Improvements of complex post-traumatic stress disorder symptoms during a multimodal psychodynamic inpatient rehabilitation treatment - results of an observational single-centre pilot study.

Background: Complex post-traumatic stress disorder (CPTSD) describes chronic disturbances in self-organization (i.e. affect dysregulation; negative self-concept; severe difficulties in relationships) which are frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. So far, evidence of psychodynamic treatment approaches for CPTSD is scarce.Methods: In this single-centre observational pilot study, symptom change during a 6-week psychodynamic inpatient treatment in a multimodal psychosomatic rehabilitation centre was evaluated using repeated measures analyses of variance (ANOVAs). Patients completed questionnaires on PTSD and CPTSD symptoms (ITQ), anxiety, depression and somatization (BSI-18), functional impairment (WHODAS) and epistemic trust, mistrust and credulity (ETMCQ) before (T1) and at the end of treatment (T2). A hierarchical linear regression analysis was calculated to identify factors associated with improved CPTSD symptoms.Results: A total of n = 50 patients with CPTSD were included in the study, of whom n = 40 (80%) completed treatment. Patients reported a significant reduction of CPTSD symptoms during treatment with a large effect size (-3.9 points; p < .001; η2 = .36), as well as a significant reduction of psychological distress (p < .001; η2 = .55) and functional impairment (p < .001; η2 = .59). At the end of treatment, 41.0% of patients no longer fulfilled the diagnostic criteria for CPTSD. Changes in epistemic stance included improved epistemic trust (ß = -.34, p = .026) and decreased epistemic credulity (ß = .37, p = .017), which together with lower age (ß = .43, p = .012) and lower depression levels at baseline (ß = .35, p = .054) were significantly associated with baseline adjusted mean change of CPTSD symptoms during therapy and explained 48% of its variance.Discussion: In our study, patients reported a significant reduction of CPTSD symptoms and comorbid symptoms during a multimodal psychodynamic inpatient rehabilitation treatment. Improved epistemic trust may facilitate the establishment of a trusting therapeutic relationship, thus fostering an environment of openness for knowledge transfer (i.e. social learning) and the exploration of diverse viewpoints and perspectives in the therapeutic process.

Complex post-traumatic stress disorder (CPTSD) is a condition often found in individuals who have experienced severe trauma, such as childhood abuse or torture.A study involving 50 patients with CPTSD showed significant improvements in symptoms and overall quality of life after undergoing a 6-week integrative multimodal psychodynamic inpatient rehabilitation treatment.The study also highlighted that improvement in epistemic trust could be a potential mechanism of change contributing to the positive therapeutic outcomes.

Sudden gains in routine clinical care: application of a permutation test for trauma-focused cognitive behavioural therapy.

Background: Sudden gains, defined as large and stable improvements of psychopathological symptoms, are a ubiquitous phenomenon in psychotherapy. They have been shown to occur across several clinical contexts and to be associated with better short-term and long-term treatment outcome. However, the approach of sudden gains has been criticized for its tautological character: sudden gains are included in the computation of treatment outcomes, ultimately resulting in a circular conclusion. Furthermore, some authors criticize sudden gains as merely being random fluctuations.Objective: Use of efficient methods to evaluate whether the amount of sudden gains in a given sample lies above chance level.Method: We used permutation tests in a sample of 85 patients with posttraumatic stress disorder (PTSD) treated with trauma-focused cognitive behaviour therapy in routine clinical care. Scores of self-reported PTSD symptom severity were permuted 10.000 times within sessions and between participants to receive a random distribution.Results: Altogether, 18 participants showed a total of 24 sudden gains within the first 20 sessions. The permutation test yielded that the frequency of sudden gains was not beyond chance level. No significant predictors of sudden gains were identified and sudden gains in general were not predictive of treatment outcome. However, subjects with early sudden gains had a significantly lower symptom severity after treatment.Conclusions: Our data suggest that a significant proportion of sudden gains are due to chance. Further research is needed on the differential effects of early and late sudden gains.

Treatment-related sudden gains exhibit clinical significance when their manifestation is above chance level.We used permutation tests to examine their occurrence in trauma-focused cognitive behaviour therapy as applied in a naturalistic treatment setting.The occurrence of sudden gains in general was not significantly higher than chance, yet early sudden gains were associated with improved treatment outcome.

Definición, descripción y conceptualización en la psicoterapia. Una visión desde las ciencias comportamentales y evidencias

In this document, psychotherapeutic practice is described from a perspective of science and evidence, using as an instrument the definitions, descriptions, and conceptualizations subsequently supported by a naturalistic and non-mediational position. Starting from the conception with psychotherapy free of union biases or any particular approach. First, a description of what it is and its phases is addressed. Then, conceptualizations in psychotherapy of personal and social problems and procedures were established. Finally, this document concludes based on the criteria proposed by the (American Psychological Association (APA), 2006) and the Plan for Comprehensive Action on Mental Health (World Health Organization, 2013) for a practice based on evidence.

En el presente documento, se describe la práctica psicoterapéutica desde una perspectiva de la ciencias y evidencias, usando como instrumento definiciones, descripciones y conceptualizaciones apoyado posteriormente por una postura naturalista y no mediacional. Partiendo desde una concepción de la psicoterapia libre de sesgos gremiales o desde alguna aproximación particular. Primero, se aborda una descripción sobre qué es y sus fases. Luego, se establecen las conceptualizaciones en psicoterapia, de problema personal y social y de procedimientos. Finalmente se concluye con el presente documento a partir de los criterios propuestos por la (American Psychological Association (APA), 2006) y el Plan para la acción integral sobre salud mental  (Organización Mundial para la Salud, 2013) para una práctica basada en la evidencia.

Freiburg personality inventory in inflammatory bowel disease: diagnosis and psychotherapeutic needs / Inventario de personalidad de Freiburg en la enfermedad inflamatoria intestinal: diagnóstico y necesidades psicoterapéuticas

A pesar de los descubrimientos recientes, los pacientes con enfermedad inflamatoria intestinal (EII) aún enfrentan desafíos para lograr la remisión. Los objetivos del estudio fueron identificar las características de los pacientes con el Inventario de Personalidad de Freiburg y la intensidad de la enfermedad colónica, comorbilidades que podrían estar relacionadas con la personalidad de los sujetos. Los datos se recopilaron en el período 2019-2020 de 46 pacientes y utilizaron métodos no paramétricos. En comparación con el grupo de control, las escalas de Inhibición, Problemas de salud y Emocionalidad tenían puntuaciones brutas significativamente más altas. Las escalas de Orientación Social, Franqueza y Extraversión tuvieron puntajes brutos significativamente más bajos. El estado de salud fue un factor médico que influyó en la escala de Quejas Somáticas, los pacientes que tenían lesiones o comorbilidades tenían puntuaciones brutas significativamente más altas. Los pacientes que tenían comorbilidades además de la EII tenían puntuaciones brutas considerablemente más altas en la escala de Excitabilidad. Se requieren intervenciones psicoterapéuticas de cambio en la percepción de la vida para abordar la descripción del sufrimiento subjetivo relacionado con molestias físicas (escala de quejas somáticas), una fuerte orientación hacia el rendimiento (escala de tensión), cambios de humor, ansiedad y pesimismo (escala de emocionalidad). Otra intervención es la reconsideración y (re)priorización de valores, como la familia, las relaciones íntimas, los amigos, la salud, el crecimiento, el desarrollo, el trabajo equilibrado, todos los cuales pueden promover una sensación de bienestar y equilibrio.(AU)

Despite recent discoveries, patients with inflammatory bowel disease (IBD) still face challenges with attainment of remission. The objectives of the study were to identify the characteristics of patients with the Freiburg Personality Inventory and the intensity of the intestinal disease, comorbidities that could be related to the personality of the subjects. Data were collected in the period 2019–2020 from 46 patients and used nonparametric methods. Compared to the normative sample, the Inhibitedness, Health Concerns, and Emotionality scales had significantly higher raw scores. The Social Orientation, Frankness, and Extraversionscales had significantly lower raw scores. Health status was a medical factor that influenced the Somatic Complaintsscale, patients who had lesions or comorbidities had significantly higher raw scores. Patients who had comorbidities in addition to IBD had considerably higher raw scores on the Excitability scale. Psychotherapeutic change interventions regarding life perception are required to tackle the description of subjective suffering related to physical inconveniences (Somatic Complaintsscale), a strong orientation toward performance (Strainscale), mood swings, anxiety, and pessimism (Emotionality scale). Another intervention is reconsidering values and (re) prioritization, such as family, intimate relationships, friends, health, growth, development, balanced work, all of which can promote a feeling of well-being and balance.(AU)

Helpful and meaningful aspects of a psychoeducational programme to treat complex dissociative disorders: a qualitative approach.

Purpose: Complex dissociative disorders (CDDs) are prevalent among psychotherapy clients, and research suggests carefully paced treatment for CDDs is helpful. The purpose of the present study is to qualitatively explore helpful and meaningful aspects of the TOP DD Network programme, a web-based adjunctive psychoeducational programme for the psychotherapeutic treatment of clients with CDDs.Methods: TOP DD Network programme participants (88 clients and 113 therapists) identified helpful and meaningful aspects of their participation in response to two open textbox questions. Framework analysis was used to qualitatively analyze client and therapist responses.Findings: Participants found the TOP DD Network programme helpful and meaningful in nuanced ways. Three themes were created: (1) Components of the Programme (subthemes: content, structure), (2) Change-Facilitating Processes (subthemes: heightened human connection, receiving external empathy and compassion, contributing to something bigger, improved therapeutic work and relationship), and (3) Outcomes (subthemes: insight, increased hope, self-compassion, increased safety and functioning). The most emphasized theme was components of the programme, which captured its content and structure.Conclusion: Clients and therapists in the TOP DD Network programme described the programme's components and processes as helpfully facilitating positive outcomes in the treatment of CDDs. Therapists may consider integrating the components and processes in the programme into their practice with clients with CDDs.

The aim of the present study was to qualitatively explore significant aspects of the TOP DD Network programme through the experiences of complex dissociative disorder (CDD) clients and psychotherapists.Helpful and meaningful aspects of the programme included its components (i.e. content and structure), processes, and outcomes.This psychoeducational programme can be effective and result in improved therapeutic processes and outcomes for individuals with CDDs in psychotherapy.

DNA methylation changes in association with trauma-focused psychotherapy efficacy in treatment-resistant depression patients: a prospective longitudinal study.

Background: Stressful events increase the risk for treatment-resistant depression (TRD), and trauma-focused psychotherapy can be useful for TRD patients exposed to early life stress (ELS). Epigenetic processes are known to be related to depression and ELS, but there is no evidence of the effects of trauma-focused psychotherapy on methylation alterations.Objective: We performed the first epigenome-wide association study to investigate methylation changes related to trauma-focused psychotherapies effects in TRD patients.Method: Thirty TRD patients assessed for ELS underwent trauma-focused psychotherapy, of those, 12 received trauma-focused cognitive behavioural therapy, and 18 Eye Movement Desensitization and Reprocessing (EMDR). DNA methylation was profiled with Illumina Infinium EPIC array at T0 (baseline), after 8 weeks (T8, end of psychotherapy) and after 12 weeks (T12 - follow-up). We examined differentially methylated CpG sites and regions, as well as pathways analysis in association with the treatment.Results: Main results obtained have shown 110 differentially methylated regions (DMRs) with a significant adjusted p-value area associated with the effects of trauma-focused psychotherapies in the entire cohort. Several annotated genes are related to inflammatory processes and psychiatric disorders, such as LTA, GFI1, ARID5B, TNFSF13, and LST1. Gene enrichment analyses revealed statistically significant processes related to tumour necrosis factor (TNF) receptor and TNF signalling pathway. Stratified analyses by type of trauma-focused psychotherapy showed statistically significant adjusted p-value area in 141 DMRs only for the group of patients receiving EMDR, with annotated genes related to inflammation and psychiatric disorders, including LTA, GFI1, and S100A8. Gene set enrichment analyses in the EMDR group indicated biological processes related to inflammatory response, particularly the TNF signalling pathway.Conclusion: We provide preliminary valuable insights into global DNA methylation changes associated with trauma-focused psychotherapies effects, in particular with EMDR treatment.

Stressful events increase treatment-resistant depression, and trauma-focused psychotherapy can be useful for these patients.Epigenome-wide data shows changes associated with trauma-focused psychotherapies, especially eye movement desensitization and reprocessing therapy, in treatment-resistant depression patients.Genes and biological pathways related to inflammatory and immune systems are among the most statistically significant results.

Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder.

Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes.Objective: Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP.Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (n = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised.Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted post-MDMA-AP self-reported PTSD severity.Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary.Trial registration: ClinicalTrials.gov identifier: NCT00090064.

Among individuals with chronic posttraumatic stress disorder, therapeutic alliance predicted changes in posttraumatic stress disorder severity following MDMA-assisted psychotherapy.Therapeutic alliance may play a key role in facilitating therapeutic improvement within MDMA-assisted psychotherapy.Further research remains necessary to confirm these preliminary findings and the role of therapeutic alliance in MDMA-assisted psychotherapy.

Implicancias teórico-clínicas de las prácticas psicoterapéuticas feministas o con perspectiva de género en Chile / Theoretical-clinical implications of feminist or gender-sensitive psychotherapeutic practices in Chile

Este artículo tiene como objetivo comprender, mediante el análisis de 16 entrevistas semies-tructuradas, las implicancias teórico-clínicas del posicionamiento con perspectiva de género o feminista en la práctica psicoterapéutica contemporánea en Chile, desde la perspectiva de consultantes y psicoterapeutas. Como resultados, se observa que el valor de esta psicoterapia radica en entregar una lectura sociocultural del malestar generizado. Sin embargo, quienes consultan reproducen estereotipos de género al elegir este enfoque a propósito del género fe-menino de la psicoterapeuta, pues consideran que habría un mayor entendimiento “por ser mu-jer”, lo cual les garantizaría un espacio seguro, libre de juicios y revictimización. Se destaca que las intervenciones de este enfoque tienen un componente político que favorece el trabajo de la desculpabilización de las consultantes. Esto resulta favorable en ciertos casos, pero po-dría obstaculizar el abordaje y reconocimiento de aquellas características singulares del sujeto que inciden en el sufrimiento y trascienden la certeza ideológica. (AU)

This article aims to understand, through 16 semi-structured interviews analysis, the theoreti-cal-clinical implications of the gender or feminist perspective in contemporary psychothera-peutic practice in Chile, from the perspective of consultants and psychotherapists. As a result, it is observed that the value of this psychotherapy lies in providing a sociocultural reading of gendered discomfort. However, those who consult reproduce gender stereotypes by choosing this approach due to the female gender of the psychotherapist, as they consider that there would be a better understanding “because of her being a woman”, which would guarantee them a safe space, free of judgments and revictimization. It should be noted that the inter-ventions of this approach have a political component that favors the work of disempowerment of the consultants. This is favorable in certain cases but could hinder the approach and recog-nition of those unique characteristics that affect particularsuffering in every case and trans-cend ideological certainty. (AU)

O eu em nós: marcas e aproximações de uma diretora no processo psicoterápico / The self in us: marks and approaches of a director in the psychotherapeutic process / El yo dentro de nosotros: marcas y enfoques de una directora en el proceso psicoterapêutico

RESUMO O objetivo deste trabalho foi aprofundar as marcas e aproximações de uma diretora no processo psicoterápico. Trata-se de um estudo de caso psicodramático utilizando o registro documental de sessões de psicoterapia bipessoal de três pacientes atendidas anteriormente pela primeira autora e os relatos da própria autora sobre suas percepções nos atendimentos. Foram apresentadas reflexões que demonstram resultados positivos sobre as aproximações na relação psicoterapêutica mediante o humor, a poesia e a música como formas de conexão entre psicodramatista e cliente.

ABSTRACT The objective of this work was to deepen the approaches and distances of a director in the psychotherapeutic process. This is a psychodramatic case study that used the documentary record of bipersonal psychotherapy sessions of three patients previously attended by the first author and the author's own reports about her perceptions in the sessions. Reflections were presented that demonstrate positive results regarding the approaches in the therapeutic relationship, using humor, poetry, and music as means of connection between the psychodramatist and the client.

RESUMEN El objetivo de este trabajo fue profundizar los acercamientos y distancias de una directora en el proceso psicoterapéutico. Se trata de un estudio de caso psicodramático utilizando el registro documental de sesiones de psicoterapia bipersonal de tres pacientes atendidos previamente por la primera autora y los relatos de la propia autora sobre sus percepciones en las sesiones. Se presentaron reflexiones que demuestran resultados positivos en relación a las aproximaciones en la relación terapéutica, utilizando el humor, la poesía y la música como formas de conexión entre el psicodramatista y el cliente.

Children's online care during COVID-19 / Atendimento on-line infantil em tempos de COVID-19

Objective: This study aims at shedding light on online child psychotherapy using cognitive-behavioral therapy as well as suggesting forms of psychological interventions during a pandemic. Method: Since the beginning of the recent coronavirus (SARS-CoV-2) outbreak, which causes COVID-19, there has been a great concern about a disease that has rapidly spread over the world, bringing about several different socio-economic issues. The fear of contracting the disease has led to safety measures and uncertainties with regard to the future, and it is believed that social isolation has had a direct and psychological impact on both adults and children. This way, we conducted a systematic search for literature review articles. Results: The clinical practice has led to observe that children had their routine interrupted and, consequently, prevented from basic activities such as going to school, being separated from friends, being apart from grandparents, spending the day with their parents, and not to mention, depending on their age, attending online classes in the most varied ways. Conclusion: It is clear that through the use of cognitive-behavioral therapy, forms of psychological interventions can be suggested in the face of the COVID-19 pandemic. Thus, it is clear that effective results are possible with online intervention.

Objetivo: O objetivo deste estudo é sistematizar conhecimentos sobre o atendimento online infantil através da terapia cognitivo-comportamental e sugerir formas de intervenções psicológicas diante da pandemia de COVID-19. Método: Desde o início do surto do coronavírus (SARS-CoV-2), causador da COVID-19, houve preocupação diante de uma doença que se alastrou rapidamente em várias regiões do mundo, com diferentes impactos. Além do medo de contrair a doença, dos cuidados com os familiares e das incertezas frente ao futuro, o isolamento causou impactos psicológicos diretamente relacionados à COVID-19 tanto em adultos como em crianças. Deste modo, foi feita uma busca sistemática por artigos. Resultados: A prática clínica levou ao entendimento de que as crianças passaram por mudanças, como a interrupção das idas à escola, o afastamento dos amigos e dos avós e a presença dos pais o dia todo em casa, além de, dependendo da idade, aulas online em diversos estilos, e a percepção de que os pais também não sabiam como lidar com a situação. Conclusão: Percebe-se que através do uso da terapia cognitivo-comportamental pode-se sugerir formas de intervenções psicológicas diante da pandemia de COVID-19. Assim, nota-se que resultados efetivos são possíveis com a intervenção on-line.

Castilla del Pino: un faro indispensable para navegantes de lo mental / Castilla del Pino: An Essential Lighthouse for Navigators of the Mental

Castilla del Pino ejerció un indudable liderazgo intelectual sobre varias generacio-nes de españoles en el último tercio del siglo XX, y de forma particular ejerció su función de intelectual aplicado a la práctica clínica de lo mental. Esta tarea constituyó un verdadero ma-gisterio para los profesionales interesados en prácticas clínicas rigurosas, respetuosas con la dignidad y los derechos de los pacientes. En este trabajo se revisan algunas de sus principa-les aportaciones como intelectual a la práctica psiquiátrica y la psicoterapia. Específicamen-te, se abordan sus contribuciones al estudio de la influencia de la ideología en la psicoterapia y la ideología de la locura y su impacto en la práctica psiquiátrica en contexto hospitalario. Sus observaciones y recomendaciones significan una magnífica guía para el ejercicio de la observación rigurosa, la reflexión y el pensamiento crítico frente al dogmatismo. (AU)

Castilla del Pino was an undoubted intellectual leader over several generations of Spaniards in the last third of the 20th century. He specifically played this role as an intellectual in the field of the mental health practice. This task constituted a true teaching for professionals interested in rigorous clinical practices, respectful of the dignity and rights of patients. This paper reviews some of his main contributions as an intellectual to psychiatric practice and psychotherapy. It specifically addresses his contributions to the study of the influence of ideology in psychotherapy, as well as the ideology of madness and its impact on psychiatric practice in a hospital context. His observations and recom-mendations are an excellent guide to the exercise of rigorous observation, reflection and critical thinking facing any dogmatism. (AU)

A experiência de atendimento de um grupo terapêutico durante a graduação: a obstaculização pelo pacto denegativo / La experiencia de asistir a un grupo terapéutico durante la graduación: el obstáculo causado por el pacto negativo / The experience of attending a therapeutic group during graduation: the obstacle caused by the negative pact

Grupos psicoterapêuticos encontram crescente receptividade nos serviços públicos e privados de saúde. Eles conjugam a expansão da capacidade de atendimento com atuação clínica crítica e propositiva frente ao individualismo da sociedade contemporânea. É importante assim pensarmos os desafios da formação dos psicólogos para este trabalho. Este artigo parte de uma dificuldade encontrada por estagiários de 4° e 5° ano do curso de psicologia, na condução de um grupo psicoterapêutico. Coloca-se como objetivo analisar a relação entre um pacto denegativo que obstaculiza o processo terapêutico com as experiências iniciais de atendimento dos estagiários. Aspectos vivenciados serão apresentados e debatidos à luz da teoria. Descreve-se a existência de um pacto denegativo neste grupo, que se opõe ao processo terapêutico dos pacientes e complexifica o desenvolvimento dos estagiários ao desafiar a confiança em suas percepções e associações, dificultando a realização de intervenções. Conclui-se que o pacto denegativo que obstaculiza o grupo se apresenta, a princípio, como um desafio aos estagiários, porém, mediante o apoio na relação entre os estagiários e supervisão é possível transformar este desafio em fonte de aprendizado.

Grupos psicoterapéuticos son cada vez más recibidos en los servicios de salud. Combinan la expansión de la capacidad de servicio con una acción clínica crítica y decidida frente al individualismo de la sociedad contemporánea. Es importante pensar en los desafíos de formar psicólogos para este trabajo. Este artículo se basa en una dificultad que enfrentan los pasantes de 4° y 5° año de psicología al momento de conducir un grupo psicoterapéutico. El objetivo es analizar la relación entre un pacto negativo que obstruye el proceso terapéutico y las experiencias de cuidado de los internos. Se debatirán experiencias y la teoría. Se describe la existencia de un pacto negativo, que se opone al proceso terapéutico de los pacientes e intensifica el desafío de los alumnos al desafiar la confianza en sus percepciones y asociaciones, lo que dificulta la realización de intervenciones. Se concluye que el pacto negativo que obstaculiza al grupo se presenta, en un primer momento, como un reto para los aprendices, sin embargo, a través del apoyo en la relación entre los aprendices y la supervisión es posible transformar este reto en una fuente de aprendizaje.

Psychotherapeutic groups are increasingly employed in health services. They combine the expansion of the service capacity with critical and purposeful clinical action in face of the individualism of contemporary society. It is important to think about the challenges of training psychologists for this work. This article is based on a difficulty encountered by 4th and 5th year psychology students, acting as trainees, when conducting a psychotherapeutic group. The objective is to analyze the relationship between a denegative pact that obstructs the therapeutic process and the trainees' initial clinical experience. This text debates aspects of this practice in light of theory. It describes a denegative pact in this group, which opposes the patients' therapeutic process and intensifies the trainees' challenge by challenging the trust in their perceptions and associations, making it more difficult for them to find spaces to intervene. It concludes that the negative pact that hinders the group presents itself, in principle, as a challenge to the trainees, however, through support in the relationship between the trainees and supervision it is possible to transform this challenge into a source of learning.

Avoidant restrictive eating disorder and panic attacks in an adult man: A case report / Trastorno evitativo restrictivo de la ingesta alimentaria y ataques de pánico en un hombre adulto: Reporte de caso

Abstract Avoidant or Restrictive Food Intake Disorder (ARFID) is an eating disorder (ED) not common in adults. In this article we present a clinical case of ARFID in a 37-year-old male patient treated in an ED center in Medellin, Colombia; displaying anxious symptoms that began a year earlier and concomitant weight loss, following a traumatic event causing an overall impairment with that patient. Several medical evaluations/examinations looking for organic causes, were excluded. Interventions were implemented by a psychiatry, a psychotherapist using cognitive-behavior therapy (CBT), and a nutritionist, all in face-to-face modality, which were carried out weekly for the first three months, then biweekly and subsequently quarterly. each lasting approximately 40-60 minutes. After the set of pharmacological interventions and psychotherapy, a great improvement in the functionality of the patient was observed. Improvement was found with respect to eating in public, food variation and panic attacks. In the absence of guidelines, it is important to use standardized and replicable treatments in this population.

Resumen El trastorno evitativo restrictivo de la ingesta (TERIA) es un trastorno alimentario (TCA) raro en adultos. Se presenta el caso de un hombre de 37 años con TERIA y trastorno de pánico atendido en un centro para TCA en Medellín, Colombia, quien presentó un año de síntomas ansiosos y pérdida de peso después de evento traumático, generando disfuncionalidad. Fue evaluada y excluida organicidad. Se realizaron intervenciones por parte de psiquiatría, psicoterapia con enfoque cognitivo conductual y nutrición, todas en modalidad presencial, las cuales se realizaron semanalmente los primeros tres meses, luego quincenalmente y posteriormente trimestralmente. Cada una con una duración de 40-60 minutos aproximadamente por sesión. Posterior al conjunto de intervenciones farmacológicas y psicoterapia, se observó una gran mejoría la funcionalidad del paciente, se encontró mejoría con respecto a comer en público, variación en los alimentos y ataques de panico. Ante la ausencia de guías de manejo de TERIA en adultos es relevante realizar tratamientos estandarizados que puedan ser replicados.

Supervisión en una Unidad de Clínica de Adultos de un Centro de Salud Mental Universitario: Un Estudio Cualitativo del Proceso

Introducción: Las supervisiones clínicas cumplen un rol esencial dentro de la formación profesional del psicólogo clínico. Se han desarrollado diferentes modelos de supervisión, sin embargo, pocos estudios abordan el cómo se desarrolla el proceso de supervisión propiamente tal. Objetivo: Describir las dinámicas de supervisión clínica grupal en la Unidad de Adultos del Servicio de Psicología Integral de una Clínica Universitaria, que proporciona atención psicológica a la comunidad. Metodología: Estudio cualitativo descriptivo y de alcance transversal, en una muestra de 5 sesiones de supervisión videograbadas, cuya interacción verbal fue sometida a análisis de contenido convencional. Resultados: Se distinguen aspectos de la apertura del proceso de supervisión, en el cual se identifica una dificultad variable de los supervisados para formular preguntas de supervisión, dificultad enmarcada en un contexto de involucramiento afectivo de los supervisados. Se identifican intervenciones de los miembros del equipo de supervisión: una transversal de validación de la experiencia del supervisado; e intervenciones durante el proceso de supervisión, como, por ejemplo, preguntas dirigidas a revisar "la experiencia" del supervisado durante la atención del caso; "construcción de hipótesis comprensivas del caso", y la entrega de "sugerencias para el abordaje terapéutico" del caso en específico, y/o que pueden ser aplicados a otros casos.

Background: Clinical supervision plays an essential role in the professional training of clinical psychologists. Different supervision models have been developed; however, few studies address how the ongoing process of supervision is developed. Objective: To describe the dynamics of clinical group supervision at the Adult Unit of the Clinical Psychology Service of a University Clinic, which provides psychological care to the community. Methodology: A descriptive qualitative study of cross-sectional scope, in a sample of 5 video-recorded supervision sessions, whose verbal interaction was subjected to conventional content analysis. Results: Aspects of the opening of the supervision process are distinguished, in which a different degree of difficulties of the supervisees to formulate supervision questions is identified, a difficulty framed in a context of affective involvement of the supervisees. Interventions by members of the supervision team are identified: a validation of the supervisee's experience which is present each one supervision process; and specific interventions during the supervision process, for example, questions aimed at reviewing «the experience» of the supervisee during the care of the case; «construction of comprehensive hypotheses of the case», and the delivery of «suggestions for the therapeutic approach» of the specific case, and/or that can be applied to other ones.

Cambio de la atención psicológica presencial a modalidad remota: facilitadores y obstáculos en la pandemia de COVID-19 / Changing face-to-face psychological care to remote mode: facilitators and obstacles in the COVID-19 pandemic / Mudança do atendimento psicológico presencial para modalidade remota: facilitadores e dificultadores na pandemia de COVID-19

Objetivo: verificar asociaciones entre variables sociodemográficas y factores que facilitan y dificultan la transición de la atención psicológica presencial a la modalidad remota en el primer año de la pandemia de COVID-19. Método: se trata de un estudio analítico, cuantitativo y de corte transversal. Después de la aprobación del Comité de Ética en Investigación, la recolección de datos se realizó mediante la aplicación de un formulario en línea que consta de 55 preguntas. Los datos fueron analizados utilizando técnicas de estadística descriptiva e inferencial. Resultados: la muestra de conveniencia estuvo compuesta por 385 psicólogos brasileños, en su mayoría mujeres (67,01%), jóvenes profesionales con hasta cinco años de actuación después de la graduación (44,16%) y predominio de actividades en la clínica privada. Se encontró que el tiempo de formación entre cinco y 10 años se asoció con una mayor percepción de dificultades y que la experiencia previa con la atención a distancia facilitó la adaptación en la transición de una modalidad a otra. Conclusión: considerando que la teleasistencia puede ser una poderosa herramienta en el escenario de la salud, se sugiere que los temas de la teleasistencia sean incluidos en la agenda de investigación y los contenidos programáticos en los currículos de los cursos de formación en salud.

Objective: to verify associations between sociodemographic variables and factors that facilitate and hinder the transition from face-to-face psychological care to remote mode in the first year of the COVID-19 pandemic. Method: this is an analytical, quantitative, cross-sectional study. After approval by the Research Ethics Committee, data collection was performed by applying an online form consisting of 55 questions. Data were analyzed using descriptive and inferential statistics techniques. Results: the intentional sampling consisted of a total of 385 Brazilian psychologists, mostly women (67.01%), young professionals with up to five years of graduation (44.16%) most of activities in the private clinic. It was found that training time between five and 10 years was associated with a greater perception of difficulties and that previous experience with remote care facilitated adaptation in the transition from one modality to another. Conclusion: considering that call center can be a powerful tool in the health scenario, it is suggested the inclusion of remote care issues in the research agenda and syllabus in the curricula of health training courses.

Objetivo: verificar associações entre variáveis sociodemográficas e fatores facilitadores e dificultadores da transição do atendimento psicológico presencial para a modalidade remota no primeiro ano da pandemia de COVID-19. Método: trata-se de um estudo analítico, quantitativo, de corte transversal. Após aprovação do Comitê de Ética em Pesquisa, a coleta foi realizada mediante aplicação de um formulário online composto por 55 questões. Os dados foram analisados por meio de técnicas de estatística descritiva e inferencial. Resultados: a amostra de conveniência foi composta por 385 psicólogos brasileiros, majoritariamente mulheres (67,01%), jovens profissionais com até cinco anos de ofício após a graduação (44,16%) e com predomínio de atividades na clínica privada. Constatou-se que o tempo de formação entre cinco e 10 anos foi associado com uma maior percepção de dificuldades e que a experiência prévia com atendimento remoto foi facilitadora da adaptação na transição de uma modalidade à outra. Conclusão: considerando que o teleatendimento pode ser uma ferramenta potente no cenário da saúde, sugere-se a inclusão das questões do atendimento remoto na agenda de pesquisa e conteúdos programáticos das grades curriculares dos cursos de formação em saúde.

Moderate-intensity aerobic exercise training as an adjunct to trauma-focused psychotherapy in traumatized refugees and asylum seekers: study protocol of a randomized controlled trial.

Background: Refugees with exposure to multiple traumatic events are at high risk for developing posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an effective treatment for the core symptoms of PTSD, but it does not reliably reduce depressive symptoms. Endurance exercise on the other hand was consistently found to be effective in treating depression making it a promising adjunct to NET. Up to date, no studies exist investigating the combination of NET and endurance exercise in a sample of refugees with PTSD and comorbid depression.Objectives: In the proposed randomized controlled trial, we aim to investigate whether a combination of NET and moderate-intensity aerobic exercise training (MAET) enhances treatment outcome for refugees with PTSD and comorbid depressive symptoms. We expect a greater improvement in psychopathology in participants who receive the combined treatment.Methods and analysis: 68 refugees and asylum seekers with PTSD and clinically relevant depressive symptoms will be recruited in the proposed study. Participants will be randomly assigned to receive either NET only (NET-group) or NET plus MAET (NET+-group). All participants will receive 10 NET sessions. Participants in the NET+-group will additionally take part in MAET. Primary (PTSD, depression) and secondary (general mental distress, agoraphobia and somatoform complaints, sleep quality) outcome measures will be assessed before treatment, after treatment, and at six-month follow-up. The hypotheses will be tested with multiple 2 × 3 mixed ANOVA's.Trial registration: German Clinical Trials Register identifier: DRKS00022145.

Refugees are at particularly high risk of developing posttraumatic stress disorder and comorbid depressive symptoms due to exposure to multiple man-made traumatic events.Narrative exposure therapy reliably reduces symptoms of posttraumatic stress disorder, but many patients retain their clinical diagnosis, untreated comorbid depressive symptoms may interfere with treatment response.The randomized controlled trial aims to investigate whether combining narrative exposure therapy with moderate-intensity aerobic exercise training enhances treatment outcomes for refugees with posttraumatic stress disorder and comorbid depressive symptoms, compared to narrative exposure therapy as a stand-alone treatment.

Exploration of eye movement desensitization and reprocessing in treating posttraumatic stress-disorder in patients with acquired brain injury: a retrospective case series.

Background: Posttraumatic stress disorder (PTSD) is prevalent in people with acquired brain injury (ABI). Despite the established efficacy of eye movement desensitization and reprocessing (EMDR) for PTSD in general, evaluation studies on EMDR in ABI patients with PTSD are limited.Objective: The aim of this study is to explore clinical features, treatment characteristics, feasibility and first indications of efficacy of EMDR in adult ABI patients with PTSD.Method: This retrospective consecutive case series included ABI patients, who received at least one session of EMDR for PTSD between January 2013 and September 2020. PTSD symptoms were measured using the Impact of Event Scale (IES) pre- and post-treatment. Affective distress was measured using the Subjective Units of Distress (SUD) pre- and post-treatment of the first target.Results: Sixteen ABI patients (median age 46 years, 50% males), with predominantly moderate or severe TBI (50%) or stroke (25%) were included. Treatment duration was a median of seven sessions. Post-treatment IES scores were significantly lower than pre-treatment scores (p < .001). In 81% of the cases there was an individual statistically and clinically relevant change in IES score. Mean SUD scores of the first target were significantly lower at the end of treatment compared to scores at the start of treatment (p < .001). In 88% of the patients full desensitization to a SUD of 0-1 of the first target was accomplished. Only few adjustments to the standard EMDR protocol were necessary.Conclusions: Findings suggest that EMDR is a feasible, well tolerated and potentially effective treatment for PTSD in ABI patients. For clinical practice in working with ABI patients, it is advised to consider EMDR as a treatment option.

This retrospective consecutive case series (N = 16) explores clinical features, treatment characteristics, feasibility and first indications of efficacy of eye movement desensitization and reprocessing (EMDR) in adult patients with acquired brain injury (ABI) and Posttraumatic stress disorder (PTSD).The results suggest that EMDR is a feasible and potentially efficacious treatment for PTSD in ABI patients, as patients demonstrated statistically and clinically significant large sized reductions in PTSD-symptoms after EMDR treatment.For clinical practice in working with ABI patients, we advise to consider EMDR as a treatment option.

Trabajando con las Preferencias del Consultante en Psicoterapia: Consideraciones Clínicas y Éticas / Working with Client Preferences in Psychotherapy: Clinical and Ethical Considerations

Algunas características de la persona que acude a psicoterapia influyen en los resultados de la misma, siendo estas variables el principal factor asociado al cambio. Un tratamiento diseñado a medida para cada caso resultará mucho más eficaz que otro que no se adapte a la singularidad de cada consultante. Este trabajo se centra en uno de los factores a tener en cuenta, las preferencias de la persona, un pilar fundamental de la práctica basada en la evidencia en psicología. Se revisan las pruebas empíricas disponibles, junto con las implicaciones y recomendaciones clínicas asociadas. A esto le seguirán otras consideraciones de tipo ético, que darán pie a una discusión acerca de los dilemas que se pueden presentar cuando se trabaja con las preferencias de cada persona.(AU)

Some characteristics of the individual who attends psychotherapy influence its outcomes, these variables being the main factor associated with change. A treatment that is tailored to each case will be much more effective than one that does not adapt to the uniqueness of each client. This paper focuses on one of the factors to take into account, the patient’s preferences, a fundamental pillar of evidence-based practice in psychology. Available empirical evidence is reviewed, along with associated clinical implications and recommendations. This is followed by other ethical considerations, which lead to a discussion about the dilemmas that can arise when working with each person’s preferences.(AU)

Trastornos adaptativos y su manejo desde atención primaria / Adaptive disorders and their management in primary care

Introducción: El trastorno de adaptación describe una respuesta emocional y conductual desproporcionada a uno o más estresores psicosociales identificables. Existen múltiples situaciones capaces de generarnos una situación de estrés agudo. Sin embargo, uno de los requisitos necesarios para poder hablar de trastorno adaptativo es que ese o esos factores estresantes supongan un deterioro en el funcionamiento normal del individuo. Objetivos: El objetivo principal de este trabajo es analizar, mediante una revisión bibliográfica, el diagnóstico y abordaje de los trastornos adaptativos dentro del ámbito de Atención Primaria. El objetivo secundario es destacar la importancia de la detección y el tratamiento precoces, así como de la gestión multidisciplinar y la promoción de la salud mental. Resultados: Los principales factores de riesgo de los trastornos adaptativos son el desempleo, los bajos ingresos,el escaso apoyo social, las enfermedades físicas y la salud mental. La prevalencia es mayor en jóvenes,especialmente entre las mujeres, y existe un riesgo aumentado de suicidio en el subtipo de estado de ánimo depresivo. El Cuestionario Internacional de Trastornos Adaptativos es actualmente la principal herramienta diagnóstica, por establecer sus criterios diagnósticos en base a la definición teórica establecida por la CIE-11. El manejo de estos trastornos se realiza principalmente mediante terapia cognitivo-conductual. Conclusiones: Los trastornos de adaptación surgen como respuestas anormales ante ciertas situaciones estresantes. El papel de los médicos de Atención Primaria en el abordaje de este trastorno es primordial, siendo necesaria su detección y manejo precoz para disminuir los niveles de ansiedad disfuncionales que presentan los pacientes.(AU)

Introduction: Adjustment disorder describes a disproportionate emotional and behavioral response to one or more identifiable psychosocial stressors. There are multiple situations capable of generating an acute stressful situation. However, one of the requirements to be able to speak of an adaptive disorder is that the stressor(s) in question should lead to an impairment of the individual's normal functioning.Objectives: The main objective of this work is to analyze , through a literature review, the diagnosis and approach to the diagnosis and management of adaptive disorders in the Primary Care setting. The secondary objective is toemphasize the importance of early detection and treatment, as well as multidisciplinary management and mentalhealth promotion. Results: The main risk factors for adjustment disorders are unemployment, low income, low social support, physical illness, and personal history of mental health. The International Questionnaire of Adaptive Disorders is currently the principal diagnostic tool, as it establishes its diagnostic criteria based on the theoretical definition established by the ICD-11. The management of these disorders is mainly through cognitive behavioural therapy.Conclusions: Adjustment disorders arise as abnormal responses to certain stressful situations. The role of primary care physicians in dealing with this disorder is essential, and early detection and management are necessary to reduce the levels of dysfunctional anxiety that patients present.(AU)

Perfis de jogo de crianças: adaptação do Children's Play Therapy Instrument (CPTI) / Play profiles of children: adaptation of the Children's Play Therapy Instrument (CPTI) / Perfiles de juego de niños: adaptación del Children's Play Therapy Instrument (CPTI)

O brincar e a vida infantil estão inevitavelmente entrelaçados, havendo inúmeras evidências da ação terapêutica do brinquedo para o desenvolvimento infantil e, consequentemente, para o desenrolar da Psicoterapia Psicodinâmica (PP). Para acessar o brincar de crianças de maneira objetiva durante o percurso da PP, foi desenvolvido o Children's Play Therapy Instrument (CPTI). O objetivo desse estudo foi adaptar para o português o CPTI, assim como realizar um estudo piloto para identificar evidências de validade do instrumento, através da análise de perfis de jogo de psicoterapias de três crianças, uma menina e dois meninos, com oito, sete e oito anos, diagnosticados com transtorno de adaptação, transtorno disruptivo da desregulação do humor e transtorno do espectro autista, nível 1, respectivamente. A versão em português do CPTI apresentou boa equivalência com a original e a fidedignidade interavaliadores foi alta, além de serem encontradas evidências preliminares de validade. O instrumento foi capaz de diferenciar os perfis de jogo de cada criança, descrevendo atividades de jogo condizentes com as psicopatologias analisadas. As possibilidades e limitações de utilização do instrumento foram discutidas. (AU)

Play and childhood are inevitably intertwined, with numerous indications of the therapeutic effects of play on child development and, consequently, on the progress of Psychodynamic Psychotherapy (PP). To access children's play during the course of PP, the Children's Play Therapy Instrument (CPTI) was developed. The aim of this study was to adapt the CPTI to Portuguese and to conduct a pilot study to identify validity evidence for the instrument through the analysis of play profiles of psychotherapies involving three children: one girl and two boys, aged eight, seven, and eight, respectively. They were diagnosed with adjustment disorder, disruptive mood dysregulation disorder, and autism spectrum disorder level 1. The Portuguese version of the CPTI showed good equivalence to the original, inter-rater reliability was high, and preliminary evidence of validity was found. The instrument was able to differentiate each child's play profiles, describing play activities consistent with the psychopathologies analyzed. The instrument's possibilities and limitations were discussed. (AU)

El juego y la vida de los niños están inevitablemente entrelazados, con numerosas evidencias de la acción terapéutica del juguete para el desarrollo infantil y, en consecuencia, para el desarrollo de la Psicoterapia Psicodinámica (PP). Para acceder de forma objetiva al juego infantil durante el transcurso de la PP, se desarrolló el Instrumento de Terapia de Juego Infantil (CPTI). El objetivo de este estudio fue adaptar el CPTI al portugués, así como realizar un estudio piloto para identificar evidencias de validez del instrumento, a través del análisis de perfiles de juego de tres psicoterapias con tres niños, se incluye una niña y dos niños de ocho, siete y ocho años, diagnosticados con trastorno de adaptación, trastorno de desregulación disruptiva del estado de ánimo y trastorno del espectro autista, nivel 1, respectivamente. El CPTI mostró una buena equivalencia con el original y la confiabilidad entre evaluadores fue alta. El instrumento logró diferenciar los perfiles de juego de cada niño, describiendo actividades de juego consistentes con las psicopatologías analizadas. Se discutieron las posibilidades y limitaciones del uso del instrumento. (AU)