Cognitive variables associated with depressive and anxiety symptoms in patients with cancer: A five-year follow-up study.

BACKGROUND: Patients with cancer are at increased risk of developing symptoms of depression and anxiety. However, data on the variables associated with these symptoms in the long term are scant. This study aims to evaluate rumination and thought suppression as explanatory variables of depressive and anxiety symptoms at one- and five-year follow-up in patients diagnosed with cancer. METHODS: A total of 131 patients with cancer were assessed at baseline (≤4 months of diagnosis), and at 1 and 5 years after diagnosis. A battery of self-reported measures was used to evaluate anxiety and depressive symptoms, rumination, thought suppression, social support, and self-efficacy. The associations among these variables were assessed with linear mixed-effects models. RESULTS: The models for depressive and anxiety symptoms explained 43.5% and 44.2% of the variance, respectively. Rumination was a significant explanatory variable of both depressive and anxiety symptoms over the five-year follow-up period, while thought suppression was only associated with anxiety symptoms. Female gender was associated with a higher risk of presenting anxiety symptoms but this same variable was also protective against depressive symptoms. CONCLUSIONS: The assessment and treatment of rumination and thought suppression in patients diagnosed with cancer is advisable, as these cognitive domains seem to be associated to symptoms of emotional disorders in the long term.

STEPPS for Borderline Personality Disorder: A Pragmatic Trial and Naturalistic Comparison With Noncompleters.

Systems Training for Emotional Predictability and Problem Solving (STEPPS) is a group psychotherapy approach that is effective for patients with borderline personality disorder (BPD) in a public health care setting. The sample in this study comprised 118 outpatients with BPD who were asked to participate in a Spanish-adapted version of STEPPS for 18 months, a psychotherapy program that could be added to their usual psychiatric intervention. They were divided into an experimental group who participated in STEPPS, and a control group, who received treatment as usual. Several variables were collected and the Borderline Evaluation of Severity Over Time (BEST) scale was administered at pretest, Months 3 and 6, posttest (Month 18), and 2-year follow-up (Month 42), after which a post hoc data analysis was carried out. The STEPPS program improved the as-usual treatment provided previously, and the results were cost-effective. A higher educational level and good patient collaboration predicted better outcome.

Déficits ejecutivos y trastornos del neurodesarrollo en la infancia y en la adolescencia / Executive function deficits and neurodevelopmental disorders in childhood and adolescence

Introducción: Actualmente, en el Manual diagnóstico y estadístico de los trastornos mentales (DSM-5) se incluye una nueva categoría diagnóstica referida a trastornos del neurodesarrollo. Son diversos los trastornos del neurodesarrollo que, aun siendo entidades diagnósticas independientes, comparten manifestaciones comunes a las que presentan personas con daño cerebral o disfunción en la corteza prefrontal, es decir, presentan diferentes alteraciones de las funciones ejecutivas. Desarrollo: El propósito de este estudio es ofrecer una visión de los hallazgos actuales sobre el funcionamiento ejecutivo en niños y jóvenes con diferentes trastornos del neurodesarrollo: trastorno del espectro autista, trastorno por déficit de atención/hiperactividad y trastorno específico del aprendizaje. Con este objetivo se revisaron 27 artículos. Los resultados de los análisis indican una asociación estadísticamente significativa entre dimensión de flexibilidad y trastorno por déficit de atención/hiperactividad (W de Wilcoxon = 123; p = 0,011) y dimensión de flexibilidad y trastorno del espectro autista (W de Wilcoxon = 101,5; p = 0,003), y ausencia de asociación estadísticamente significativa entre las diferentes dimensiones evaluadas y trastorno específico del aprendizaje. Conclusiones: Las dimensiones ejecutivas se encuentran afectadas en los diferentes trastornos del neurodesarrollo en grado variable. Podemos hipotetizar la existencia de un continuo en las dimensiones que se encuentran afectadas en los diferentes trastornos del neurodesarrollo; en ocasiones, es complejo establecer límites categoriales cuando se comparan distintos trastornos

Introduction: Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has new criteria that include a diagnostic reference to neurodevelopmental disorders. Neurodevelopmental disorders are diverse, and even though they are independent diagnostic entities they share common manifestations in people with brain damage or dysfunction of the prefrontal cortex; that is, neurodevelopmental disorders present different alterations in executive functions. Development: The aim of the present study was to offer an overview of the recent findings on executive functioning in children, adolescents and young adults with different neurodevelopmental disorders: autistic spectrum disorder, attention-deficit/hyperactivity disorder and specific learning disorder. Hence, with this objective, 27 studies from the literature were reviewed. The results indicate a statistically significant association between the dimension of flexibility and attention deficit/hyperactivity disorder (W of Wilcoxon = 123.0; p = 0.011), and flexibility with autistic spectrum disorder (W of Wilcoxon = 101.5; p = 0.003); and absence of a statistically significant association between the different assessed dimensions and specific learning disorder. Conclusions: The dimensions of executive functioning are affected to a variable degree in different neurodevelopmental disorders. We can hypothesis that the dimensions that are affected in the different neurodevelopmental disorders can be characterized in terms of the existence of a continuum, and occasionally those dimensions are too complex to establish categorical limits when comparing different neurodevelopmental disorders

Modelo de funciones ejecutivas basado en análisis factoriales en población infantil y escolar: metaanálisis / Model of executive functions based on factorial analyses in child and school populations: a meta-analysis

Introducción. Las funciones ejecutivas se definen como un conjunto de habilidades implicadas en diversas actividades que son novedosas para el individuo y que precisan una solución creativa. No es fácil su conceptualización ni la identificación de los factores que las configuran en la población infantil y escolar. Objetivo. Analizar la estructura y los componentes de la función ejecutiva en población preescolar y escolar. Desarrollo. Se revisaron 35 artículos que utilizan diferentes enfoques de análisis factoriales para la extracción de los factores. La probabilidad de ocurrencia de un estudio con tres factores en la etapa de 0 a 12 años es 1,44 veces superior a la de los estudios que se centran en otra estructura. La probabilidad de ocurrencia de un estudio que se centra en la dimensión de flexibilidad en la etapa de 0 a 12 años es 1,45 veces superior a la presencia de un estudio que se centra en cualquier otra dimensión. La asociación entre las diferentes estructuras y dimensiones analizadas con la edad con tau-b de Kendall indica una asociación estadísticamente significativa entre estudios con tres factores y edad (tau = 0,29; p = 0,044) y flexibilidad con la edad (tau = 0,37; p = 0,012). Conclusiones. La diversidad de resultados obtenidos puede atribuirse y está en consonancia con la pluralidad de conceptualizaciones teóricas, pruebas empleadas y análisis estadísticos efectuados. Se puede concluir que actualización/memoria de trabajo, inhibición y flexibilidad son los procesos ejecutivos más comúnmente encontrados en los modelos factoriales de control ejecutivo en niños de preescolar y escolar

Introduction. Executive functions are defined as a set of skills that are involved in various activities which are novel to the individual and which require a creative solution. It is not easy or straight forward to conceptualise or identify the factors that make up a population of young children. Aim. To analyse the components of executive function due to the clinical implications in different neurodevelopmental disorders in a population-based sample of young children. Development. From the body of literature, 35 published papers that used different factor analysis approaches for factor extraction were reviewed. The probability of a study with three factors being undertaken in the stage between 0 to 12 years is 1.44 times higher than studies being undertaken with some focus on another structure. The probability of a study being undertaken that focuses on the Flexibility dimension in the stage between 0 to 12 years is 1.45 times higher than a study being undertaken that focuses on any other dimension. The association between the different structures and dimensions that are analysed with respect to age using the Kendall tau-b indicates a statistically significant association between: studies with three factors and age (tau = 0.29; p = 0.044) and flexibility with age (tau = 0.37; p = 0.012). Conclusions. The diversity of the obtained results can be attributed to, and is in line with, the plurality of theoretical conceptualisations, tests used and statistical analyzes carried out. It can be concluded that working memory, inhibition and flexibility are the executive processes most commonly found in the factorial models of executive control in young children and adolescents

Tratamiento psicológico de los trastornos emocionales en Atención Primaria: el manual de tratamiento transdiagnóstico del estudio PsicAP / Psychological treatment of emotional disorders in Primary Care: The transdiagnostic treatment manual of the PsicAP study

Una parte sustancial de las consultas de Atención Primaria (AP) tiene como motivo principal algún tipo de trastorno emocional, especialmente los relacionados con la depresión, la ansiedad y las somatizaciones. Estos trastornos mentales más comunes tienen altos costes para los afectados y para la sociedad en general. Pese a la existencia de terapias psicológicas que han demostrado ser eficaces para esos trastornos, rara vez se utilizan en el primer nivel asistencial. El objetivo del proyecto de Psicología en Atención Primaria (PsicAP) es demostrar la eficacia de una terapia de cognitivo-conductual grupal transdiagnóstica para tratar los trastornos emocionales más frecuentes en AP. Esta terapia, de sólo 7 sesiones, es especialmente apropiada para el contexto de AP. En este trabajo se presenta el manual de tratamiento, sesión a sesión, con extractos que ilustran contenidos clave de las sesiones. Finalmente, se discuten las implicaciones de un protocolo de estas características en un momento en el que el psicólogo clínico y el residente de Psicología Clínica empiezan a estar presentes en AP en España

A substantial percentage of primary care (PC) visits are motivated by some type of emotional disorder, especially depression, anxiety and somatization. These common mental disorders represent a significant burden for the people affected and for the society. Despite the availability of effective psychological therapies for these disorders, psychological interventions are rarely used in PC. The aim of the Psychology in Primary Care (PsicAP) project is to demonstrate the efficacy of a transdiagnostic cognitive-behavioural group therapy to treat the most prevalent emotional disorders in PC. This therapy, which involves only 7 sessions, is especially appropriate for PC settings. In the present article, we present the treatment manual, session by session, with extracts that illustrate key contents of the sessions. Finally, we discuss the implications of a protocol of this type at a time when clinical psychologists and clinical psychology interns are starting to be integrated into the PC setting in Spain

Tratamiento psicológico de los trastornos emocionales en atención primaria: fundamentos teóricos y empíricos del estudio PsicAP / Psychological treatment of emotional disorders in primary care: Theoretical and empirical basis of the PsicAP study

El proyecto Psicología en Atención Primaria (PsicAP) pretende promover el tratamiento psicológico basado en la evidencia para los trastornos emocionales en atención primaria. Este trabajo presenta los fundamentos teóricos y empíricos del programa de tratamiento de PsicAP, destacando 4 aspectos clave: la evidencia sobre la eficacia del tratamiento cognitivo-conductual, el modelo de tratamiento escalonado, el enfoque transdiagnóstico y el formato de tratamiento grupal. Por último, se destacan las implicaciones prácticas de esta iniciativa que puede ayudar a reducir la distancia entre la investigación sobre la eficacia de los tratamientos psicológicos y la práctica clínica, así como la atención al derecho del paciente a decidir sobre el tratamiento, de eficacia probada, que desea recibir

The project Psychology in Primary Care (PsicAP) aims to promote evidence-based psychological treatments in Primary Care. This paper presents the theoretical and empirical basis of the PsicAP treatment program, highlighting four key aspects: evidence-based treatment using cognitive behavioral techniques; stepped care model; transdiagnostic approach and group format treatment. Finally, we highlight the practical implications of this initiative, that seeks to reduce the gap between research on the effectiveness of psychological treatments and clinical practice, as well as attending to the patient's right to choose which treatment he/she wants to receive

Propuesta de un modelo de funciones ejecutivas basado en análisis factoriales / Proposed model of executive functions based on factorial analyses

Introducción. Desde que Lezak acuñara el término de funciones ejecutivas como las capacidades mentales esenciales para llevar a cabo una conducta eficaz, creativa y aceptada socialmente, éstas han adquirido progresivo protagonismo en la investigación neuropsicológica. Diversos modelos han sido planteados para explicar su naturaleza, pero no existe consenso respecto a si nos encontramos ante un constructo unitario o un sistema de procesamiento multimodal con componentes independientes, pero interconectados. Para conocer la estructura de este constructo se han utilizado estudios de lesión, neuroimagen y, recientemente, el análisis factorial, que se plantea como una metodología prometedora para ampliar nuestro conocimiento sobre un concepto tan genérico como las funciones ejecutivas. Desarrollo. El propósito de este estudio es realizar una revisión sistemática de modelos factoriales de atención y control ejecutivo en adultos, entre los años 1991-2016, utilizando las bases de datos PubMed, OvidSP y PsycINFO. En total, se revisaron 33 artículos. A partir de la bibliografía, se realiza una propuesta integradora de los procesos ejecutivos. Conclusiones. Aunque no disponemos de un único modelo que pueda explicar la complejidad de las funciones ejecutivas, sí parece existir acuerdo respecto a su multidimensionalidad. En análisis factoriales, actualización, inhibición y alternancia gozan de fuerte evidencia, si bien hay trabajos que plantean factores novedosos. Nuestra propuesta integradora trata de combinar los procesos ejecutivos hallados en la bibliografía con sus correspondientes correlatos neuroanatómicos, defendiendo que la metodología ideal debería utilizar información procedente de estudios de lesión, técnicas de neuroimagen y modelos psicométricos-computacionales (AU)

Introduction. Since Lezak coined the term executive functions to refer to the mental capabilities that are considered essential for performing efficacious, creative and socially acceptable behaviour, they have gradually grown in importance in neuropsychological research. Different models have been proposed to explain their nature, but there is no general agreement as to whether we are dealing with a unitary construct or a multimodal processing system with independent, but interconnected, components. With the aim of gaining a deeper knowledge of the structure of this construct, researchers have conducted lesion, neuroimaging and, more recently, factorial analysis studies, the latter being seen as a promising methodology for expanding our knowledge about such a generic concept as the executive functions. Development. The purpose of this study is to carry out a systematic review of factorial models of attention and executive control in adults, between the years 1991 and 2016, using the PubMed, OvidSP and PsycINFO databases. Altogether, 33 papers were reviewed. Based on the literature, an integrating proposal of the executive functions is put forward. Conclusions. Although we do not have just one single model that can account for the complexity of the executive functions, there does seem to be general agreement on their multidimensionality. In factorial analyses, there is strong evidence of updating, inhibition and alternation, although there are also studies that propose novel factors. Our integrating proposal aims to combine the executive processes found in the literature with their corresponding neuroanatomical correlates, and defends the stance that the ideal methodology should use information from lesion studies, neuroimaging techniques and psychometric-computational models (AU)