Alternativas psicoterapéuticas efectivas en el tratamiento del paciente alcohólico / Effective psychotherapy alternatives in the treatment of the alcoholic patient

En la actualidad existe un amplio rango de formas de intervención psicológicas que se emplean para el tratamiento del alcoholismo; no obstante, los estudios que documentan la efectividad de estas alternativas hacen énfasis en un grupo de acciones que son más efectivas en el tratamiento del paciente alcohólico. Objetivo: Resumir las principales evidencias sobre la efectividad de los distintos enfoques existentes en el tratamiento de la dependencia alcohólica, a partir de un análisis de las pruebas existentes y diferenciarlas de las alternativas que han demostrado una limitada efectividad. Desarrollo: En los últimos años ha aumentado el interés por conocer la efectividad de las distintas alternativas de intervención en el alcoholismo, en gran parte por el interés marcado que existe en la administración adecuada de recursos de los que se dispone para el enfrentamiento de esta enfermedad. Los estudios sobre efectividad de las intervenciones además de necesarios para los profesionales que prestan ayuda psicoterapéutica, son cruciales para los decisores políticos que manejan los recursos dedicados a la salud, fundamentalmente para la toma de decisiones sobre el destino de los fondos basándose en el análisis de costo-beneficio. Conclusiones: Entre los enfoques interventivos con efectividad documentada se destacan las intervenciones breves, entrevistas motivacionales, entrenamiento en habilidades sociales y de afrontamiento cognitivo-conductual, el reforzamiento comunitario, el contrato conductual, las terapias aversivas y la prevención de las recaídas. Entre las terapias con limitaciones se pueden mencionar la psicoterapia del insight, consejería confrontacional, el entrenamiento en relajación, consejería y el empleo de recursos educativos(AU)

ctually there is a wide rank of psychological intervention that are used for the treatment of alcoholism , otherwise , the studies that document the effectiveness of the alternatives make emphasis in a group of actions which are more effective in the treatment of alcoholic patient. Objective: To recapitulate the main evidences about the effectiveness of the different views in the treatment of this alcoholic dependence, starting by an analyzing the existing evidence and differentiate them from the alternatives which have proved a limited effectiveness. Development: In the last few years there has been an increase in the interest for knowing the effectiveness of the different alternatives of intervention in alcoholism, in great part due to the marked interest that there is in the adequate management of the resources which are available for facing this disease. Thestudies about the effectiveness of the interventions although they are necessary for professionals that give psychotherapeutic help, are essential for politicians who handle the resources dedicated to health mainly to taking decisions about the destination of capitals based on the cost- benefit analysis. Conclusions: Brief interventions, motivational interviews, training in social abilities and of cognitive-behavioral coping, communitarian reinforcement, behavioral contract, aversive therapies and the prevention of relapses are found among the approaches of intervention with documented effectiveness. Insight therapy, confrontational counseling, training in relaxation, counseling and the use of educative resources are found among the therapies with limitations(AU)

Alternativas psicoterapéuticas efectivas en el tratamiento del paciente alcohólico / Effective psychotherapy alternatives in the treatment of the alcoholic patient

Fundamento: En la actualidad existe un amplio rango de formas de intervención psicológicas que se emplean para el tratamiento del alcoholismo; no obstante, los estudios que documentan la efectividad de estas alternativas hacen énfasis en un grupo de acciones que son más efectivas en el tratamiento del paciente alcohólico Objetivo: Resumir las principales evidencias sobre la efectividad de los distintos enfoques existentes en el tratamiento de la dependencia alcohólica, a partir de un análisis de las pruebas existentes y diferenciarlas de las alternativas que han demostrado una limitada efectividad. Desarrollo: En los últimos años ha aumentado el interés por conocer la efectividad de las distintas alternativas de intervención en el alcoholismo, en gran parte por el interés marcado que existe en la administración adecuada de recursos de los que se dispone para el enfrentamiento de esta enfermedad. Los estudios sobre efectividad de las intervenciones además de necesarios para los profesionales que prestan ayuda psicoterapéutica, son cruciales para los decisores políticos que manejan los recursos dedicados a la salud, fundamentalmente para la toma de decisiones sobre el destino de los fondos basándose en el análisis de costo-beneficio. Conclusiones: Entre los enfoques interventivos con efectividad documentada se destacan las intervenciones breves, entrevistas motivacionales, entrenamiento en habilidades sociales y de afrontamiento cognitivo-conductual, el reforzamiento comunitario, el contrato conductual, las terapias aversivas y la prevención de las recaídas. Entre las terapias con limitaciones se pueden mencionar la psicoterapia del insight, consejería confrontacional, el entrenamiento en relajación, consejería y el empleo de recursos educativos.

Background: Actually there is a wide rank of psychological intervention that are used for the treatment of alcoholism , otherwise , the studies that document the effectiveness of the alternatives make emphasis in a group of actions which are more effective in the treatment of alcoholic patient. Objective: To recapitulate the main evidences about the effectiveness of the different views in the treatment of this alcoholic dependence, starting by an analyzing the existing evidence and differentiate them from the alternatives which have proved a limited effectiveness. Development: In the last few years there has been an increase in the interest for knowing the effectiveness of the different alternatives of intervention in alcoholism, in great part due to the marked interest that there is in the adequate management of the resources which are available for facing this disease. The studies about the effectiveness of the interventions although they are necessary for professionals that give psychotherapeutic help, are essential for politicians who handle the resources dedicated to health mainly to taking decisions about the destination of capitals based on the cost- benefit analysis. Conclusions: Brief interventions, motivational interviews, training in social abilities and of cognitive-behavioral coping, communitarian reinforcement, behavioral contract, aversive therapies and the prevention of relapses are found among the approaches of intervention with documented effectiveness. Insight therapy, confrontational counseling, training in relaxation, counseling and the use of educative resources are found among the therapies with limitations.

Activación conductual y depresión: conceptualización, evidencia y aplicaciones en iberoamérica / Behavioral activation and depression: conceptualization, evidence and applications in latin america

La depresión es uno de los problemas en salud mental más prevalentes. En Latinoamérica se constituye como la primera problemática en cuanto a años de vida perdidos por incapacidad, lo que implica que se deben hacer esfuerzos importantes en desarrollar estrategias de intervención eficaces para su intervención. Este artículo tiene como objetivo, en primer lugar, ofrecer una revisión conceptual de la activación conductual, una de las estrategias de intervención que han probado ser eficaces en el tratamiento de la depresión y sus diferentes modalidades, en segundo lugar, examinar el uso que ha tenido en el manejo de la depresión en diferentes poblaciones y por último, revisar la evidencia empírica en Iberoamérica.

Depression is nowadays one of the most prevalent mental health problems. In Latin America is the main problem in terms of years of life lost due to disability, implying that major efforts should be made to develop effective intervention strategies for treatment. This article aims, first, to provide a conceptual review of the Behavioral Activation, one of the interventions that have proven to be effective to treat depression and its various forms, secondly, to examine its use to treating depression with different populations and finally, to review the empirical evidence in Latin America.

Activación conductual: revisión histórica, conceptual y empírica / Behavioral activation: historical, conceptual and empirical review

La Activación Conductual (AC) ha mostrado su efectividad como uno de los tratamientos más importantes para la depresión. Esta revisión de la literatura aborda aspectos históricos, variaciones y evidencia relacionada con la efectividad de la AC en diferentes problemáticas y poblaciones. Inicialmente se retoman sus alcances y uso, lo que le ha permitido constituirse como una de las terapias que cuenta con apoyo empírico para el manejo de la depresión. La revisión histórica permite ver su establecimiento como una Terapia de Tercera Generación y sus bases filosóficas en una perspectiva contextualista funcional. Posteriormente, se mencionan los diferentes tipos de activación conductual y algunos estudios relacionados con su efectividad tanto en depresión como en condiciones co-mórbidas. Finalmente, se realizaron recomendaciones para futuras investigaciones, entrenamiento, modalidades y problemas que pueden llegar a ser intervenidos a través de la activación conductual.

Behavioral Activation (BA) has shown its effectiveness as one of the most important treatments for depression. This review shows the historical antecedents, its different approaches, and the empirical evidence, which are linked with BA efficacy. In a first moment, are posed their scope and the way as it has been implemented, to get into one of the empirical evidence based therapies to treat depression. The historical review allows to see how it got a place as a Third Wave Therapy, and its philosophical roots on functional contextualistim. Furthermore, different models of Behavioral Activation and researches, which have shown their effectiveness to intervene depression and comorbid conditions, are presented. Finally, some recommendations are mentioned about futures studies, training, models, and problems, which could be implemented with BA.

Teen pregnancy and sexually transmitted infections in youth: a community prevention evidence-based program in Texas, USA / Infecciones de transmisión en la juventud: un programa de prevención comunitario basado en la evidencia, en Texas EEUU

Teen pregnancies and sexually transmitted diseases (STDs) continue to be a major health, social and financial problem across the country, and especially in Texas. While national research has shown that abstinence education is not working, the Texas Legislature, Texas School System and the Lubbock community still require “Abstinence-Only” education. The current paper is based on a community prevention evidence-based program in Lubbock, Texas entitled “Teen Straight Talk” (TST, 2007). TST is designed to educate and provide information on the topics of body image, teen and peer pressure, depression and suicide, along with understanding sexuality and how the body works, abstinence, contraception, teenage pregnancy, STDs, protection and sexual responsibility. The program reduces barriers between adults and parents and the youth they care for. TST is a joint effort among faculty, undergraduate and graduate students from Texas Tech University and Texas Tech University Health Sciences Center and community partners. Empirical data has been collected since 2008 to fulfill the program main goals: a) Understand parent’s knowledge and attitudes on sexual development as well as increase awareness of needs and benefits of comprehensive sexual education programs for parents and adolescents; b) Train volunteer students to promote healthy teenage sexual development in the Lubbock Community, c) Deliver comprehensive, medically, psychologically and sociologically correct sexual education to families and teenagers concerning risk and protective factors related to sexual activity. Empirical and social implications of TST are discussed.

El embarazo juvenil y las infecciones de transmisión sexual (ITS) continúan siendo un problema de salud, económico y social de índole mayor en Estados Unidos particularmente en Texas. Mientras evidencia empírica a nivel nacional demuestra que la educación basada en abstinencia no funciona, la legislatura en Texas, el sistema educativo en las escuelas y en las comunidades de Texas aun requieren que se utilicen los programas de “Solo-Abstinencia.” Este artículo esta basado en un programa comunitario de prevención basado en evidencia empírica en Lubbock, Texas llamado “Teen Straight Talk” (TST, 2007). TST fue diseñado para educar y proveer información sobre los temas de imagen corporal, presión de pares y adolescentes, depresión y suicidio, en conjunto con el desarrollo sexual y el entendimiento acerca de cómo funciona nuestro cuerpo, abstinencia, métodos anticonceptivos, embarazo juvenil, enfermedades de transmisión sexual, protección y responsabilidad sexual. El programa intenta reducir las barreras entre adultos y padres de familia y sus hijos adolescentes, y se ha implementado en ingles y español. TST es un esfuerzo conjunto entre investigadores, estudiantes de pregrado y postgrado en Texas Tech University y Texas Tech University Ciencias de la Salud y líderes comunitarios. Desde el 2008, datos empíricos han sido recolectados para evaluar las metas del proyecto: a) Entender el conocimiento y las actitudes de los padres acerca del desarrollo sexual y a la vez informar acerca de la necesidad y los beneficios de los programas comprensivos de educación sexual para padres y adolescentes, b) Entrenar estudiantes voluntarios para promover la salud y el desarrollo sexual de los adolescentes en la comunidad de Lubbock

Coincidência de conexão do tom emocional com abstração e o resultado psicoterapêutico / Coincidence of connecting emotional tone with abstraction and the psychotherapeutic outcome

O estudo objetivou testar a afirmação de que "pacientes que não têm êxito em conectar suas emoções com cognição durante suas terapias provavelmente não melhorarão". Dois processos de psicoterapias psicodinâmicas breves, um bem-sucedido e outro malsucedido, foram analisados com o Modelo dos Ciclos Terapêuticos. O Modelo dos Ciclos Terapêuticos é um método de análise de texto por computador que permite identificar padrões de emoção-abstração na narrativa de interlocutores. Quatro padrões são identificados: Relaxamento, Experiência, Reflexão e Conexão. Momentos clinicamente significantes são mais associados à Conexão. Levantou-se a hipótese de que o caso bem-sucedido apresentaria maior proporção de Conexão. Quanto à Reflexão, ao Relaxamento e à Experiência, não eram esperadas diferenças. Encontrou-se maior proporção de Conexão e de Relaxamento no caso bem- sucedido, e diferenças não significantes em Reflexão e Experiência. Considerações sobre a magnitude das mudanças, valência das emoções e abstrações e sequência de ocorrência dos padrões sugerem novas análises.(AU)

The current study aimed to test the statement that "patients who do not succeed in connecting their emotions with cognition during therapy are unlikely to improve". Two processes of brief psychodynamic psychotherapies, one successful the other not, were analyzed in accordance with the Therapeutic Cycles Model. The Therapeutic Cycles Model is a computer-assisted text analysis method that permits the identification of emotion-abstraction patterns in narratives by interlocutors. Four patterns are identified: Relaxing, Experiencing, Reflecting and Connecting. Clinically significant moments are mostly associated with Connecting. It was hypothesized that a successful process would differ from an unsuccessful one, having a higher proportion of Connecting. As far as Reflecting, Experiencing and Relaxing are concerned, no differences were expected. Results pointed to a higher proportion of Connecting and Relaxing in the successful process and no difference in respect of Experiencing and Reflecting. Considerations about the magnitude of change, emotion and abstraction valence and the sequence of patterns, suggest further analysis.(AU)

Coincidência de conexão do tom emocional com abstração e o resultado psicoterapêutico / Coincidence of connecting emotional tone with abstraction and the psychotherapeutic outcome

O estudo objetivou testar a afirmação de que "pacientes que não têm êxito em conectar suas emoções com cognição durante suas terapias provavelmente não melhorarão". Dois processos de psicoterapias psicodinâmicas breves, um bem-sucedido e outro malsucedido, foram analisados com o Modelo dos Ciclos Terapêuticos. O Modelo dos Ciclos Terapêuticos é um método de análise de texto por computador que permite identificar padrões de emoção-abstração na narrativa de interlocutores. Quatro padrões são identificados: Relaxamento, Experiência, Reflexão e Conexão. Momentos clinicamente significantes são mais associados à Conexão. Levantou-se a hipótese de que o caso bem-sucedido apresentaria maior proporção de Conexão. Quanto à Reflexão, ao Relaxamento e à Experiência, não eram esperadas diferenças. Encontrou-se maior proporção de Conexão e de Relaxamento no caso bem- sucedido, e diferenças não significantes em Reflexão e Experiência. Considerações sobre a magnitude das mudanças, valência das emoções e abstrações e sequência de ocorrência dos padrões sugerem novas análises.

The current study aimed to test the statement that "patients who do not succeed in connecting their emotions with cognition during therapy are unlikely to improve". Two processes of brief psychodynamic psychotherapies, one successful the other not, were analyzed in accordance with the Therapeutic Cycles Model. The Therapeutic Cycles Model is a computer-assisted text analysis method that permits the identification of emotion-abstraction patterns in narratives by interlocutors. Four patterns are identified: Relaxing, Experiencing, Reflecting and Connecting. Clinically significant moments are mostly associated with Connecting. It was hypothesized that a successful process would differ from an unsuccessful one, having a higher proportion of Connecting. As far as Reflecting, Experiencing and Relaxing are concerned, no differences were expected. Results pointed to a higher proportion of Connecting and Relaxing in the successful process and no difference in respect of Experiencing and Reflecting. Considerations about the magnitude of change, emotion and abstraction valence and the sequence of patterns, suggest further analysis.

Un nuevo sesgo en la racionalidad: el impacto de las neurociencias en las teorías filosóficas de la racionalidad humana: [revisión] / A new bias in human rationality: the impact of neurosciences in the philosophical theories of human rationality: [review]

Los psicólogos experimentales creen que la investigación sobre los sesgos en la racionalidad humana permite mostrar las estructuras primigenias de la mente, de manera más clara que el estudio sobre los razonamientos válidos. En esta comunicación indago sobre estos sesgos con el propósito de detectar cuáles son los límites reales del funcionamiento racional humano. En la literatura filosófica tradicionalmente se consideró tres tipos de sesgos, a saber: en el razonamiento lógico, en el uso de las leyes probabilísticas y del “pensamiento cálido”. Tomando como referencia los resultados de los estudios neurofisiológicos de A. Damasio propongo un nuevo tipo de sesgo en la racionalidad humana que aún no ha sido considerado en la literatura filosófica. Al mismo lo denomino sesgos del “pensamiento frío”, pues es consecuencia de la falta de emociones y sentimientos en el proceso de toma de decisiones. A su vez, muestro de qué manera estos estudios neurofisiológicos impactan en el pensamiento filosófico pues permiten contar con nueva evidencia empírica acerca de los sesgos en la racionalidad y posibilitan una evaluación y corrección de algunas teorías de la racionalidad humana.

Experimental psychologists believe that research on human rationality biases allow for a better understanding of the primordial structures of the mind than studies on valid reasoning do. In this communication I inquire into human rationality biases to better understand the true limits of the functioning of human rationality. Three types of human rationality biases were typically considered in the philosophical literature: logical reasoning biases, biases in the use of probabilistic laws and biases related to the “hot-thinking”. Here I propose a new type of bias in human rationality, not considered before in philosophical literature, and taking the results of neurophysiologic studies carried out by A. Damasio as a reference. I refer to this new bias as “cold-thinking”, since it results from the lack of emotions and feelings in the decision making process. In addition, I show how the mentioned neurophysiologic studies impact on philosophical thinking, since the studies provide new empiric evidence on human rationality biases, enabling the assessment and adjustment of human rationality theories.