Contingency management for smoking cessation for individuals with overweight or obesity: A randomized controlled trial.

BACKGROUND: Interventions for quitting smoking and weight control among individuals with excess weight are scarce. Our study evaluated the effectiveness of cognitive behavioral therapy (CBT) plus contingency management (CM) in this population, and examined whether CM for smoking cessation improved CBT treatment outcomes at end of treatment (EOT) and at 1-, 3-, 6-, and 12-month follow-ups (FU). METHODS: In an 8-week randomized clinical trial, 120 adults who smoke with overweight or obesity (54.16% females; MBMI = 31.75 ± 4.31) were randomly assigned to CBT for both quitting smoking and weight control (n = 60) or the same treatment plus CM for smoking cessation (n = 60). Outcome variables were compared (i.e., treatment completion, smoking abstinence, weight change and secondary outcomes). RESULTS: At EOT, the CBT + CM group achieved 78.33% 7-day point-prevalence abstinence rates compared to 61.67% in the CBT group (p = .073), and rates declined over time (12-month FU: 18% vs 12%). Participants who attained abstinence weighed more compared to baseline at EOT (Mkg = 1.07; SD = 1.88) and over time (12-month FU: Mkg = 4.19; SD = 4.31). No differences were found between the two groups in outcome variables. CONCLUSIONS: Both interventions were effective in promoting abstinence and reducing tobacco use over time. Combining CBT with CM for smoking cessation did not improve treatment outcomes in individuals with overweight or obesity compared to CBT only. Future studies should evaluate whether implementing CM for weight maintenance helps control post-cessation weight gain in this population.

Validation of the Food Purchase Task (FPT) in a clinical sample of smokers with overweight and obesity.

Obesity is a major health problem associated with disease burden and mortality. In this context, analyzing food as a powerful reinforcer from a behavioral economics framework could be relevant for the treatment and prevention of obesity. The purposes of this study were to validate a food purchase task (FPT) in a clinical sample of Spanish smokers with overweight and obesity and to assess the internal structure of the FPT. We also analyzed the clinical utility of single-item breakpoint (i.e., commodity price that suppresses demand). A total of 120 smokers [% females: 54.2; Mage = 52.54; SD = 10.34] with overweight and obesity completed the FPT and weight/eating-related variables. Principal component analysis was used to examine the FPT structure, and a set of correlations were used to examine the relationship between the FPT, eating and weight-related variables. The FPT demonstrated robust convergent validity with other measures of eating. Higher food demand was related to higher food craving (r = .33), more binge eating problems (r = .39), more weight gain concerns (r = .35), higher frequency of both controlled (r = .37) and uncontrolled (r = .30) grazing, as well as to an eating style in response to emotions (r = .34) and external eating (r = .34). Of the demand indices, Intensity and Omax showed the highest magnitudes of effects. The FPT factors, persistence and amplitude, do not improve individual FPT indices; and the single-item breakpoint was not related to any eating or weight variable. The FPT is a valid measure of food reinforcement with potential clinical utility in smokers with obesity/overweight.

Post-Cessation Weight Gain among Smokers with Depression Predicts Smoking Relapse.

Objective: Weight gain (WG) is one of the most widespread consequences of smoking cessation, although there is a great variability of post-cessation weight changes among smokers. Its approach is critical because it depicts an important barrier to trying to quit smoking and because it has been considered as a long-term predictor of relapse. Notwithstanding, little is known about post-cessation WG specifically among depressed smokers. The current study sought to: (1) describe the WG at posttreatment and follow-ups in smokers with depression, (2) examine the predictors of posttreatment WG, and (3) analyze whether post-cessation WG predicts smoking relapse at 6-month follow-up. Methods: The sample was comprised of 125 smokers with depression who achieved tobacco abstinence at posttreatment following a psychological smoking cessation intervention. Smoking abstinence was biochemically verified through carbon monoxide and urine cotinine. Multiple linear and hierarchical logistic regressions were conducted to examine predictors of WG at posttreatment and tobacco relapse at 6-month follow-up, respectively. Results: Abstinent participants gained an average of 3.55 kg at 6-month follow-up compared to 1.49 kg among participants who relapsed. Greater nicotine dependence (ß = .372, p = .001) and diastolic pressure at baseline (ß = .252, p = .021) predicted higher WG at end of treatment. WG at posttreatment increased the likelihood of relapse 6 months later (B = .303, OR = 1.354; 95% CI [1.006, 1.822]). Limitations: Weight concerns, disordered eating, and BMI were not recorded, and they could be related to the present findings. Conclusions: These results suggest that individuals with depression during treatment for smoking cessation should be regularly screened and offered treatment to prevent WG.

Effectiveness of including weight management in smoking cessation treatments: A meta-analysis of behavioral interventions.

INTRODUCTION: The potential of weight gain after smoking cessation reduces the incentive to quit. This meta-analysis examines the efficacy of behavioral interventions for smoking cessation that also address post-cessation weight gain. METHODS: Medline, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials on behavioral treatments targeting both health outcomes. Six separate meta-analyses were undertaken to assess treatment efficacy on smoking abstinence and weight outcomes at end of treatment (EOT), short-term, and long-term follow-up. Individual and treatment moderators were examined as well as methodological quality and publication bias of studies. RESULTS: A total of 28 studies were included in the meta-analysis. There was a statistically significant positive impact of treatments addressing both targets on smoking outcomes at EOT (RR = 1.279, 95% CI: 1.096, 1.492, p = .002), but not at follow-ups. Age impacted on EOT abstinence rates Q (1) = 4.960, p = .026) while increasing the number of sessions significantly improved EOT abstinence rates (p = .020). There was no statistically significant impact of these treatments on weight at EOT (Hedges' g = -0.015, 95% CI: -.164, 0.135, p = .849) or follow-ups (short term: Hedges' g = 0.055, 95% CI: -0.060, 0.170, p = .347; long term: Hedges' g = -0.320, 95% CI: -.965, 0.325, p = .331). There were minimal impacts of publication bias, mostly related to sample size, meaning studies including small sample sizes revealed larger effect sizes on abstinence at EOT. DISCUSSION: Addressing post-cessation weight management in treatments for smoking cessation significantly enhances tobacco abstinence at EOT though it was not found to have a lasting impact after treatment.

Effectiveness of psychological interventions for eating disorders in adolescence: An overview of systematic reviews / Eficacia de las Intervenciones Psicológicas en el Tratamiento de los Trastornos Alimentarios en Adolescentes: Una Meta-Revisión

Eating disorders (EDs) are high prevalent among adolescents with serious consequences. Evidence of effectiveness of psychological interventionsfor eating disorders in adolescents lacks a systematic synthesis of systematic reviews. The goal of this umbrella review is to summarize evidencefrom systematic reviews examining effects of psychological interventions for eating disorders targeting adolescents. Web of Science, PsycINFO andCochrane Database of Systematic Reviews were searched for systematic reviews on effectiveness and/or efficacy of any psychological interventionaiming to treat eating disorders in terms of outcomes in adolescents (improvement of eating-disorder symptoms, weight restoration and treatmentretention). The methodological quality of each study was assessed using AMSTAR 2. The original search identified 831 reviews, 9 of which wereincluded in the overview of systematic reviews rated as having a low methodological quality. Predominant psychological interventions for EDsin adolescents are family-based interventions. The efficacy of cognitive behavioral therapy and third-wave treatments has been less researched.Anorexia nervosa and bulimia nervosa are the EDs that have been studied the most. This study provides evidence supporting the positive impactof psychological interventions on eating disorders in adolescents. Family based treatment is the most evidence-based psychological intervention.There is a need for high-quality systematic reviews as well as systematic reviews to examine if psychological interventions are effective for different eating disorders. (AU)

La prevalencia de los trastornos alimentarios es elevada entre los adolescentes con consecuencias graves. La evidencia de la eficacia de las intervencionespsicológicas para los trastornos alimentarios en adolescentes carece de una meta-revisión de revisiones sistemáticas. El objetivo de esta revisiónparaguas es resumir la evidencia de las revisiones sistemáticas que examinan los efectos de las intervenciones psicológicas para los trastornosalimentarios en adolescentes. Se realizaron búsquedas en Web of Science, PsycINFO y Cochrane Database of Systematic Reviews de revisionessistemáticas sobre la efectividad y/o eficacia de las intervenciones psicológicas para trastornos alimentarios en adolescentes (reducción de síntomas, restauración del peso y retención en el tratamiento). La calidad metodológica de cada estudio se evaluó mediante AMSTAR 2. En la búsquedainicial se identificaron 831 registros, y 9 revisiones sistemáticas se incluyeron en la meta-revisión con una valoración de calidad metodológica baja.Las intervenciones psicológicas predominantes para los trastornos alimentarios en adolescentes fueron las intervenciones basadas en la familia.La eficacia de la terapia cognitivo-conductual y los tratamientos de tercera generación está menos estudiada. La anorexia nerviosa y la bulimianerviosa son los trastornos alimentarios con mayor número de estudios. Hay evidencia del impacto positivo de las intervenciones psicológicas paralos trastornos alimentarios en adolescentes. El tratamiento basado en la familia es la intervención psicológica con mayor evidencia. Se necesitanrevisiones sistemáticas de mayor calidad, así como revisiones sistemáticas para examinar la eficacia de las intervenciones psicológicas para los distintos trastornos alimentarios. (AU)

Pilot randomized trial of cognitive-behavioral treatment plus contingency management for quitting smoking and weight gain prevention among smokers with overweight or obesity.

BACKGROUND: Post-cessation weight gain is a risk factor for relapse among quitters. The primary study aim was to evaluate, among smokers with overweight or obesity, the feasibility and acceptability of a cognitive-behavioral treatment (CBT) plus contingency management (CM) for quitting smoking and weight control. The secondary aim was to examine preliminary tobacco abstinence and weight change outcomes. METHODS: In an 8-week pilot randomized clinical trial, 41 participants (Mage = 52.73, SD = 10.91, 56.1% females) with overweight or obesity (MBMI = 31.86, SD = 4.7) received a CBT for both quitting smoking and weight gain prevention (n = 24) or the same treatment plus CM (n = 17), consisting of providing incentives contingent upon smoking abstinence biochemically verified. RESULTS: Recruitment success rate was 80.39% (41/51), completion rate was 90.24% (37/41), and mean number of sessions attended (out of 15 possible) was 13.20 (SD = 3.1). Mean satisfaction rating for the treatment (1-10 likert-type scale with 10 being most satisfactory) was 9.73 (SD =.61). Preliminary efficacy data indicated that the CM group achieved higher abstinence rates compared with the CBT condition (100% vs. 58.33%, p = .007). Abstinent participants increased 1.25 kg (SD = 1.79) their baseline body weight at the end of treatment (p = .001). CONCLUSIONS: Providing weight gain prevention strategies and CM within a smoking cessation treatment seems feasible and acceptable. Preliminary data indicated that including CM facilitates tobacco abstinence rates, nevertheless no advantage for CM was found for weight control.

Prevalence and Correlates of Prescription Drug Misuse Among Spanish Adolescents.

BACKGROUND: Prescription drug (PD) misuse among adolescents constitutes a growing health concern worldwide. This study aimed to provide up-to-date prevalence and correlates of PD misuse (i.e., tranquilizers, opioids and stimulants) among a national representative sample of high-school adolescents in Spain. METHOD: We used nationwide data from 36,788 adolescents (51.93% females) aged between 14 and 18 who completed the 2018-2019 Survey on Drug Use in Secondary Education in Spain (ESTUDES). Lifetime misuse of the following PD was assessed: tranquilizers without prescription, opioids to get high, and prescription stimulants to improve academic performance. Other substance use, sociodemographic characteristics, academic performance related variables, and the quality of parental relationship were assessed. RESULTS: Lifetime prevalence of PD misuse was 8.50% for tranquilizers, 2.34% for stimulants, and 2.20% for opioids. Past-month tobacco use and lifetime illegal substance use were the only correlates associated with all PD categories (ORs between 1.419 and 6.788). The remaining sociodemographic, academic and family correlates were PD category-specific. CONCLUSIONS: This information may help in the development of empirically-based preventive interventions.

Asistencia a un tratamiento para dejar de fumar con personas con trastorno por uso de sustancias / Smoking cessation treatment attendance among smokers with substance use disorders

Este estudio aporta evidencia para entender las tasas de no asistencia en fumadores con TUS asignados a un tratamiento de cese del tabaquismo. Los hallazgos indican que era más probable la no asistencia al tratamiento de los pacientes más jóvenes, en tratamiento por uso de cocaína, y con un menor número de días en tratamiento por uso de sustancias. Futuros ensayos de cesación tabáquica con esta población difícil de tratar deberían tener en cuenta la incorporación de estrategias para mejorar la asistencia y las tasas de retención. Esperamos que esta información sea útil para profesionales de la salud en su diseño e implementación de intervenciones para reducir las enfermedades relacionadas con el tabaquismo entre la población con TUS. (AU)

Prevalence and Correlates of rescription Drug Misuse Among Spanish adolescents / Prevalencia y Correlatos del Consumo de Fármacos de Prescripción Entre Adolescentes Españoles

Background: Prescription drug (PD) misuse among adolescents constitutesa growing health concern worldwide. This study aimed to provide up-to-date prevalence and correlates of PD misuse (i.e., tranquilizers, opioidsand stimulants) among a national representative sample of high-schooladolescents in Spain. Method: We used nationwide data from 36,788adolescents (51.93% females) aged between 14 and 18 who completedthe 2018-2019 Survey on Drug Use in Secondary Education in Spain(ESTUDES). Lifetime misuse of the following PD was assessed: tranquilizerswithout prescription, opioids to get high, and prescription stimulants toimprove academic performance. Other substance use, sociodemographiccharacteristics, academic performance related variables, and the quality ofparental relationship were assessed. Results: Lifetime prevalence of PDmisuse was 8.50% for tranquilizers, 2.34% for stimulants, and 2.20% foropioids. Past-month tobacco use and lifetime illegal substance use were theonly correlates associated with all PD categories (ORs between 1.419 and6.788). The remaining sociodemographic, academic and family correlateswere PD category-specific. Conclusions: This information may help in thedevelopment of empirically-based preventive interventions.

Antecedentes: el consumo de fármacos deprescripción (FP) en los adolescentes constituye un problema creciente. Elobjetivo de este estudio fue proporcionar una estimación de las prevalenciasy correlatos de los FP (i.e., tranquilizantes, opioides y estimulantes) enuna muestra representativa de adolescentes en España.Método: 36.788adolescentes (51,93% mujeres) de edades comprendidas entre 14 y 18 añoscompletaron la Encuesta 2018-2019 sobre uso de drogas en EnseñanzasSecundarias en España (ESTUDES). Se evaluó la prevalencia-vida de lossiguientes FP: tranquilizantes sin prescripción, opioides para colocarsey estimulantes de prescripción para mejorar el rendimiento académico.También se evaluó el consumo de otras sustancias, las característicassociodemográficas, variables académicas y las relaciones parentales.Resultados: la prevalencia-vida fue de 8,50% para tranquilizantes, 2,34%para estimulantes y 2,20% para opioides. El consumo de tabaco en el últimomes y el consumo de sustancias ilegales alguna vez en la vida se asociaroncon el uso de los tres FP (OR entre 1,419 y 6,788). El resto de las variablessociodemográficas, académicas y familiares estuvieron relacionadas conuna categoría específica de FP. Conclusiones: esta información puede ser deayuda en el desarrollo de intervenciones preventiva basadas en la evidencia.

Depression symptom profiles and long-term response to cognitive behavioral therapy plus contingency management for smoking cessation.

BACKGROUND: Depression is heterogeneous in nature and using diagnostic categories limits insight into understanding psychopathology and its impact on treatment efficacy. This secondary analysis sought to: 1) identify distinct subpopulations of cigarette users with depression, and 2) examine their response to cognitive-behavioral treatment (CBT) + contingency management (CM) for smoking cessation at one year. METHOD: The sample comprised 238 (74 % females) adults who smoke receiving CBT only or CBT + CM. A latent class analysis was conducted on baseline depressive symptoms measured using the Beck Depression Inventory-II. Generalized estimating equations assessed the main and interactive effects of class, time, treatment, and sex on smoking abstinence. RESULTS: Three distinct classes were identified: C1 (n= 76/238), characterized by mild depression, loss of energy, pessimism, and criticism, C2 (n= 100/238) presenting moderate severity and decreased appetite, and C3 (n= 62/238) showing severe depression, increased appetite, and feelings of punishment. There was a significant cluster × treatment interaction, which indicated additive effects of CM over CBT alone for Class 1 and 2. Persons in Class 1 and 2 were 3.60 [95 % CI: 1.62, 7.97] and 2.65 [95 % CI: 1.19, 5.91] times more likely to be abstinent if CBT + CM was delivered rather than CBT only. No differential sex effects were observed on treatment response according to cluster. CONCLUSIONS: Profiling depression symptom subtypes of cigarette users may be more informative to improve CM treatment response than merely focusing on total scores.

Activation level as a mediator between behavioral activation, sex, and depression among treatment-seeking smokers.

INTRODUCTION: Behavioral activation (BA) has gained interest when combined with tobacco interventions as it relates to improved depression and cessation rates. However, no prior efforts have examined mediators of BA effectiveness and sex-dependent effects. This secondary analysis assesses the main and interactive effects of sex and type of smoking cessation intervention [a cognitive behavioral treatment (CBT) only, or CBT + BA] on depressive symptoms among treatment-seeking patients with depression. It also examines the activation level as a mediator between BA, BA by sex, and depression. METHOD: 120 smokers were assigned to an 8-week CBT or to CBT + BA. They completed the Beck Depression Inventory-II (BDI-II) and the Behavioral Activation for Depression scale-short-form (BADS-SF). A two-way ANOVA assessed the effects of sex and treatment condition on participants' BDI-II scores. A moderated mediational analysis tested whether the indirect effect of treatment condition on BDI-II through BADS-SF differed by sex. RESULTS: After controlling for end-of-treatment smoking status and baseline BDI-II, there were no significant effects of treatment condition, sex, and their interaction on end-of-treatment BDI-II. Being a male was indirectly associated with higher BDI-II scores through lower BADS-SF score (point estimate = -3.440; SE = 1.637; BC 95% CI [-7.105, -0.749]). This effect was not found for women. CONCLUSIONS: There is a need to tailor interventions by sex when treating smokers with depression. It is recommended to assess symptoms such as mental rumination or self-consciousness, which tend to be more pronounced in women.

Systematic Review of Preventive Programs for Reducing Problem Gambling Behaviors Among Young Adults.

Young adulthood is a developmental period from late adolescence to one's late twenties or early thirties. Prevalence studies internationally have reported that individuals in this age group tend to have the highest rates of problem gambling. However, much of the prevention work designed to minimize the risk of problem and disordered gambling has been primarily focused on school settings and aimed at high school students. The objective of this study was to summarize the existing literature on the effectiveness of prevention programs aimed at reducing the prevalence of gambling problems in young adults. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six electronic academic databases were consulted in order to examine the studies conducted during the last 20 years. After removing duplicates and adhering to the inclusion and exclusion criteria, nine studies were included in this review. All studies targeted college or university students and followed a selective or indicated prevention strategy. A Personalized Normative Feedback approach was incorporated in most of the studies, which had generally good results in reducing and/or minimizing at-risk or problem gambling. The limited number of studies included in this review highlights the need to address scientific quality standards before proceeding with the design, implementation and widespread dissemination of these preventive programs as well as the need to ensure the program's efficacy prior to implementation.

Cognition and addiction
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In this targeted review, we summarize current knowledge on substance-use disorder (SUD)-related cognitive deficits, the link between these deficits and clinical outcomes, and the cognitive training, remediation, and pharmacological approaches that have the potential to rescue cognition. We conclude that: (i) people with SUDs have moderate deficits in memory, attention, executive functions, and decision-making (including reward expectancy, valuation, and learning); (ii) deficits in higher-order executive functions and decision-making are significant predictors of relapse; (iii) cognitive training programs targeting reward-related appetitive biases, cognitive remediation strategies targeting goal-based decision-making, and pharmacotherapies targeting memory, attention, and impulsivity have potential to rescue SUD-related cognitive deficits. We suggest avenues for future research, including developing brief, clinically oriented harmonized cognitive testing suites to improve individualized prediction of treatment outcomes; computational modeling that can achieve deep phenotyping of cognitive subtypes likely to respond to different interventions; and phenotype-targeted cognitive, pharmacological, and combined interventions. We conclude with a tentative model of neuroscience-informed precision medicine.
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En este artículo de revisión, se resume el conocimiento actual acerca de los déficits cognitivos relacionados con el trastorno por uso de sustancias (TUS), el vínculo entre estos déficits y los resultados clínicos, y el entrenamiento cognitivo, la remediación y los enfoques farmacológicos potencialmente útiles para la recuperación cognitiva. Se concluye que: 1) las personas con TUS tienen déficits moderados en memoria, atención, funciones ejecutivas y en la toma de decisiones (incluidas la expectativa de recompensa, la valoración y el aprendizaje), 2) los déficits en las funciones ejecutivas superiores y en la toma de decisiones son importantes predictores de recaída, 3) los programas de entrenamiento cognitivo orientados a los sesgos en las apetencias relacionadas con la recompensa, las estrategias de remediación cognitiva dirigidas a la toma de decisiones basadas en objetivos y las farmacoterapias focalizadas en memoria, atención e impulsividad tienen el potencial de recuperar los déficits cognitivos relacionados con el TUS. Se sugieren alternativas para futuras investigaciones, incluyendo el desarrollo de secuencias de pruebas cognitivas breves, armónicas y con una orientación clínica para mejorar la predicción individual de los resultados del tratamiento; los modelos computacionales que pueden conseguir un fenotipado profundo de los subtipos cognitivos que respondan probablemente a diferentes intervenciones; y las intervenciones cognitivas y/o farmacológicas para un fenotipo específico. Se concluye con un modelo tentativo de medicina de precisión basada en la neurociencia.

Nous résumons dans cet article ciblé les connaissances actuelles sur les troubles cognitifs liés à l'utilisation d'une substance (TUS), sur le lien entre ces troubles et les résultats cliniques, sur l'entraînement cognitif, la remédiation cognitive et les traitements pharmacologiques qui peuvent aider la cognition. Nos conclusions sont les suivantes : 1) les troubles des personnes souffrant de TUS sont modérés pour la mémoire, l'attention, les fonctions exécutives et la prise de décision (y compris l'attente de récompense, l'évaluation et l'apprentissage) ; 2) les troubles des fonctions exécutives et de prise de décision d'ordre supérieur sont des prédicteurs significatifs de rechute ; 3) les programmes d'entraînement cognitif ciblant les biais appétitifs liés à la récompense, les stratégies de remédiation cognitive ciblant la prise de décision basée sur objectif et les traitements médicamenteux ciblant la mémoire, l'attention et l'impulsivité peuvent aider les troubles cognitifs liés aux TLS. Nos propositions de recherche future sont : des séquences de tests cognitifs brèves, harmonisées et cliniquement orientées pour améliorer une prédiction individualisée des résultats thérapeutiques ; un modelage numérique pour un phénotypage profond des sous-types cognitifs susceptibles de répondre aux différentes interventions ; et des interventions cognitives ciblées sur le phénotype, pharmacologiques et associées. Nous proposons en conclusion un modèle de médecine de précision éclairé par les neurosciences.

Psychometric properties of a brief on-line screening instrument to detect at-risk gamblers / Propiedades psicométricas de un instrumento de cribado breve on-line para la detección de jugadores de riesgo

Background: Gambling facilitates the development of psychopathological problems in some gamblers. Rapid and easy detection of the presence of these problems, or the risk of their development, will allow early action at the beginning of the problem, including preventive action. For this purpose, we developed the "Sistema de Cribado de Riesgo de Problemas de Juegos" (SCRI-PJ [Risk of Gambling Problems Screening System]), an on-line instrument for the detection of people who have, or may develop, gambling problems. The goal of this work is to present and validate the SCRI-PJ. Method: 85 people with gambling problems undergoing treatment and 119 people from the general population were assessed with the SCRI-PJ and the DSM-RT Diagnostic Criteria for Pathological Gambling questionnaire. Results: the SCRI-PJ showed high internal consistency (α= .96), sensitivity (94.2%) specificity (91.4%), with a negative predictive value of 98.6%. Conclusion: the SCRI-PJ is a brief and effective screening instrument to detect people with gambling problems or who are at risk of developing them (AU)

Antecedentes: los juegos de azar facilitan el desarrollo de problemas psicopatológicos en algunos jugadores. Detectar de forma rápida y sencilla la presencia de estos problemas, o el riesgo de su desarrollo, permitirá actuar precozmente al inicio del problema, incluso de forma preventiva. Con este propósito se ha desarrollado el Sistema de Cribado de Riesgo de Problemas de Juego (SCRI-PJ), un instrumento on-line para la detección de personas que tengan o puedan desarrollar problemas con el juego. El objetivo de este trabajo es presentar y validar el SCRI-PJ. Método: 85 personas con problemas de juego en tratamiento y 119 personas de la población general fueron evaluados mediante el SCRI-PJ y el cuestionario Criterios diagnósticos DSM-IV-TR para el Juego Patológico. Resultados: el SCRI-PJ mostró una alta consistencia interna (α= .96), sensibilidad (94,2%) y especificidad (91,4%), con un valor predictivo negativo del 98,6%. Conclusión: el SCRI-PJ es un instrumento de cribado breve y eficaz para detectar a las personas con problemas de juego o en riesgo de desarrollarlos (AU)

Psychometric properties of a brief on-line screening instrument to detect at-risk gamblers.

BACKGROUND: Gambling facilitates the development of psychopathological problems in some gamblers. Rapid and easy detection of the presence of these problems, or the risk of their development, will allow early action at the beginning of the problem, including preventive action. For this purpose, we developed the “Sistema de Cribado de Riesgo de Problemas de Juegos” (SCRI-PJ [Risk of Gambling Problems Screening System]), an on-line instrument for the detection of people who have, or may develop, gambling problems. The goal of this work is to present and validate the SCRI-PJ. METHOD: 85 people with gambling problems undergoing treatment and 119 people from the general population were assessed with the SCRI-PJ and the DSM-RT Diagnostic Criteria for Pathological Gambling questionnaire. RESULTS: the SCRI-PJ showed high internal consistency (α= .96), sensitivity (94.2%) specificity (91.4%), with a negative predictive value of 98.6%. CONCLUSION: the SCRI-PJ is a brief and effective screening instrument to detect people with gambling problems or who are at risk of developing them.

Premature termination of psychological treatment for anxiety disorders in a clinical setting / Terminación prematura del tratamiento psicológico para los trastornos de ansiedad en el contexto clínico

BACKGROUND: Empirically supported psychological treatments (ESTs) have demonstrated their effectiveness and clinical utility for the treatment of anxiety disorders (AD) but few studies have assessed the factors associated with premature termination in ESTs for AD. METHOD: The goals of this study, which involved 291 patients with a diagnosis of anxiety who had received outpatient psychological care, consisted of examining premature termination of treatment (PTT), comparing the individual characteristics of the patients who successfully completed treatment with those who terminate it prematurely, and analyzing the predictors of PTT. RESULTS: Of the sample, 8.2% refused to start treatment, 28.5% dropped out before completing it, and 63.2% successfully completed treatment. In 50% of the cases, PTT occurred during the first 7 sessions, and in 80%, before the 15th session. Alternatively, 76.4% of the patients who complete treatment successfully do so before session 20. We found that patients with PTT attended a significantly lower number of treatment sessions and attended the sessions more irregularly and unpunctually. Presenting a generalized anxiety disorder (GAD), problems with punctuality and with task performance were predictors of failure to complete treatment. CONCLUSIONS: These findings suggest the need to reinforce early adherence to treatments to help patients remain in treatment

ANTECEDENTES: los tratamientos psicológicos empíricamente apoyados (TEAs) han demostrado utilidad clínica para el abordaje de los trastornos de ansiedad (TA), pero pocos estudios han evaluado los factores asociados a la terminación prematura (TPT). MÉTODO: se examinaron las tasas de TPT, sus predictores y las características de aquellos pacientes que terminaron prematuramente frente a los que completan, en una muestra de 291 pacientes, en atención ambulatoria y diagnosticados de algún trastorno de ansiedad. RESULTADOS: el 8,2% de los participantes rechazaron comenzar el tratamiento, el 28,5% abandonaron antes de completarlo y el 63,2% completaron con éxito. El 50% de los casos de TPT se produce durante las 7 primeras sesiones y en el 80% antes de la sesión 15. El 76,4% de los pacientes que finalizan con éxito su tratamiento lo hacen antes de la sesión 20. El grupo TPT acudió a un número significativamente menor de sesiones y asistieron de manera más irregular e impuntual. Resultaron predictores de no completar el tratamiento presentar un Trastorno de Ansiedad Generalizada, problemas de puntualidad y en la ejecución de tareas. CONCLUSIONES: los resultados apuntan la necesidad de reforzar la adhesión temprana a los tratamientos para ayudar a los pacientes a mantenerse en los mismos

Premature termination of psychological treatment for anxiety disorders in a clinical setting.

BACKGROUND: Empirically supported psychological treatments (ESTs) have demonstrated their effectiveness and clinical utility for the treatment of anxiety disorders (AD) but few studies have assessed the factors associated with premature termination in ESTs for AD. METHOD: The goals of this study, which involved 291 patients with a diagnosis of anxiety who had received outpatient psychological care, consisted of examining premature termination of treatment (PTT), comparing the individual characteristics of the patients who successfully completed treatment with those who terminate it prematurely, and analyzing the predictors of PTT. RESULTS: Of the sample, 8.2% refused to start treatment, 28.5% dropped out before completing it, and 63.2% successfully completed treatment. In 50% of the cases, PTT occurred during the first 7 sessions, and in 80%, before the 15th session. Alternatively, 76.4% of the patients who complete treatment successfully do so before session 20. We found that patients with PTT attended a significantly lower number of treatment sessions and attended the sessions more irregularly and unpunctually. Presenting a generalized anxiety disorder (GAD), problems with punctuality and with task performance were predictors of failure to complete treatment. CONCLUSIONS: These findings suggest the need to reinforce early adherence to treatments to help patients remain in treatment.

Characteristics of demand and psychological treatments in a university clinic / Características de la demanda y de los tratamientos psicológicos en una clínica universitaria

The objectives of this study are to describe the most common characteristics of patients receiving psychological treatment and the treatments administered. We analyzed a sample of 856 patients at the University Psychology Clinic of the Complutense University of Madrid. Five diagnostic categories accounted for 78.4% of demand: anxiety disorders (31.9%), no diagnosis (15.4%), other problems requiring clinical attention (14.2%), mood disorders (9.5%) and adaptive disorders (7.4%). A total of 17.7% presented a comorbid diagnosis and 49.3% had received treatment previously. The mean of assessment and treatment sessions was 3.5 and 12.7, respectively. The most commonly applied techniques included psychoeducation (95.1%), cognitive restructuring (74.8%), relaxation (74.4%), and control of internal dialogue (68.1%).Of the patients that had finished contact with the clinic, 68.3% were a therapeutic success. We discuss the generalization of the results and the implications for the profession and clinical practice

Los objetivos del estudio son describir las características de los pacientes que acuden a tratamiento psicológico y de los tratamientos aplicados. Se analiza una muestra de 856 pacientes de la Clínica Universitaria de Psicología de la Universidad Complutense. Cinco categorías diagnósticas cubren el 78.4% de la demanda: trastornos de ansiedad (31.9%), sin diagnóstico (15.4%), otros problemas objeto de atención clínica (14.2%), trastornos del estado de ánimo (9.5%) y trastornos adaptativos (7.4%). El 17.7% presentaba un diagnóstico comórbido y el 49.3% habían recibido un tratamiento previo. La media de sesiones de evaluación fue de 3.5 y 12.7, respectivamente. Las técnicas más utilizadas fueron psicoeducación (95.1%), reestructuración cognitiva (74.8%), relajación (74.4%) y control del diálogo interno (68.1%).De los pacientes que habían finalizado el contacto con el centro el 68.3% obtuvo el alta terapéutica. Se discute la generalización de los resultados e implicaciones para la profesión y la práctica clínica

Factors associated with prolonging psychological treatment for anxiety disorders.

BACKGROUND: Anxiety disorders are one of the disorders most frequently requested for psychological attention. The purpose of this study is to identify the factors that can explain a longer duration of psychological treatment for anxiety disorders. METHOD: 202 patients from the University Psychology Clinic of the Complutense University of Madrid were analyzed. RESULTS: Multivariate regression analysis showed that the presence of obsessive-compulsive disorder and the application of arousal control techniques followed by modeling and other specific techniques were the best predictors of treatment duration. CONCLUSION: Reducing as much as possible the number of techniques applied without reducing intervention efficacy is suggested. In some disorders that produce a greater life disorganization, it may be useful to try to organize the patient´s life either as a first goal or at the same time as the intervention program, so as to increase its effectiveness and reduce the number of sessions.