Who seeks Internet-based interventions for depression in Brazil? / Quem procura intervenções baseadas na Internet para a depressão no Brasil?

Specific psychological treatments for depressive disorders delivered on the Internet have shown effectiveness and presented advantages over face-to-face treatments (potentially less expensive, flexible schedules, available in remote areas). This paper aims to describe the characteristics of those who sought help from an online self-guided intervention for depression and to explore hypotheses about predictors of enrollment to the program. Based on a sample of 282 of individuals who filled in screening questionnaires, we verified that the respondents were mainly female, were on average 34.36 years old, were primarily recruited through Facebook, had been previously diagnosed by mental health professionals, presented moderate self-efficacy perception, and had moderately severe symptoms of depression. Respondents who reported comorbid conditions were more likely to attend enrollment interviews, and being in treatment or not did not influence attendance. Such characterization may provide strategies to reach more people and to optimize the design of interventions targeting help-seeking depressed individuals in Brazil.

Alguns tratamentos para a depressão baseados na Internet se mostraram efetivos e apresentaram vantagens em relação a tratamentos presenciais (potencialmente menos caros, com horários mais flexíveis e com disponibilidade em áreas remotas). Este artigo descreve as características de indivíduos que procuraram ajuda de uma intervenção autoguiada on-line e explora hipóteses sobre preditores de adesão ao programa. Baseado em uma amostra de 282 indivíduos que preencheram questionários de triagem, verificou-se que os participantes eram majoritariamente mulheres, tinham em média 34,36 anos, foram recrutados em sua maioria pelo Facebook, apresentaram diagnóstico psiquiátrico prévio feito por algum profissional de saúde mental, apresentaram percepção de autoeficácia moderada e sintomas depressivos moderadamente severos. Os respondentes que relataram condições comórbidas apresentaram mais chances de avançar para as entrevistas diagnósticas, e estar ou não em tratamento não influenciou a chegada às entrevistas. Estas descrições podem auxiliar na identificação de estratégias para se atingir mais indivíduos e para otimizar o desenho das intervenções on-line para brasileiros que as buscam.

Psychodynamic Profile in an Early Dropout Case: Comparing Therapist's and External Judges' perspectives

INTRODUCTION: contemporary psychodynamic therapy research supports combining clinical judgment with empirical evidences. Recent studies suggest that systematically analyzing single cases may contribute to such efforts. Also, current criteria for evidence-based case studies recommend different perspectives on therapeutic process and outcome, such as therapist's and external judges' ratings. Finally, client's dropout conforms a challenge for psychotherapy research. AIMS & METHODS: as part of a SPR Small Research Grant, this study analyzed and compared the psychodynamic profile proposed both by therapist and two external judges, for the same case of early dropout from focused psychodynamic psychotherapy, consisting of two diagnostic interviews and five subsequent sessions, in a patient with an emotional disorder. Being blind to the rating process of the counterpart, Operationalized Psychodynamic Diagnosis (OPD-2) was used by therapist and judges to generate a psychodynamic profile including five therapeutic foci. External judges rating was achieved through consensus, following CQR's guidelines. RESULTS & DISCUSSION: similarities and differences among therapist's and judges' psychodynamic profiles were found. Result's contributions to the understanding of case's early dropout are discussed, along with OPD-2's usefulness for psychodynamic practice-oriented research.(AU)

Perspectiva del terapeuta acerca de la negociación de la alianza: Un instrumento para su evaluación / Therapist's perspective about alliance negotiation: an instrument's evaluation

Resumen La negociación de alianza es la capacidad que tienen paciente y terapeuta para resolver problemas vinculares y desacuerdos en terapia. Si bien este concepto es una noción diádica, con implicancias importantes para el tratamiento, actualmente solo existe un instrumento, desde la perspectiva del paciente, que permite su medición. El objetivo de este artículo es presentar el desarrollo y el estudio de las propiedades psicométricas preliminares de la Escala de Negociación de la Alianza, versión terapeuta (ANS-T). A estos fines, se convocó una muestra de 188 terapeutas de distintas aproximaciones teóricas que completaron un conjunto inicial de ítems tentativos del ANS-T junto con el Inventario de Alianza de Trabajo (WAI, por su sigla en inglés), otra escala para medición de la alianza. Para el análisis de datos se realizó un análisis de componentes principales, se estudiaron medidas de confiabilidad como el alfa de Cronbach y correlaciones ítem-total corregidas, así como también evidencias de validez de criterio a partir de las correlaciones entre el ANS-T y la WAI. Los resultados del análisis de componentes principales sugirieron una solución unidimensional integrada por nueve ítems. Los análisis conducidos sobre la versión final de la ANS-T mostraron una adecuada consistencia interna (a = .82) y homogeneidad de sus ítems (r ítem-total corregidas: entre .34 y .66) junto con evidencias de validez de criterio (r con WAI: .51, p < .001). Las cualidades del instrumento y sus propiedades psicométricas sugieren que la ANS-T es un recurso valioso tanto para la clínica como para la investigación.

Abstract Alliance negotiation is defined as the patient and therapist's ability to solve relational problems and disagreements (in therapeutic goals and tasks) during therapy. Although this construct is essentially a dyadic notion, with important clinical implication for treatments of different theoretical frameworks, currently there is only one instrument that can measure alliance negotiation and it is only based on the patients' perspective about therapy. The aim of this paper is to develop and examine the preliminary psychometric properties of the Alliance Negotiation Scale, therapist form. In the context of the importance attributed to analyzing relational constructs with a dyadic perspective, this instrument will not only allow to measure the perception of alliance negotiation from therapist's point of view, but also it will provide the necessary information to have a dyadic measurement of alliance negotiation by using both the original Alliance Negotiation Scale and the Alliance Negotiation Scale, therapist form in the same cases. With this purpose, a sample of 188 therapists from different theoretical frameworks completed an initial pool of twenty four preliminary items of the Alliance Negotiation Scale, therapist form. All the items of Alliance Negotiation Scale, therapist form, were developed based on the original Alliance Negotiation Scale, adapted to be completed by the therapist, and scored in a seven point Likert scale ranging from 1 (Never) to 7 (Always). The sample of therapist also completed the Working Alliance Inventory, therapist from, a widely spread standard measure of therapeutic alliance. For both instruments we asked the therapist to answer the measures thinking about a patient they have recently treated. To avoid a bias in patients' selection and ceiling effects in alliance scores, half of the sample of therapists was randomized to use as a reference a patient they considered easy, while the other half was asked to select a difficult patient. For data analyzes we first ran a principal component analysis in order to find the best factorial solution for the items and to establish the construct validity of the scale. Based on that factorial solution we analyzed the internal consistency of the final version of the Alliance Negotiation Scale, therapist form, using Cronbach's alphas coefficients and item's homogeneity using adjusted item-total correlations. Finally, to test for criterion validity we explored the associations between the Alliance Negotiation Scale, therapist form, and the Working Alliance Inventory, therapist from, using Pearson's correlations. The principal component analysis suggested a one-dimensional solution integrated by nine items, explaining a 42.16% of the total variance. All the items in this solution had factorial weights above .40. Furthermore, the analysis of reliability on this version of the scale showed an adequate internal consistency (Cronbach's a = .82). The adjusted item-total correlations presented also evidences of homogeneity (r's range: between .34 and .66), suggesting that all the items explores different aspects from a common construct, without being redundant. Finally, the correlations between the Alliance Negotiation Scale, therapist form, and the Working Alliance Inventory, therapist from, presented evidences of criterion validity (r with WAI: .51, p < .001). This result showed an association between the measures but also indicate that they do not measure the exact some construct. The specific characteristics and properties of the Working Alliance Inventory, therapist from, presented in this paper, suggested that this measure represents an important contribution both for clinical practice and research. Future studies will need to further explore and confirm the psychometric properties of the Working Alliance Inventory, therapist from, and analyze its application for dyadic measures of the therapeutic alliance negotiation in psychotherapy.

Focos Terapéuticos en un Caso de Abandono Temprano: Perspectivas del Terapeuta y de Jueces Externos / Therapeutic Foci in an Early Dropout Case: Therapist's and External Judges' Perspectives

Introducción: es necesario mayor estudio de la experiencia de abandono terapéutico temprano. Indagar sistemáticamente casos únicos puede conformar una respuesta orgánica a este desafío. Objetivos y métodos: se analizó y comparó la evolución de focos terapéuticos, planteados por el terapeuta tratante y por dos juezas externas, para un caso de abandono temprano de psicoterapia psicodinámica focalizada de un trastorno emocional. Ciegos a la codificación de la contraparte, terapeuta y juezas utilizaron el Diagnóstico Psicodinámico Operacionalizado-2 (OPD-2) para generar un perfil psicodinámico y establecer focos de tratamiento. Para cada foco, aplicaron la Escala de Presencia de Foco y la Escala de Cambio Estructural de Heidelberg. Resultados y discusión: se observaron puntos de convergencia y divergencia entre las perspectivas de terapeuta y juezas externas. Se discute la utilidad de dichos puntos para la comprensión del abandono temprano del paciente, así como las implicancias del OPD-2 como herramienta de investigación orientada a la práctica

Introduction: more study on the experience of therapeutic early dropout is needed. The systematic study of psychodynamic single cases can conform an organic response to this challenge. Aims & Methods: therapeutic foci's evolution, proposed by both treating therapist and two external judges, for the same early dropout case of a focused psychodynamic psychotherapy for an emotional disorder, were analyzed and compared. Blind to the counterpart's rating process, therapist and judges employed Operationalized Psychodynamic Diagnosis (OPD-2) in order to generate a psychodynamic profile and establish therapeutic foci. For each focus, they applied the Focus Presence Scale and the Heidelberg Structural Change Scale. Results & Discussion: specific convergences' and discrepancies' points between therapist's and judges' perspectives were observed. Such points' usefulness for the understanding of patient's early dropout, together with OPD-2' implications as a practice-oriented research tool, are discussed

Satisfacción de los pacientes en tratamientos por abuso de sustancias y su relación con variables de las instituciones asistenciales / Clients' satisfaction with a substance abuse treatments and its relationship with the institution characteristics

La satisfacción que los pacientes tienen con respecto a sus tratamientos es un indicador de la calidad de los mismos y un importante predictor de sus posibles resultados. Se analizaron los niveles de tal satisfacción en una muestra de pacientes con problemáticas de abuso de sustancias, tratados en instituciones del Área Metropolitana de Buenos Aires (AMBA). Los grados de satisfacción fueron a su vez analizados en relación con las características diferenciales de las instituciones (tipo de institución, ubicación geográfica, género de los pacientes aceptados, presencia de cualidades atípicas en las instituciones) y la evolución de los tratamientos (duración y cantidad de interrupciones del proceso). A partir de un muestreo aleatorio por conglomerados y estratificado, se convocó una muestra de 216 participantes pertenecientes a 22 centros, que completaron un cuestionario de satisfacción, diseñado para este estudio. Los resultados mostraron niveles elevados de satisfacción en las distintas áreas exploradas, observando características distintivas de las instituciones asociadas a diferentes niveles de satisfacción, como es el caso del tipo de institución y el género de los participantes aceptados. No obstante, no se encontraron diferencias en los grados de satisfacción en función del tiempo de desarrollo del tratamiento y la cantidad de interrupciones del mismo. Los resultados obtenidos son discutidos en relación a los alcances del estudio, a la vez que se presentan sus limitaciones y se proponen futuras investigaciones para avanzar sobre esta temática.

The client satisfaction about his treatments it is an important indicator of its quality, but also a fundamental predictor of treatment outcome. Specifically, in patients with drug abuse disorders, the degrees of satisfaction with their treatments have presented lineal correlations with the amount of therapeutic change and the continuity in treatment (prevention of drop-out). Thus, the analysis of clients' satisfaction with their treatments is presented as an indirect and alternative strategy to analyze the effects of therapy for drug abuse disorders, a main health, social, and political problem in the world wide. In this exploratory study we analyzed the levels of satisfaction about their treatment in a sample of client's with substance abuse disorders, treated in institutions of the Buenos Aires Metropolitan Area (AMBA). Then we explored the relationship among the levels of satisfaction with the specific features of the institutions where the treatments were conducted (type of institution, geographic location, genre of the clients accepted, and the presence of atypical characteristics) and with characteristics of the evolution of those treatments (treatments length and amount of interruptions during the therapeutic process). Based on a stratified cluster random sampling strategy, using the above-described characteristics of the institutions analyzed in this study to create the clusters, we designed a sample of 216 subjects that were treated in 22 institutions with treatments subsidized by the Argentine National Secretary for the Prevention of Drug Abuse and the Fight against Drug Trafficking (SEDRONAR by its acronym in Spanish). All the participants of this research completed a questionnaire developed ad hoc and based on previous developments, to explore patient's levels of satisfaction in six areas: Admission, General environment (divided into the sub-areas Human and physical context and Mistreatment), Satisfaction with food, Staff evaluation (divided into the sub-areas Overall staff assessment and Specific staff assessment), Satisfaction with treatment (divided into the sub-areas Treatment features, Treatments results, and Complementary therapeutic devices), and General treatment evaluation. Results showed that there were same features of the institutions related to different levels of satisfaction in the participants of the study. Regarding the type of institution, patients of the psychiatric clinics presented the lowest degrees of satisfaction while the patients of the day hospitals had the highest levels of satisfaction. Also different levels of satisfactions were observed based on the genre of the patients accepted in the institutions. Patients of the institutions that only accept male clients have greater degrees of satisfaction than patients in mixed institutions. No significant differences were found in patient's satisfaction due to institution geographical location. Also, we have not found a significant association between patient's satisfaction and treatment length or between treatment satisfaction and amount of interruptions in the therapy. The results are discussed in the context of the scopes of the study, while further research is suggested to move forward in the exploration of this issue. The differences in satisfaction due to the type of institution might be explained by the degree of openness and flexibility of the setting, but also by the severity of the patients that are included in eacht type of institutions. As well, the differences in satisfaction based on the genre of the patients accepted by the institution could be explained by the predominance of male patients in the population (85%) and the possible lack of adaptation of treatment characteristics to female specific necessities. However, the results of this research must be interpreted extremely cautious because of limitations of the study related to the sample method and the unknown psychometric properties (in terms of validity and reliability) of the instrument used.

Clinical and Theoretical Considerations of Psychoanalysts and Cognitive Behavioral Therapists Regarding Generalized Anxiety Disorder in Argentina. A Qualitative Study of the Research-Practice Gap

Este artigo apresenta dois estudos qualitativos que exploram a lacuna entre investigação e prática, como se relaciona com ao Transtorno de Ansiedade Generalizada, comparando as diferentes considerações teóricas e clínicas da psicanalistas e terapeutas cognitiva-comportamentais de Buenos Aires. MÉTODOS: No primeiro estudo, foram convidados um grupo de dez psicanalistas especializados e cinco terapeutas cognitivacomportamentais especializados para apresentar explicitamente a sua conceituação teórica desta desordem, com base nos critérios de diagnóstico da quinta edição do Manual Diagnóstico e Estatístico de Transtornos Mentais. No segundo estudo, vinte psicoterapeutas (dez de cada orientação teórica) foram convidados a ouvir uma gravação de áudio de um paciente fictício preenche os critérios diagnósticos de TAG e para apresentar sua impressão clínica sobre o caso. Através da análise qualitativa, as categorias foram criadas e avaliado após a sua frequência para ambos os estudos. RESULTADOS/DISCUSSÃO/CONCLUSÕES: Os resultados mostraram semelhanças e diferenças em conceituações teóricas e clínicas dos participantes e sugerem que as orientações do terapeuta podem representar diferentes implicações e obstáculos para superar a lacuna entre pesquisa e prática da psicoterapia.(AU)

This paper presents two qualitative studies exploring the gap between research and practice, as related to Generalized Anxiety Disorder, by comparing the differing theoretical and clinical considerations of psychoanalysts and cognitive behavioral therapists from Buenos Aires. METHODS: In the first study, a group of ten expert Psychoanalysts and five expert Cognitive-Behavioral Therapists were asked to explicitly present their theoretical conceptualization of this disorder, based on the diagnostic criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. In the second study, twenty psychotherapists (ten from each theoretical orientation) were asked to listen to an audio recording of a fictional patient meeting GAD's diagnostic criteria, and to present their clinical impression about the case. Through qualitative analysis, categories were created and rated upon their frequency for both studies. RESULTS/DISCUSSION/CONCLUSION: Results showed similarities and differences in participants' theoretical and clinical conceptualizations and suggested that therapist orientations may pose differing implications and obstacles to breach the psychotherapy research-practice gap.(AU)

Propiedades psicométricas de la adaptación argentina del Inventario de Alianza de Trabajo Breve - versión paciente (WAI-SR-A): un análisis factorial confirmatorio / Psychometric properties of the argentinean adaptation of the Working Alliance Inventory, Short Version ¨C Patient¡¯s Form (WAI-SR-A): a confirmatory factor analysis

La alianza terapéutica representa un concepto central para la investigación y el ejercicio de prácticas clínicas en psicoterapia. En este estudio se presenta la adaptación argentina del Inventario de Alianza de Trabajo en su versión breve y del paciente (WAI-SR-A), junto con el análisis de sus propiedades psicométricas. Se convocó una muestra no probabilística de 153 pacientes que se encontraban realizando tratamientos con una extensión mínima de 5 sesiones. Se condujo un análisis factorial confirmatorio que aportó evidencias en favor de la validez de constructo del instrumento. Los resultados del análisis factorial fueron replicados mediante un procedimiento de Bootstrap utilizando 500 sub-muestras aleatorias. A su vez, se analizaron los índices alpha de Cronbach convencional y alpha de Cronbach ordinal y las correlaciones ítem-total corregidas en las dimensiones del instrumento, mostrando que el inventario y sus tres sub-escalas presentan adecuados niveles de consistencia interna y homogeneidad. Los resultados del estudio posicionan al WAI-SR-A como un instrumento válido y confiable para el análisis de la alianza terapéutica en el contexto argentino. Contar con un inventario de estas características puede favorecer el estudio empírico y seguimiento clínico de los procesos psicoterapéuticos, beneficiando tanto a psicoterapeutas como a investigadores...

El método de investigación cualitativa consensual (Consensual Qualitative Research, CQR): una herramienta para la investigación cualitativa en psicología clínica / Consensual Qualitative Research (CQR) method: a tool for qualitative research in clinical psychology

En el siguiente trabajo se presenta el método de investigación cualitativa consensual (CQR por la sigla en inglés de Consensual Qualitative Research)¹, desarrollado por Hill, Thompson y Nutt-Williams (1997), con el in de ilustrar su aplicabilidad al análisis de entrevistas a psicoterapeutas, realizadas en el contexto de investigaciones en curso sobre procesos terapéuticos. Se introduce brevemente el campo de la investigación cualitativa en psicología clínica. Se describe el modelo CQR, sus pasos y metodología. Se analizan las relaciones entre el método CQR y otras metodologías de investigación cualitativa. Se presenta una ejemplíficación de análisis de datos. Finalmente, se discuten las implicancias del CQR y de los métodos de análisis cualitativos en general, para el campo de la investigación en psicología clínica.

In the present paper the Consensual Qualitative Research (CQR) method developed by Hill, Thompson & Nutt-Williams (1997) is presented, aiming to illustrate its applicability for analyzing interviews to psychotherapists in the context of on going psychotherapeutic process researches. The field of qualitative research in clinical psychology is briely presented. CQR model is described, with its steps and methodology. The relationships between CQR and other qualitative research methodologies are analyzed. An example of data analysis is offered. Finally, future research´s implications of CQR and qualitative methods in general, in the ield of clinical psychology, are discussed.