Fortalezas de carácter en pacientes adultos en tratamiento psicoterapéutico / Character strengths in adult patients in psychotherapeutic treatment

Resumen La investigación que se informa tuvo como objetivos: 1) estudiar las 24 fortalezas de carácter en pacientes adultos que se encuentran en diferentes etapas de un tratamiento cognitivo conductual psicoterapéutico naturalista; y 2) analizar la relación de las fortalezas con algunas del progreso durante el tratamiento, la alianza terapéutica y la adherencia al tratamiento desde la perspectiva del terapeuta. Se contó con una muestra intencional de 85 pacientes adultos de ambos sexos en tratamiento psicoterapéutico ambulatorio y sus respectivos terapeutas. Se utilizaron: una hoja de datos demográficos y del tratamiento, el Inventario de Fortalezas y Virtudes y una encuesta de opinión para el terapeuta. Los resultados mostraron que los pacientes en la etapa final presentan una mayor fortaleza de Autorregulación. Los pacientes con depresión presentaban menores fortalezas de apertura mental y capacidad de perdonar, en comparación con pacientes con trastornos de ansiedad y con trastornos comórbidos ansioso-depresivos. Aquellos pacientes que habían tenido un tratamiento psiquiátrico previo presentaban menores niveles de la fortaleza persistencia. Un mayor tiempo de tratamiento se asoció con mayores niveles de las fortalezas Liderazgo y curiosidad, en tanto que un mayor malestar psicológico se vinculó con una disminución de una alta cantidad de fortalezas. La fortaleza espiritualidad se halló significativamente asociada al progreso en el tratamiento según su terapeuta. Una mayor apertura mental se halló vinculada a mayor adherencia a horarios, sugerencias y mejor vínculo terapéutico según la opinión del terapeuta. El estudio del funcionamiento positivo en pacientes permitirá enriquecer la psicología clínica para convertirse en una disciplina más integradora.

Abstract The study of positive traits or strengths has been the cornerstone of positive psychology. Positive psychology assumes that positive variables are different in nature from psychopathological variables and they do not necessarily improve with a usual psychotherapeutic treatment. They would require another type of intervention to progress: a positive intervention. Studies on character strengths in the clinical population are very scarce and, in general, focused on depression. Previous studies found that higher levels of hope, vitality, spirituality and leadership strengths were related to lower levels of anxiety and depression. In addition, lower levels of gratitude have been linked to symptoms of depression. The study of strengths and progress during treatment is very limited, whereas the relationship between strengths of character and treatment process has not yet been investigated. This research aims to: 1) study the 24 character strengths in adult patients who are at different stages of a naturalistic cognitive behavioral treatment; and 2) to analyze the relationship of character strengths with progress during treatment, therapeutic alliance and adherence to treatment from the therapist's perspective. Therapist's report has proven to be a very valuable source of information about the therapeutic process and outcome. An intentional sample of 85 adult outpatients (25 men and 60 women) was used and their respective therapists (11 men and 7 women). Patients had mainly anxiety, depressive or comorbid anxiety-depressive disorders; 22 were in the initial stage, 46 in the intermediate stage and 17 in the final stage of treatment.They completed a demographic and treatment datasheet, the Inventory of Strengths and Virtues and the therapist filled in an opinion survey. The study was cross-sectional. The treatment was cognitive-behavioral. The therapists did not receive any training or instruction during study, the treatment was "as usual". Stages of treatment, initial, intermediate or final, were assigned by the therapist. The results showed that patients in the final stage have greater self-regulation strength. In this strength, there are no differences between patients at initial and intermediate stages of treatment but it increases significantly in the group that was finishing treatment. It should also be noted that in the 23 remaining strengths there are no differences among patients at the different stages of treatment. Patients with depression had lower strengths of open-mindedness and forgiveness compared to patients with anxiety disorders and comorbid anxiety-depressive disorders. Those patients who had had a previous psychiatric treatment had lower levels of Persistence strength. However, no differences were found between patients who had a previous psychological treatment and those who had not. A longer duration of treatment was associated with higher levels of leadership and curiosity strengths, while greater psychological distress was associated with a decrease in a high number of strengths. The strength spirituality was found to be significantly associated with progress in treatment according to the therapist. A greater open-mindedness was associated with better adherence to schedules, suggestions and therapeutic alliance according to the therapist´s opinion.The association between character strengths and the therapist's opinion has been mild to moderate, which is expected for being a hetero-report. This has been the first study to compare the character strengths between patients at different stages of a naturalistic psychotherapeutic treatment and to include patients with anxiety disorders. This research provided a first approach to the relationship between character strengths and the therapist's perception of progress in therapy and some treatment process related variables. The study of positive functioning in patients will enrich clinical psychology to become a more integrative discipline. In this way, the goal of therapy will not only be to alleviate the negative symptoms, but also to help individuals build a full life.

Assessing the measurement invariance of a Latin-American Spanish translation of the Body Appreciation Scale-2 in Mexican, Argentinean, and Colombian adolescents.

In order to advance in the study of positive body image among different cultures, it is important to create culturally appropriate measures. We examined the psychometric properties of a Latin-American Spanish translation of the Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015a), specifically assessing measurement invariance using a large sample of 3845 male and female adolescents from Argentina, Mexico, and Colombia. Participants completed the BAS-2, Eating Disorder Inventory-2, Male Body Attitude Scale and the Sociocultural Attitudes Toward Appearance Questionnaire-3. The BAS-2 had a unidimensional factor structure in each of the three samples. We confirmed the structural, metric, and scalar invariance of the scale regardless of gender or country. Adolescents in Argentina had lower body appreciation compared with those in Mexico and Colombia. Overall, females had lower body appreciation than males, with the greatest gender difference found in the Argentinean sample. Our findings strongly support the validity and reliability of this Latin-American translation of the BAS-2 in measuring positive body image in adolescents in Argentina, Mexico, and Colombia.

Positive Variables in Adult Patients Who Are at Different Stages of a Naturalistic Psychotherapeutic Treatment.

This study aimed twofold: 1) to study some positive variables (three paths to well-being, life satisfaction, overall well-being and meaning of life) in adult patients who are at different stages of a naturalistic cognitive behavioral psychotherapeutic treatment and 2) to analyze their relationship with the progress during treatment, therapeutic alliance and adherence to treatment from the therapist´s perspective. The sample was composed of 85 outpatients who were in psychotherapeutic treatment. Patients completed the Three Pathways to Well-being Scale, Meaning in Life Questionnaire, Satisfaction with Life Scale, Well-being Index and Symptom Checklist-90-Revised. Therapists completed treatment related data and an opinion survey of patient´s progress, adherence to treatment and therapeutic relationship. Findings showed positive variables to be higher at the final stage of psychotherapy, particularly higher satisfaction with life, engagement, well-being, and presence of meaning in life. Higher positive variables were moderately associated with more progress during treatment according to therapist's perspective; however a low association was found with adherence to treatment and therapeutic relationship. No differences were found in positive variables according the type of prevalent symptoms.

PSYCHOMETRIC PROPERTIES OF THE THREE PATHWAYS TO WELL-BEING SCALE IN A LARGE SAMPLE OF ARGENTINEAN ADOLESCENTS.

The Authentic Happiness Theory considers that well-being can be reached by three main pathways: a pleasant life, an engaged life, or a meaningful life. This study investigates the psychometric properties of the Three Pathways to Well-being scale in Argentinean adolescents and compares that to prior results for Argentinean adults. A sample of 255 Argentinean adolescent students (110 boys, 145 girls) aged between 13 and 18 years (M age = 15.5, SD = 1.6) was used in this study. The participants completed the Spanish versions of the Three Pathways to Well-being scale, the Meaning in Life Questionnaire, the Satisfaction With Life Scale, and the Personal Wellbeing Index. Confirmatory factor analyses verified the three-factor structure of the test, accounting for 46% of the variance. The internal consistencies were α = .76 for the pleasant life, α = .80 for the engaged life, and α = .70 for the meaningful life. Concurrent validity was examined with the Satisfaction With Life Scale, the Personal Wellbeing Index, and the Meaning in Life Questionnaire, and the engaged life was the pathway most strongly associated with the positive related measures.

Satisfaction with life, well-being, and meaning in life as protective factors of eating disorder symptoms and body dissatisfaction in adolescents.

This study aimed to investigate the relationship among three potential protective factors: satisfaction with life, three routes to well-being and meaning in life, and eating disorder symptoms and body dissatisfaction in male and female adolescents. The sample was composed of 247 adolescent students aged 13 to 18 years. The findings of this study support the protective roles of satisfaction with life and engagement as routes to well-being in male adolescents and particularly in female adolescents. Positive interventions to promote satisfaction with life and engagement in activities in school are highly recommended.

Factores protectores de la salud mental: Un estudio comparativo sobre valores, autoestima e inteligencia emocional en población clínica y población general / Protective factors in mental health: A comparative study on values, self-esteem and emotional intelligence in clinical and general populations

El objetivo del trabajo que se informa fue realizar un estudio comparativo de tres factores protectores de la salud mental: inteligencia emocional, valores y autoestima entre 60 pacientes diagnosticados con trastornos de ansiedad y/o depresión y 60 sujetos de población normal. Así la muestra total quedó conformada por 120 sujetos. Los instrumentos utilizados fueron: la Escala de Valores de Schwartz (1992), la Escala de Inteligencia Emocional Bar-On (1997), la Escala de Autoestima de Rosenberg (1965), la Escala de Ansiedad STAI-rasgo (Spielberger, Gorsuch, Lushene, Vagg & Jacobs, 1983) y la Escala de Depresión de Beck-II (Beck, Steer & Brown, 2006). Los resultados indicaron que Autoestima y un aspecto de la inteligencia emocional, Felicidad, fueron las variables que mejor distinguieron al grupo clínico del grupo de población general. Dos componentes de la inteligencia emocional, Manejo de Estrés y Estado de Animo, distinguieron claramente entre sujetos con alta y baja ansiedad. Ambas dimensiones permitieron identificar correctamente a un 91.7% de sujetos con alta ansiedad. Un bajo nivel de valores de Autotrascendencia, una alta Autoestima y una alta dimensión del Estado de Animo de la inteligencia emocional permitieron distinguir un 85.3% de los pacientes con alta y baja depresión. Los resultados están en consonancia con los principios de la Psicología Positiva, en tanto que aspectos positivos también contribuyen a las variables patológicas y por lo tanto pueden fortalecerse a través de intervenciones positivas.

Clinical Psychology is trying to find new approaches to treat psychopathological problems. For this purpose, it takes the contributions of Positive Psychology for promoting mental health. In Clinical Psychology, the positive aspects are tackled in two main ways: as factors to strength in periods of health, and as factors to enhance in periods of illness. Positive or protective factors from Positive Psychology perspective are not conceived as prevention of illness but as promotion of health. Although many studies have focused on several protective factors such as hope, psychological well-being or effective coping, there are other factors much less studied. That is the case of emotional intelligence in a clinical context, the values that a person sustains and its relation with the level of self-esteem. The aim of this study is to present a com parative research of three protective factors of mental health: emotional intelligence, personal values and selfesteem between general and clinical populations. Specifically, it aims to: compare the three protective factors between the two populations and to assess what aspects of emotional intelligence, what type of values and what level of self-esteem relate to low levels of anxiety and depression. The sample was composed of two groups: one group of general population (n = 60) and one group of clinical population (n = 60) formed by patients with a diagnosis of anxiety disorders and/or depression. The general population sample was matched with the clinical sample by age and gender. The mean age in the clinical sample was 34.72 years old (SD = 10.23) and 34.23 years old (SD = 11.96) in the general population sample. The clinical group was composed of 12 men and 48 women whereas in the general population group there were 13 men and 47 women (79.2% of women in the whole sample). Participants signed informed consent and completed the questionnaires in presence of a researcher. The instruments used in this study were the Schwartz´s Portrait Values Questionnaire (1992), the Emotional Intelligence Inventory of Bar-On (1997), the Rosenberg Self-esteem Scale (1965), the STAI-trait Scale (Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983), and the Beck-II (Beck, Steer, & Brown, 2006). Results indicated that Selfesteem, the value Self-direction and the aspects of emotional intelligence (Emotional Self-awareness, Assertiveness, Selfregard, Self-actualization, Interpersonal relationship, Reality Testing, Stress Tolerance, Happiness, and Optimism) were significantly different between the two groups. The clinical sample scored significantly lower in all the aforementioned variables. In order to examine which of these variables discriminated between the two sample groups, a discriminant analyses was carried out. Self-esteem and, an aspect of emotional intelligence, Happiness, were the only variables to clearly differentiate between the clinical and the general samples. However, both variables could only classify a 71.1% of participants. On the basis of percentile values of STAI and Beck scales (cut-off point 70th percentile), both samples were divided into two groups: high and low anxiety level and high and low depression level. Two components of emotional intelligence, Stress Tolerance and General Mood, clearly distinguished between participants with high or low anxiety level. Both aspects allowed a correct identification of 91.7% of participants. On the other hand, low Self-transcendence personal values, high Selfesteem, and high General Mood component of emotional intelligence discriminated between subjects with high or low depression level, with a correct identification of 85.3% of participants. Results are in consonance with the fundamentals of Positive Psychology in terms that positive aspects also relate to pathological variables and, thus, may be enhanced with positive interventions. Both self-esteem and the different dimensions of emotional intelligence have specific structured programs to promote them.

Effects of craving self-report measurement on desire for heroin in opioid dependent individuals.

This study aims to investigate whether the administration of questionnaires measuring subjective craving induces more craving for opiates compared to questionnaires measuring other subjective states. The study was conducted in 2000. The sample was composed of 53 patients that were treated as inpatients and outpatients for their opioid dependence syndrome. Participants were assigned randomly into four groups. Both a craving and negative affect condition were presented to each group. The administration of the Visual Analogue Scale (VAS) preceded and followed each condition. Findings of the present study show that the administration of questionnaires measuring instant as well as general craving does not have a distinctive effect on measures of unidimensional craving compared to a questionnaire focused on anxiety and depression states. Because of the small sample, the results should be interpreted cautiously.

Personality disorders, depression, and coping styles in Argentinean bulimic patients.

This study investigates the coping styles of bulimic patients with personality disorders (PDs) and the effects of the level of depression on the relations between PDs and coping. The sample consisted of 75 Argentinean bulimic outpatients engaged in treatment. Patients completed the SCID II (Structural Interview for DSM IV-Personality Disorders), COPE (Coping Inventory), and the SCL-90-R (Symptom Checklist-90-Revised). No differences in the coping styles of bulimic patients with or without a PD were found. However, when three specific PDs were considered-Avoidant, Obsessive-Compulsive, or Borderline PDs-clear differences in the coping styles of the bulimics were found. However, the differences disappeared when depression was controlled. Regarding the severity of the three specific PDs, coping styles were only found to be associated with the Avoidant PD. Depression showed to affect the relations between coping styles and two specific PDs-Avoidant and Borderline PDs-in bulimic patients.

The role of core beliefs in the specific cognitions of bulimic patients.

Cognitive models of bulimia nervosa have stressed the importance of self-beliefs in the maintenance of the disorder. However, new findings show a deeper and more general level of beliefs also to play a role in eating disorders. These beliefs are long-standing, absolute, and unconditional. In the present study, the relations between such core beliefs and specific cognitions regarding eating, shape, and weight were examined. The sample consisted of 75 bulimic outpatients who started treatment. The patients completed the Schema Questionnaire, the Eating Disorders Inventory-2, the SCL-90-R, and the Mizes Anorectic Cognitions Questionnaire at intake. Strong relations between some core beliefs and the specific cognitions regarding shape, weight, and eating were found. The modification of core beliefs appears to be a very important issue to incorporate into treatment.