicométricas de fiabilidad y validez en la escala VISQ-R. Los modelos de mediación, por su parte, indican un papel de mediación de las medidas de disociación entre todas las escalas del VISQ-R menos el lenguaje interno dialógico y la propensión a las alucinaciones verbales. Se discuten las implicaciones para los modelos de las alucinaciones verbales y futuras líneas de investigación

Relationship between inner dialog and ideas of reference and the mediating role of dissociation.

Recent lines of research have begun to concentrate on internal dialogue and its relationship to a diversity of psychopathological phenomena present in psychotic disorders. This study was intended as a preliminary exploration of the relationship of internal dialogue, dissociation and ideas of reference. To do this, a sample of 318 students filled in an internal dialogue scale (the VISQ, McCarthy-Jones & Fernyhough), one for dissociation (DES-II, Carlson & Putnam) and another for ideas of reference (REF, Lenzenweger, Bennett & Lilenfeld). The results confirm the hypothesis posed in the sense that internal dialogue was positively associated with dissociation and with ideas of reference. A partial mediation effect of dissociation was also found between inner speech and ideas of reference. Lines of future research this study opens and its possible integration in a model on ideas of reference are discussed.

The relationship of depersonalization and absorption to hallucinations in psychotic and non-clinical participants.

The purpose of this study was to examine the relationship between dissociative variables and hallucinations, or predisposition to hallucinations, respectively, in patients with psychoses and non-clinical participants, controlling for any possible effect of emotional variables and age. Three groups were formed for this purpose: patients diagnosed with schizophrenia with auditory hallucinations at the time of study, healthy participants prone to hallucinations, and healthy participants not prone to hallucinations. The final sample was 318 participants with a mean age of 21.41 years (SD: 5.78) and a male-to-female ratio of 67:251. All participants were given the Tellegen Absorption Scale, the Cambridge Depersonalization Scale and the Metacognitions Questionnaire. The results showed that patients with psychosis had higher levels of depersonalization than participants prone and not prone to hallucinations. Prone participants showed higher levels of absorption than patients with psychosis and healthy participants with no proneness to hallucinations. Finally, a multinomial logistic regression analysis showed that depersonalization increased the probability of belonging to the group of patients with psychosis and auditory hallucinations, and absorption in the group prone to hallucinations. The conclusions discuss the importance of dissociative variables in understanding the etiology of hallucinations and consider the possibility that different psychological processes may occur in healthy participants prone to hallucinations and in hallucinations in persons with psychoses.

Social functioning as a predictor of the use of mental health resources in patients with severe mental disorder.

Previous studies have tried to determine the factors causing greater use of health resources by patients with mental disorders. These studies have essentially focused on socio-economic variables. Nevertheless, many other variables, such as social functioning, have not yet been explored. This study aims to assess the effect of social functioning on mental health service use in a sample of patients with severe mental disorder (schizophrenia, other psychotic disorders or bipolar affective disorder) in an area of Spain. The Social Functioning Scale (SFS) was administered to 172 family members of patients with a severe mental disorder who were receiving care at a community mental health unit. Analysis of bivariate logistic regression identified specific areas as predictors of the use of mental health resources over a 12-month follow-up period. The overall social functioning score predicted need for hospital admissions. In addition, interpersonal behaviour had a major role in the number of outpatient visits, while social isolation significantly predicted the need for hospitalization. These results point out the necessity for including psychosocial variables, such as social functioning in current mental health resource use models.

Beck anxiety inventory: psychometric characteristics in a sample from the clinical Spanish population

Even though the Beck Anxiety Inventory (BAI) is one of the most popular instruments to assess anxiety today, only limited data is available about its psychometric characteristics and normative values in clinical Spanish populations. A study was conducted to test the psychometric characteristics of a Spanish adaptation of the Beck Anxiety Inventory (BAI) in a sample of 918 outpatients being treated at a community mental health center in Spain. Results confirmed the adaptation’s high internal consistency (∝ = .91), substantial test-retest reliability at 8-10 weeks (r = .84, p < .01), and satisfactory convergent validity with the Anxiety (r = .86, p < .01), Somatization (r = .81, p < .01), Obsessive compulsive (r = .60, p < .01), and Phobic Anxiety (r = .63, p < .01) dimensions of the SCL-90-R, and with the Anxious Thoughts Inventory (r = .57, p < .01). Gender differences in BAI scores did occur, so normative values appear separately for each gender (AU)

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Aplicación del programa de Reducción del Estrés Basado en la Atención Plena (REBAP) en pacientes con enfermedad orgánica atendidos en el Programa de Enlace e Interconsultas de Salud Mental. Un estudio piloto / No disponible

El Programa de Enlace e Interconsultas de Salud Mental del Hospital Universitario "Virgen del Rocío" de Sevilla atiende a pacientes hospitalizados que presentan alteraciones emocionales que repercuten negativamente en su enfermedad (cáncer, dolor crónico, trasplante de órganos, enfermedades crónicas, etc.) e interfieren en su proceso de recuperación. Algunos/as de estos/as pacientes precisan atención psicoterapéutica tras el alta hospitalaria y una posible alternativa eficaz sería la aplicación del programa REBAP (Reducción del estrés basado en la Atención Plena). El principal objetivo del uso de este programa de tratamiento sería que los/as pacientes tomasen una respuesta emocional adaptativa ante la enfermedad orgánica que padecen, de modo que las alteraciones emocionales disminuyeran y dejaran de interferir en el curso de la enfermedad. El presente trabajo recoge los datos de un estudio piloto realizado con un grupo de pacientes a quienes se les aplicó el programa a lo largo de ocho sesiones usando un formato grupal. Los resultados obtenidos apuntan a que el programa REBAP es un instrumento útil para lograr que la sintomatología afectiva de los/as pacientes disminuya, puesto que consiguen preservar su autoestima y aceptar de forma más adaptativa las limitaciones derivadas de su enfermedad física

The Consultation-Liaison Mental Health program of the University Hospital "Virgen del Rocío", in Seville, assists to patients with emotional disturbances that negatively impact their illness (cancer, chronic pain, organ transplantation, chronic diseases, etc.) and interfere with their recovery process. Some patients require psychotherapeutic care after hospital discharge and a possible effective alternative would be the implementation of the MBSR (Mindfulness Based Stress Reduction) program. The main purpose of this treatment program would be that patients took an adaptive emotional response to the organic disease causing the reduction of the emotional disturbance and stopping the interference in the course of the disease. This paper provides data from a pilot study of a group of patients who were administered the program over eight group sessions. The results indicate that the program is useful to make affective symptomatology decrease, since patients get to preserve their self-esteem and accept in a more adaptively way the limitations imposed by his physical illness

Fiabilidad y validez de la Escala de Autoestima de Rosenberg (EAR) en pacientes con diagnóstico de psicosis / Reliability and validity of the Rosenberg Self-Esteem Scale (RSES) in patients with a diagnosis of psychosis

Se estudia la fiabilidad y validez de La Escala de Autoestima de Rosenberg (EAR) en una muestra de 107 pacientes con diagnóstico de psicosis tratados/as en una Unidad de Salud Mental Comunitaria. Los resultados indican una alta consistencia interna, una satisfactoria fiabilidad temporal y confirman la validez de constructo del instrumento. La amplia difusión de esta escala, así como su fácil aplicación y sus aceptables características psicométricas apoyan el interés de su utilización en pacientes con diagnóstico de psicosis (AU)

Reliability and validity of a Spanish adaptation of the Rosenberg Self-Esteem Scale (RSES) were tested on a sample of 107 psychotic outpatients treated at a Community Mental Healh Center. Results confirm a high internal consistency, test-retest reliability and construct validity. The widespread application of the scale, simple application and acceptable psychometric characteristics support the interest on its use use for patients with psychotic diagnosis (AU)