Efficacy of the Therapeutic Game "Trisquel" in the Treatment of Patients With Substance-Related Disorders Randomized Clinical Study.

Substance-related disorders (SRD) have been consistently associated with alterations both in cognitive and executive functions, which affect to patients' quality of life. The main objective of this work was to test the beneficial cognitive effects on patients with SRD after the implementation of "Trisquel," an intervention program in board game format. To check the effectiveness of Trisquel program, a group of people diagnosed with SRD was randomly assigned either to the experimental group or to the control group. The experimental group performed Trisquel structured sessions twice a week during 3 months, while the control group performed routinely conventional therapeutic activities with the same frequency and duration. Neuropsychological tests were done to both groups before and after the intervention. After the 3 months of intervention the experimental group showed the following statistically significant improvements for WAIS-III subtests: number key, symbol search, arithmetic, direct digits, inverse digits, total digits, letters-numbers in the processing speed index and in the working memory index. Regarding STROOP tests, statistically significant progress was observed in the phonetic fluency letter P, phonetic fluency letter M, phonetic fluency letter R subtests, word-reading and word-color subtests. The control group only obtained improvements for WAIS-III subtests of arithmetic, letters-numbers and in the working memory index. The results of this study confirm that "Trisquel" is an effective intervention program for people diagnosed with SRD, getting improvements in processing speed (psychomotor and reading), attentional subprocesses (focused and sustained) and executive functions (updating and inhibition).

Effectiveness of the “Trisquel” board game intervention program for patients with schizophrenia spectrum disorders.

Schizophrenia spectrum disorders present emotional, cognitive and/or behavioural alterations relat- ed to daily functioning. Therefore, it is necessary to develop intervention programs focused on the improvement of these constructs. The aim of this work is to analyse the effect of the intervention program “Trisquel” on cognitive functioning, symptomatologic perception and psychosocial functioning.

Efectividad del programa de intervención «El Trisquel» en personas con trastornos del espectro de la esquizofrenia / Effectiveness of the «Trisquel» board game intervention program for patients with schizophrenia spectrum disorders

INTRODUCCIÓN: Los trastornos del espectro de la esquizofrenia presentan alteraciones emocionales, cognitivas o conductuales relacionadas con el funcionamiento diario. Por ello, es necesario desarrollar programas de intervención enfocados a la mejora de estos constructos. El objetivo de este trabajo es analizar el efecto en el funcionamiento cognitivo, la percepción sintomatológica y el funcionamiento psicosocial del programa de intervención «El Trisquel». METODOLOGÍA: Se llevó a cabo un diseño experimental con un total de 24 personas con diagnóstico de trastorno del espectro de la esquizofrenia que fueron asignadas aleatoriamente al grupo experimental «El Trisquel» y al grupo control. El grupo «El Trisquel» realizó dos sesiones estructuradas semanales durante tres meses, mientras que el grupo control realizó sesiones de estimulación cognitiva con la misma frecuencia e intensidad. Se administraron pruebas neuropsicológicas, clínicas y funcionales antes y después de la intervención. RESULTADOS: Tras el programa de intervención, en el grupo «El Trisquel» se encontraron mejorías estadísticamente significativas en los subtests de letras y números (p = 0,029), en el índice de memoria de trabajo (p = 0,020) WAIS-III, en sensibilidad interpersonal (p = 0,015) e ideación paranoide (p = 0,049) SCL-90-R y en funcionamiento psicosocial EEAG (p = 0,020). Y en el grupo control, en velocidad de procesa-miento (p = 0,034) WAIS-III y percepción de la salud SF-36 (p = 0,017). CONCLUSIONES: Los resultados de este estudio sugieren que «El Trisquel» puede ser un programa de intervención eficaz para inducir mejoras en el funcionamiento de la memoria operativa, en las dimensiones sintomatológicas de sensibilidad interpersonal e ideación paranoide y en el funcionamiento psicosocial en personas con diagnóstico de trastorno del espectro de la esquizofrenia

INTRODUCTION: The disorders of the schizophrenia spectrum present emotional, cognitive and/or behavioural alterations, related to daily functioning, therefore it is necessary to develop intervention programmes focused on the improvement of these constructs. The objective of this work is to analyze the effect on cognitive functioning, symptomatological perception and psychosocial functioning of the Trisquel intervention program. METHODOLOGY: An experimental design was carried out with a total of 24 people with a diagnosis of schizophrenia spectrum disorder who were randomly assigned to the experimental group Trisquel and the control group. The Trisquel group con-ducted two structured weekly sessions for three months, while the control group conducted cognitive stimulation sessions with the same frequency and intensity. Neuropsychological, clinical and functional tests were administered before and after the intervention. RESULTS: After the intervention program in the Trisquel group, statistically significant improvements were found in the subtest of letters and numbers (p = 0,029), in the working memory index (p = 0,020) WAIS-III, in interpersonal sensitivity (p = 0,015) and paranoid ideation (p = 0,049) SCL-90-R and in psychosocial functioning EEAG (p = 0,020). And in the control group, in processing speed (p = 0,034) WAIS-III and health perception SF-36 (p = 0,017). CONCLUSIONS: The results of this study suggest that «Trisquel» may be an effective intervention program to induce improvements in the functioning of working memory, in the symptomatic dimensions of interpersonal sensitivity and paranoid ideation, and in psychosocial functioning in people with a diagnosis of schizophrenia spectrum disorder

Diferencias entre hombres y mujeres en los procesos de toma de decisiones en pacientes con trastornos relacionados con sustancias / Differences between men and women in decision-making processes in patients with substance-related disorders

Resumen Los trastornos relacionados con sustancias (TRS) pueden cursar con alteraciones neuropsicológicas que afectan las actividades de la vida diaria de una persona. El objetivo principal de este trabajo es estudiar el proceso de la toma de decisiones en pacientes con TRS y analizar si hay diferencias entre hombres y mujeres. Se administró una versión computarizada de la Iowa Gambling Task (IGT) a una muestra total de 101 pacientes con TRS que solicitaron tratamiento ambulatorio, 81 hombres (80,2%) y 20 mujeres (19,8%). Los resultados muestran una alteración en la toma de decisiones. Asimismo, se observó un peor rendimiento en el grupo de los hombres en la toma de decisiones en comparación con el grupo de las mujeres. Estos datos comprueban la importancia de tener en cuenta el sexo a la hora del diagnóstico e intervención en personas con TRS. Se precisan estudios futuros que profundicen en estas diferencias.

Abstract Substance-related disorders (TRS) can cause neuropsychological alterations that affect the activities of a person's daily life. The main objective of this work is to study the process of decision making in patients with TRS and to analyze if there are differences between men and women. A computerized version of the Iowa Gambling Task (IGT) was administered to a total sample of 101 patients with TRS who requested outpatient treatment, 81 men (80.2%) and 20 women (19.8%). The results obtained show an alteration in the decision making. Likewise, a worse performance was observed in the group of men in decision making compared to the group of women. These data point to the importance of taking into account sex at the time of diagnosis and intervention in people with SDB. Future studies are needed to delve into these differences.

Current status of acceptance and commitment therapy for chronic pain: a narrative review.

It is well known that chronic pain is prevalent, complex to manage, and associated with high costs, in health care and society in general. Thanks to advances in new forms of cognitive behavioral therapy (known as third-wave CBT), currently clinicians and researchers have an empirically validated psychological treatment with increasing research support for the treatment of chronic pain. This treatment is called acceptance and commitment therapy (ACT). The main aim of this paper is to provide a narrative review that summarizes and integrates the current state of knowledge of ACT in the management of chronic pain as well as discuss current challenges and opportunities for progress. Based on the psychological flexibility model, ACT extends previous forms of CBT and integrates many CBT-related variables into six core therapeutic processes. ACT is a process-based therapy that fosters openness, awareness, and engagement through a wide range of methods, including exposure-based and experiential methods, metaphors, and values clarification. To our knowledge, there are three published systematic reviews and meta-analyses that support the effectiveness of ACT for chronic pain and many studies focused on specific processes derived from the psychological flexibility model. There is also promising support for the cost-effectiveness of ACT; however, the current evidence is still insufficient to establish firm conclusions about cost-effectiveness and the most efficient means of delivery. Additional well-designed economic evaluations are needed. Other research aims include delineating the neurobiological underpinnings of ACT, refining available outcome and process measures or develop new ones for ACT trials, and meeting the challenge of wide dissemination and implementation in real-world clinical practice.

Utilidad clínica y propiedades psicométricas del inventario conductual de Cambridge / Clinical usefulness and psychometric properties of the Cambridge Behavioural Inventory

Introducción. Un área importante de la evaluación neuropsicológica son los síntomas psicológicos y conductuales. El inventario conductual de Cambridge -Cambridge Behavioural Inventory (CBI)- es una medida de autoinforme dirigida a allegados que recoge una amplia variedad de síntomas conductuales que pueden darse en el curso de las enfermedades neurológicas. El principal objetivo del estudio es comprobar la utilidad clínica de su adaptación al castellano. Sujetos y métodos. El CBI fue cumplimentado por 215 allegados de pacientes remitidos desde los servicios de neurología y psiquiatría. Se compararon los perfiles del CBI de cuatro grupos de pacientes formados sobre la base de sus principales características clínicas, datos psicométricos, pruebas de imagen y juicio clínico del profesional solicitante del estudio neuropsicológico. Resultados. La mayoría de las escalas (10 de 13) del CBI tuvo valores de consistencia interna aceptables, y las escalas de memoria y atención/orientación, correlaciones elevadas con medidas objetivas de memoria y orientación temporal. Los perfiles del CBI de los grupos de pacientes con distintas condiciones (trastorno orgánico de la memoria, trastorno funcional de la memoria, variante conductual de demencia frontotemporal y enfermedad de Alzheimer) fueron consistentes con sus principales características. Conclusiones. El CBI es un instrumento psicométricamente fiable y con adecuada validez convergente y discriminante que puede ser útil en el proceso de evaluación neuropsicológica, aportando información relevante no sólo sobre el funcionamiento cognitivo y las capacidades funcionales, sino también sobre los síntomas conductuales y psicológicos de los pacientes con trastornos cognitivos (AU)

Introduction. An important area in neuropsychological assessment is that of psychological and behavioural symptoms. The Cambridge Behavioural Inventory (CBI) is a self-report measure aimed at relatives which takes account of a wide range of behavioural symptoms that may occur during the course of neurological diseases. The main objective of the study is to test the clinical usefulness of its Spanish adaptation. Subjects and methods. The CBI was completed by 215 members of kin of patients referred from neurology and psychiatry services. The CBI profiles of four groups of patients were compared, these being grouped according to their main clinical characteristics, psychometric data, imaging tests and the clinical judgement of the professional requesting the neuropsychological study. Results. Most of the scales (10 out of 13) of the CBI yielded acceptable internal consistency values, and the memory and attention/orientation scales showed high correlations with objective measures of memory and time orientation. The CBI profiles of the groups of patients with different conditions (organic memory disorder, functional memory disorder, behavioural variant of frontotemporal dementia and Alzheimer’s disease) were consistent with their main features. Conclusions. The CBI is a psychometrically reliable instrument with adequate convergent and discriminant validity that can be useful in the process of neuropsychological assessment. It can provide relevant information not only about cognitive functioning and the functional capabilities, but also about the behavioural and psychological symptoms of patients with cognitive disorders (AU)

Differential effects of two virtual reality interventions: distraction versus pain control.

There is evidence that virtual reality (VR) pain distraction is effective at improving pain-related outcomes. However, more research is needed to investigate VR environments with other pain-related goals. The main aim of this study was to compare the differential effects of two VR environments on a set of pain-related and cognitive variables during a cold pressor experiment. One of these environments aimed to distract attention away from pain (VRD), whereas the other was designed to enhance pain control (VRC). Participants were 77 psychology students, who were randomly assigned to one of the following three conditions during the cold pressor experiment: (a) VRD, (b) VRC, or (c) Non-VR (control condition). Data were collected regarding both pain-related variables (intensity, tolerance, threshold, time perception, and pain sensitivity range) and cognitive variables (self-efficacy and catastrophizing). Results showed that in comparison with the control condition, the VRC intervention significantly increased pain tolerance, the pain sensitivity range, and the degree of time underestimation. It also increased self-efficacy in tolerating pain and led to a reduction in reported helplessness. The VRD intervention significantly increased the pain threshold and pain tolerance in comparison with the control condition, but it did not affect any of the cognitive variables. Overall, the intervention designed to enhance control seems to have a greater effect on the cognitive variables assessed. Although these results need to be replicated in further studies, the findings suggest that the VRC intervention has considerable potential in terms of increasing self-efficacy and modifying the negative thoughts that commonly accompany pain problems.

Effects of an acceptance/defusion intervention on experimentally induced generalized avoidance: a laboratory demonstration.

This study tests the effectiveness of an acceptance/defusion intervention in reducing experimentally induced generalized avoidance. After the formation of two 6-member equivalence classes, 23 participants underwent differential conditioning with two elements from each class: A1 and B1 were paired with mild electric shock, whereas A2 and B2 were paired with earning points. Participants learned to produce avoidance and approach responses to these respective stimuli and subsequently showed transfer of functions to non-directly conditioned equivalent stimuli from Class 1 (i.e., D1 and F1 evoked avoidance responses) and Class 2 (i.e., D2 and F2 evoked approach responses). Participants were then randomly assigned to either a motivational protocol (MOT) in which approaching previously avoided stimuli was given a general value, or to a defusion protocol (DEF) in which defusion (a component of Acceptance and Commitment Therapy) was trained while approaching previously avoided stimuli was connected to personally meaningful examples. A post-hoc control group (CMOT) was conducted with 16 participants to control for differences in protocol length between the former two groups. All participants in the DEF group showed a complete suppression of avoidance responding in the presence of Class 1 stimuli (A1-F1 and additional novel stimuli in relation to them), as compared to 40% of participants in the MOT condition and 20% in the CMOT condition. The acceptance/defusion protocol eliminated experimentally induced avoidance responding even for stimuli that elicited autonomic fear responses.

Eficacia de la terapia de aceptación y compromiso en personas con trastorno mental crónico. Un ensayo aleatorizado / No disponible

El presente estudio analizó el impacto de un tratamiento basado en la aceptación(Terapia de Aceptación y Compromiso; ACT) en personas con trastorno mental crónico. Esta intervención enseña a los pacientes a aceptar aquellos eventos privados que son inevitables y a identificar y centrarse en acciones dirigidas hacia objetivos valiosos para ellos.23 participantes con un alto nivel de cronificación fueron asignados al azar al tratamiento habitual (TAU) o a un protocolo de siete sesiones de ACT más TAU. Los participantes del grupo de ACT mostraron cambios en la dirección deseada tanto en las conductas de evitación como en el nivel de actividades realizadas en dirección a los objetivos valorados. Estos cambios se mantuvieron y fueron aún más significativos a largo plazo, tal y como cabía esperar de una intervención basada en la aceptación. Destacan los resultados en el seguimiento a los ocho meses respecto a la sintomatología, a pesar de que esta no era el objetivo de la intervención. Los resultados obtenidos son de gran relevancia habida cuenta de la alta cronicidad y disfuncionalidad social de los participantes (AU)

This study examined the impact of a treatment based on the acceptance (Acceptance and Commitment Therapy, ACT)in people with chronic mental disorder. This intervention teaches patients to accept these private events that are inevitable and to identify and focus on actions directed toward valued goals for them. Twenty-three participants with a high-level of chronicity were randomized to treatment as usual (TAU) protocol or 7 sessions of ACT plus TAU. The ACT group participants showed changes in the desired direction both in avoidance behavior and the level of activities toward valued goals. These changes were maintained and were even more significant in the long term, as might be expected of an intervention based on acceptance. Notable results at 8 months follow-up regarding the symptoms, even though it was not the aim of the intervention. The results are of great importance given the high chronicity and social dysfunctionality of the participants (AU)

"Decentering" reflects psychological flexibility in people with chronic pain and correlates with their quality of functioning.

OBJECTIVE: Acceptance and mindfulness-based treatments for chronic pain attempts to alter the impact of pain-related thoughts and feelings on behavior without necessarily changing the thoughts and feelings themselves. A process called "decentering" appears relevant to these treatments because it includes the capacity to observe thoughts and feelings from a detached perspective, as transient events in the mind, that do not necessarily reflect reality or the self. This study examines relations of decentering with other processes related to "psychological flexibility" and the daily functioning of people with chronic pain. METHOD: Consecutive adults seeking treatment for chronic pain (N = 150) provided data for the study by completing a set of measures, including a measure of decentering, the Experiences Questionnaire (EQ). RESULTS: The EQ demonstrated adequate internal consistency reliability, and correlation results supported its validity. Decentering significantly correlated with anxiety, depression, and psychosocial disability. In multiple regression analyses it added a significant increment to explained variance in the prediction of depression and psychosocial disability. Across all measures of functioning, pain acceptance and decentering combined accounted for an average of 23.6% of variance while pain accounted for 2.5%. CONCLUSIONS: People with chronic pain may benefit from the capacity to contact their thoughts and feelings from a perspective as a "separate observer," to see them as transient, and to experience them as cognitively "defused."

The use of virtual reality for coping with pain with healthy participants / El uso de la realidad virtual para el afrontamiento del dolor con participantes sanos

The present study investigates whether a virtual reality (VR) intervention can influence pain catastrophizing, pain self-efficacy and other pain-related measures reported during a cold-pressor experience. Forty-five healthy participants underwent two consecutive cold-pressor trials, one using VR and one without VR exposure, in counterbalanced order. The VR intervention encouraged participants to search actively for the correspondence between the pain experienced and a VR stereoscopic figure, which could be interactively manipulated. The VR intervention led to significant increases in pain threshold, pain tolerance and pain self-efficacy, as well as a significant reduction of in vivo pain catastrophizing. The possibilities of using VR as a tool for enhancing perceived pain control are discussed (AU)

El presente estudio investiga si una intervención con Realidad Virtual (RV) puede influir en el catastrofismo, la autoeficacia y otras medidas relacionadas con el dolor. Cuarenta y cinco participantes sanos se sometieron a dos ensayos consecutivos de cold-pressor, uno utilizando RV y otro sin exposición a RV, en orden contrabalanceado. La intervención con RV estaba basada en la manipulación de una figura estereoscópica que representaba la sensación dolorosa. La intervención con RV condujo a incrementos significativos en el umbral de dolor, la tolerancia y la percepción de autoeficacia, así como a reducciones significativas en las puntuaciones de catastrofismo. A partir de los resultados obtenidos, se discuten las posibilidades de usar la RV como técnica para aumentar el control percibido sobre el dolor (AU)

The use of virtual reality for coping with pain with healthy participants.

The present study investigates whether a virtual reality (VR) intervention can influence pain catastrophizing, pain self-efficacy and other pain-related measures reported during a cold-pressor experience. Forty-five healthy participants underwent two consecutive cold-pressor trials, one using VR and one without VR exposure, in counterbalanced order. The VR intervention encouraged participants to search actively for the correspondence between the pain experienced and a VR stereoscopic figure, which could be interactively manipulated. The VR intervention led to significant increases in pain threshold, pain tolerance and pain self-efficacy, as well as a significant reduction of in vivo pain catastrophizing. The possibilities of using VR as a tool for enhancing perceived pain control are discussed.

Interactive and passive virtual reality distraction: effects on presence and pain intensity.

The current study explores the effects of interactive versus passive Virtual Reality (VR) distraction on the sense of presence and pain intensity. Sixty-eight healthy students (mean age 21.8, SD = 4.3) underwent two consecutive cold-pressor trials (subject's hand immersed into 6 °C water as long as possible, with a time limit of five minutes), one without VR and another providing a VR distraction "Surreal World." Participants were randomly assigned to an interactive VR distraction condition, where a number of interactions with the environment were possible, or to a passive VR distraction condition, where they were also exposed to the surreal world, but instead of interacting with the virtual environment, they watched the navigation generated by another participant assigned to the interactive condition. After the VR cold-pressor trial, each subject provided ratings of pain intensity and rated the degree to which they had felt "present" in the virtual environment. Results showed that most of the participants who experienced the interactive VR distraction reported less pain intensity relative to the no-VR trial. However, in the passive VR condition, only 5.9% of participants showed a decreased level of pain intensity relative to the no-VR trial. Also, the amount of presence reported was significantly higher during the interactive VR distraction and correlated negatively with pain intensity scores.

Control over the virtual environment influences the presence and efficacy of a virtual reality intervention on pain.

The main aim of this study is to investigate whether the control the user has over a virtual environment (VE) influences the sense of presence. A secondary purpose is to explore the relationship between Virtual Reality (VR) presence and pain tolerance during a cold-pressor experience. Ninety-four participants underwent two consecutive cold-pressor trials, one without VR exposure and the other providing a VR stereoscopic figure used as a symbolic representation of the sensation of pain. Participants were randomly assigned to an interactive condition in which they could actively manipulate the VR figure to achieve a pleasant, tranquil environment (analogous to no-pain situation) or to a passive intervention, in which they observed the changes in the VR figure. Results showed that the amount of VR presence reported was significantly higher in the interactive condition. Participants had a higher pain tolerance during both VR conditions than in the no-VR trial, with a greater increase in pain tolerance from the non-VR trial in the interactive condition. Presence scores correlated significantly and positively with pain tolerance scores. We discuss the importance of VR interaction and control over the VR environments used in VR pain interventions designed to increase cognitive control over pain.

Processes of change in psychological flexibility in an interdisciplinary group-based treatment for chronic pain based on Acceptance and Commitment Therapy.

There are now numerous studies of Acceptance and Commitment Therapy (ACT) for chronic pain. These studies provide growing support for the efficacy and effectiveness of ACT in this context as well as for the role of ACT-specific therapeutic processes, particularly those underlying psychological flexibility. The purpose of the present study was to continue to build on this work with a broader focus on these processes, including acceptance of pain, general psychological acceptance, mindfulness, and values-based action. Participants included 168 patients who completed an ACT-based treatment for chronic pain and a three-month follow-up. Following treatment and at follow-up, participants reported significantly reduced levels of depression, pain-related anxiety, physical and psychosocial disability, medical visits, and pain intensity in comparison to the start of treatment. They also showed significant increases in each of the processes of psychological flexibility. Most uncontrolled effect sizes were medium or large at the follow-up. In correlation analyses changes in the four processes measures generally were significantly related to changes in the measures of depression, anxiety, and disability. In regression analyses the combined processes were related to changes in outcomes above and beyond change in pain intensity. Although in some ways preliminary, these results specifically support the unique role of general psychological acceptance in relation to improvements achieved by treatment participants. The current study clarifies potential processes of change in treatment for chronic pain, particularly those aiming to enhance psychological flexibility.

Presence, involvement and efficacy of a virtual reality intervention on pain.

We explored the impact of an interactive VR environment on pain cognitions (in vivo catastrophizing and pain self-efficacy) and pain-related measures: pain threshold, pain tolerance, Pain Sensitivity Range (PSR), pain intensity and time estimation in a sample of healthy students. Sense of presence is essential to conduct a psychological treatment; if patients are not able to involve themselves in a virtual world they cannot experience relevant emotions, and the desired processes that are necessary for most psychological treatments will not occur. However, some authors argue that presence must be distinguished from the degree of engagement, involvement in the portrayed environment. The results obtained in our study are consistent with this view, since the Involvement scale of the IPQ did not correlate with any of the measures related with the treatment's efficacy.

The illusion of presence influences VR distraction: effects on cold-pressor pain.

This study investigated whether VR presence influences how effectively VR distraction reduces pain intensity during a cold-pressor experience. Thirty-seven healthy students underwent a cold pressor task while interacting with a VR distraction world. After the VR cold-pressor experience, each subject provided VAS ratings of the most intense pain experienced during the hand immersion and rated their illusion of having been inside the virtual world. Results showed that the amount of VR presence reported correlated significantly and negatively with ratings of pain intensity. The importance of using an appropriately designed VR to achieve effective VR analgesia is highlighted.

The use of virtual reality for a human classical conditioning procedure.

The present study investigated the use of a VR stereoscopic figure as conditioned stimulus (CS). A differential conditioning procedure was applied on 67 participants, where a VR stereoscopic figure (CS+) was paired with electric shock and other VR stereoscopic figure (CS-) was presented without shock. Evaluative and expectancy measures were taken. Results showed that, after acquisition, the CS+ by itself became a more negative stimulus, as evidenced by the evaluative ratings. Besides, the presentation of the CS+ evoked an active expectancy of the unconditioned stimulus (US). The use of VR stereoscopic figures as CSs seems feasible to design innovative experimental paradigms.

The impact of acceptance-based versus avoidance-based protocols on discomfort.

This study aimed to isolate the conditions under which aversive stimulation is experienced as more or less discomforting/unpleasant. Discomfort was induced by playing loud noises through headphones while participants performed computer tasks. We employed 4 main conditions. Condition 1: the acceptance-based protocol (ACT), intended to integrate discomfort in a valued direction, was implemented before the Inclusion Task (task performance could continue despite the presence of the noise). Subsequently, the experiential avoidance-based protocol (EA), intended to promote a relation of opposition between discomfort and valued actions, was implemented before the Opposition Task (task performance was suspended until the participants eliminated the sounds). Condition 2: this order was reversed. Conditions 3 and 4: the tasks were presented without any protocol. The ACT protocol produced the lowest level of discomfort, particularly when it was implemented before participants had experimental experience in trying to control discomfort. Two postcontrol conditions confirmed this result. Implications for prevention and treatment of psychological suffering are discussed.

Brief Acceptance-based Protocols Applied to the Work with Adolescents

This article describes three brief acceptance-based protocols that were implemented with adolescents presenting psychological barriers to cope with different issues. The first was a values-acceptance protocol applied to adolescents to promote safe sex behaviours. The second protocol was applied to young chess promises to improve their chess performance. The third protocol was applied to children showing impulsive and antisocial behaviors. In all cases, the outcomes were satisfactory. Besides the clinical significance, the implementation of all three protocols served to further refine the acceptance-based clinical methods used in the work with our clients, and to better explore the verbal processes underlying the efficacy of such methods (AU)

El presente trabajo describe tres protocolos breves basados en la aceptación que fueron aplicados a adolescentes que presentaban barreras psicológicas para afrontar situaciones diferentes en su vida diaria: el primero se aplicó a adolescentes para promover hábitos de conducta sexual protegida; el segundo, a jóvenes promesas del ajedrez, para mejorar su rendimiento; el tercero a adolescentes con conducta antisocial e impulsiva. En los tres casos, los resultados de la aplicación de los protocolos fueron satisfactorios. Más allá de la significación clínica, estos protocolos sirvieron para mejorar los métodos clínicos utilizados con nuestros clientes, y para ahondar más en el estudio de los procesos verbales a la base de la eficacia de dichos métodos (AU)