Factores asociados al impacto emocional de la pandemia por Covid-19 en profesionales sanitarios / [Factors associated with the emotional impact of the Covid-19 pandemic on health professionals]

El objetivo de este trabajo fue explorar el impacto emocional de la Covid-19 en profesionales sanitarios del Hospital Clínico Universitario de Valencia, e identificar las variables asociadas. Participaron 228 profesionales que cumplimentaron en mayo de 2020 una encuesta online elaborada ad hoc. Los profesionales sanitarios experimentaron síntomas de estrés (32%), depresión (26%), ansiedad (14%) y recuerdos intrusos (7,5%). Se observó mayor frecuencia de tristeza y ansiedad en mujeres y en profesionales que habían presentado síntomas de Covid-19. La categoría profesional con síntomas emocionales más frecuentes fue el de auxiliar de enfermería, y para estrés también enfermeros y residentes. Las unidades con mayor afectación fueron las de primera línea. Las variables psicológicas que se asociaron negativamente con la frecuencia de todas las manifestaciones sintomáticas fueron: autocuidado, autoestima, resiliencia y uso de estrategias de afrontamiento activas, junto a autoeficacia y apoyo social para estrés y depresión. Pese a las limitaciones del estudio, los resultados pueden contribuir a orientar programas preventivos para profesionales sanitarios en futuras crisis sanitarias.

The aim of this study was to explore the emotional impact of Covid-19 on healthcare professionals at the Clinical and University Hospital of Valencia (Spain), and to identify the associated variables. A total of 228 professionals completed an ad hoc online survey in May 2020. The healthcare professionals experienced symptoms of stress (32%), depression (26%), anxiety (14%) and intrusive memories (7.5%). A higher frequency of sadness and anxiety was observed in women and in professionals who had presented Covid-19 symptoms. The professional category with the most frequent emotional symptoms was that of auxiliary nurses, and for stress also nurses and residents. The most affected were the first line units. The psychological variables that were negatively associated with the frequency of all symptomatic manifestations were: self-care, self-esteem, resilience and use of active coping strategies, together with self-efficacy and social support for stress and depression. Despite the limitations of the study, the results may contribute to guide preventive programs for health professionals in future health crises.

Discovering what is hidden: The role of non-ritualized covert neutralizing strategies in Obsessive-Compulsive Disorder.

BACKGROUND AND OBJECTIVES: Neutralizing strategies are secondary to obsessions and an additional cause of distress and interference, but they have received little attention in theories and research, especially the non-ritualized covert strategies. This study focuses on the comparative impact of non-ritualized covert and compulsive-overt strategies in the course of OCD. METHODS: Eighty-two OCD adult patients completed measures assessing distress, interference, appraisals and overt and covert neutralizing strategies to control obsessions. Thirty-eight patients who had completed cognitive therapy were assessed again after treatment. RESULTS: Only overt compulsions are associated with OCD severity. Nonetheless, considering the main symptom dimension, covert strategies are also associated with severity in patients with moral-based obsessions. Patients who used covert strategies more frequently, compared to those who use them less, reported more sadness, guilt, control importance, interference, and dysfunctional appraisals. Regarding the overt strategies, patients who used them more reported more anxiety and ascribed more personal meaning to their obsessions than the patients who used them less. After treatment, recovered patients decreased their use of both covert and overt strategies, while non-recovered patients did not. There was a higher rate of non-recovered patients among those who used more non-ritualized covert strategies before treatment. LIMITATIONS: Emotions and appraisals were assessed with a single item. OCD symptom dimensions were only assessed by the Obsessive-Compulsive Inventory. CONCLUSIONS: In addition to studying overt compulsions, the impact of covert neutralizing strategies on the OCD course and severity warrants more in-depth study.

Group versus individual cognitive treatment for Obsessive-Compulsive Disorder: changes in non-OCD symptoms and cognitions at post-treatment and one-year follow-up.

Current cognitive approaches postulate that obsessions and compulsions are caused and/or maintained by misinterpretations about their meaning. This assumption has led to the development of cognitive therapeutic (CT) procedures designed to challenge the dysfunctional appraisals and beliefs patients have about their obsessions. Nonetheless, few studies have compared the efficacy of individual and group CT in changing the dysfunctional cognitions that hypothetically underlie Obsessive-Compulsive Disorder (OCD). In this study, 44 OCD patients were assigned to individual (n=18) or group (n=24) CT. Sixteen completed the individual CT, and 22 completed the group CT. The effects of the two CT conditions on depression and worry tendencies were comparable. Individual treatment was more effective than group treatment in decreasing scores on dysfunctional beliefs (responsibility, overestimation of threat, and intolerance to uncertainty) and the use of suppression as a thought control strategy. The post-treatment changes were maintained one year later. The correlations between symptom improvement (OCD severity change) and belief changes were moderate: in the individual treatment the greatest associations were with beliefs about thoughts (importance and control), whereas in the group treatment the greatest associations were with beliefs related to anxiety in general (threat overestimation and intolerance to uncertainty).

Dysfunctional belief domains related to obsessive-compulsive disorder: a further examination of their dimensionality and specificity.

International consensus has been achieved on the existence of several dysfunctional beliefs underlying the development and/ or maintenance of the Obsessive-Compulsive Disorder (OCD). Nevertheless, questions such as the dimensionality of the belief domains and the existence of OCD-specific dysfunctional beliefs still remain inconclusive. The present paper addresses these topics through two different studies. Study 1: A series of confirmatory factor analyses (N = 573 non-clinical subjects) were carried out on the Obsessive Beliefs Spanish Inventory-Revised (OBSI-R), designed to assess dysfunctional beliefs hypothetically related to OCD. An eight-factor model emerged as the best factorial solution: responsibility, over-importance of thoughts, thought-action fusion-likelihood, thought action fusion-morality, importance of thought control, overestimation of threat, intolerance of uncertainty and perfectionism. Study 2: The OBSI-R and other symptom measures were administered to 75 OCD patients, 22 depressed patients, and 25 non-OCD anxious patients. Results indicated that, although OCD patients differed from their non-clinical counterparts on all of the OBSI-R subscales, no evidence of OCD-specificity emerged for any of the belief domains measured, as the OCD subjects did not differ from the other two clinical groups of patients.

Dysfunctional belief domains related to obsessive-compulsive disorder: a further examination of their dimensionality and specificity

International consensus has been achieved on the existence of several dysfunctional beliefs underlying the development and/or maintenance of the Obsessive-Compulsive Disorder (OCD). Nevertheless, questions such as the dimensionality of the belief domains and the existence of OCD-specific dysfunctional beliefs still remain inconclusive. The present paper addresses these topics through two different studies. Study 1: A series of confirmatory factor analyses (N= 573 non-clinical subjects) were carried out on the Obsessive Beliefs Spanish Inventory-Revised (OBSI-R), designed to assess dysfunctional beliefs hypothetically related to OCD. An eight-factor model emerged as the best factorial solution: responsibility, over-importance of thoughts, thought-action fusion-likelihood, thought action fusion-morality, importance of thought control, overestimation of threat, intolerance of uncertainty and perfectionism. Study 2: The OBSI-R and other symptom measures were administered to 75 OCD patients, 22 depressed patients, and 25 non-OCD anxious patients. Results indicated that, although OCD patients differed from their non-clinical counterparts on all of the OBSI-R subscales, no evidence of OCD-specificity emerged for any of the belief domains measured, as the OCD subjects did not differ from the other two clinical groups of patients (AU)

Hay un consenso internacional sobre la existencia de ciertas creencias disfuncionales que subyacen al desarrollo y/o al mantenimiento del trastorno obsesivo-compulsivo (TOC). No obstante, temas tales como la dimensionalidad de tales creencias y si son específicas del TOC, siguen pendientes de resolución. Este artículo examina estos aspectos mediante dos estudios diferentes: Estudio 1: Se realizaron análisis factoriales confirmatorios (573 sujetos no clínicos) del Inventario Español de Creencias Obsesivas-Revisado (ICO-R), que fue diseñado para evaluar creencias disfuncionales relacionadas con el TOC. La mejor solución factorial posible fue la de 8 factores: responsabilidad; importancia de los pensamientos; fusión pensamiento-acción probabilidad; fusión pensamiento-acción, moralidad; importancia de controlar los pensamientos; sobrestimar el peligro; intolerancia a la incertidumbre; y perfeccionismo. Estudio 2: El ICO-R se administró, junto con otros cuestionarios de síntomas, a 75 pacientes TOC, 22 deprimidos, y 25 pacientes con trastornos de ansiedad no-TOC. Los resultados indican que, si bien los pacientes TOC difieren de la población no clínica en todas las subescalas del ICO-R, ninguno de los dominios de creencias es específico del TOC, dado que estos pacientes no se diferenciaron de los otros dos grupos en ninguna de las subescalas del ICO-R (AU)

Cognitive therapy for autogenous and reactive obsessions: clinical and cognitive outcomes at post-treatment and 1-year follow-up.

This study provides data about the differential effectiveness of cognitive therapy (CT) for obsessive-compulsive disorder (OCD) symptom presentation. Two OCD manifestations, autogenous and reactive, are considered. Seventy OCD patients started CT; 81.40% completed it and 72.85% were available 1 year later. Fifteen of the 57 treatment completers had autogenous obsessions, whereas 33 had reactive obsessions. Nine patients had both obsession modalities. Reactive patients were more severe, as they scored higher on thought suppression and on the dysfunctional beliefs of intolerance to uncertainty and perfectionism. Autogenous patients scored higher on the over-importance of thoughts beliefs. Although CT was effective in reducing OCD severity and the ascription to dysfunctional beliefs and neutralizing strategies in both the autogenous and the reactive patients, a significantly better outcome was observed for the autogenous patients, both at post-treatment (with 73.33% recovering versus 33.33% for reactives) and 1 year later.

Group versus individual cognitive treatment for obsessive-compulsive disorder: Changes in severity at post-treatment and one-year follow-up.

BACKGROUND: Very few studies have compared the efficacy of individual and group cognitive behaviour therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) by taking into consideration the change in OCD severity in both the short and long term. AIMS: To conduct an open trial of individual versus group CBT for OCD, comparing the clinical and statistically significant changes in severity both at post-treatment and one year later. METHOD: Forty-two OCD subjects were assigned to individual (n = 18) or group CBT (n = 24, in four groups). Sixteen and 22 subjects completed the treatment in the individual and group conditions, respectively. The Yale-Brown Obsessive Compulsive Scale was recorded at pre-treatment, post-treatment and at the one-year follow-up. RESULTS: At the end of treatment, the clinically significant change was comparable for the two treatment conditions and remained stable at the one-year follow-up. Of the 16 participants who completed the individual CBT treatment, 68.75% were classified as recovered at post-treatment, compared to 40.9% of those receiving group CBT. At follow-up the rate of recovery decreased to 62.5% in individual CBT and to 31.8% in group CBT. CONCLUSIONS: Group CBT is effective in decreasing OCD severity. The post-treatment changes were maintained one year later. Nevertheless, these changes were higher in the individual delivery of CBT.

To seek advice or not to seek advice about the problem: the help-seeking dilemma for obsessive-compulsive disorder.

BACKGROUND: Although obsessive-compulsive disorder (OCD) is associated with considerable distress, it has been reported that OCD patients delay considerably in seeking treatment for their problem. The present study aimed to explore some variables hypothetically involved in the help-seeking process among OCD patients. METHODS: Twenty-six OCD patients without comorbid conditions completed the Interview of Help-Seeking, specifically designed for this study, which assesses to what extent patients delay seeking treatment for their problem, and three group of variables: factors influencing the recognition of the problem, reasons for delaying the treatment-seeking, and reasons for finally seeking treatment. Participants also completed OCD measures, as well as a questionnaire on thought control strategies. RESULTS: The mean length of delay in seeking treatment was 39.38 (SD = 50.95) months, and a great variety of reasons for delaying were observed. The OCD patients who delayed consultation longer, in comparison with patients who delayed less time, used fewer social control strategies, and they were less aware of the interference and behavioral changes associated with the problem. CONCLUSIONS: To gain more insight about the problem and to experience greater interference from the symptoms were determinants in the active search for help. Conversely, the main barriers to the help-seeking were the fears of stigma and the meaning of the thought contents. Additionally, the fact that patients are willing to disclose their obsessions to other people may favor an adequate representation of the problem and the need to seek mental health treatment.