ABSTRACT
Resumen El proceso de regulación emocional está siendo foco de gran cantidad de investigaciones en la actualidad. Se estima que se encuentra asociada al desarrollo y mantenimiento del 75 % de los trastornos mentales del Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM, por sus siglas en inglés). En esta línea se han estado estudiando en los últimos años, a nivel global, protocolos transdiagnósticos que tienen, como foco de tratamiento, dicho proceso. El objetivo de este estudio consistió en explorar la familiaridad de los profesionales de la salud mental, de hospitales públicos del área metropolitana de Buenos Aires, con el constructo de la desregulación emocional y los protocolos diseñados para el tratamiento de pacientes con dichas características. A su vez, se buscó conocer el grado de acercamiento de los profesionales clínicos a las investigaciones sobre psicoterapias. A estos fines, se diseñó un cuestionario con 40 preguntas de respuestas abiertas y opción múltiple que fue completado por 75 profesionales (psicólogos y psiquiatras) de hospitales públicos del área metropolitana de Buenos Aires. La mayoría reportó conocer el constructo de desregulación emocional, pero al pedirles que conceptualicen un caso diseñado para este estudio muy pocos utilizaron el constructo. En cuanto a los protocolos transdiagnósticos diseñados para intervenir en la desregulación emocional, son muy poco implementados. Por su parte, menos de la mitad reportó haber leído investigaciones empíricas. Los cursos elegidos para continuar la formación son en su mayoría psicoanalíticos y la participación en congresos internacionales es escasa. Se propone la necesidad de fomentar el uso de intervenciones basadas en evidencia en hospitales públicos y la divulgación de protocolos transdiagnósticos con evidencia para la desregulación emocional.
Abstract A substantial amount of evidence regarding comorbidity among mental disorders has been accumulated during the last years. Moreover, it has been identified that there is a great variability within nosological categories. These limitations of categorical systems lead to the development of the transdiagnostic paradigm which contemplates the existence of underlying processes common to different diagnoses. The process of emotional regulation is currently the focus of many investigations. It is estimated that it is associated with the development and maintenance of 75 % of DSM mental disorders. Emotional dysregulation is being studied particularly as a common factor in depression and anxiety, the two most prevalent disorders in Argentina. Related to this, transdiagnostic protocols aiming this process have been studied in the last years at a global level. The Unified Protocol has been developed by Barlow from a transdiagnostic perspective aiming to offer an evidence-based intervention that could be faithfully used in heterogeneous groups. It was created for emotional disorders with a specific focus on emotional dysregulation, contemplating comorbidity and heterogeneity. This makes the Unified Protocol a proper and valid intervention for the most prevalent disorders in Argentina. The objective of this study was to explore the familiarity of mental health practitioners, of public hospitals in the metropolitan area of Buenos Aires, with the emotional dysregulation construct and protocols designed for the treatment of patients with these characteristics. Moreover, the degree in which clinicians approach psychotherapy research was evaluated. For this purpose, a cross-sectional descriptive study was carried on. A questionnaire was designed with 40 questions (25 with closed answer and 15 with short open answer) that investigated five thematic areas: demographic characteristics, therapeutic approach, knowledge about the emotional dysregulation construct and treatment protocols, knowledge about the transdiagnostic paradigm and approach to empirical research. The questionnaire was completed by 75 practitioners (psychologists and psychiatrists) from public hospitals of the metropolitan area of Buenos Aires. After analyzing the results, it can be said that the most prominent theoretical framework from which practitioners work in public hospitals is psychoanalysis. The most prevalent diagnoses are anxiety and depression and comorbidity is frequent (M = 2.23, SD = .707). When studying the familiarity to the construct of emotional dysregulation, it was observed that even though most of them reported knowing the emotional dysregulation construct (89.3 %), when asked to conceptualize a person with intense and long-lasting emotional distress and difficulty in controlling their behavior and recognizing their emotions, very few mentioned difficulties in the regulation of emotions (13.51 %). Individual format treatment was the most chosen by psychologists for patients with these characteristics (69 %). Psychiatrists reported pharmacotherapy as the most chosen treatment (87.5 %). Group format is not frequently used. In regards to transdiagnostic protocols designed to intervene in emotional dysregulation, they are very poorly implemented. Dialectical Behavioral Therapy was reported to be known by 80 % of the sample, but used by 33.9 %, while the Unified Protocol was referred to be known by 34.7 % and used by 7.69 % of them. On the other hand, the gap between clinical practice and research seems to be wide. Less than half of the practitioners reported reading empirical research (44 %). And the transdiagnostic paradigm is known by 46.7 % of practitioners. When asked to mention the most influential authors in their practice, Freud and Lacan (classical psychoanalytic authors) were mentioned by the majority. The courses chosen to continue their training are mostly psychoanalytic and participation in international congresses is low (10.45 %). These results show the need to look for ways to encourage the use of evidence-based interventions in public hospitals and specifically the dissemination of transdiagnostic protocols with evidence for emotional dysregulation, being emotional disorders the most prevalent.
ABSTRACT
Objetivo: el objetivo de este estudio instrumental fue adaptar la versión española del Inventario de Burnout de Maslach (MBI-HSS) en una muestra (n = 544) de psicólogos y psiquiatras argentinos de entre 23 y 71 años de edad. Métodos: para evaluar la estructura interna del instrumento se realizó un análisis factorial confirmatorio (AFC) por medio del método de estimación de Máxima Verosimilitud robusto. La consistencia interna se calculó mediante el coeficiente de confiabilidad compuesta (fc). Resultados: el modelo inicial mostró índices de ajuste aceptables (CFI = .87, TLI = .86; RMSEA = .06; SRMR = .07). Tras la eliminación del ítem 12 del análisis, el ajuste del modelo mejoró satisfactoriamente (CFI = .91, TLI = .90, RMSEA = .05, SRMR = .06) confirmándose la estructura trifactorial. El cálculo de consistencia interna arrojó valores considerados muy buenos (fc > .70). Conclusión: se concluye que el MBI-HSS es una escala fiable y válida para la evaluación del Burnout en psicólogos y psiquiatras argentinos. Se discuten los resultados y sus posibles implicaciones en futuras investigaciones.
Objective: The aim of this instrumental study was to adapt the Spanish version of the Maslach Burnout Inventory - Human Services Survey (MBI-HSS) in a sample (n = 544) of Argentinian psychologists and psychiatrists aged 23 to 71. Method: A confirmatory factor analysis (CFA) was conducted to evaluate the internal structure of the instrument using the robust maximum likelihood estimation. Additionally, the internal consistency was calculated using the composite reliability (CR) coefficient. Results: The original structure provided an acceptable ût to the data (CFI = .87, TLI = .86, RMSEA = .06, SRMR = .07). However, the three-factor model had a closer fit to the data after excluding item 12 from the analysis (CFI = .91, TLI = .90, RMSEA = .05, SRMR = .06). The internal consistency yielded very good values (CR > .70). Conclusion: It is concluded that the MBI-HSS is a reliable and valid scale to measure burnout in Argentinian psychologists and psychiatrists. The results and their possible implications for future investigations are discussed in this paper.
ABSTRACT
Este artículo describe el diseño, implementación y evaluación de un adiestramiento para profesionales de ayuda que trabajan en instituciones de educación superior en Puerto Rico. Está dirigido al desarrollo de destrezas y conocimiento en la evaluación y el manejo del riesgo suicida en estudiantes universitarios-as. Se realizó un diseño cuasiexperimental de medidas repetidas con 39 profesionales de las disciplinas de consejería, psicología y trabajo social. Se encontraron diferencias estadísticamente significativas entre la pre y posprueba, t (38) = -9.281, p = 0. Los resultados sugieren que un adiestramiento basado en la evidencia que utilice como guía las competencias e incorpore el uso de ejercicios prácticos aumenta el conocimiento y destrezas de intervención de profesionales de la salud mental en la evaluación y manejo de riesgo suicida.
This article describes the design, implementation and evaluation of a suicide risk assessment and management training for professionals working in institutions of higher education in Puerto Rico. We conducted a quasiexperimental design with 39 professionals in counseling, psychology and social work. Statistically significant differences were found between pre and post-tests, t (38) = -9.281, p = 0. Results suggest that an evidence-based training that follows the core competencies and includes practical exercises, increases the knowledge and intervention skills of mental health professionals in the assessment and management of suicide risk.
ABSTRACT
Objetivos: identificar as barreiras dos profissionais da rede de saúde mental; descrever as barreiras dos profissionais da rede de saúde mental; planejar, propor e implementar o projeto de educação permanente para a rede de saúde mental, tendo como foco as barreiras encontradas. Método: estudo descritivo e exploratório, de campo e abordagem qualitativa, do tipo pesquisa ação a ser realizada no Centro de Atenção Psicossocial em Japeri/RJ. Os sujeitos serão profissionais que atuam na área da saúde do município de Japeri. Os dados serão coletados por entrevista e oficinas, e tratados pela Técnica de Análise de Conteúdo e discutidos com base no referencial teórico de Paulo Freire e Donald Schön. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa, protocolo n. 765780. Resultados esperados: contribuir para o processo de reflexão e construção no espaço do trabalho, visando melhor assistência no âmbito do Sistema Único de Saúde.(AU)
Objectives: to identify the barriers of professionals in the mental health system; to describe the barriers of professionals in the mental health system; to plan, propose and implement the permanent learning project for mental health network focusing on the barriers faced. Methods: descriptive and exploratory study with qualitative approach, action search type to be taken at the Psychosocial Care Center in Japeri/RJ. The subjects are professionals who work in health care in the city of Japeri. Data will be collected through interviews and workshops, and treated by content analysis technique and discussed based on the theoretical framework of Paulo Freire and Donald Schön. The research project was approved by the Research Ethics Committee, Protocol 765780. Expected results: to contribute to the process of reflection and construction in the workplace, to better care under the National Health System.(AU)
Objetivos: identificar las barreras de los profesionales de la red de salud mental; describir las barreras de los profesionales de la red de salud mental; planear, proponer e implementar el proyecto de educación permanente para red de salud mental teniendo como foco las barreras encontradas. Método: estudio descriptivo y exploratorio, de campo y enfoque cualitativo, del tipo investigación acción a ser realizada en el Centro de Atención Psicosocial en Japeri/RJ. Los sujetos serán profesionales que actúan en el área de la salud de la ciudad de de Japeri. Los datos serán recogidos por entrevista y talleres, y tratados por la Técnica de Análisis de Contenido y discutidos con base en el referencial teórico de Paulo Freire y Donald Schön. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, protocolo n. 765780. Resultados esperados: contribuir para el proceso de reflexión y construcción en el espacio de trabajo, visando mejor asistencia en el ámbito del Sistema Único de Salud.(AU)
