Terapia sistémica breve en personas expuestas a un evento altamente estresante reciente: Un ensayo controlado aleatorizado / Brief systemic therapy in people exposed to a recent highly stressful event: A randomised controlled trial

Resumen: Antecedentes: Los eventos altamente estresantes pueden tener efectos nocivos en el bienestar y salud mental en las personas. Objetivo: Evaluar la eficacia de un protocolo de intervención preventiva basado en la Terapia Sistémica Breve orientado a personas que vivenciaron de manera reciente un evento altamente estresante. Método: Participaron 75 personas, 39 conformaron el grupo experimental y 36 el grupo control. Para el análisis de los datos se siguió un diseño cuantitativo con dos grupos (experimental y control) y con dos puntos temporales (pre y post-intervención). Al grupo experimental se añadió un seguimiento a los seis meses. El protocolo estuvo estructurado en cuatro sesiones y apuntaba a incidir sobre los síntomas postraumáticos, el crecimiento postraumático, la respuesta rumiativa y las estrategias de afrontamiento. Resultados: Se observó un aumento del crecimiento postraumático, de la rumiación deliberada, del afrontamiento centrado en el problema y de la reinterpretación positiva en el grupo experimental. En cambio, solo hubo una tendencia no significativa en la reducción de la sintomatología postraumática y en la búsqueda de apoyo social. Conclusiones: Estos resultados contribuyen al desarrollo de la Terapia Sistémica Breve y apoyan su utilidad en la intervención preventiva con personas expuestas a un evento altamente estresante.

Abstract: Background: Highly stressful events can have harmful effects on people's well-being and mental health. Objective: To evaluate the efficacy of a preventive intervention protocol based on Brief Systemic Therapy oriented to people who recently experienced a highly stressful event. Method: Seventy-five people participated, 39 were in the experimental group and 36 in the control group. A quantitative design with two groups (experimental and control) and two time points (pre- and post-intervention) was used for data analysis. A six-month follow-up was added to the experimental group. The protocol was structured in four sessions and aimed to impact on posttraumatic symptoms, posttraumatic growth, ruminative response and coping strategies. Results: An increase in posttraumatic growth, deliberate rumination, problem-focused coping, and positive reinterpretation was observed in the experimental group. In contrast, there was only a nonsignificant trend in reduced posttraumatic symptomatology and in seeking social support. Conclusions: These results contribute to the development of Brief Systemic Therapy and support its usefulness in preventive intervention with people exposed to a highly stressful event.

Bibliometric Differences Between WEIRD and Non-WEIRD Countries in the Outcome Research on Solution-Focused Brief Therapy.

Solution Focused Brief Therapy (SFBT) developed in parallel to Positive Psychology, as a type of intervention that also emphasizes the strengths and resources of clients. The aim of this study was to examine the development of outcome research on SFBT and to determine whether it is predominantly carried out in Western, Educated, Industrialized, Rich and Democratic (WEIRD) countries. A literature review was conducted using a bibliometric methodology, identifying: (a) authors and countries, (b) time trends, (c) language of publications; (d) and journals; (e) samples on which they were tested; (f) characteristics of interventions; and (g) main study designs. A total of 365 original outcome research articles published in scientific journals on solution-focused interventions were extracted. The results show that outcome research on SFBT has grown steadily over the last three decades. Although it started in WEIRD countries, the number of outcome research publications generated in non-WEIRD countries is now higher. There is little international collaboration and, although English is the main language of publication in WEIRD countries, English, Chinese and Parsi predominate in non-WEIRD countries. Productivity is low and most authors have only published one paper. The journals that have published the most papers have a very diverse visibility. The tested interventions are conducted both in clinical and non-clinical samples; mostly in individual and group format; face-to-face; and not only in the form of psychotherapy, but also as coaching and school interventions. Almost half of the publications are randomized controlled trials. The results confirm the wide applicability of SFBT as a single or main component of psychosocial interventions. They support the claim that solution-focused interventions are not a WEIRD practice, but a global practice.

Evaluación de un protocolo de intervención en Terapia Sistémica Breve para personas expuestas a un evento estresante reciente / Evaluation of a Brief Systemic Therapy intervention protocol for people who have experienced a recent stressful event

Resumen Los eventos altamente estresantes son sucesos que potencialmente generan consecuencias negativas en las personas afectadas, como síntomas postraumáticos y depresivos. El presente estudio evalúa un protocolo de intervención preventiva, orientado a personas que han vivido un evento altamente estresante reciente, basado en la Terapia Sistémica Breve. Cuatro terapeutas aplicaron el protocolo a cuatro usuarias. Se entrevistó a estas ocho personas acerca de su experiencia en la aplicación y recepción del protocolo. Mediante escalas de fiabilidad y validez contrastada se evaluaron los cambios pre-post en sintomatología postraumática, sintomatología depresiva, crecimiento postraumático y satisfacción con la vida; también se midió la relación terapéutica. Los resultados muestran apreciaciones positivas en terapeutas y usuarias, el desarrollo de una relación terapéutica adecuada y avances en tres de los cuatro indicadores cuantitativos de cambio. Se concluye que el protocolo está en condiciones de utilizarse en estudios controlados.

Abstract Highly stressful events are occurrences that potentially create negative consequences for the affected people, such as post-traumatic and depressive symptoms. This study assesses a preventive intervention protocol, aimed to people who have lived a recent highly stressful event, based on the Brief Systemic Therapy. Four therapists applied the protocol to four female users. These eight persons were interviewed about the experience in relation to the application and reception of the protocol. Through contrasted reliability and validity scales, pre and post changes in posttraumatic symptomatology, depressive symptomatology, posttraumatic growth and satisfaction with life were assessed; the therapeutic relation was also measured. The results show positive appraisals in therapists and female users, the development of a proper therapeutic relation and progress in three out of four quantitative change indicators. It is concluded that the protocol is suitable to be used in controlled studies.

IMPACT of nurses' solution-focused communication on the fluid adherence of adult patients on haemodialysis.

AIM: To test the hypothesis that fluid adherence in patients on haemodialysis can be improved through nurses' solution-focused communication with patients on issues of adherence. BACKGROUND: Adherence to fluid-intake restrictions is low in patients on haemodialysis, creating serious health risks. Psychosocial interventions to increase adherence have typically focused on patients and ignored patient/staff interactions. DESIGN: This is a single-group, pre-post pilot study registered in ClinicalTrials.gov (identifier: NCT03432988). METHOD: A 1-month baseline of interdialytic weight gain was taken in April 2016 for a group of 36 adult patients in a hospital haemodialysis unit. Then, the nurses of the unit received a 4 hr training in solution-focused communication on issues of fluid adherence and applied it with the patients of the sample. Interdialytic weight gains were measured during another month. One month after the training, in October 2016, interdialytic weight gains were measured for another month. RESULTS: After introducing solution-focused communication on fluid adherence, patients' average interdialytic weight gains decreased significantly, below the level considered indicative of problematic adherence. These results were maintained at follow-up. CONCLUSIONS: Our results suggest that a novel approach to adherence, nurses' solution-focused communication with patients on haemodialysis, may improve patients' adherence to fluid restriction. More rigorous, controlled studies are required to confirm long-term benefits and to understand the causal mechanisms that may underlie the effectiveness of this intervention.

Spanish adaptation of the Solution-Focused Inventory (SFI) / Adaptación española del Cuestionario Centrado en Soluciones

The aim of this study was to examine the psychometric properties of the solution-Focused Inventory (SFI) in a Spanish population, replicating the original validation study of Grant et al. (2012). The SFI, designed to evaluate solution-focused thinking, is a 12-item scale with three subscales: problem Disengagement, goal orientation and resource activation. The instrument was adapted and translated into Spanish, then two studies were carried out to examine its psychometric properties. The first study confirmed the instrument's structure, and its good internal consistency. The second study confirmed its convergent validity; SFI was positively correlated with measures of well-being, resilience, satisfaction with life and perspective taking, and negatively correlated with psychopathology. This second study confirmed the stability of the SFI scores across time. In sum, these two studies provide additional support for the reliability and validity of the SFI as a measure of solution-focused thinking, and open its use to Spanish-speaking populations.

El objetivo de este estudio fue analizar las propiedades psicométricas del cuestionario centrado en soluciones (CCS) en una muestra española, replicando el estudio original de Grant et al. (2012). El CCS diseñado para evaluar los pensamientos centrados en las soluciones, compuesta de tres subescalas: Distanciamiento del problema, orientación a la Meta y activación de recursos. Fue traducido y adaptado al castellano, posteriormente se realizaron dos estudios para examinar sus propiedades psicométricas. El primer estudio confirmó la estructura del instrumento y obtuvo una buena consistencia interna. El segundo estudio confirmó su validez convergente; el CCS correlacionó positivamente con el bienestar, resiliencia, satisfacción con la vida y toma de perspectiva, y negativamente con una medida de psicopatología. El segundo estudio confirmó la estabilidad, a lo largo del tiempo. Estos dos estudios confirman que el CCS es una medida que evalúa pensamientos centrados en las soluciones y puede ser utilizado para población española.

Effectiveness of Brief Systemic Therapy versus Cognitive Behavioral Therapy in routine clinical practice / Efectividad de la Terapia Sistémica Breve versus la Terapia Cognitivo-Conductual en la práctica clínica rutinaria

BACKGROUND: Combining strategies and techniques from different therapeutic approaches is a common procedure in routine mental health practice. It has been claimed that the integration of systemic brief therapies offers useful psychotherapeutic alternatives, especially in our overloaded public mental health services. However, this claim has rarely been put to the test, and comparison with well-established empirically-based treatments has been scarce. METHOD: Of 419 patients referred to an Adult Ambulatory Mental Health Service, 212 were allocated to Cognitive-Behavioral Therapy (CBT), and 207 to an integrative Brief Systemic Therapy (BST). Follow-up assessments of patients' status took place between one and three years later. RESULTS: Both therapy models were found to be equivalent in their percentage of therapeutic discharges, drop-outs, relapses and in the use of other mental health services during the follow-up period. Although both treatments were cost-efficient, BST was not briefer than CBT. The between-group equivalence was also confirmed, analyzing the data by psychiatric diagnosis.CONCLUSIONS: This study provides some preliminary data that suggest that BST might be an effective and efficient treatment in public mental health practice, comparable to well-established treatments like CBT

ANTECEDENTES: la combinación de estrategias y técnicas de diferentes modelos psicoterapéuticos es un procedimiento común en la práctica habitual en salud mental. Se ha propuesto que la integración de terapias sistémicas breves ofrece alternativas psicoterapéuticas útiles, especialmente en nuestros sobrecargados servicios públicos de salud mental. Sin embargo, esta afirmación apenas ha sido investigada y la comparación con tratamientos empíricamente validados ha sido escasa. MÉTODO: de 419 pacientes adultos remitidos a un Servicio Ambulatorio de Salud Mental, 212 fueron asignados a Terapia Cognitivo-Conductual (TCC) y 207 a una Terapia Sistémica Breve integrativa (TSB). Las evaluaciones del estado de los pacientes tuvieron lugar entre uno y tres años más tarde. RESULTADOS: ambos modelos terapéuticos resultaron equivalentes en términos de sus porcentajes de altas terapéuticas, abandonos, recaídas y uso de otros servicios de salud mental durante el tiempo de seguimiento. Aunque ambos tratamientos fueron coste-eficientes, la TSB no fue más breve que la TCC. La equivalencia entre grupos fue también confirmada analizando los datos según los diagnósticos psiquiátricos. CONCLUSIONES: este estudio aporta datos preliminares que sugieren que la TSB podría ser un tratamiento efectivo y eficiente en servicios públicos de salud mental, comparables con otros tratamientos bien establecidos como la TCC

Effectiveness of Brief Systemic Therapy versus Cognitive Behavioral Therapy in routine clinical practice.

BACKGROUND: Combining strategies and techniques from different therapeutic approaches is a common procedure in routine mental health practice. It has been claimed that the integration of systemic brief therapies offers useful psychotherapeutic alternatives, especially in our overloaded public mental health services. However, this claim has rarely been put to the test, and comparison with well-established empirically-based treatments has been scarce. METHOD: Of 419 patients referred to an Adult Ambulatory Mental Health Service, 212 were allocated to Cognitive-Behavioral Therapy (CBT), and 207 to an integrative Brief Systemic Therapy (BST). Follow-up assessments of patients’ status took place between one and three years later. RESULTS: Both therapy models were found to be equivalent in their percentage of therapeutic discharges, drop-outs, relapses and in the use of other mental health services during the follow-up period. Although both treatments were cost-efficient, BST was not briefer than CBT. The between-group equivalence was also confirmed, analyzing the data by psychiatric diagnosis. CONCLUSIONS: This study provides some preliminary data that suggest that BST might be an effective and efficient treatment in public mental health practice, comparable to well-established treatments like CBT.

The Effect of Solution-Focused Versus Problem-Focused Questions: A Replication.

In therapeutic conversations, questions can be considered as interventions in their own right. This study is a cross-cultural replication of Grant (Journal of Systemic Therapies, 2012, 31, 2, 21) study on the effects of different types of questions on various clinically relevant variables. A total of 204 students of a Spanish university described a real-life problem that they wanted to solve and were then randomly assigned to either a solution-focused or a problem-focused questions condition. Before and after answering the questions, they completed a set of measures that assessed positive and negative affect, self-efficacy, and goal attainment. Solution-focused questions produced a significantly greater increase in self-efficacy, goal approach, and action steps than problem-focused questions, and a significantly greater decrease in negative affect, providing further empirical support to solution-focused practices.

Cost-efficiency of a brief family intervention for somatoform patients in primary care.

We sought to determine the cost-efficiency of a brief family intervention program for patients with somatoform disorder. Two hundred fifty-six somatoform patients from 7 centers of primary care in Chile were randomly assigned to either brief family intervention (BFI) or treatment as usual. The experimental group presented a significant cost reduction (p = .001) 6 months and 12 months after the intervention, with lower costs than the control group on all measured variables and no decrease in patient satisfaction. Our results suggest that BFI might be a cost-efficient way of meeting the needs of somatoform patients. Replications in other cultural contexts and dismantling studies to identify the effective ingredients of BFI are recommended.

Trastornos somatomorfos en la atención primaria: características psicosociales y resultados de una propuesta de consejería familiar / Somatoform disorder in primary health care: psycho-social characteristics and results of a familiar counseling proposal

The article describes the psychosocial characteristics of patients with somatization disorder and the results of a family counseling proposal, applied by the primary care health equipment. The objective of the counseling was that the patients recovered their personal skills, that allow them to take control or the solution of their problems, and they could act independently. Method: The sample was constituted by 128 patients from seven centers of primary attention health of the Bío-Bío Region. Results show that the main patient complaint is related to the family and the application was successful for 75 percent of the cases. Discussion: The results are discussed in relation to their limitations and future projections.

El presente artículo tiene como propósito, describir las características psicosociales de los pacientes con trastornos somatomorfos y los resultados de una propuesta de consejería familiar aplicada a estos por equipos de salud en la atención primaria. El objetivo de la consejería fue que los pacientes recuperaran sus competencias personales, a objeto de tener el control o resolución de sus problemas, y poder funcionar autónomamente. Método: La muestra, estuvo constituida por 128 pacientes, pertenecientes a 7 centros de Salud de atención primaria de la Región del Bío-Bío. Resultados: Muestran que la queja principal estaba relacionada con la familia y que la aplicación de la consejería fue exitosa en un 75 por ciento de los casos. Discusión: Los resultados son discutidos en relación a sus limitaciones y proyecciones futuras.

Terapia familiar breve y atención primaria: un caso de trastorno somatomorfo / Brief familiar therapy in primary health care: a case of somatization disorder

En este artículo se presenta un modelo de Terapia Familiar que puede ser útil en la atención primaria para el tratamiento de pacientes somatomorfos o con trastornos somatomorfos. El objetivo fue describir un caso de trastorno somatomorfo y una forma de intervención a través de la Terapia Familiar Breve. El Método incluyo la recogida de la historia clínica y aplicación de la Terapia Familiar Breve por dos profesionales de la salud: psicólogo y médico de familia. Los resultados muestran una disminución de la sintomatología y recuperación de su competencia personal para funcionar autónomamente. Se discute el valor de la aplicación de la Terapia Familiar Breve o de corta duración en la atención de pacientes con trastornos somatomorfos y la importancia de usar estrategias que mejoren la resolutividad del sistema.

This article presents a model of familiar therapy useful at primary health care for the treatment of patients with somatization disorder or somatization. The objective is to describe a case of somatization disorder and an intervention form of Brief Family Therapy. The method included the recollection of clinical history and the application of Brief Family Therapy by two health professionals: a psychologist and a family doctor. The results showed symptomatology reduction and patient autonomy. The use of Brief Family Therapy with somatization disorder is discussed in primary care and the importance of improving the system resoluty.