ABSTRACT
Fundamento: En la actualidad existe un amplio rango de formas de intervención psicológicas que se emplean para el tratamiento del alcoholismo; no obstante, los estudios que documentan la efectividad de estas alternativas hacen énfasis en un grupo de acciones que son más efectivas en el tratamiento del paciente alcohólico Objetivo: Resumir las principales evidencias sobre la efectividad de los distintos enfoques existentes en el tratamiento de la dependencia alcohólica, a partir de un análisis de las pruebas existentes y diferenciarlas de las alternativas que han demostrado una limitada efectividad. Desarrollo: En los últimos años ha aumentado el interés por conocer la efectividad de las distintas alternativas de intervención en el alcoholismo, en gran parte por el interés marcado que existe en la administración adecuada de recursos de los que se dispone para el enfrentamiento de esta enfermedad. Los estudios sobre efectividad de las intervenciones además de necesarios para los profesionales que prestan ayuda psicoterapéutica, son cruciales para los decisores políticos que manejan los recursos dedicados a la salud, fundamentalmente para la toma de decisiones sobre el destino de los fondos basándose en el análisis de costo-beneficio. Conclusiones: Entre los enfoques interventivos con efectividad documentada se destacan las intervenciones breves, entrevistas motivacionales, entrenamiento en habilidades sociales y de afrontamiento cognitivo-conductual, el reforzamiento comunitario, el contrato conductual, las terapias aversivas y la prevención de las recaídas. Entre las terapias con limitaciones se pueden mencionar la psicoterapia del insight, consejería confrontacional, el entrenamiento en relajación, consejería y el empleo de recursos educativos.
Background: Actually there is a wide rank of psychological intervention that are used for the treatment of alcoholism , otherwise , the studies that document the effectiveness of the alternatives make emphasis in a group of actions which are more effective in the treatment of alcoholic patient. Objective: To recapitulate the main evidences about the effectiveness of the different views in the treatment of this alcoholic dependence, starting by an analyzing the existing evidence and differentiate them from the alternatives which have proved a limited effectiveness. Development: In the last few years there has been an increase in the interest for knowing the effectiveness of the different alternatives of intervention in alcoholism, in great part due to the marked interest that there is in the adequate management of the resources which are available for facing this disease. The studies about the effectiveness of the interventions although they are necessary for professionals that give psychotherapeutic help, are essential for politicians who handle the resources dedicated to health mainly to taking decisions about the destination of capitals based on the cost- benefit analysis. Conclusions: Brief interventions, motivational interviews, training in social abilities and of cognitive-behavioral coping, communitarian reinforcement, behavioral contract, aversive therapies and the prevention of relapses are found among the approaches of intervention with documented effectiveness. Insight therapy, confrontational counseling, training in relaxation, counseling and the use of educative resources are found among the therapies with limitations.
Subject(s)
Humans , Alcoholics/psychology , Psychotherapy , Interview, PsychologicalABSTRACT
La depresión es uno de los problemas en salud mental más prevalentes. En Latinoamérica se constituye como la primera problemática en cuanto a años de vida perdidos por incapacidad, lo que implica que se deben hacer esfuerzos importantes en desarrollar estrategias de intervención eficaces para su intervención. Este artículo tiene como objetivo, en primer lugar, ofrecer una revisión conceptual de la activación conductual, una de las estrategias de intervención que han probado ser eficaces en el tratamiento de la depresión y sus diferentes modalidades, en segundo lugar, examinar el uso que ha tenido en el manejo de la depresión en diferentes poblaciones y por último, revisar la evidencia empírica en Iberoamérica.
Depression is nowadays one of the most prevalent mental health problems. In Latin America is the main problem in terms of years of life lost due to disability, implying that major efforts should be made to develop effective intervention strategies for treatment. This article aims, first, to provide a conceptual review of the Behavioral Activation, one of the interventions that have proven to be effective to treat depression and its various forms, secondly, to examine its use to treating depression with different populations and finally, to review the empirical evidence in Latin America.
Subject(s)
Humans , Depression/psychology , Depression/therapy , Behavior Therapy/methods , Latin America , SpainABSTRACT
La Activación Conductual (AC) ha mostrado su efectividad como uno de los tratamientos más importantes para la depresión. Esta revisión de la literatura aborda aspectos históricos, variaciones y evidencia relacionada con la efectividad de la AC en diferentes problemáticas y poblaciones. Inicialmente se retoman sus alcances y uso, lo que le ha permitido constituirse como una de las terapias que cuenta con apoyo empírico para el manejo de la depresión. La revisión histórica permite ver su establecimiento como una Terapia de Tercera Generación y sus bases filosóficas en una perspectiva contextualista funcional. Posteriormente, se mencionan los diferentes tipos de activación conductual y algunos estudios relacionados con su efectividad tanto en depresión como en condiciones co-mórbidas. Finalmente, se realizaron recomendaciones para futuras investigaciones, entrenamiento, modalidades y problemas que pueden llegar a ser intervenidos a través de la activación conductual.
Behavioral Activation (BA) has shown its effectiveness as one of the most important treatments for depression. This review shows the historical antecedents, its different approaches, and the empirical evidence, which are linked with BA efficacy. In a first moment, are posed their scope and the way as it has been implemented, to get into one of the empirical evidence based therapies to treat depression. The historical review allows to see how it got a place as a Third Wave Therapy, and its philosophical roots on functional contextualistim. Furthermore, different models of Behavioral Activation and researches, which have shown their effectiveness to intervene depression and comorbid conditions, are presented. Finally, some recommendations are mentioned about futures studies, training, models, and problems, which could be implemented with BA.
Subject(s)
Psychology, Clinical , Effectiveness , Efficacy , Depression , Therapeutics , Adaptation, Psychological , Compliance , Empirical ResearchABSTRACT
O estudo objetivou testar a afirmação de que "pacientes que não têm êxito em conectar suas emoções com cognição durante suas terapias provavelmente não melhorarão". Dois processos de psicoterapias psicodinâmicas breves, um bem-sucedido e outro malsucedido, foram analisados com o Modelo dos Ciclos Terapêuticos. O Modelo dos Ciclos Terapêuticos é um método de análise de texto por computador que permite identificar padrões de emoção-abstração na narrativa de interlocutores. Quatro padrões são identificados: Relaxamento, Experiência, Reflexão e Conexão. Momentos clinicamente significantes são mais associados à Conexão. Levantou-se a hipótese de que o caso bem-sucedido apresentaria maior proporção de Conexão. Quanto à Reflexão, ao Relaxamento e à Experiência, não eram esperadas diferenças. Encontrou-se maior proporção de Conexão e de Relaxamento no caso bem- sucedido, e diferenças não significantes em Reflexão e Experiência. Considerações sobre a magnitude das mudanças, valência das emoções e abstrações e sequência de ocorrência dos padrões sugerem novas análises.
The current study aimed to test the statement that "patients who do not succeed in connecting their emotions with cognition during therapy are unlikely to improve". Two processes of brief psychodynamic psychotherapies, one successful the other not, were analyzed in accordance with the Therapeutic Cycles Model. The Therapeutic Cycles Model is a computer-assisted text analysis method that permits the identification of emotion-abstraction patterns in narratives by interlocutors. Four patterns are identified: Relaxing, Experiencing, Reflecting and Connecting. Clinically significant moments are mostly associated with Connecting. It was hypothesized that a successful process would differ from an unsuccessful one, having a higher proportion of Connecting. As far as Reflecting, Experiencing and Relaxing are concerned, no differences were expected. Results pointed to a higher proportion of Connecting and Relaxing in the successful process and no difference in respect of Experiencing and Reflecting. Considerations about the magnitude of change, emotion and abstraction valence and the sequence of patterns, suggest further analysis.