Los trastornos de la personalidad ¿realidad o ficción? El sombrío futuro de su diagnóstico / Personality disorders: reality or fiction? The bleak future of your diagnosis

El diagnóstico categorial de los trastornos de la personalidad (TTPP) ha sido criticado por diversas razones, entras las que se encuentran el solapamiento de síntomas entre distintos trastornos, su elevada comorbilidad o el carácter dicotómico de su diagnóstico. Estas críticas han llevado al desarrollo de un planteamiento dimensional en las últimas versiones de los sistemas de clasificación, DSM-5/DSM-5-TR y CIE-11, considerando dos aspectos: el funcionamiento de la personalidad y una serie de rasgos patológicos. A pesar de la cuantiosa literatura publicada desde principio de este siglo sobre esta propuesta dimensional, no está claro, a día de hoy, que tenga alguna utilidad clínica. La vaga, abstracta y poco operativizable exposición de lo que constituye el funcionamiento de la personalidad y la compleja y forzada designación de rasgos mayores y menores (facetas) en el DSM-5/DSM-5-TR o sólo mayores y opcionales en la CIE-11, complican el diagnóstico dimensional de los TTPP. En este trabajo se discuten todas estas cuestiones en un intento de aportar algo de luz para un futuro menos sombrío que el actual panorama de los TTPP.(AU)

The categorical diagnosis of personality disorders (PDs) has been criticized forvarious reasons, among which are overlapping of symptoms between differentdisorders, their high comorbidity, and the dichotomous nature of their diagnosis.These criticisms have led to the development of a dimensional approach in thelatest versions of the classification systems, DSM-5/DSM-5-TR and ICD-11,considering two substantial aspects for its new diagnosis: personality functioning,and a series of pathological features. Despite the large amount of literature thathas been published since the beginning of this century on this dimensionalproposal, it is not clear, to date, that this approach enhances clinical utility. Thevague, abstract, and inoperative exposition of what constitutes personalityfunctioning and the complex and forced designation of major and minor traits(facets) in the DSM-5/DSM-5-TR, and only major and optional traits in the ICD-11,complicate, in an unusual way, the dimensional diagnosis of PDs. This paperdiscusses all of these issues in an attempt to shed some light on the potentially darkfuture of the current PDs panorama.(AU)

El papel de la impulsividad en la orientación al suicidio de universitarios con antecedentes de conducta autolesiva / The role of impulsivity in suicidal orientation of university students with a history of self-injurious behavior

El objetivo de esta investigación fue describir el efecto de la depresión, la desesperanza y la impulsividad sobre la orientación al suicidio y el papel de la impulsividad como mediador de la orientación suicida en universitarios con antecedentes de conductas autolesivas. Participaron 1.645 jóvenes entre los 18 y 29 años, de dos ciudades colombianas. Se seleccionaron 218 jóvenes (M= 21,00; DT= 2,99) que informaron de al menos un intento de suicidio en el último año, quienes contestaron el “Inventario de orientación suicida”, la “Escala de desesperanza de Beck”, el “Inventario de depresión de Beck” y la “Escala de impulsividad de Barratt”. La depresión, la desesperanza y la impulsividad explicaron el 63% de la variación de la orientación al suicidio (R2= 0,635; IC 95% [0,555; 0,713]; p= 0,001). La impulsividad medió con depresión en aquellos casos en los que la orientación suicida era alta, cuyos efectos totales, directos e indirectos, fueron estadísticamente significativos (p< 0,001). La impulsividad desempeña un papel mediador entre la depresión y la desesperanza en la predicción de la orientación suicida.(AU)

The aim of this research was to describe the effect of depression,hopelessness, and impulsivity on orientation to suicide and the role of impulsivityas a mediator of suicidal orientation in university students with a history of self-injury behaviors. 1645 young people between 18 and 29 years old participated,from two Colombian cities. 218 young people were selected (M= 21.00; SD= 2.99)who reported at least one suicide attempt in the last year, who answered the“Suicidal Orientation Inventory”, the “Beck Hopelessness Scale”, the “BeckDepression Inventory” and the “Barratt Impulsivity Scale”. Depression,hopelessness, and impulsivity explained 63% of the variation in suicidal orientation (R 2 = .635, IC 95% [.555, .713], p= .001). Impulsivity mediated with depression inthose cases in which suicidal orientation was high, whose total, direct and indirecteffects were statistically significant (p< .001). Impulsivity plays a mediating rolebetween depression and hopelessness in predicting suicidal orientation.K EY WORDS : depression, hopelessness, impulsivity, suicidality, college youth.(AU)

Facial infrared thermography as an index of social anxiety.

Previous research on physiological indices of social anxiety has offered unclear results. In this study, participants with low and high social anxiety performed five social interaction tasks while being recorded with a thermal camera. Each task was associated with a dimension assessed by the Social Anxiety Questionnaire for Adults (1 = Interactions with strangers. 2 = Speaking in public/Talking with people in authority, 3 = Criticism and embarrassment, 4 = Assertive expression of annoyance, disgust or displeasure, 5 = Interactions with the opposite sex). Mixed-effects models revealed that the temperature of the tip of the nose decreased significantly in participants with low (vs. high) social anxiety (p < 0.001), while no significant differences were found in other facial regions of interest: forehead (p = 0.999) and cheeks (p = 0.999). Furthermore, task 1 was the most effective at discriminating between the thermal change of the nose tip and social anxiety, with a trend for a higher nose temperature in participants with high social anxiety and a lower nose temperature for the low social anxiety group. We emphasize the importance of corroborating thermography with specific tasks as an ecological method, and tip of the nose thermal change as a psychophysiological index associated with social anxiety.

Predictive Model of Suicide Risk in Young People: The Mediating Role of Alcohol Consumption.

Suicidal behavior is one of the public health problems that cause most deaths in young people and has been associated with emotional and affective problems, so predictive models are required to account for the relationship between depression, anxiety, hopelessness, and alcohol consumption to propose actions for its prevention. The Plutchik Suicide Risk Scale, the CAGE Questionnaire, the Hopelessness Scale, the Depression Inventory and the Beck Anxiety Scale were applied. A total of 1.379 young people (M = 20.45; SD = 3.23) from the cities of Manizales (n = 739; 53.6%) and Medellín (n = 640; 46.5%) in Colombia were evaluated. The variables of anxiety, hopelessness and depression explained 51% (R2 = 0.509; 95% CI = 0.467-0.552; p = 0.001) of the variation in suicidal risk. Likewise, alcohol consumption is a mediating variable between depression and anxiety in the prediction of suicidal risk, whose total, direct and indirect effects are statistically significant. The findings support the role of alcohol consumption as a mediating variable between anxiety, depression, hopelessness and suicidal risk in young people, given the difficulties it causes in information processing, regulation of emotions and therefore in having an adequate coping with the demands of the environment. This justifies the importance of directing suicide prevention actions through strategies for the reduction of alcohol consumption and the management of emotions in young people. HIGHLIGHTSAlcohol modulates the effect of depression and anxiety on suicide riskThis is a study on the risk of suicide in young people in ColombiaThe findings have implications for timely clinical interventions.

Aplicación internacional del programa “Intervención multidimensional para la ansiedad social” (IMAS): II. Eficacia del tratamiento para problemas relacionados con la ansiedad social / [International application of the program "Multidimensional intervention for social anxiety" (IMAS): II. Efficacy of treatment for problems related to social anxiety]

En un trabajo anterior (Caballo et al., 2021) comprobamos la eficacia del programa de Intervención multidimensional para la ansiedad social (IMAS) en la reducción de los síntomas de ansiedad social. En este estudio cuasiexperimental, con medidas pre/postratamiento y seguimiento, hallamos el impacto del programa IMAS en otros problemas relacionados con la ansiedad social. 57 personas diagnosticadas con un trastorno de ansiedad social (TAS), según el DSM-5, contestaron a cuestionarios que medían habilidades sociales, depresión, síntomas del trastorno de la personalidad por evitación, alcoholismo, autoestima, sensibilidad personal, preocupaciones y calidad de vida. Diferentes terapeutas llevaron a cabo el tratamiento en Ecuador, España y Paraguay. Los resultados mostraron importantes mejoras en el postratamiento en prácticamente todos los aspectos evaluados, mejoras que se mantenían a los seis meses. Los tamaños del efecto sobre la eficacia del tratamiento iban de medianos a grandes. Se comparó también el programa IMAS con terapia cognitivo conductual individual y tratamiento farmacológico, con resultados favorables para el programa IMAS. Este nuevo programa para el tratamiento de la ansiedad social tiene un impacto importante en otros problemas relacionados habitualmente con el TAS.

In a previous work (Caballo et al., 2021) we tested the effectiveness of the Multidimensional Intervention for Social Anxiety (MISA) program in reducing social anxiety symptoms. In this quasi-experimental study, with pre/post-treatment and follow-up measures, we examined the impact of the MISA program on other problems related to social anxiety. 57 people diagnosed with social anxiety disorder (SAD), according to DSM-5, were assessed with a diagnostic interview and questionnaires measuring social skills, depression, avoidant personality disorder symptoms, alcoholism, self-esteem, personal sensitivity, worries, and quality of life. Different therapists carried out the treatment in Ecuador, Spain, and Paraguay. The results showed significant improvements at post-treatment in virtually all measures assessing the above variables, improvements that were maintained at six months. Effect sizes on treatment effectiveness ranged from medium to large. The MISA program was also compared with individual cognitive behavioral therapy and pharmacological treatment, with favorable results for the MISA program. In conclusion, this new program for the treatment of social anxiety has a significant impact on other problems usually related to SAD.

Efficacy of cognitive-behavioural therapy for lifestyle modification in metabolic syndrome: a randomised controlled trial with a 18-months follow-up.

OBJECTIVE: To test the efficacy of cognitive-behavioural therapy (CBT) for lifestyle modification in patients with metabolic syndrome (MetS). DESIGN: 76 MetS patients completed this clinical trial, with 18 months follow-up. 45 participants from the experimental group (EG - CBT) and 31 to the control group (CG - usual care). The CBT programme was performed by a psychologist in a face-to-face group format, during 12 weekly sessions lasting 90 minutes. The intervention for the CG consisted of workshops with basic information about MetS and it's associated cardiovascular risk. MAIN OUTCOME MEASURES: Efficacy of (CBT) in (MetS) patients. RESULTS: Results showed reduction in weight (mean difference - MD -2.633, 95%CI [-4.322, -0.943]; p<.003), waist circumference (MD -2.944, 95%CI [-5.090, -0.798]; p<.008), body mass index (MD -0.915, 95%CI [-1.494, -0.335]; p<.003), systolic (MD -0.046, 95%CI [-0.685, -0.023]; p<.0002) diastolic blood pressure (MD -4.777, 95%CI [-7.750, -1.804]; p<.002), and cardiovascular risk score after 18 months. An increase in adherence to the Mediterranean diet and assertiveness and a reduction in anger were observed in EG. The CG did not show any significant differences. CONCLUSION: The CBT focused on changes in lifestyle seems to be effective in the reduction of MetS and cardiovascular risk factors. TRIAL REGISTRATION: Registered at clinicaltrials.gov (NCT02949622) - PROMETS (Multimodal Intervention Program for Patients with Metabolic Syndrome).

Calidad de vida y estrategias de afrontamiento en pacientes con cáncer ginecológico / Quality of life and coping strategies in patients with gynecological cancer

Resumen Introducción: El cáncer ginecológico impacta psicológicamente a la mujer. En este proceso las Estrategias de Afrontamiento-EA, al parecer, se asocian con la Calidad de Vida relacionada con la Salud-CvRS; sin embargo, se desconoce el valor predictivo de las EA sobre la CvRS. Este artículo tiene como finalidad identificar las diferencias y la naturaleza de la relación entre la CvRS y las EA respecto al apoyo psicológico, así como identificar si las EA predicen la CvRS. Método: Se efectuó un diseño no-experimental con 55 mujeres entre 27 y 69 años, M = 42.3, DE = 10.1, diagnosticadas con cáncer ginecológico. La CvRS se evaluó con el FACT-Cx y el SF-36; las EA, con el CAEPO. Resultados: las mujeres con asistencia psicológica tienen mejor CvRS y EA, igualmente, la CvRS se correlacionó con las EA positivas. La dimensión de salud general también es explicada por las EA positivas e inversamente por las EA negativas. Las EA que mejor predicen las CvRS son: Enfrentamiento y Lucha Activa, y Autocontrol y Control Emocional, mientras que las EA negativas afectan la CvRS. Conclusión: Los resultados resaltan la necesidad de acompañamiento psicológico que promueva EA positivas y beneficien la CvRS en mujeres con cáncer ginecológico.

Abstract Introduction: Gynecological cancer impacts women psychologically. In this process, the Coping Strategies-CS are apparently associated with Health-Related Quality of Life HRQL; however, the predictive value of CS on HRQL is unknown. This article aims to identify the differences and the nature of the relationship of HRQL and CS regarding psychological support, as well as to identify whether CS predict HRQL. Method: A non-experimental design was performed with 55 women between 27 and 69 years old, M = 42.3, DE = 10.1, diagnosed with gynecological cancer. The HRQL was evaluated with the FACT-Cx and the SF-36; and the CS, with CAEPO (Spanish acronym). Results: Women with psychological support have better HRQL and CS, likewise, HRQL was correlated with positive CS. The general health dimension is also explained by positive CS, and inversely by negative CS. The CS that best predict HRQL are: active confrontation and fighting, and self-control and emotional control, while negative CS affect HRQL. Conclusion: The results highlight the need for psychological support that promotes positive CS and benefits HRQL in women with gynecological cancer.

Riesgo suicida y su relación con la inteligencia emocional y la autoestima en estudiantes universitarios / Suicidal risk and its relation with emotional intelligence and self-esteem in university students

Resumen: El objetivo fue establecer la relación del riesgo suicida con la inteligencia emocional y autoestima en una muestra de 1414 estudiantes universitarios de dos ciudades colombianas a partir de un estudio cuantitativo, con diseño no experimental de tipo transversal. Se usaron como instrumentos la Escala de Riesgo Suicida de Plutchik (RS), las versiones adaptadas de Trait Meta-Mood Scale (TMMS-24) y la Escala de Autoestima de Rosenberg (RAE), y una Ficha sociodemográfica ad hoc. Los resultados evidencian correlaciones estadísticamente significativas (p<.001) positivas entre riesgo suicida, atención emocional y autodesprecio; y negativas (p<.001) entre riesgo suicida, inteligencia emocional, claridad emocional, regulación emocional, autoestima y autoconfianza. Se indica que la inteligencia emocional respecto de la claridad, regulación, autoestima y autoconfianza son factores protectores del riesgo suicida, y, al contrario, la atención emocional y el autodesprecio son factores de riesgo para el suicidio.

Abstract: The objective was to establish of suicidal risk with emotional intelligence and self-esteem in a sample of 1414 university students of two Colombian cities from a quantitative study, with a non-experimental cross-sectional design. The Plutchik-RS Suicide Risk Scale, the adapted versions of the Trait Meta-Mood Scale (TMMS-24) and the Rosenberg-RAE Scale of Self-Esteem and an ad hoc Sociodemographic Record was used as instruments. The results show positive statistically significant correlations (p> 0.001) among suicidal risk, emotional attention and self-deprecation; and negative correlations (p> 0.001) among suicidal risk, emotional intelligence, emotional clarity, emotional regulation, self-esteem and self-confidence. We would like to highlight that emotional intelligence regarding clarity, regulation, self-esteem and self-confidence are protective factors of suicidal risk, and conversely, emotional attention and self-deprecation are risk factors for suicide.

Predictores psicológicos del riesgo suicida en estudiantes universitarios / No disponible

Este trabajo muestra los factores de riesgo y predictores psicológicos asociados a la conducta suicida en estudiantes universitarios en Manizales y Medellín (Colombia). Participaron 1408 estudiantes y se utilizaron las escalas de riesgo suicida de Plutchik, desesperanza y depresión de Beck e impulsividad de Barratt. Se encontró un factor de riesgo suicida del 23,2%. El análisis de regresión binaria muestra que la depresión (OR = 1,2), impulsividad (OR = 1,04), desesperanza (OR = 1,1), intento de suicidio (OR = 31,5), enfermedad mental e intento de suicidio en la familia (OR = 2,2; OR = 2,1) explican entre el 41% y el 62% de la varianza del riesgo suicida. Mediante el análisis de modelado de ecuaciones estructurales se establecieron tres modelos explicativos que muestran que la enfermedad mental e intento de suicidio en la familia (modelo 1), impulsividad (modelo 2) y antecedentes de intento de suicidio por parte del estudiante (modelo 3) son variables mediadoras del riesgo suicida. El mayor efecto total se produjo en el modelo 3, que explica en un 62,7% la variación del riesgo suicida

This work shows the risk factors and psychological predictors associated with suicidal behavior in university students in Manizales and Medellín (Colombia). The sample comprised 1408 students. Plutchik's suicide risk, Beck's despair and depression and Barratt impulsivity scales were used. A suicide risk factor of 23.2% was found. Binary regression analysis shows that depression (OR = 1.2), impulsivity (OR = 1.04), hopelessness (OR = 1.1), suicide attempt (OR = 31.5), mental illness and family suicide attempt (OR = 2.2, OR = 2.1) explain between 41% and 62% of the variance of suicide risk. Through a structural equation modeling analysis, three explanatory models were established that show mental illness and suicide attempt in the family (model 1), impulsivity (model 2), and a history of suicide attempt by the student (model 3) are suicide mediating variables. The greatest total effect occurred in model 3, which explains 62.7% of the variation in suicide risk

Propiedades psicométricas del Cuestionario de ansiedad social para adultos (CASO) en Perú / Psychometric properties of the Social Anxiety Questionnaire for Adults (SAQ) in Peru

Resumen La investigación sobre la evaluación de la ansiedad social en Iberoamérica es escasa. En los últimos años se ha informado sobre las características psicométricas del "Cuestionario de ansiedad social para adultos" (CASO) en distintos países iberoamericanos, excepto Perú. El objetivo de este estudio fue analizar las pruebas de validez basadas en el constructo, las pruebas de validez basadas en la relación con otras variables de tipo convergente y la fiabilidad del CASO, utilizando una muestra no clínica de 3064 peruanos. El análisis factorial confirmatorio comprobó que el modelo de cinco factores relacionados se ajustaba mejor a los datos que el modelo jerárquico y se halló que el modelo unifactorial no tenía un buen ajuste. Las correlaciones entre los factores del CASO (de .608 a .709) indicaron que cada uno de ellos evalúa aspectos específicos del constructo y aportan, a su vez, a la medición global del mismo. Los coeficientes de fiabilidad fueron de aceptables a muy buenos (.78( (( .85, .75( (( .83). La alta correlación (r= .69) con la subescala de Ansiedad de la "Escala de ansiedad social de Liebowitz, versión de autoinforme" (LSAS-SR), apoya su relación con la variable convergente. Estas adecuadas características psicométricas del CASO respaldan su utilización con población peruana.

Abstract Research on the assessment of social anxiety in Ibero-America is scarce. In recent years, the psychometric characteristics of the Social Anxiety Questionnaire for adults (SAQ) have been reported in different Ibero-American countries except Peru. The aim of this study was to analyze the construct and the convergent validity, and the reliability of the SAQ, using a non-clinical sample of 3064 Peruvians. The confirmatory factorial analysis showed that the model of five-related factors was better adjusted to the data than the hierarchical model, and that the unifactorial model did not have a good fit. The correlations between their factors (from .608 to .709) indicate that each of them evaluates specific aspects of the construct and also contribute to the overall measurement of it. The reliability coefficients were from acceptable to very good (.78( (( .85, .75( (( .83). The high correlation (r= .69) with the Anxiety subscale of the "Liebowitz Social Anxiety Scale-Self-Report version" (LSAS-SR) supports its convergent validity. These appropriate psychometric characteristics of the questionnaire support its use with the Peruvian population.

[Scales for social support for eating habits and exercise: psychometric properties]. / Escalas de apoyo social para los hábitos alimentarios y para el ejercicio: propiedades psicométricas.

OBJECTIVE: Social support can introduce favorable changes in lifestyle to reduce the cardiovascular risk. The aim of this study was to verify these changes in the clinical population participating in this study and present the psychometric properties of the scales of social support for 'Eating Habits' and 'Exercise' in patients diagnosed with metabolic syndrome. METHODS: 135 participants attending a programme for changing lifestyle habits. Sociodemographic, psychological, and lifestyle variables were assessed at the Hospital Universitario Virgen de las Nieves (HUVN) in Granada (Spain) between 2013 and 2014. The following procedures were used: Confirmatory factor analysis (CFA), internal consistency, sensibility to change and temporal stability. RESULTS: The AFC confirmed the original structure of both scales, except for the exclusion of factor 2 (family) from the social support scale for the year. For the social support scale, the local adjustment, all items presented high values of factor loads and individual reliability (λ≥0.64 and R2≥0.41, respectively). For the exercise scale, the local adjustment, the items presented high values of factor loads and individual reliability (λ≥0.62 and R2≥0.38, respectively). Internal consistency values were between adequate and excellent, with Cronbach's alpha figures between 0.714 and 0.864. Regarding sensitivity to change, the experimental group increased the perception of social support for food and exercise. The control group did not show significant differences. CONCLUSIONS: Our results show adequate indices for validity and reliability of the measures. Both measures appeared to be useful to assess social support in patients diagnosed with metabolic syndrome.

OBJETIVO: El apoyo social puede introducir cambios favorables en el estilo de vida de cara a reducir el riesgo cardiovascular. El objetivo de este estudio fue verificar dichos cambios en la población clínica que participó en el mismo y presentar las propiedades psicométricas de dos escalas de apoyo social: los hábitos alimentarios y el ejercicio. Ambas fueron aplicadas en pacientes con síndrome metabólico (SM). METODOS: Participaron 135 sujetos en un programa de modificación de estilo de vida. Las medidas sociodemográficas, psicológicas y de estilo de vida fueron tomadas en el Hospital Universitario Virgen de las Nieves (HUVN) de Granada (España) durante 2013 y 2014. Se realizaron los siguientes análisis: análisis factorial confirmatorio(AFC), de la consistencia interna, de la sensibilidad al cambio y de la estabilidad temporal. RESULTADOS: El AFC confirmó la estructura original de ambas escalas, excepto por la exclusión del factor 2 (familia) de la escala de apoyo social para el ejercicio. Para la escala de apoyo social, el ajuste local, todos los ítems presentaron altos valores de cargas factoriales y fiabilidades individuales (λ≥0,64 y R2≥0,41, respectivamente). Para la escala de ejercicio, el ajuste local, los ítems presentaron altos valores de cargas factoriales y fiabilidades individuales (λ≥0,62 y R2≥0,38, respectivamente). Los valores de consistencia interna resultaron entre adecuados y excelentes, con cifras de alfa de Cronbach entre 0,714 y 0,864. En cuanto a la sensibilidad al cambio, el grupo experimental aumentó la percepción del apoyo social para la alimentación y para el ejercicio. El grupo de control no presentó diferencias significativas. CONCLUSIONES: Los resultados muestran niveles adecuados de validez y fiabilidad, demostrando que las escalas son adecuadas para evaluar el apoyo social en pacientes con SM.

Evaluation of the Reliability and Validity of the Social Anxiety Questionnaire for Children in Adolescents with Social Anxiety Disorder.

Little research has focused on the measurement of specific facets of social anxiety disorder (SAD) in adolescents. In this study, we report on the Social Anxiety Questionnaire for Children (SAQ-C; Caballo et al., 2016), a 24-item questionnaire which assesses six facets of social anxiety in youth: 1) Speaking in public/Interactions with teachers, 2) Interactions with the opposite sex, 3) Criticism and embarrassment, 4) Assertive expression of annoyance, disgust, or displeasure, 5) Interactions with strangers, and 6) Performing in public. The SAQ-C has been shown to have sound psychometric properties in large samples of non-clinical Latin-American and Spanish youth. The present study aimed to provide the first evaluation of the psychometric properties of the SAQ-C in a clinical sample of 58 English-speaking adolescents diagnosed with SAD in the United States. Findings support the reliability and validity of this new measure and reveal specific facets of social anxiety not adequately captured in other frequently used self- report measures. Implications of the findings for assessment and treatment are addressed.

Psychometric properties of the Liebowitz Social Anxiety Scale in a large cross-cultural Spanish and Portuguese speaking sample

Objective: To examine the psychometric properties of the Liebowitz Social Anxiety Scale-Self Report (LSAS-SR) based on a large sample recruited from 16 Latin American countries, Spain, and Portugal. Methods: Two groups of participants were included: a non-clinical sample involving 31,243 community subjects and a clinical sample comprising 529 patients with a diagnosis of social anxiety disorder (SAD). Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used in order to determine the psychometric properties of the LSAS-SR. Results: EFA identified five factors with eigenvalues greater than 1.00 explaining 50.78% of the cumulative variance. CFA and ESEM supported this 5-factor structure of the LSAS-SR. The factors included: 1) speaking in public; 2) eating/drinking in front of other people; 3) assertive behaviors; 4) working/writing while being observed; and 5) interactions with strangers. Other psychometric properties such as inter-factor correlations, invariance, reliability, and validity of the scale were also found. Conclusion: Psychometric data support the internal consistency and convergent validity of the LSAS-SR. It seems to be a valid and reliable measure of global social anxiety for Spanish and Portuguese-speaking countries, although when considering a multidimensional approach (factor-based assessment) it seems to be lacking some relevant social situations that are feared in those countries.

A new Multidimensional Intervention for Social Anxiety: The MISA Program / Una nueva Intervención multidimensional para la ansiedad social: el programa IMAS

This article presents a new treatment program for social anxiety, specifically for social anxiety disorder (social phobia) and avoidance personality disorder. Its name, Multidimensional Intervention for Social Anxiety (MISA), indicates that it revolves around the five dimensions that our research team found working on social anxiety with participants from 20 countries for more than 15 years, namely (1) interaction with strangers, (2) interaction with the opposite sex, (3) assertive expression of annoyance, disgust, or displeasure, (4) embarrassment or criticism, and (5) speaking in public/interaction with persons of authority. It incorporates both traditional techniques of cognitive behavioral therapy and strategies of third-generation therapies. The MISA program is applied in a group format through 15 treatment sessions of 2.5 hours each, plus one booster session, and pre/post-treatment and follow-up assessment sessions. We believe that it is currently the best treatment program available for social anxiety and in the coming months we will be able to substantiate this claim

Se presenta un nuevo programa de tratamiento para la ansiedad social, específicamente para el trastorno de ansiedad social (fobia social) y el trastorno de personalidad por evitación. Su nombre, Intervención multidimensional para la ansiedad social (IMAS), indica que gira alrededor de las cinco dimensiones que nuestro equipo de investigación encontró trabajando en ansiedad social con 20 países durante más de 15 años, como son: 1) Interacción con desconocidos, 2) Interacción con el sexo opuesto, 3) Expresión asertiva de molestia, desagrado o enfado, 4) Quedar en evidencia/Hacer el ridículo, y 5) Hablar en público/Interacción con personas de autoridad. Incorpora tanto técnicas tradicionales de la terapia cognitivo conductual como estrategias de las terapias de tercera generación. El programa IMAS se aplica en formato grupal a lo largo de 15 sesiones de tratamiento de 2,5 horas cada una, más una sesión de apoyo y las sesiones de evaluación pre/postratamiento y seguimiento. Creemos que en estos momentos constituye el mejor programa de tratamiento para la ansiedad social y en los próximos meses estaremos en disposición de demostrar esta afirmación

Psychometric properties of the Liebowitz Social Anxiety Scale in a large cross-cultural Spanish and Portuguese speaking sample.

OBJECTIVE: To examine the psychometric properties of the Liebowitz Social Anxiety Scale-Self Report (LSAS-SR) based on a large sample recruited from 16 Latin American countries, Spain, and Portugal. METHODS: Two groups of participants were included: a non-clinical sample involving 31,243 community subjects and a clinical sample comprising 529 patients with a diagnosis of social anxiety disorder (SAD). Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used in order to determine the psychometric properties of the LSAS-SR. RESULTS: EFA identified five factors with eigenvalues greater than 1.00 explaining 50.78% of the cumulative variance. CFA and ESEM supported this 5-factor structure of the LSAS-SR. The factors included: 1) speaking in public; 2) eating/drinking in front of other people; 3) assertive behaviors; 4) working/writing while being observed; and 5) interactions with strangers. Other psychometric properties such as inter-factor correlations, invariance, reliability, and validity of the scale were also found. CONCLUSION: Psychometric data support the internal consistency and convergent validity of the LSAS-SR. It seems to be a valid and reliable measure of global social anxiety for Spanish and Portuguese-speaking countries, although when considering a multidimensional approach (factor-based assessment) it seems to be lacking some relevant social situations that are feared in those countries.

Relaciones entre depresión, estrés y esquemas disfuncionales tempranos en adolescentes / Relationships between depression, stress, and early maladaptive schemas in adolescents

La depresión en adolescentes es un problema clínico y social importante. El presente estudio examina las relaciones bidireccionales que se producen entre los esquemas disfuncionales tempranos, los eventos estresantes y la depresión. Se formaron dos grupos de adolescentes, uno con sintomatología alta en depresión (N= 110, 76 mujeres, edad media de 15,45; DT= 1,69) y otro con sintomatología baja en depresión (N= 115, 76 mujeres, edad media de 15,65; DT= 1,05). Ambos grupos completaron medidas de depresión, eventos estresantes y de tres dominios de esquemas disfuncionales tempranos (desconexión y rechazo, foco en los demás y autonomía dañada) en dos intervalos con una separación de cuatro meses. Los resultados muestran la importancia de los esquemas de desconexión y rechazo en la depresión. Además, los eventos estresantes predijeron un aumento de todos los dominios de esquemas y los síntomas de depresión predijeron un aumento de esquemas de autonomía dañada. Estos resultados son valiosos para comprender los mecanismos a través los cuales el estrés y la depresión funcionan en los adolescentes

The prevalence of depression in adolescents is an important clinical and social problem. The present study examines the bidirectional relationships that occur between the level of cognition of early maladaptive schemas, stressors and depression. Two groups of adolescents were formed, one comprised adolescents with high symptomatology in depression (n= 110, 76 women, Mage= 15.45, SD= 1.69), and the other adolescents with low symptomatology in depression (n= 115, 76 women, Mage= 15.65, SD= 1.05). Both groups completed measures of depression, stressors and three domains of early maladaptive schemas (disconnection and rejection, focus on others and impaired autonomy) at two different points in time spaced four months apart. The results show the importance of the disconnection and rejection schemas in depression. Moreover, the stressors predicted an increase in all the schema domains and depressive symptoms predicted an increase in the impaired autonomy schema domain. These results are very valuable to understand the mechanisms through which stress and depression work in adolescents

Efectos del tratamiento de adolescentes con fobia social en el neuroticismo y la extraversión / The effects of treatment of adolescents with social phobia on neuroticism and extraversion

El objetivo de este estudio es presentar los efectos de la aplicación de un protocolo de tratamiento manualizado, en una muestra comunitaria de 67 adolescentes españoles (62,68% mujeres), en la fobia social generalizada (FSG) y en el neuroticismo (N) y la extraversion (E). Los participantes fueron asignados al azar a un grupo de control (n = 33; M = 15,21 años; DT = 1,04) y otro de tratamiento (n = 34; M = 15,29 años; DT = 1,10). Todos cumplieron los criterios requeridos para el diagnóstico de fobia social (subtipo generalizado; APA, 1994) y rellenaron el "Inventario de ansiedad y fobia social" (SPAI), el "Cuestionario Eysenck de personalidad" para niños (EPQ-J) y para adultos (EPQ-A), según su edad cronológica. También se cuantifico el tiempo mirando en la dirección del interlocutor durante un test situacional. Los resultados muestran que: (I) el tratamiento es eficaz para eliminar/reducir la FSG; y (II) N y E muestran cambios significativos entre el prestest y el postest que se prolongan en el seguimiento. Se discuten las implicaciones de estos hallazgos y la estabilidad de N y E

The aim of this study is to present the effects of the application of a manualized treatment protocol in a community sample of 67 Spanish adolescents (62.68% women) in generalized social phobia (GSP), in neuroticism (N), and extraversion (E). The participants were randomly assigned to a control group (n = 33; M = 15.21 years old, SD = 1.04) and a treatment group (n = 34; M = 15.29 years old, SD = 1.10). All met the criteria required for the diagnosis of social phobia (generalized subtype, APA, 1994) and completed the Inventory of Anxiety and Social Phobia (SPAI), and the Eysenck Personality Questionnaire for children (EPQ-J) or for adults (EPQ-A) according to their age. The time looking at the conversation partner during a situational test was also quantified. The results show that: (I) the treatment is effective to eliminate / reduce GSP; and (II) N and E show significant changes between the pretest and the posttest that are prolonged in the follow-up. The implications of these findings and the stability of N and E are discussed

Escalas de apoyo social para los hábitos alimentarios y para el ejercicio: propiedades psicométricas / Scales for social support for eating habits and exercise: psychometric properties

OBJETIVO: El apoyo social puede introducir cambios favorables en el estilo de vida de cara a reducir el riesgo cardiovascular. El objetivo de este estudio fue verificar dichos cambios en la población clínica que participó en el mismo y presentar las propiedades psicométricas de dos escalas de apoyo social: los hábitos alimentarios y el ejercicio. Ambas fueron aplicadas en pacientes con síndrome metabólico (SM). MÉTODOS: Participaron 135 sujetos en un programa de modificación de estilo de vida. Las medidas sociodemográficas, psicológicas y de estilo de vida fueron tomadas en el Hospital Universitario Virgen de las Nieves (HUVN) de Granada (España) durante 2013 y 2014. Se realizaron los siguientes análisis: análisis factorial confirmatorio(AFC), de la consistencia interna, de la sensibilidad al cambio y de la estabilidad temporal. RESULTADOS: El AFC confirmó la estructura original de ambas escalas, excepto por la exclusión del factor 2 (familia) de la escala de apoyo social para el ejercicio. Para la escala de apoyo social, el ajuste local, todos los ítems presentaron altos valores de cargas factoriales y fiabilidades individuales (lamda≥0,64 y R2≥0,41, respectivamente). Para la escala de ejercicio, el ajuste local, los ítems presentaron altos valores de cargas factoriales y fiabilidades individuales (lamda≥0,62 y R2≥0,38, respectivamente). Los valores de consistencia interna resultaron entre adecuados y excelentes, con cifras de alfa de Cronbach entre 0,714 y 0,864. En cuanto a la sensibilidad al cambio, el grupo experimental aumentó la percepción del apoyo social para la alimentación y para el ejercicio. El grupo de control no presentó diferencias significativas. CONCLUSIONES: Los resultados muestran niveles adecuados de validez y fiabilidad, demostrando que las escalas son adecuadas para evaluar el apoyo social en pacientes con SM

OBJECTIVE: Social support can introduce favorable changes in lifestyle to reduce the cardiovascular risk. The aim of this study was to verify these changes in the clinical population participating in this study and present the psychometric properties of the scales of social support for 'Eating Habits' and 'Exercise' in patients diagnosed with metabolic syndrome. METHODS: 135 participants attending a programme for changing lifestyle habits. Sociodemographic, psychological, and lifestyle variables were assessed at the Hospital Universitario Virgen de las Nieves (HUVN) in Granada (Spain) between 2013 and 2014. The following procedures were used: Confirmatory factor analysis (CFA), internal consistency, sensibility to change and temporal stability. RESULTS: The AFC confirmed the original structure of both scales, except for the exclusion of factor 2 (family) from the social support scale for the year. For the social support scale, the local adjustment, all items presented high values of factor loads and individual reliability (lamda≥0.64 and R2≥0.41, respectively). For the exercise scale, the local adjustment, the items presented high values of factor loads and individual reliability (lamda≥0.62 and R2≥0.38, respectively). Internal consistency values were between adequate and excellent, with Cronbach's alpha figures between 0.714 and 0.864. Regarding sensitivity to change, the experimental group increased the perception of social support for food and exercise. The control group did not show significant differences. CONCLUSIONS: Our results show adequate indices for validity and reliability of the measures. Both measures appeared to be useful to assess social support in patients diagnosed with metabolic syndrome

Efficacy of Cognitive Behavioral Therapy in Adherence to the Mediterranean Diet in Metabolic Syndrome Patients: A Randomized Controlled Trial.

OBJECTIVE: Verify the efficacy of cognitive behavioral therapy (CBT) in adherence to the Mediterranean diet (MedDiet) in metabolic syndrome (MetS) patients. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: In the Multimodal Intervention Program for Patients with Metabolic Syndrome clinical trial, 79 MetS patients completed the intervention. Of those, 48 belonged to the experimental group and 31 to the control group. The intervention received by the experimental group was CBT; the control group followed usual care and attended a workshop on healthy lifestyle. MAIN OUTCOME MEASURE(S) AND ANALYSIS: Anthropometric, biochemical, psychological, and lifestyle measures were taken before and after the intervention at 3 and 6 months. Analyses included paired t tests, ANOVA, and ANCOVA. RESULTS: The ANOVA results showed a statistically significant interaction between the 2 groups in waist circumference (P = .009), triglycerides (P = .015), and adherence to the MedDiet (P = .026). The ANCOVA results indicated between-group difference in waist circumference (P = .026 and .062 at 3 and 6months, respectively), in triglycerides (P = .009 and .860 at 3 and 6 months, respectively), and in MedDiet (P = .024 and .273 at 3 and 6 months, respectively). CONCLUSIONS AND IMPLICATIONS: In interventions in which CBT was applied, significant improvements were observed in MetS patients, especially in adherence to the MedDiet.

[Validity and reliability of the self-efficacy to regulate exercise scale in patients with metabolic syndrome]. / Validez y fiabilidad de la escala de autoeficacia para el ejercicio físico en pacientes con síndrome metabólico.

OBJECTIVE: Self-efficacy refers to beliefs in individuals' own capacities to do something. With the intent of evaluate the validity and reliability, we investigated the psychometric properties of the Self-Efficacy to Regulate Exercise Scale (SERES) in patients with metabolic syndrome (MetS). METHODS: 135 participants with medical diagnosis of MetS took part in the study (Mage=55.5, SD=7.6). We investigated sociodemographic, psychological, and life-style variables. Participants were recruited at the Hospital Universitario Virgen de las Nieves (HUVN) in Granada (Spain) between 2013 and 2014. In order to characterise the sample, descriptive statistics were used. Factorial analysis, internal consistency and convergent reliability of the SERES were also calculated. Group differences were investigated using Student's t test. RESULTS: A solution with two factors was extracted, which explained 72.7% of the variance of the SERES. The internal consistency values for the total score of the SERES were (0.925 and 0.864) according to the values of Cronbach's alpha and Guttman's two halves, respectively. Significant correlations of the SERES were detected for with physical exercise, assertiveness, stress, anger, and active life-style (e.g., renouncing to sedentary behaviours). CONCLUSIONS: This was the first study to report on psychometric properties of the SERES. Results supported the adequacy of the measure for use with patients with MetS. SERES seemed to be useful in evaluating self-efficacy in relation to physical exercise, psychosocial, and lifestyle variables.

OBJETIVO: La autoeficacia percibida se refiere a la creencia en la propia capacidad para hacer algo. El objetivo de este trabajo fue obtener la validez y la fiabilidad de la escala de autoeficacia para el ejercicio físico (AEEF) en pacientes con síndrome metabólico (SM) y para ello fueron verificadas las propiedades psicométricas de la misma. METODOS: Participaron en el estudio 135 sujetos con una edad media de 55,5 años (DT=7,6) que cumplían los criterios diagnósticos para el SM. Se tomaron medidas sociodemográficas, psicológicas y de estilo de vida de los mismos. Los sujetos fueron reclutados en el Hospital Universitario Virgen de las Nieves (HUVN) de Granada (España) durante los años de 2013 a 2014. La caracterización de la muestra fue realizada a través de análisis descriptivos. Se realizó el análisis factorial, de la consistencia interna y de validez convergente del AEEF; las diferencias intra e intergrupales fueron evaluadas a través de la prueba t de Student. RESULTADOS: Extrajimos una solución de 2 factores que explicaron el 72,7% de la varianza común. Los valores de consistencia interna para la puntuación total de la AEEF fueron de (0,925 y 0,864) según los valores del alfa de Cronbach y del método de las dos mitades de Guttman, respectivamente. Las correlaciones de la AEEF con la frecuencia de la práctica de ejercicios, la renuncia al sedentarismo, la asertividad, el estrés y la ira fueron estadísticamente significativas. CONCLUSIONES: Este es el primer estudio sobre las propiedades psicométricas de la versión española de la AEEF. Los resultados mostraron niveles aceptables de validez y fiabilidad en pacientes con SM. La escala demostró ser útil para evaluar la asociación de la autoeficacia relativa al ejercicio físico con distintas variables psicosociales y de estilo de vida.