Effectiveness of mindfulness-integrated cognitive behavior therapy on anxiety, depression and hope in multiple sclerosis patients: a randomized clinical trial

Abstract Introduction Multiple sclerosis (MS) is a chronic medical condition that attracts particular attention because of the high risks associated with it. MS patients suffer from medical problems, depression, anxiety, and reduced hopefulness. These issues can increase the severity of the disease and treatment resistance and reduce patients' individual and social efficacy. Mindfulness-integrated cognitive behavior therapy (MICBT) is a new approach that is being applied in chronic diseases and can be used in combination with existing treatments. Therefore, the present study investigated the efficacy of MICBT in terms of anxiety, depression, and hope in MS patients. Methods A sample of 20 patients with MS was randomly selected at Shafa Hospital in Kerman City, Iran. Patients were then assigned to one of two groups of 10 people using a random number table. The experimental group received MICBT. The control group also received the same therapy after study completion. The assessment tools used in this study included the Beck Depression Inventory-Second Edition (BDI-II), Beck Anxiety Inventory (BAI), and Miller Hope Scale (MHS). Measurements were conducted at three stages: pre-test, post-test, and follow-up. For data analysis, means and standard deviations were calculated and one-way analysis of covariance was conducted using SPSS 24. Results Compared with controls, MICBT was effective for reducing depression (P < 0.001, F = 72.55), anxiety (P < 0.001, F = 100.75). Additionally, MICBT was effective in improving hope (P < 0.001, F = 45.36). Changes were maintained in the follow-up phase. Conclusion The MICBT affects depression, anxiety and hope of MS patients. Therefore, mental health professionals can benefit from the results obtained in the present study to reduce depression and anxiety and increase hope in this group of patients. Clinical trial registration: Iranian Registry of Clinical Trials, IRCT201601030258N4.

Efectividad del tratamiento temprano de niños con mutismo selectivo en los centros educativos / Effectiveness of early treatment of children with selective mutism in educational centers

Resumen El mutismo selectivo (MS) es un trastorno de ansiedad de baja prevalencia, lo que dificulta su investigación. Pese a su inicio temprano su diagnóstico no suele hacerse antes del acceso a la escolaridad obligatoria. El objetivo de este estudio fue valorar la eficiencia de un protocolo cognitivo-conductual para la intervención psicológica en el contexto educativo (ipmsce), siguiendo los criterios de la Task Force in Promotion and Dissemination of Psychological Procedures. Participaron 10 niños que presentaban una demora inferior a dos años entre el inicio del MS y su diagnóstico (1.00 ± 0.54). La edad media fue de 4.94 años y el 80% fueron niñas. Se utilizó un diseño de acumulación de casos, con medidas del tratamiento antes de su aplicación, al finalizar y en un seguimiento a los 12 meses, obtenidas a través de los padres, los profesores y un test situacional. Los resultados muestran la efectividad de la intervención.

Abstract Selective mutism (SM) is an anxiety disorder of low prevalence, which makes its investigation difficult. Despite its early start, its diagnosis is not usually made before access to compulsory schooling. The objective of this study was to assess the efficiency of a cognitive-behavioral protocol for psychological intervention in the educational context (ipmsce), following the criteria of the Task Force in Promotion and Dissemination of Psychological Procedures. Ten children with a delay of less than two years between the onset of SM and its diagnosis (1.00 ± 0.54) participated. The average age was 4.94 years and 80 % were girls. A case accumulation design was used, with measures of treatment before its application, at the end and in a followup at 12 months, obtained through parents, teachers and a situational test. The results show the effectiveness of the intervention.

Efeitos do tratamento com alarme para enurese no autoconceito de crianças / Effects of alarm treatment for enuresis on children's self-concept / Efectos del tratamiento con alarma para enuresis en el autoconcepto de niños

O objetivo do estudo foi avaliar a eficácia do tratamento comportamental para enurese com uso de alarme, realizado à distância, e avaliar efeitos da intervenção no autoconceito dos participantes. Trata-se de um ensaio clínico com delineamento quase-experimental de grupos. Trinta e uma crianças com enurese primária monossintomática participaram (M(idade)=8,3; DP=1,3), 15 meninos (48,3%). Para avaliar a enurese, foi utilizado o Formulário de Avaliação da Enurese; para o autoconceito, a Escala de Autoconceito Infantojuvenil; para instruções sobre o tratamento, o Guia de Pais. A taxa de sucesso no tratamento foi de 71%. Houve diferença estatisticamente detectável na variação do autoconceito pessoal pré e pós-intervenção (M=4,8; DP=1,9; vs M=6,1; DP=1,9; p=0,01), independentemente do desfecho, e diferenças no autoconceito social entre as médias de crianças que tiveram sucesso no tratamento (M=9,8; DP=1,9 vs M=0,5; DP=1,5; p=0,03). A proposta de tratamento da enurese apresentada é viável e eficaz e impactou positivamente o autoconceito das crianças avaliadas. (AU)

The objective of the study was to evaluate the efficacy of enuresis alarm therapy, performed at a distance, and to evaluate the effects of the intervention on the participants' self-concept. This is a clinical trial with a quasi-experimental group design. Thirty-one children with mono-symptomatic primary enuresis participated (M(age)=8.3, SD=1.3), 15 boys (48.3%). Assessments were made using the Enuresis Evaluation Form; Child-Juvenile Self-Concept Scale; and the Parents' Guide, for treatment instructions. Treatment success rate was 71%. There was a statistically significant difference in the variation of the personal self-concept before and after intervention (M=4.8, SD=1.9; vs M=6.1, SD=1.9; p=0.01), regardless of the outcome (M=9.8, SD=1.9 vs M=0.5, SD=1.5; p=0.03), and differences in the social self-concept among the means of children who had successful treatment (M=9.8, SD=1.9 vs M=0.5, DP=1.5; p=0.03). The proposed enuresis treatment is feasible and effective, and positively impacted the self-concept of the children evaluated. (AU)

El objetivo del estudio fue evaluar la eficacia del tratamiento comportamental para Enuresis, con uso de alarma, realizado a distancia, y evaluar también los efectos de la intervención en el autoconcepto de los participantes.Se trata de un ensayo clínico con delineamiento casi experimental de grupos. Participaron 31 niños con enuresis primaria monosintomático (M(edad)=8,3; DP=1,3), 15 varones (48,3%). Para evaluar la enuresis fue utilizado el Formulario de Evaluación de Enuresis, para el autoconcepto; Escala de Autoconcepto Infanto Juvenil, para instrucciones sobre el tratamiento; Guía de Padres. La tasa de éxito del tratamiento fue de 71%. Hubo diferencia estadísticamente detectable en la variación del autoconcepto personal antes y después de la intervención (M=4,8; DP=1,9; vs M=6,1; DP=1,9; p=0,01) independiente de los resultados, y diferencias en el autoconcepto social entre el promedio de los niños que tuvieron un tratamiento exitoso (M=9,8; DP=1,9 vs M=0,5; DP=1,5; p=0,03). La propuesta del tratamiento de enuresis presentada es viable y eficaz e impactó positivamente en el autoconcepto de los niños evaluados. (AU)

Consejería breve en tabaquismo / Brief counseling in smoking

La consejería breve o intervenciones breves, son un conjunto de estrategias efectivas para la cesación, que actúan a nivel conductual y que pueden ser brindadas por cualquier profesional de la salud y que demandan poco tiempo de la práctica clínica asistencial, están basadas en la mejor calidad de evidencia, se encuentran ampliamente difundidas y son recomendadas por numerosas guías de práctica clínica de todo el mundo, su duración estimada es de 2 a 5 minutos por consulta. Puede utilizarse con toda la población fumadora independientemente del sexo, edad, raza y nivel de adicción a la nicotina. Las intervenciones breves están constituidas por 5 componentes fundamentales: 1. Conocer el estatus de fumador, registrarlo en ficha clínica y actualizarlo en cada consulta.2. Realizar consejo anti tabáquico claro.3. Evaluar el nivel de motivación (o etapa de cambio de la dependencia). 4. Elaborar un programa de tratamiento: Fecha de abandono Intervención psicosocial. 5. Seguimiento....

Brief advice or brief interventions are a set of effective strategies for smoking cessation, and acting to behavioral level that can be provided by any health professional and requires little time from the clinical practice. They are based on quality evidence, widely known and recommended by numerous clinical guidelines throughout the world. It should take from 2 to 5 minutes per visit. It can be used with the whole smoking population, regardless their gender, age, race or level of nicotine addiction. Brief interventions consist of 5 fundamental components: 1. Knowing the smoking status, record it on the medical records and update it on every visit. 2. Make a clear advice on smoking cessation 3. Assess the level of motivation (or stage of change of dependency) 4. Design a treatment program: - Date of quitting - Psychosocial intervention 5. Follow up...

Increasing the Social Validity of Function-Based Treatments for Problem Behavior / Aumentando la Validez Social de los Tratamientos Funcionales para la Conducta Problemática

Functional assessment, and function-based treatments, are the gold standard for the treatment of problem behavior. Historically, these assessment and treatment evaluations have been conducted in austere clinical settings to increase internal validity. While prioritizing internal validity is critical in the initial stages of a treatment evaluation, if there is not an eventual shift to prioritizing the external or social validity of the treatment it may inevitably fail in the natural environment. The purpose of this case example is to outline a socially valid approach to the assessment and treatment of problem behavior that ensures individuals' and their families' lives benefit in meaningful ways. More specifically, this case-example will outline a method of prioritizing social validity to identify treatment goals, conduct functional analysis, evaluate and generalize treatment, and implement caregiver training.

La evaluación funcional y los tratamientos funcionales son el estándar de oro para el tratamiento de la conducta problemática. Históricamente, esas evaluaciones y tratamientos se han conducido en escenarios clínicos austeros para aumentar la validez interna. Si bien el priorizar la validez interna es crítico en las etapas iniciales de la evaluación de un tratamiento, si eventualmente no hay un cambio para priorizar la validez externa o social del tratamiento, éste puede fallar en un escenario natural. El propósito del ejemplo de caso que se presenta en este trabajo es mostrar una aproximación válida para la evaluación y tratamiento de conducta problemática que asegura que las vidas de los individuos y de sus familias se beneficien de forma significativa. Más específicamente, el ejemplo de caso que se presenta mostrará un método para identificar las metas del tratamiento priorizando la validez social, para conducir un análisis funcional, evaluar y generalizar el tratamiento y entrenar al cuidador.

Terapia cognitivo-comportamental em cefaleia crônica / Cognitive behavioral treatment in chronic headache

A terapia cognitivo-comportamental (TCC) é a abordagem psicoterápica mais pesquisada atualmente. Seus fundamentos procuram identificar pensamentos e comportamentos inadequados ou disfuncionais automáticos. Ajuda o paciente a desenvolver habilidades e empregar as técnicas cognitivas para rebater as crenças que destroem sua aceitação da responsabilidade no emprego de técnicas de enfrentamento e autogerenciamento da dor. Também são administradas técnicas de relaxamento para alívio de alguns sintomas da dor crônica.

Eating Disorders

Therapist competency is fundamental to the success in treating most psychological disorders. However, the skills required to effectively treat eating disorders may be more demanding than many other problems, because competency requires mastery of considerable educational information about physical complications associated with eating-disorder symptoms and chronic weight suppression. The cognitive-behavioral model of treatment has become well-defined in recent years; however, the mark for therapist competency continues to rise as the knowledge base has expanded with the high level of clinical and research interest in eating disorders. The guidelines provided in this paper are intended to provide a springboard for the training and supervision to improve patient care.

La competencia del terapeuta es fundamental para el éxito en el tratamiento de los Trastornos Psicológicos. Sin embargo, las habilidades que se requieren para tratar eficazmente los Trastornos del Comportamiento Alimentarios pueden ser más demandantes que para otros problemas, porque la competencia requiere del dominio de considerable información educativa acerca de las complicaciones físicas asociadas con los síntomas de los Trastornos Alimentarios y la supresión crónica de peso. El modelo de tratamiento cognitivo-conductual se ha convertido en el mejor definido en recientes años, sin embargo, el marco de la competencia del terapeuta continúa aumentando, dado que, la base de conocimientos se ha ampliado con el alto nivel de interés en la investigación clínica y en los trastornos alimentarios. Las directrices que proporciona este artículo tiene objetivo servir de trampolín para la formación y supervisión para mejorar la atención al paciente.

Stress, Sleep Physiology, and Related Insomnia Disorders

Excessive stress gives rise to disturbances in various systems in humans and activates defense mechanisms to maintain homeostasis in the body. Sleep is an essential biological process of which the underlying regulating mechanism involves numerous anatomical structures and biochemical substances that can be compromised by stress and the immune system. Immune sub-stances such as interleukin-1beta and tumor necrosis factor are related to the homeostatic process of sleep. Interleukin-1beta interacts by being involved in an immune regulating feedback chain that activates the hypothalamo-pituitary-adrenal axis which, in turn, is related to the circadian process. Moreover, stress-induced insomnia activates the hypothalamo-pituitary-adrenal axis further to bring about a vicious cycle of stress and insomnia. The pathophysiological theory responsible for chronic insomnia is that of stressdiathesis, which is a series of processes consisting of predisposition, precipitating, and perpetuating factors. In clinical practice, as the process in which stressinduced insomnia passes into a chronic course is directly related to treatment, the understanding of perpetuating factors is indispensable. Sleep disturbance is a very common complaint among pa-tients with posttraumatic stress disorder. Increased noradrenergic activity and REM sleep dysregul-ation seem to have a role in mediating sleep disturbances of this disorder. Sleep disturbance must always be taken into account as an important clinical variable whenever evaluating or managing stress.

Major Lessons from the MTA in Treatment of Attention-Deficit Hyperactivity Disorder

OBJECTIVES: The current review aimed to describe the major findings of the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit Hyperactivity Disorder (MTA) with regard to the treatment of children with attention-deficit hyperactivity disorder (ADHD). METHODS: We performed a general review of the literature regarding the efficacy of the MTA's proposed treatments. RESULTS: There is a large and still increasing body of evidence regarding the MTA's treatment outcomes. We present and discuss details of the findings at each follow-up point. CONCLUSION: Currently, findings regarding the MTA's treatments suggest children with combined-type ADHD exhibit significant impairment in adolescence, despite their initial symptom improvement. Further studies, using innovative treatment approaches and targeting specific areas of adolescent impairment, are needed in order to enhance ADHD treatment outcomes.

Treatment Relationships in Cognitive-Behavioral Treatment of Children and Adolescents / 신경정신의학

This article reviewed the literatures which demonstrated correlations between therapeutic relationship variables and treatment outcomes in children and adolescents, and also examined factors which affect a positive therapeutic relationship. Results from this review revealed that a positive therapeutic relationship is essential for cognitive-behavioral treatment (CBT) with children and adolescents, and also indicated that the therapeutic effect is the most powerful when a therapist maintains a collaborative relationship. Finally, basic strategies for maintaining a collaborative relationship have been suggested. These include strategies such as ; 1) setting a goal for therapy focusing on enhanced motivation for therapy ; 2) facilitating the engagement of parents in the treatment process ; 3) creating a collaborative atmosphere ; 4) educating the client about therapy ; 5) liciting feedback ; 6) making creative and innovate modifications of traditional CBT methods ; and, 7) providing choices for the client.

Tratamento cognitivo e comportamental para transtornos do controle de impulsos / Cognitive-behavioral treatment for impulse control disorders

OBJECTIVES: This paper reviews the cognitive-behavioral treatment of kleptomania, compulsive buying, and pathological gambling. METHOD: A review of the published literature was conducted. RESULTS: Treatment research in all of these areas is limited. The cognitive-behavioral techniques used in the treatment of kleptomania encompass covert sensitization, imaginal desensitization, systematic desensitization, aversion therapy, relaxation training, and alternative sources of satisfaction. Regarding compulsive buying, no empirical support for treatment exists but common techniques examined were covert sensitization, exposure and response prevention, stimulus control, cognitive restructuring, and relapse prevention. Treatment of pathological gambling has been successful in both group and individual format using techniques such as aversive therapy, systematic desensitization, imaginal desensitization and multimodal behavior therapy (which have included in vivo exposure, stimulus control, and covert sensitization) along with cognitive techniques such as psychoeducation, cognitive-restructuring, and relapse prevention. CONCLUSIONS: There is a general consensus in the literature that cognitive-behavioral therapies offer an effective model for intervention for all these disorders. An individualized case formulation is presented with a case study example. Clinical practice guidelines are suggested for each disorder.

OBJETIVOS: Este artigo revisa o tratamento da cleptomania, do comprar compulsivo e do jogo patológico. MÉTODO: Realizou-se uma revisão da literatura publicada. RESULTADOS: A pesquisa sobre o tratamento em todas essas áreas é limitada. As técnicas cognitivo-comportamentais utilizadas no tratamento da cleptomania compreendem sensibilização encoberta, dessensibilização imaginal, dessensibilização sistemática, terapia de aversão, treinamento de relaxamento e fontes alternativas de satisfação. Com relação ao comprar compulsivo, não existe amparo empírico para o tratamento, mas as técnicas comuns examinadas foram sensibilização encoberta, exposição e prevenção de resposta, controle do estímulo, reestruturação cognitiva e prevenção de recaída. O tratamento do jogo patológico teve êxito tanto no formato em grupo como no individual, utilizando técnicas tais como terapia aversiva, dessensibilização sistemática, dessensibilização imaginal e terapia comportamental multimodal (incluindo exposição in vivo, controle do estímulo e sensibilização encoberta), juntamente com técnicas cognitivas, tais como psicoeducação, reestruturação cognitiva e prevenção de recaída. CONCLUSÕES: Há um consenso geral na literatura de que as terapias cognitivo-comportamentais oferecem um modelo eficaz de intervenção em todos esses transtornos. Uma formulação de caso individualizada é apresentada com um exemplo de estudo de caso. Sugerem-se diretrizes para a prática clínica de cada transtorno.

Resultados preliminares del Programa de Intervención Breve para Adolescentes que Inician el Consumo de Alcohol y otras Drogas / Preliminary study of a brief intervention program for adolescents who initiate alcohol and other drugs consumption

During the last two decades, alcohol, tobacco and illicit drug consumption among young people has come to be regarded as a serious public health problem, both in Mexico and internationally. This recognition has resulted from a trend toward higher levels of use, greater diversification of the types of drugs used and abused, and increased drug marketing. Epidemiological data show that most users initiate drug use when they are about 16 years old. However, the age of first drug experimentation appears to be decreasing, with recent reports indicating an average age 12 or 13 years at present. The societal costs of adolescent drug use cut across different domains including physical and mental health, car crashes, and morbidity and mortality related to substance misuse. The personal costs of teen drug use include school failure, drop-out, and truancy. Moreover, aggressive behavior and crime, risky sexual behaviour, and many other behavioural problems have been shown to be associated with adolescent drug use. Research from many different disciplines has increased knowledge about (a) important dimensions of adolescent substance use and (b) the processes and variables related to the origin and maintenance of addictive behavior among teenagers. Despite this growing body of knowledge, few current prevention and treatment programs are based on empirical investigation. Moreover, many current intervention programs have not been adequately evaluated in regard to effectiveness. A recent development in the addiction field is brief intervention (BI). BIs have been demonstrated to be effective in the treatment of addictive behavior among adult problem drinkers, with the most successful programs based on the Theory of the Social Learning. Only recently have BIs been tried with adolescent populations. While promising, little empirical research exists about the effectiveness of brief treatment with adolescents. The primary goals of BIs are to (a) reduce or eliminate substance consumption and (b) to mitigate the adverse effects of using alcohol or other drugs (i.e., harm reduction). While the goals of BIs are clear, the effectiveness of such programs with adolescents, despite their promise, is not well researched. For this reason, it is important to develop and empirically test BI programs for adolescents demonstrating problematic alcohol or other drug consumption. Schools represent a particularly good place to access adolescents who would benefit from BIs, and BIs represent an attractive alternative to the typical strategies used by school to address student substance use (i.e., suspension or expulsion). The main goal of this investigation was to develop and to evaluate a brief intervention program for teenagers with substance abuse (but who have not developed substance dependence) between 14 and 18 years old. The intervention program tries to: (a) promote a change in drug consumption through establishing consumption goals (in the case of the alcohol, moderation or abstinence; in the case of illegal drugs, abstinence); (b) identify high-risk situations in which use is probable; and (c) develop alternative strategies to these situations. The theorical bases of the intervention include Self-control Theory, Motivational Interviewing, Relapse Prevention and <>. Our brief intervention program consisted of six steps: 1. case detection, which involved the identification of adolescents who abuse alcohol or another drugs, by means of teacher's reports, legal and psychology personnel, trained by the investigators; 2. screening, which involved determining whether adolescents met inclusion criteria; 3. assessment, which addressed the frequency and amount of consumption and self-confidence to suitably face situation of probable drug; 4. induction to the program, the objective of which was to sensitize the adolescents about the importance of attending treatment; 5. intervention; and, 6. one, three and six months follow-up assessments. The intervention program consisted of four individual sessions with the participants in which they chose their own substance reduction goals, identified their high risk situations, developed coping plans for each high risk situation, and appraised the impact of their substance use on their own life-goals success. The researchers used a single-case design with 25 participants, 17 of whom had alcohol problems and eight of whom had marijuana problems. The age average of participants was 16 years (SD = 1.8), and 19 were male and six were female. The average age of first consumption was 14 years old (SD = 1.72); the average duration of substance use was 18 months. From the complete sample, 45% reported consumption one or twice per week, 22% reported daily consumption, and the remainder consumed once a month. Results indicated that from the 25 participants, 24 demonstrated changes from the baseline in their consumption pattern (measured by frequency and quantity) during intervention and at follow-up assessments. Self-efficacy levels (self-perceptions about the capability to abstain or use moderately in high risk situations) changed as well. Specifically, among the adolescents who consumed alcohol a one-way ANOVA revealed significant changes in average consumption between the baseline, treatment, and follow-up phases F(2.48) = 17.691, p < .001. Bonferroni's post-hoc tests showed differences between baseline ( = 8.89, SD = 3.55) and treatment ( = 4.46, SD = 3.27), and between baseline and the follow-up ( = 3.29, SD = 1.35). Student's t tests for each subject showed that 16 adolescents significantly reduced their alcohol consumption from the baseline to the follow-up. Only one participant demonstrated increased use (from five standard drinks per drinking occasion at the baseline to 5.90 standard drinks at the follow-up). Regarding consumers of marijuana, a one-way ANOVA showed significant changes in consumption across the baseline, treatment and follow-up phases F(2.21) = 8.219, p = .002. Bonferroni's post-hoc tests showed significant differences between the baseline ( = 18.23, SD = 16.62) treatment phases ( = 1.07, SD = 0.77), and between the baseline and the follow-up phases ( = 1.59, SD = 1.06). An additional one-way ANOVA revealed significant changes in self-efficacy. Specifically, participants demonstrated increased self-efficacy in situations including: Unpleasant emotions, Pleasant emotions, Testing personal control, Conflict with others, Social pressure, and Pleasant time with others (all p < .01), F(2.78) = 24.30, 12.47, 11.34, 11.02, 16.91 and 25.62, respectively. Self-efficacy in regard to Physical discomfort and Urges and temptations to drink also showed significant changes, but at p < .05 F(2.78) = 3.97 and 3.26, respectively. Finally, in order to evaluate the impact of the intervention on problems that participants associated with their alcohol use (or other drugs), seven areas were examined: School, Health, Cognitive, Interpersonal, Family, Legal and Economic. At the end of the treatment, there was a reduction in the number of problems related to these seven areas, compared with the baseline.

En las últimas décadas, el abuso de drogas legales e ilegales en los jóvenes ha sido considerado como un serio problema de salud pública, tanto en el ámbito internacional como en nuestro país. Los estudios epidemiológicos indican que la mayoría de los consumidores experimentan por primera vez con drogas alrededor de los 16 años, pero esta experimentación continúa disminuyendo presentándose en promedio a los 12 o 13 años. Esto representa altos costos para la sociedad y el individuo. Por ejemplo, en áreas de la salud se incrementan los costos de la atención médica, los servicios de salud mental y los tratamientos especializados, además de aumentar la probabilidad de accidentes y muertes relacionadas con el abuso; en el área escolar se presenta el fracaso y/o la deserción escolar, y la expulsión de los estudiantes por parte de las instituciones; y en el área social se pueden presentar conductas agresivas y/o delictivas, contacto sexual de riesgo y otros problemas de conducta relacionados con el consumo de sustancias. De los diferentes programas existentes, resaltan las intervenciones breves en el tratamiento de usuarios que abusan pero que no dependen de las sustancias. Este tipo de intervenciones se basan en la Teoría del Aprendizaje Social y están diseñadas para reducir los patrones de abuso de alcohol u otras drogas. Sin embargo, la aplicación de las intervenciones breves se ha realizado principalmente en adultos, y es hasta últimas fechas que éstas se han adaptado a población adolescente que abusa de las sustancias, sin tenerse todavía resultados concluyentes. Es por esto que es fundamental desarrollar programas de intervención breve como una alternativa para adolescentes que inician el abuso de alcohol u otras drogas. Otro punto que requiere atención es el desarrollo de estrategias para detectar los casos en las escuelas, con la finalidad de ofrecer los servicios de atención en las propias instituciones educativas sin que el adolescente tenga consecuencias como la suspensión o la expulsión. Ante este fenómeno se ha recomendado fortalecer acciones que se basan en la identificación temprana de patrones de consumo que ponen en riesgo al adolescente a diferentes problemas relacionados con el abuso de las drogas. Estos programas se deben caracterizar por ser costo-eficientes, breves y capaces de instrumentarse en una variedad de escenarios, así como de aplicarse a una variedad de culturas. Por lo tanto, el objetivo de esta investigación fue desarrollar y evaluar un programa de intervención breve para adolescentes de entre 14 y 18 años de edad, estudiantes de nivel medio y medio superior, que consumen alcohol en exceso u otras drogas, y que presentan problemas relacionados con este patrón de consumo pero sin cubrir los síntomas físicos de la dependencia. Para realizar la evaluación se utilizó un diseño de caso único con 25 réplicas, 17 casos de consumo de alcohol y 8 casos de consumo de mariguana. De los 25 adolescentes que participaron en el estudio, 24 mostraron una disminución en el patrón de consumo (cantidad y frecuencia de consumo), al comparar las mediciones de los datos recabados en las fases de línea base, tratamiento y seguimiento. Así mismo, se dieron cambios en el nivel de auto-eficacia (percepción de la capacidad de los sujetos para controlar sus situaciones de consumo), es decir, al finalizar el tratamiento los adolescentes se percibieron a sí mismos con mayor capacidad para controlar la cantidad de consumo en situaciones de riesgo. Además, al final del tratamiento los sujetos reportaron una reducción del número de problemas relacionados con su consumo. Esta investigación es uno de los primeros esfuerzos por demostrar el impacto de las intervenciones breves en el patrón de consumo de los adolescentes. Las limitaciones del estudio fueron que no se determinó el efecto específico de cada uno de los componentes del programa ni tampoco se evaluó la presencia de otras conductas problemáticas (comorbilidad). Sin embargo, esta investigación ofrece un apoyo empírico a los programas de intervención breve en población adolescente de nuestro país.

Repensando las adicciones: el paradigma cognitivo y el trastorno por dependencia / Rethinking addictions: the cognitive paradigm and substance dependence disorder

El objetivo del siguiente trabajo es revisar algunas estrategias psicoterapéuticas utilizadas para el trastorno por dependencia de sustancias. Desde el paradigma cognitivo se estudian diferentes creencias distorsionadas frecuentes en nuestro medio. Éstas denotan la dificultad de abordar el problema de las drogas desde el conocimiento científico basado en la evidencia. Se plantean problemáticas como el modelo de enfermedad, la alianza terapéutica, la ilegalidad, el objetivo del tratamiento, la medicación, las ideologías y las implicancias para las intervenciones sociales. Se repasan estrategias que han demostrado eficacia: Estrategias Motivacionales, Prevención de Recaídas, Manejo de Contingencias, Terapia Cognitiva Estándar y Reducción del Daño. Se concluye con la importancia de aplicar el conocimiento científico actual en los programas de tratamiento y en las políticas preventivas

The aim of this task is to review some psychotherapeutic strategies used for the treatment of Substance Dependence Disorder. Different distorted beliefs, from the cognitive paradigm, which are usually assumed in our society, are studied here. These beliefs reveal difficulty in facing the drug problem, from the scientific knowledge based on evidence. Different problems are set up, such us the illness pattern, therapeutic alliance, treatment aims, unlawful acts, medication, ideologies and implications for the social interventions. Different strategies that have proved effectiveness are reviewed. Motivational Interview, Contingencies Management, Standard Cognitive Therapy and Harm Reduction have been pointed out. We come to an end with the recommendation to use the scientific knowledge for the treatment programs and preventive policies

La obesidad: aspectos psicológicos y conductuales / Obesity: Psychological and Behavioral Aspects

Introducción: La obesidad es un problema médico de creciente gravedad por su morbilidad y su alta y creciente prevalencia. Objetivo: Realizar una revisión actualizada acerca de la obesidad y su tratamiento, con énfasis en los aspectos de mayor interés para la práctica psiquiátrica. Resultados: La obesidad es una enfermedad crónica de difícil manejo y alta tasa de recurrencia, que se asocia con complicaciones médicas graves. Los factores psicológicos y conductuales son muy relevantes en el curso de esta enfermedad. Adicionalmente, algunos pacientes mentales tienen un mayor riesgo de presentar el problema por mayor inactividad, difi cultad para hacer cambios en el estilo de vida y el uso de psicotrópicos, muchos de los cuáles se asocian con aumento de peso.

Introduction: Obesity is a serious medical condition due to its morbidity and high and ever growing prevalence. Objectives: To review the subject of obesity and its treatment, with an emphasis on issues of greater interest to psychiatric practice. Results: This chronic medical condition is very diffi cult to treat and has a high rate of recurrence, and is associated with serious medical consequences. Psychological and behavioral factors strongly infl uence the course of this disease. Additionally, some mental patients are especially vulnerable to obesity due to greater inactivity, diffi culty in performing behavioral changes, and use of psychotropic medications, many of which may cause weight gain.

Cognitive-Behavioral Treatment of Late-Life Anxiety Disorder

This paper reviews the Cognitive-Behavioral Treatment (CBT) of late-life anxiety disorders, mainly focused on generalized anxiety disorder. CBT for late-life anxiety disorder is usually based on the same programs with demonstrated efficacy in younger adults, with specific treatment components included relaxation training, cognitive restructuring, and exposure. CBT for late-life anxiety disorders was proved to be more effective than no treatment. But, the existing body of work does not clearly indicate the superiority of CBT over alternative psychosocial interventions. Another serious limitation of CBT is that the rates of attrition in many trials are higher among older adults than among younger adults. Those limitations are strongly suggested that augmented CBT to meet the late-life adult's characteristics and needs, like as execute function, should be developed. Enhanced CBT is the one of the example, it includes the standard CBT elements, as well as additional attention to at-home practice assignments, reminder telephone call and weekly reviews of concepts and techniques. In conclusion, this review suggested the potential value of CBT for late-life anxiety disorders. Based on the current literature, nonstandard and augmented therapies appear to produce best results.

Cognitive and Group Treatment of Internet Addiction in Adolescents

A review of the literature and the authors' recent researches on the treatment of internet addiction among adolescents based on a cognitive behavioral approach suggest that most severely addicted adolescents have various co-morbid psychiatric problems and that the cognitive behavioral approach in a group setting is effective in the improvement of not only addictive behavior but also emotional and general behavioral problems including insight, depression, anxiety, and impulsiveness. Adolescents with internet addiction, especially who are severely affected, need a comprehensive psychiatric treatment of co-morbid problems and other behavioral problems.

Treatment of Sleep Disorders

Sleep medicine is a relatively new field to which medical practitioners have a limited exposure. During the last 20 years, many categories of sleep disorders have been defined. Sleep disorders produce various, sometimes serious, symptoms that cause physical, neuropsychological, and psychiatric problems. Medical doctors should recognize what symptoms are related to sleep disorders and make a first step to establish treatment plans that can help the patients. Based on sleep pharmacology we can understand the mechanisms of sleep physiology and ultimately can make appropriate prescriptions for patients. In Korea, actually, the physicians usually prescribe hypnotics indiscriminately for sleep problems, without considering any various sleep disorders and precise diagnostic procedures. Insomnia is not a simple homogenous disease entity, thus the exact diagnosis is essential for appropriate treatment. Especially, primary insomnia has a psychophysiological origin. Hypnotic medication is just one of the several treatment modalities for insomnia. To certain patients, behavioral modifications, rather than hypnotics, are effective. In fact, antidepressants and benzodiazepines can aggravate certain sleep disorders. In this article, the author reviews nonpharmacological treatment of insomnia, the medication specific to different sleep disorders, and treatment guidelines of hypnotics.

Pharmacological and Behavioral Approaches in the Treatment of Pathological Gambling / 대한정신약물학회지

Pathological gambling is classified as impulse control disorder in DSM-IV, but in clinical aspects it is similar with addictive disorder. Hence some pharmacological agents which are used to addictive disorders could be effective to pathological gambling. The author summarizes and discusses the treatment study results of mood stabilizers, serotonin reuptake inhibitors, naltrexone and other potentially promising agents. Recent double-blind, placebo-controlled studies show SSRIs and naltrexone effective to reduce urges of gamblers. However further studies with large patient population and longer treatment duration are required. The author also discusses cognitive behavioral treatment, family education and Gamblers Anony-mous (GA). Western cognitive behavioral treatment consists of cognitive correction, problem solving technique, social skill training and relapse prevention, but we need to modify these rechnics to fit to our clinical population.

Neuropsychiatric Treatment of Patients with Traumatic Brain Injury

The neuropsychiatric sequelae of traumatic brain injury are effects on complex aspect of cognition, emotion and behavior. They include problems with attention and arousal, concentration, executive function, intellectual changes, memory inpairments, personality changes, affective disorders, anxiety disorders, psychosis, apathy, aggression, and irritability. There are many useful therapeutic approaches available for people who have been brain injuries. Although a multifactioral, multidisciplinary, collaborative approach to treatment is proposed, for purposes of exposition the author have divided treatment into psychopharmacological, cognitive, behavioral, psychological, and social interventions.

Development of an OPD-based childhood obesity control program and the effects of its utilization

BACKGROUND: Although childhood obesity is an increasing public health problem in our society and a number of regimens have been developed and distributed for the treatment of adult obesity, few studies have focused on therapeutic programs for obese children. The objective of this study was to deveIop and measure the effects of an OPD-based childhood obesity control program. METHOD: 'The OPD-based childhood obesity control program was developed by reviewing the preexisting literature and consulting specialists. It was applied to the 4-6th grade obese(obesity index >or=30% ) children. The effects of intervention were assessed by the changes in obesity-related behavior, caloric and nutrient intake and exercise amount. The effects in the OPD-based group (group I) were also compared with the school-based group (group II) and the no intervention group (group III). RESULTS: The OPD-based program was developed based on behavioral modification principles such as self monitoring, stimulus control, positive reinforcement, social support, cognitive change and behavioral contracts and contained diet and exercise therapy. The developed program was applied to 34 pairs(child and mother) in the treatment group of which 21 pairs completed the basic session and 17 pairs completed the additional follow up session. Significant changes, decreases, in obesity index were observed In the OPD-based group. No significant changes were found in the school-based group whereas increased degrees of obesity were found in the no intervention group. Obesity related behavior scores were significantly increased in both the OPD- and school-based groups. The children in both the OPD-based group showed significant decrease in dietary intake and increase in exercise amount. CONCLUSION: Although it was a short-term treatment result, the OPD-based program was more effective than the school-based program in childhood obesity control. We suggest that a control program of comparable intensity and individualization as ours is required, for effective childhood obesity control.