RESUMO
INTRODUCTION: The aim of this study is to explore the effectiveness of a training programme aimed at managing patients' chronic pain in physiotherapy students in Spain. The programme addressed providing them with efficient skills to manage patients' chronic pain from psychological flexibility (PF) perspective. METHODS: The programme integrates communication skills training into PF-based training. It sought to contribute to better recognise the role of psychosocial factors in chronic pain and to better promote adherence to treatment. This is an observational study with a pre- and post-training programme design and a 2-month follow-up. A total of 35 physiotherapy students, divided into three groups, participated in a 10-hour training course. Training focused on three areas: (1) communication skills, (2) therapeutic adherence and (3) managing distress and pain. The three areas were addressed from the PF point of view. Impact of training was measured through standardised questionnaires that assessed attitudes towards chronic pain, an ad hoc questionnaire that assessed responses to difficult communicative situations and a training satisfaction scale. RESULTS: Final analyses showed that attitudes changed significantly after training, biomedical attitude scores decreased and biopsychosocial attitude increased, while pain was considered less disabling, and informed empathic responses in communication situations increased. These changes were maintained at 2-month follow-up. Satisfaction with the training was high. CONCLUSION: We conclude that a brief training programme based on the PF model may help students develop a more comprehensive approach and improve their skills for managing chronic pain.
RESUMO
El objetivo principal de este estudio clínico es analizar los problemas psicológicos derivados del diagnóstico, tratamientos y secuelas del cáncer de mama como Trastorno de Evitación Experiencial (TEE) y aportar datos sobre las posibilidades de una intervención basada en la Terapia de Aceptación y Compromiso (ACT). Se pretende delimitar la eficacia de estrategias específicas de aceptación y de control cognitivo, definiendo más ajustamente qué tipos de cambios propician unas estrategias en comparación con otras 12 mujeres diagnosticadas y tratadas por cáncer de mama que acudían a la Asociación Española Contra el Cáncer y que cubrían criterios de selección, fueron asignadas al azar a dos condiciones de tratamiento, de aceptación y otra basada en la terapia cognitiva, cuyo eje fueron las estrategias de control cognitivo. El tratamiento estuvo formado por 8 sesiones, 3 individuales y 5 grupales. Los grupos de tratamiento estuvieron formados por 3 mujeres. Se tomaron medidas de ansiedad, depresión, calidad de vida y áreas importantes afectadas, antes y después de la intervención (medidas pre, post test) y se realizaron tres seguimientos, a los 3, a los 6 y a los 12 meses. Los resultados mostraron una mayor repercusión de la intervención basada en ACT, especialmente cuando se tienen en cuenta los cambios a largo plazo (al año de seguimiento). También destaca que los cambios de la condición de ACT se centran en la activación conductual aún en presencia de malestar (AU)
The aim of current study was to analyse the psychological disorders associated with the diagnosis, treatment and consequences of breast cancer through the functional dimension of Emotional Avoidance, as well as to provide some empirical support for the usefulness of the Acceptance and Commitment Therapy (ACT) in this domain. Specifically, the impact of acceptance-based and cognitive-control-based strategies was compared, with the purpose of obtaining a better understanding of the elements that account for the changes observed with the respective psychological strategies. Twelve women diagnosed and treated with breast cancer who assisted to the Spanish Association against Cancer and who met certain selection criteria were randomly assigned to one of two treatment conditions: six women received an ACT-based protocol which addressed acceptance strategies and six women received a Cognitive-based protocol which addressed cognitive-control strategies. Each treatment consisted of 8 sessions, 3 individual sessions and 5 group sessions, 3 individual sessions and 5 group sessions; 3 women integrated each treatment group. Measures on anxiety, depression, life quality and affected valued life areas were obtained at pre- and post intervention. Additionally, three follow-up were taken, at 3, 6 and 12 months. Results showed a higher impact of the ACT-based intervention, mainly when long-term changes were considered (12 months follow-up). Other remarkable finding was that the changes observed in the ACT condition were associated to a behavioral activation, even when discomfort and suffering were present (AU)
