Psicoterapia breve dinámica y su aplicación en pacientes con trastorno mental severo en una unidad de alta dependencia psiquiátrica / Brief dynamic psychotherapy and its application in patients with severe mental disorder in a high dependency psychiatric unit

El objetivo de este artículo es hacer una revisión de las principales características de la teoría y la técnica de la Psicoterapia Breve Psicoanalítica: conceptos básicos, historia,origen, diferentes definiciones, objetivos, indicaciones y contraindicaciones, así como lasmodificaciones en la técnica con sus característicaspropias y definitorias. Se muestrasu aplicabilidad y utilidad en una Unidad deAlta Dependencia Psiquiátrica (UADP), conresultados efectivos y eficientes en un entornoestructurado en el que paralelo a la psicoterapia,cada uno de los miembros de la Unidadejerce una función terapéutica necesariaen pacientes con un Trastorno Mental Severo.Por último se expone una experiencia en psicoterapia dinámica breve en nuestra UADP. (AU)

The goal of this article is to review the main characteristics of the theory and technique of Brief Psychoanalytic Psychotherapy: basic concepts, history, origin, different definitions, objectives, indications and contraindications,as well as the modificationsin the technique with its own and definingcharacteristics. Its applicability and usefulnessin a Highly Dependent Psychiatric Unitis shown, with effective and efficient resultsin a structured environment, in which, in parallelto psychotherapy, each one of the Unitmembers exercises a necessary therapeuticfunction in patients with a severe mental disorder.Finally, an experience in brief dynamicpsychotherapy in our UADP is exposed. (AU)

Treating systemic issues in families affected by cystic fibrosis: A solution-focused approach.

Cystic fibrosis (CF) presents with various symptoms that impair day-to-day functioning and require lifelong treatment. Due to the chronic and severe nature of this disease, families are often impacted by the stress associated with treatment, complications of the disease, and the understanding that their loved one will one day die from CF. This article seeks to address a perceived gap in the literature for providing a model-specific approach to address psychosocial stress in families affected by CF. We provide a rationale for using solution-focused brief therapy (SFBT) to work with this population based on its empirically supported effectiveness, versatility, and capacity to be brief in nature. We describe how SFBT interventions can be used by practitioners working with this population, present a fictitious case illustration depicting the clinical use of specific SFBT interventions, and offer suggestions for future research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Changes in the number of suicide re-attempts in a French region since the inception of VigilanS, a regionwide program combining brief contact interventions (BCI).

BACKGROUND: Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. They are easier to generalize to an entire population than other forms of intervention. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and mailings, according to a predefined algorithm. It was implemented gradually in the Nord-Pas-de-Calais (NPC), France, between 2015 and 2018. Here, we evaluate the effectiveness of VigilanS, in terms of SA reduction, using annual data collected by participating centers. Hypothesis tested: the higher the VigilanS implementation in a center (measured by penetrance), the greater the decrease in the number of SA observed in this center. METHODS: The study period was from 2014 to 2018, across all of NPC centers. We performed a series of linear regressions, each center representing a statistical unit. The outcome was the change in the number of SA, relative to the initial number, and the predictive variable was VigilanS' penetrance: number of patients included in VigilanS over the total number of SA. Search for influential points (points beyond threshold values of 3 influence criteria) and weighted least squares estimations were performed. RESULTS: Twenty-one centers were running VigilanS in 2018, with an average penetrance of 32%. A significant relationship was identified, showing a sharp decrease in SA as a function of penetrance (slope = - 1.13; p = 3*10- 5). The model suggested that a 25% of penetrance would yield a SA decrease of 41%. CONCLUSION: VigilanS has the potential to reduce SA. Subgroup analyzes are needed to further evaluate its effectiveness. Subgroup analyses remain to be done, in order to evaluate the specific variations of SA by group.

Effectiveness of psychoanalysis and long-term psychodynamic psychotherapy on personality and social functioning 10 years after start of treatment.

The evidence on potentially greater benefits of psychoanalysis (PA) vs. long-term psychodynamic psychotherapy (LPP) is scarce. This study compared the effectiveness of PA and LPP on personality and social functioning during a 10-year follow-up from the beginning of the treatments. The eligible patients, 41 self-selected for PA and 128 assigned to LPP, were 20-45 years of age and had anxiety or mood disorder. Outcomes were analyzed using ten standard measures of personality and social functioning, carried out 5-9 times during the follow-up. Different change patterns by time in PA and LPP emerged, suggesting less benefit of PA during the first years of follow-up and more benefit in most outcomes thereafter. Greater post-treatment improvement in PA than in LPP was seen up to 1-2 years after PA had ended in more mature defense style (DSQ), level of personality organization (LPO), more positive self-concept (SASB), more improved social adjustment (SAS-SR) and sense of coherence (SOC). However, at the 10-year follow-up the differences were non-significant. In conclusion, PA may give some additional benefits when long-term aims are linked to personality and social functioning. The relatively small differences and higher costs in comparison to LPP may restrict the feasibility of PA.

["VigilanSeu.r.se": A new profession?] / « VigilanSeu.r.se ¼ : un nouveau métier ?

In January 2015, in accordance with decades of scientific work based on maintaining contact, was born an innovative device for suicide prevention: VigilanS. To ensure this link, the choice was made to build a team with an equal number of nurses and psychologists, all located within the medical regulation. Nowadays, they are named "VigilanSeur": an original entity that highlights the emergence of this new profession, at the crossroads of several disciplines.

Motivational enhancement treatment in outpatient addiction centers: A multisite randomized trial / Intervención de incremento motivacional en centros ambulatorios para las adicciones: un ensayo aleatorizado multicéntrico

Background/Objectives: Motivational Enhancement Treatment in Spanish (METS) is a brief intervention aimed at resolving patient ambivalence towards behavior change that has demonstrated efficacy in substance use disorder treatment to reduce use and increase treatment engagement in different populations. In order to have evidence for its implementation in Mexico, a multi-site, randomized, two-arm, controlled clinical trial was conducted at three outpatient addiction treatment centers in the country to compare the effect of METS with Counseling as Usual (CAU). Method: One hundred and twenty patients were randomized to receive three sessions of METS (n = 54) or CAU (n = 66) during the first four weeks of treatment and were assessed during the following 12 weeks. Primary outcome measures were self-reported days of substance use and of treatment services utilization, which were tested using Generalized Estimating Equations. Results: Results associated both conditions with significant changes in substance use over, whereas there were no differences between conditions in substance use or in service utilization. Conclusions: Findings do not support the hypothesis that METS is more effective than CAU, but suggest that brief interventions at treatment initiation may improve patient outcomes (AU)

Antecedentes/Objetivos: La Intervención de Incremento Motivacional (METS) es una intervención breve para resolver la ambivalencia del paciente con respecto a su comportamiento y ha demostrado eficacia en distintas poblaciones para reducir el consumo de sustancias e incrementar la asistencia al tratamiento en adicciones. Con el objetivo de generar evidencia para su implementación en México, se desarrolló un ensayo clínico controlado, multisede, aleatorizado, de dos brazos en tres centros de tratamiento ambulatorio para adicciones, para comparar el efecto de METS con el del tratamiento usual (CAU). Método: Ciento veinte pacientes fueron aleatorizados a tres sesiones de METS (n = 54) o CAU (n = 66) durante las primeras cuatro semanas de tratamiento y evaluados durante las siguientes doce. Se midieron resultados mediante autoinforme de días con consumo de sustancias y días de utilización de servicios, los cuales fueron analizados mediante ecuaciones de estimación generalizadas. Resultados: Los resultados asociaron ambas condiciones a cambios significativos en uso de sustancias a lo largo del tiempo, pero no demostraron diferencias entre condiciones en el uso de sustancias o en la utilización de servicios. Conclusiones: Los hallazgos contradicen la hipótesis de superioridad de METS sobre CAU, pero sugieren que las intervenciones breves al inicio del tratamiento pudieran mejorar la respuesta del paciente (AU)

Advances in Motivational Interviewing for Pediatric Obesity: Results of the Brief Motivational Interviewing to Reduce Body Mass Index Trial and Future Directions.

Rates of childhood obesity in the United States remain at historic highs. The pediatric primary care office represents an important yet underused setting to intervene with families. One factor contributing to underuse of the primary care setting is lack of effective available interventions. One evidence-based method to help engage and motivate patients is motivational interviewing, a client-centered and goal-oriented style of counseling used extensively to increase autonomous motivation and modify health behaviors. This article summarizes the methods and results from a large trial implemented in primary care pediatric office and concludes with recommendations for improving the intervention and increasing its dissemination.

Sustained reduction in health care costs after adjunctive treatment of graded intensive short-term dynamic psychotherapy in patients with psychotic disorders.

The aim of this pilot study was to evaluate the changes in symptom severity and long-term health care cost after intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with psychotic disorders undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 13 one-hour sessions of graded ISTDP to 38 patients with psychotic disorders. Costs for health care services were compiled for a one-year period prior to the start of ISTDP (baseline) along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Results revealed that health care cost reductions were significant for the one-year post-treatment period relative to baseline year, for both physician costs and hospital costs, and the reductions were sustained for the follow-up period of four post-treatment years. Furthermore, at treatment termination self-reported symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and reduce costs in selected patients with psychotic disorders, and that gains are sustained in long-term follow-up. Future research directions are discussed.

Intelligence as a predictor of outcome in short- and long-term psychotherapy.

Intelligence has been suggested as a suitability factor for short-term therapy whereas its possible effect on short-term versus long-term therapy still is unknown. The aim of this study was to compare the prediction of intelligence on the level of psychiatric symptoms and psychosocial functioning in psychotherapies of different lengths. A total of 251 outpatients from the Helsinki Psychotherapy Study, aged 20­46 years, and suffering from mood or anxiety disorders were allocated to two long-term and two short-term therapies. Intelligence was assessed at baseline with the Wechsler Adult Intelligence Scale (WAIS-R). Psychiatric symptoms and psychosocial functioning were assessed 5­10 times during a 5-year follow-up using two primary symptom measures (HDRS and HARS) and one primary measure of psychosocial functioning (GAF). Short-term therapy was more effective than long-term therapy during the first year of follow-up. During the second to fourth follow-up year no differences between short- and long-term therapies or the intelligence groups were found. At the fifth follow-up year, however, long-term psychotherapy showed a statistically significantly larger change in all three primary measures compared to short-term therapy among those with higher intelligence. No differences between therapy groups were noted in those with lower intelligence. People with higher intelligence may benefit more from long-term than from short-term psychotherapy. These findings should be confirmed.

Benchmarking routine psychological services: a discussion of challenges and methods.

BACKGROUND: Policy developments in recent years have led to important changes in the level of access to evidence-based psychological treatments. Several methods have been used to investigate the effectiveness of these treatments in routine care, with different approaches to outcome definition and data analysis. AIMS: To present a review of challenges and methods for the evaluation of evidence-based treatments delivered in routine mental healthcare. This is followed by a case example of a benchmarking method applied in primary care. METHOD: High, average and poor performance benchmarks were calculated through a meta-analysis of published data from services working under the Improving Access to Psychological Therapies (IAPT) Programme in England. Pre-post treatment effect sizes (ES) and confidence intervals were estimated to illustrate a benchmarking method enabling services to evaluate routine clinical outcomes. RESULTS: High, average and poor performance ES for routine IAPT services were estimated to be 0.91, 0.73 and 0.46 for depression (using PHQ-9) and 1.02, 0.78 and 0.52 for anxiety (using GAD-7). Data from one specific IAPT service exemplify how to evaluate and contextualize routine clinical performance against these benchmarks. CONCLUSIONS: The main contribution of this report is to summarize key recommendations for the selection of an adequate set of psychometric measures, the operational definition of outcomes, and the statistical evaluation of clinical performance. A benchmarking method is also presented, which may enable a robust evaluation of clinical performance against national benchmarks. Some limitations concerned significant heterogeneity among data sources, and wide variations in ES and data completeness.

Validación de una versión breve de la escala de comportamiento impulsivo UPPS-P / Validation of a short Spanish version of the UPPS-P impulsive behaviour scale

Objetivo. La impulsividad es un constructo multifactorial con un papel central en la psicopatología y en especial en las adicciones. El objetivo de este estudio es desarrollar y validar una versión española de la escala breve de comportamiento impulsivo UPPS-P1, que evalúa cinco rasgos relacionados con el comportamiento impulsivo: urgencia positiva, urgencia negativa, falta de premeditación, falta de perseverancia y búsqueda de sensaciones. Métodos. Participaron 189 sujetos que completaron la versión breve de la escala UPPS-P. Sobre esta muestra, se llevó a cabo un análisis factorial confirmatorio que corroboró la validez de la estructura factorial de cinco dimensiones de la escala original. Resultados. Los resultados indicaron buenos índices de fiabilidad. La validez externa de la escala queda apoyada por su asociación específica con una escala de evaluación de estrategias de regulación emocional. Conclusión. La versión breve en español de la Escala UPPS¿P presenta buenas propiedades psicométricas y puede considerarse un instrumento prometedor para su uso en contextos de investigación y especialmente por su brevedad en contextos clínicos (AU)

Aim. Impulsivity is a multifaceted construct that has a prominent role in psychiatry and especially in addiction. The objective of the current study is to develop and validate a Spanish version of the short UPPS-P impulsive behavior scale1, which assesses five distinct impulsivity traits (positive urgency, negative urgency, lack of premeditation, lack of perseverance, and sensation seeking). Material and methods. One hundred and eighty-nine participants were included in the study. Confirmatory factor analyses supported the five-factor model of the original scale. Results. The results indicated good internal reliability. External validity was supported by specific relationships with a scale assessing emotion regulation strategies. Conclusion. Accordingly, the short Spanish version of the UPPS-P scale presents good psychometric properties and may be considered a promising instrument for both research and clinical practice (AU)

Psychometric properties of the Spanish human system audit short-scale of transformational leadership

The aim of this research is to examine the psychometric properties of a Spanish version of the Human System Audit transformational leadership short-scale (HSA-TFL-ES). It is based on the concept of Bass developed in 1985. The HSA-TFL is a part of the wider Human System Audit frame. We analyzed the HSA-TFL-ES in five different samples with a total number of 1,718 workers at five sectors. Exploratory Factor Analysis corroborated a single factor in all samples that accounted for 66% to 73% of variance. The internal consistency in all samples was good (α = .92 - .95). Evidence was found for the convergent validity of the HSA-TFL-ES and the Multifactor Leadership Questionnaire. These results suggested that the HSA-TFL short-scale is a psychometrically sound measure of this construct and can be used for a combined and first overall measurement (AU)

El objetivo de esta investigación es examinar las propiedades psicométricas de la versión española de la escala corta de Liderazgo Transformacional de la Auditoría del Sistema Humano (HSA-TFL-ES). La escala se basa en el concepto de Liderazgo Transformacional desarrollado por Bass en 1985. La HSA-TFL-ES ha sido administrada a un total de 1,718 trabajadores, distribuidos en cinco muestras diferentes correspondientes a distintos sectores empresariales. El análisis factorial exploratorio corroboró la existencia de un solo factor que explica entre 66% y 73% de la varianza. La consistencia interna obtenida ha sido buena (α = .92 - .95). Además, los resultados obtenidos muestran validez convergente entre la escala HSA-TFL-ES y el Cuestionario Multifactorial de Liderazgo (Multifactorial Leadership Questionnaire - MLQ). Los resultados evidencian que la escala corta HSA es una medida psicométricamente adecuada del constructo de Liderazgo Transformacional, por lo que puede ser utilizada para una primera medición global del mismo (AU)

Interpersonal psychotherapy: past, present and future.

The authors briefly describe the origins, theory, and development of interpersonal psychotherapy: its roots in clinical outcome research, its spread from major depression to other psychiatric disorders and its increasing dissemination as an empirically validated clinical intervention included in treatment guidelines. They attempt to forecast research, organizational and training issues the growing interpersonal psychotherapy community may face in the future.

¿Por qué se alargan los tratamientos psicológicos? Predictores de una mayor duración del tratamiento y diferencias entre los casos de corta y larga duración / Why are psychological treatments prolonged? Predictors of a longer duration of treatment and analysis of the differences between long- and short-term cases

El objetivo del estudio es identificar qué variables pueden explicar una mayor duración de los tratamientos psicológicos y analizar las diferencias entre casos extremos de corta y larga duración. Se analizaron los datos de 419 pacientes de la Clínica Universitaria de Psicología de la Universidad Complutense de Madrid. Los factores que mejor explicaban la duración del tratamiento eran: número de técnicas aplicadas, presencia de comorbilidad, haber recibido algún tratamiento anterior y presentar un diagnóstico principal de trastorno del estado de ánimo o trastorno de la conducta alimentaria. Se obtuvieron diferencias significativas entre los casos de corta y larga duración en el número de técnicas aplicadas y el número de objetivos terapéuticos establecidos al comienzo del tratamiento, también en variables clínicas (grupo diagnóstico, comorbilidad y haber recibido algún tratamiento anterior) y sociodemográficas (edad y nivel educativo). Se discuten los resultados y se proponen líneas de actuación y/o reflexión (AU)

The purpose of this study was to identify variables that may explain a longer psychological treatment and to analyze differences between shortand long-term cases. Data from 419 patients of the University Clinic of Psychology at the Complutense University of Madrid were analyzed. Number of intervention techniques, comorbidity, previous treatments, and a primary diagnosis of mood disorder or eating disorder were the factors that explained longer treatment duration. Significant differences were observed between short- and long-term cases in number of intervention techniques, number of therapeutic objectives, and also in some clinical variables (diagnostic group, comorbidity, previous treatment) and demographics (age and educational level). Results are discussed and some lines of intervention and/ or reflection are proposed (AU)

Efectividad de la psicoterapia breve en los centros de salud mental I: Diseño, tratamientos y procedimiento / Effectiveness of Brief Psychotherapy in Community Mental Health Centers I: design, treatments and procedures

Introducción. El objetivo de la presente investigación ha sido comparar mediante un ensayo clínico la efectividad de una Psicoterapia Breve con el tratamiento habitual de los Trastornos Mentales Comunes en los Centros de Salud Mental (CSM) de Asturias. En este artículo se describen la justificación, el diseño y los procedimientos de ese estudio. Los primeros resultados se publican en Fernández- Méndez y cols. (en prensa). Sujetos y método. Se seleccionaron al azar 216 personas mayores de 14 años que consultaban por primera vez en seis CSM y que fueron diagnosticadas de trastornos depresivos, de ansiedad y/o de adaptación. Ciento cuarenta y una cumplían los criterios de inclusión y aceptaron participar en la investigación, siendo asignadas al azar a dos grupos: Psicoterapia breve integradora- ecléctica (n = 76) o Tratamiento habitual en los CSM (n = 65). Se han comparado sus resultados a los 6, 12, 24 y 36 meses en diversos índices de mejoría clínica, funcionamiento psicosocial e indicadores sanitarios indirectos. Los datos se han obtenido del Registro de Casos Psiquiátricos, de la Historia Clínica y del propio paciente. Se han usado los siguientes instrumentos: Impresión Clínica Global (ICG, Guy, 1976), Inventario de Discapacidad de Sheehan (SDI, Sheehan, 1996) y Cuestionario de Satisfacción (Moré y Muñoz, 2000) (AU)

Background. The aim of the current research has been comparing the effectiveness of a brief psychotherapy with the usual treatment of Common Mental Disorders in Mental Health Centers (MHC) of Asturias. The present article describes the rationale, design and procedures of the study. Initial outcome findings are reported by Fernández- Méndez et al (in press). Subjects and method. Two hundred and sixteen patients over the age of 14 were selected at random among those who consulted for the first time in six MHC and were diagnosed of depressive, anxiety or adjustment disorders. One hundred and forty-one fulfilled the inclusion criteria and agreed to take part in the study; they were assigned at random into two groups: brief integrative-eclectic psychotherapy (n = 76) or usual treatment in the MHC (n = 65). Their results have been compared at 6, 12, 24 and 36 months against diverse indexes of clinical improvement, psycho-social functioning and sanitary indirect indicators. Information has been obtained from the Psychiatric Cases Record, the Clinical History and from the patients. The following instruments have been used: the Clinical Global Impression of Improvement scale, the Sheehan Disability Inventory and a Satisfaction Survey (AU)

Predictors of outcome in patients with common mental disorders receiving a brief psychological treatment: an exploratory analysis of a randomized controlled trial from Goa, India.

OBJECTIVE: A randomized placebo-controlled trial of treatment for common mental disorders in Goa, India found that psychological treatment (problem-solving) was no more effective than placebo. The study aimed to identify factors predicting outcome amongst participants receiving the psychological treatment, as measured by score on the Revised Clinical Interview Schedule (CISR). METHOD: The CISR scores at 2 months, 6 months and 12 months were modelled using multiple linear regression with a random effect for patients. Two types of variables were examined. Patient variables were age; sex; religion; education; marital status; severity of psychiatric morbidity at recruitment; and severity of social and life problems faced by the subject. Treatment variables were number of sessions attended and the hospital site. RESULTS: About half the participants had a depressive disorder; most of the remainder had mixed anxiety-depression. Overall adherence with the intervention was low; more than a third of patients attended only one session. Attending a greater number of sessions and facing a severe life problem were significantly associated with a worse outcome (p<0.005). CONCLUSION: The severe nature of life problems faced by some patients with common mental disorders may limit the efficacy of clinic-based psychological treatments in low income countries.

Brief intervention for problem drinkers in a Chinese population: a randomized controlled trial in a hospital setting.

BACKGROUND: Alcohol is a legal and accessible substance in Taiwan. As excessive alcohol has been linked to health and social problems, it is necessary to develop a brief, rapid, and low-cost tool to help health care providers deal with persons in Taiwan whose alcohol consumption has become hazardous or harmful to their health. METHODS: A randomized controlled clinical trial with 6- and 12-month follow-ups was designed. Eighteen medical/surgical units at a medical center in northern Taiwan were randomly assigned to 2 groups: experimental (n = 9) and control (n = 9). Inpatients on the units were enrolled if they met the following criteria: were older than 18 years, had no severe psychiatric illness, and were not pregnant. The experimental group (n = 138) received the intervention, a 15-minute counseling visit in which nurses screened participants using the Alcohol Use Disorders Identification Test (AUDIT), provided a health promotion booklet for adults, and individually discussed the booklet contents with patients based on their drinking level (AUDIT score). The control group (n = 137) received no treatment. Patterns of alcohol consumption were determined by AUDIT scores at baseline, 6, and 12 months later. RESULTS: Alcohol use disorders identification test scores decreased significantly in both groups at 6 months after the intervention, but did not differ significantly between the 2 groups. However, 12 months after the brief alcohol intervention, experimental subjects' AUDIT scores were significantly better than those of the control group. CONCLUSIONS: Our brief alcohol intervention provided a 12-month benefit for problem drinkers in Taiwan.

The future orientation of constructive memory: an evolutionary perspective on therapeutic hypnosis and brief psychotherapy.

We explore a new distinction between the future, prospective memory system being investigated in current neuroscience and the past, retrospective memory system, which was the original theoretical foundation of therapeutic hypnosis, classical psychoanalysis, and psychotherapy. We then generalize a current evolutionary theory of sleep and dreaming, which focuses on the future, prospective memory system, to conceptualize a new evolutionary perspective on therapeutic hypnosis and brief psychotherapy. The implication of current neuroscience research is that activity-dependent gene expression and brain plasticity are the psychobiological basis of adaptive behavior, consciousness, and creativity in everyday life as well as psychotherapy. We summarize a case illustrating how this evolutionary perspective can be used to quickly resolve problems with past obstructive procrastination in school to facilitate current and future academic success.