BEST FOR CAN - bringing empirically supported treatments to children and adolescents after child abuse and neglect: update to the study protocol.

Background: The implementation trial BESTFORCAN aims to evaluate the dissemination of Trauma-Focused Behavioural Therapy (TF-CBT) for children and adolescents in Germany with posttraumatic stress symptoms (PTSS) after child abuse and neglect (CAN) with a focus on supervision.Objective: This update to the study protocol outlines changes made due to practical reasons in the course of the ongoing trial while maintaining methodological quality.Method: The amendments to the original study protocol comprise (1) a more refined operationalisation of the primary outcome sufficiently adherent TF-CBT therapy (SATT), (2) changes in the study sites and (3) additional inclusion of one post-gradual psychotherapy training institute.Discussion: The adaptions to the original study protocol ensured high methodological quality through the transparent presentation of protocol modification: ensuring the recruitment of participating psychotherapists in training by including a further post-gradual training institute as well as an adaption of the measurement of SATT with high external validity. The objectives, diagnostic set, and secondary outcomes remained unimpaired by the amendment. Therefore, we expect the trial to provide evidence for the effect of model-specific trauma-focused supervision on the implementation outcomes of TF-CBT as compared to supervision as usual.Trial registration: German Clinical Trials Register identifier: DRKS00020516..

Update to the study protocol of the trial BESTFORCAN that investigates the implementation of trauma-focused behavioural therapy for children and adolescents with posttraumatic stress symptoms following abuse with a focus on the role of supervision.Adaptions have been made regarding the specification of the definition of sufficiently adherent intervention, relocation of the data-handling centre and the recruitment of one additional psychotherapy institute.The adaptions have no impact on the objectives, diagnostic set, secondary outcomes, or processes of data handling.

Trichotillomania Treatment Update. / Actualización en el tratamiento de la tricotilomanía.

Trichotillomania (TTM) is an obsessive-compulsive disorder in which affected individuals recurrently pull-out hair from any region of the body, causing hair loss or alopecia. The management of TTM is a therapeutic challenge for dermatologists and consists of a combination of pharmacological and non-pharmacological alternatives. Cognitive-behavioral therapy has successfully been used to treat TTM. However, not all patients are willing to follow this treatment strategy. Unconventional support tools are proposed, such as electronic devices, internet therapies and microneedling. N-acetylcysteine and memantine are considered suitable first-line therapies thanks to their favorable safety and efficacy profile, low risk of adverse effects, and significant benefits. The use of other drugs, including fluoxetine, clomipramine, olanzapine, and naltrexone has limited evidence of variable efficacy. The present review illustrates the current treatment modalities for the management of TTM.

Skills training followed by either EMDR or narrative therapy for posttraumatic stress disorder in adult survivors of childhood abuse: a randomized controlled trial.

Background: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..

The study directly compares Skills Training in Affective and Interpersonal Regulation (STAIR) followed by either EMDR or Narrative Therapy in the trauma-processing phase in routine clinical setting.The brief phase-based treatment was found to be effective in reducing both symptoms of PTSD as well as emotion regulation and interpersonal problems in survivors of childhood abuse.Posttraumatic Stress Disorder in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or Narrative Therapy in the trauma-processing phase.

Efecto de una intervención cognitivo-conductual en cuidadores de niños con TEA: depresión, ansiedad, estrés y calidad de vida / Effect of a cognitive-behavioral intervention on caregivers of children with ASD: depression, anxiety, stress, and quality of life

Este estudio tuvo como objetivo evaluar el efecto de una intervención cognitivo conductual en la sintomatología de depresión, ansiedad y estrés, la sobrecarga percibida y la calidad de vida en cuidadores de niños con trastorno del espectro autista. Se realizó un estudio experimental con grupo intervención y control, con mediciones de autorreporte pretest-postest. Participaron en el estudio un total de 53 cuidadores: 22 en el grupo experimental y 31 en el grupo control en lista de espera. La mayoría de los participantes fueron mujeres de entre 35 y 64 años, casadas o en una relación formal, con estudios profesionales o superiores y que realizaban alguna actividad remunerada. Los resultados del análisis intergrupal mostraron una disminución de la sintomatología asociada al estrés y sobrecarga percibida y un aumento en la calidad de vida en el grupo experimental. Los datos intragrupales dan cuenta de que, los sujetos del grupo control no tuvieron cambios en ninguna variable, por el contrario, en el grupo experimental se observa una disminución significativa en los índices de ansiedad, estrés y sobrecarga percibida y un aumento en la calidad de vida. Todos estos cambios ocurrieron con tamaños de efecto mediano y grande. Se analizan los mecanismos de cambio y se discuten los hallazgos del estudio a la luz de sus limitaciones. Se concluye que una intervención cognitivo conductual es una estrategia con efectos positivos para brindar apoyo psicológico a los cuidadores de niños con autismo. (AU)

This study aimed to evaluate the effect of a cognitive behavioral intervention on symptoms of depression, anxiety and stress, perceived overload and quality of life in caregivers of children with autism spectrum disorder. An experimental study was conducted out with an intervention and control group, with self-report pretest-posttest measurements. A total of 53 caregivers participated in the study: 22 in the experimental group and 31 in the waiting list control group. The majority of participants were women between 35 and 64 years old, married or in a formal relationship, with professional or higher education and who carried out some paid activity. The results of the intergroup analysis showed a decrease in the symptoms associated with stress and perceived overload and an increase in the quality of life in the experimental group. Intra-group data showed that the subjects of the control group had no change in any variable, in contrast, in the experimental group there was a significant decrease in anxiety, stress and perceived overload indices and an increase in the quality of life. All these changes occurred with medium and large effect sizes. The mechanisms of change are analyzed and the study's findings are discussed in light of its limitations. It is concluded that a cognitive behavioral intervention is a strategy with positive effects for providing psychological support to caregivers of children with autism. (AU)

Tratamiento psicológico de la tartamudez crónica: estudio descriptivo de cinco casos clínicos / Psychological treatment of persistent stuttering: Descriptive study of five clinical cases

La tartamudez persistente se define por la permanencia de las disfluencias y la presencia de factores cognitivos, conductuales y comunicativos que contribuyen a mantenerla y agravarla. Por tanto, su tratamiento clínico debe centrarse en mejorar la fluidez del habla, asegurar la generalización del nuevo patrón prosódico y manejar los pensamientos disfuncionales y las conductas de evitación social y comunicativa que ayudan a mantener el problema y provocan una pérdida significativa de calidad de vida. Objetivo: Medir la eficacia de un tratamiento estandarizado para pacientes adultos con tartamudez persistente centrado en la fluidez de habla y en los aspectos psicológicos implicados. Material y métodos: Estudio clínico analítico de los resultados de la intervención. Se realizó una evaluación de todos los aspectos implicados en la tartamudez persistente mediante instrumentos validados y registro de habla. Se aplicó el protocolo de un tratamiento para tartamudez crónica. Resultados: Se evaluó la fluidez del habla en muestras de habla espontánea y lectura y las subescalas del cuestionario OASES de cinco pacientes con tartamudez de entre 21 y 25años. El tratamiento redujo el porcentaje de sílabas tartamudeadas en todos los casos, tanto en habla como en lectura, así como una reducción de las puntuaciones en todas las subescalas del OASES. Conclusión: Los resultados clínicos obtenidos indican eficacia del protocolo empleado para la modificación de la frecuencia de tartamudeos y de otros fenómenos asociados. Se exponen algunas consideraciones de interés para los terapeutas de la tartamudez crónica.(AU)

Persistent stuttering is defined by the permanence of disfluencies and the presence of cognitive, behavioral, and communication factors that contribute to maintaining and aggravating it. Therefore, clinical treatment should focus on improving speech fluency, ensuring generalization of the new prosodic pattern, and managing dysfunctional thoughts and social and communicative avoidance behaviors that help maintain the problem and cause significant loss of quality of life in patients. Objective: The main objective is to measure the efficacy of a standardized treatment focused on speech fluency and psychological aspects for adult patients with persistent stuttering. Material and methods: Analytical clinical study of the results of the psychological intervention. An evaluation of all aspects involved in persistent stuttering was carried out using validated instruments and speech recording. The protocol of a clinical treatment for chronic stuttering was applied. Results: Speech fluency in spontaneous speech and reading samples and the OASES questionnaire subscales from five stuttering patients aged 21-25years were assessed. The treatment reduced the percentage of stuttered syllables in all cases, both in speaking and reading, as well as a reduction in scores on all OASES subscales. Conclusion: Clinical results obtained indicate the efficacy of the protocol used to modify the frequency of stuttering and other associated behaviors. Some considerations of interest for therapists of chronic stuttering are exposed.(AU)

Prolonged grief disorder treatment: An approach to COVID-19 grief / Tratamiento del trastorno de duelo prolongado: Una aproximación al duelo en tiempos de COVID-19

Abstract Background It has been estimated that COVID-19 grief will affect approximately sixteen million people worldwide, while the prevalence of prolonged grief disorder (PGD) could rise to 40%. Objective To review treatments that can be administered to patients with PGD due to COVID-19. Method PUBMED and Google Scholar were searched with the following keywords: prolonged grief disorder, complicated grief, grief and psychotherapy, and treatment of prolonged grief, complicated grief or persistent complex grief. Results Fifty articles were reviewed on the efficacy of interpersonal therapy, rational emotional-behavioral therapy, supportive therapy, humanistic therapy, systemic family therapy, group therapy, writing therapy, Internet-based intervention, and a modality of cognitive behavioral therapy used with prolonged grief, metacognitive therapy, and acceptance and commitment therapy. Discussion and conclusion There is no consensus on the psychotherapeutic treatment of choice for people with PGD due to the loss of a family member to COVID-19. Group therapy is effective in reducing the intensity of uncomplicated grief, cognitive-behavioral therapy is highly efficacious in reducing the severity of grief, metacognitive therapy specifically designed for PGD has a positive impact on depression, anxiety, stress, rumination, and quality of life while Acceptance and Commitment Therapy is helpful for restoring spirituality. Psychotherapy is most effective when combined with drug therapy. It is suggested that comparative studies be undertaken of psychotherapeutic techniques for managing patients with PGD associated with COVID-19 and the adaptation of these techniques to virtual settings.

Resumen Antecedentes Se estima que el duelo secundario a COVID-19 dejará cerca de 16 millones de personas afectadas mundialmente, y la prevalencia del Trastorno de Duelo Prolongado (TDP) pudiera incrementarse al 40%. Objetivo Revisar los tratamientos susceptibles de aplicar en pacientes con TDP por COVID-19. Método Se realizó la búsqueda en PUBMED y Scholar google con las palabras clave trastorno de duelo prolongado, duelo complicado, duelo y psicoterapia y tratamiento del duelo prolongado o complicado o complejo persistente. Resultados Se revisaron 50 artículos, se refirió la eficacia de la terapia interpersonal, la terapia racional emotiva del comportamiento, la terapia de apoyo, la terapia humanista, la terapia familiar sistémica, la terapia grupal, la terapia de escritura, la intervención basada en internet, y una modalidad de terapia cognitivo conductual aplicada al duelo prolongado, la terapia metacognitiva y la terapia de aceptación y compromiso. Discusión y conclusión No hay consenso sobre el uso preferencial de tratamientos psicoterapéuticos en personas con TDP por la pérdida de una familiar por COVID-19. La terapia grupal es efectiva en disminuir la intensidad del duelo no complicado, la terapia cognitivo conductual es altamente efectiva para disminuir la gravedad del duelo, la Terapia Metacognitiva diseñada específicamente para el TDP impacta positivamente en la depresión, ansiedad y calidad de vida; y la Terapia de Aceptación y Compromiso es útil en el restablecimiento de la espiritualidad. La psicoterapia es más eficaz cuando se combina con terapia farmacológica. Se sugiere la realización de estudios comparativos entre técnicas psicoterapéuticas para el manejo de pacientes con TDP asociado a COVID-19 y la adaptación de estas técnicas a ambientes virtuales.

Mutismo selectivo: cuando la timidez se hace extrema / Selective mutism: when shyness becomes extreme

El mutismo selectivo es un trastorno poco frecuente y a menudo infradiagnosticado, que puede afectar al rendimiento escolar y repercutir negativamente en su desarrollo. Ocurre antes de los 5 años y está caracterizado por la incapacidad de comunicarse en ámbitos donde el niño no se siente cómodo, como puede ser la escuela; en cambio, en otros lugares, como el domicilio, se comunica y actúa sin problemas. Genera inquietud familiar. Su tratamiento principal es la terapia cognitivo conductual. La combinación de esta terapia con la administración de fármacos se reserva para casos más graves. Se describe a continuación un caso diagnosticado hace 6 meses y en tratamiento desde entonces (AU)

Selective mutism is a less frequent disorder, often underdiagnosed, which negatively affects the child’s development and school performance. This disorder takes place before the age of five. It is characterized with the incapacity to speak in places where the child does not feel comfortable, as school, but at home they speak without problem. In fact, the detection occurs at school, and generates family distress due to their surprise for their child’s attitude. The treatment is based on cognitive-conductive therapy, and just in severe cases pharmacotherapy is needed. A case diagnosed 6 months ago and under treatment since then is described below. (AU)

Terapia Cognitivo-Comportamental em Grupo: Estratégia de Psicoeducação com Estudantes de Enfermagem / Group Cognitive Behavioral Therapy: Strategy for Psychoeducation with Nursing Students / Terapia Cognitivo-Conductual en Grupo: Estrategia para la Psicoeducación con Estudiantes de Enfermeira

Este estudo teve por objetivo apresentar os resultados de um grupo psicoterápico psicoeducativo desenvolvido junto a estudantes de Enfermagem. Foram realizados seis encontros com cinco estudantes de uma universidade pública do Estado de São Paulo. Os encontros foram audiogravados, transcritos e submetidos à análise temático-reflexiva. Os resultados encontrados permitiram a construção de cinco categorias temáticas: (1) Desafios da adaptação ao ensino superior; (2) Concepções sobre saúde mental na universidade; (3) Autocuidado e equilíbrio entre a vida universitária e pessoal; (4) Relações interpessoais e vida universitária; (5) Perspectivas e expectativas sobre a formação. O processo de integração à universidade requer mobilização cognitiva, afetiva e social, sendo que as relações com os pares, professores e familiares foram destacadas como importantes para essa adaptação. As participantes destacaram conhecer a importância do cuidado em saúde mental, mas admitiram dificuldades de promoverem o autocuidado. O espaço grupal foi utilizado como ambiente de escuta, estabelecimento de vínculo e autocuidado. Os grupos psicoeducativos demonstraram ser importantes para a construção de estratégias de enfrentamento e um espaço para o acolhimento de demandas que emergem nessa etapa do desenvolvimento.

This study aimed to present the results of a psychoeducational psychotherapy group developed with Nursing students. Six meetings were held with five students from a public university in the state of São Paulo. The meetings were audio-recorded, transcribed and submitted to a reflexive-thematic analysis. The results found allowed the construction of five thematic categories: (1) Challenges of adapting to higher education; (2) Conceptions about mental health at the university; (3) Self-care and balance between university and personal life; (4) Interpersonal relationships and university life; (5) Perspectives and expectations about training. The process of integration into the university requires cognitive, affective and social mobilization, and relationships with peers, teachers and family members were highlighted as important for this adaptation. The participants highlighted knowing the importance of mental health care, but also admitted difficulties in promoting self-care. The group space was used as a listening environment, bonding and self-care. Psychoeducational groups proved to be important for the construction of coping strategies and a space for the reception of emerging demands.

Este estudio tiene como objetivo presentar los resultados de un grupo de psicoterapia psicoeducativa desarrollado con estudiantes de Enfermería. Se realizaron seis reuniones con cinco estudiantes de una universidad pública del Estado de São Paulo. Las reuniones fueron grabadas en audio, transcritas y sometidas a un análisis temático-reflexivo. Los resultados encontrados permitieron la construcción de cinco categorías temáticas: (1) Desafíos de la adaptación a la educación superior; (2) Concepciones sobre la salud mental en la universidad; (3) Auto cuidado y conciliación de la vida universitaria y personal; (4) Relaciones interpersonales y vida universitaria; (5) Perspectivas y expectativas sobre la formación. El proceso de integración universitaria requiere de una movilización cognitiva, afectiva y social, y las relaciones con pares, docentes y familiares son importantes para la adaptación. Los participantes destacan conocer la importancia del cuidado de la salud mental, pero admiten que tienen dificultad para promover el auto cuidado. El espacio grupal fue utilizado como ambiente de escucha, vinculación y auto cuidado. Los grupos psicoeducativos demostraron ser importantes para la construcción de estrategias de afrontamiento y un espacio de recepción de demandas emergentes.

Eficacia de las terapias online de activación conductual y cognitivo conductual para el tratamiento de la depresión en mujeres mexicanas víctimas de violencia / Efficacy of online behavioral activation and cognitive-behavioral therapies for the treatment of depression in Mexican women victims of violence

Antecedentes: La violencia contra la mujer (VCM) y la pandemia por COVID-19 son problemáticas que han afectado la salud mental de las mujeres, con secuelas como la depresión. Objetivo: Comparar la eficacia del tratamiento breve de activación conductual (BATD) y la terapia cognitiva conductual (TCC) con adaptaciones culturales administradas online (telesalud) para la depresión en víctimas de VCM durante la COVID-19 en México. Método: Se realizó un ensayo clínico aleatorizado con 20 mujeres mexicanas de 18-60 años con depresión que experimentaron VCM en los últimos seis meses durante la COVID-19. Las participantes fueron asignadas de manera aleatorizada 1:1 a los grupos BATD y TCC. Para el análisis de datos se aplicaron las pruebas Friedman y U de Mann-Whitney, y se estimó el Índice de Cambio Confiable. Resultados: Se encontró una disminución en síntomas depresivos (p < .001) e incremento en los niveles de activación (p < .001) a favor del grupo BATD, al término de la intervención y en el seguimiento en contraste con la TCC. Conclusiones: La BATD mostró ser eficaz en crisis de emergencia sanitaria en contextos de VCM. Aunar evidencia de intervenciones eficientes para esta población contribuye a mitigar las afecciones de salud mental.

Background: Violence against women (VAW) and the COVID-19 pandemic are issues that have affected women's mental health, with sequela such as depression. Objective: To compare the efficacy of brief behavioral activation therapy (BATD) and cognitive behavioral therapy (CBT) with cultural adaptations administered online by telehealth for depression in victims of VAW during COVID-19 in Mexico. Method: A randomized clinical trial was conducted with 20 Mexican women aged 18-60 years with depression who experienced VAW in the last six months during COVID-19. Participants were randomized 1:1 to the BATD and CBT groups. For data analysis, Friedman and Mann-Whitney U tests were applied, and the Reliable Change Index was estimated. Results: A decrease in depressive symptoms (p < .001) and an increase in activation levels (p < .001) were found in favor of the BATD group at the end of the intervention and at follow-up, in contrast to CBT. Conclusions: BATD was shown to be effective in health emergency crises in VAW contexts. Gathering evidence of efficient interventions for this population contributes to mitigating mental health conditions.

La eficacia de la terapia cognitivo-conductual para el duelo prolongado / Efficacy of cognitive-behavioral therapy for prolonged grief

Antecedentes: El Duelo Prolongado (DP) es una forma patológica del duelo dados los síntomas patentes y el tiempo que perduran, generando malestar y limitando la funcionalidad psicosocial. Durante años se ha empleado la Terapia Cognitivo-Conductual (TCC) para el tratamiento del DP, pero se sugiere que la activación conductual no específica es suficiente, se hallan fallos metodológicos en las muestras de TCC, o se cuestiona si es necesaria la exposición. Objetivo: Analizar si la TCC es realmente eficaz para mejorar el DP en adultos. Método: Se realizó una revisión sistemática mediante la búsqueda en las bases de datos Medline, PsycINFO, PubMed, Scopus y Web of Science desde junio de 2022 hasta febrero de 2023, así como mediante una comunicación personal. Se identificaron 9 estudios que cumplían los criterios de inclusión y exclusión establecidos. Resultados: Se comparan las evaluaciones basales, del postratamiento y seguimiento. Todos los estudios reflejan mejorías superiores en la condición de TCC frente a otras modalidades terapéuticas o frente a la propia TCC sin exposición, a excepción de uno que establece igualdad de eficacia con Eye Movement Desensitization and Reprocessing (EMDR). Se analiza el riesgo de sesgo siguiendo los criterios Cochrane, presentando una adecuada calidad metodológica; el nivel de evidencia científica, 1+; y el grado de recomendación, A. Conclusiones: Los resultados respaldan la eficacia de la TCC para el tratamiento del DP en la población adulta, aunque es fundamental realizar nuevos estudios que fortalezcan esta evidencia. Hasta entonces, se recomienda su aplicación a quienes padezcan DP (AU)

Background: Prolonged Grief (PG) is a pathological form of bereavement given the overt symptoms and the period of time they endure, generating distress and limiting psychosocial functioning. For years, Cognitive Behavioral-Therapy (CBT) has been used for the treatment of PG. Nonetheless, it is suggested that non-specific behavioral activation could be sufficient, methodological problems are found in CBT samples, or it is questioned whether the exposure component is necessary or not. Objective: To analyze whether CBT is really effective to improve PG among the adult population. Methods: A systematic review was conducted through Medline, PsycINFO, PubMed, Scopus and Web of Science databases from June 2022 to February 2023, as well as by means of personal communication. 9 studies that met the established inclusion and exclusion criteria were identified. Results: Baseline post-treatment and follow-up assessments are compared. All studies reflect superior improvements in the CBT condition compared to other therapeutic modalities or compared to CBT without exposure, excluding one study that establishes equal efficacy with Eye Movement Desensitization and Reprocessing (EMDR). The risk of bias was analyzed according to Cochrane criteria, presenting an adequate methodological quality; the level of scientific evidence, 1+; and the grade of recommendation, A. Conclusions: The results support the efficacy of CBT for the treatment of PG in the adult population. Nevertheless, it is essential to conduct new studies that strengthen this evidence. Until then, it is recommended its application among those suffering from PG (AU)

Desenvolvimento de uma tecnologia digital de apoio à terapia cognitivo-comportamental / Development of a digital technology to support cognitive behavioral therapy / Desarrollo de una tecnología digital de apoyo a la terapia cognitivo-conductual

INTRODUÇÃO: Na atualidade, abordagens que se utilizam de aplicativos tecnológicos para solução de problemas psicológicos têm sido cada vez mais comuns, de modo que múltiplos estudos têm evidenciado eficácia bem estabelecida nessa modalidade de intervenção. OBJETIVO: O objetivo do presente trabalho é o de apresentar o projeto-piloto do desenvolvimento de uma ferramenta, com componentes mobile e web, de apoio ao tratamento psicológico via Terapia Cognitivo-Comportamental. De forma específica, será discorrido sobre a metodologia de desenvolvimento da pesquisa e projeto de software, apresentação da solução tecnológica desenvolvida, avaliação da solução e as considerações finais. METODOLOGIA: A metodologia adotada foi o Design Science Research (DSR), que propõe a resolução de problemas por meio de criação de artefatos. RESULTADOS: Como resultado obteve-se uma solução tecnológica centralizada e eficaz, por meio de um Software as a Service (SAAS), composto por um sistema web que permite ao psicoterapeuta gerenciar o tratamento psicológico pela Terapia Cognitivo-comportamental e um aplicativo móvel que possibilita ao paciente o registro preciso de funcionamento cognitivo-comportamental diário, frequência de sintomas, atividades gamificadas, e técnicas de manejo. CONCLUSÃO: A integração entre áreas da psicologia e da tecnologia tem sido cada vez mais comum, contudo é primordial a condução de estudos que descrevam desde sua concepção até a sua aplicação, com vistas a uma validação baseada em evidências científicas.

INTRODUCTION: Currently, psychological perspectives that use technological applications to solve mental health disorders have been increasingly common, in addition multiple studies have shown well-established effectiveness in this type of intervention. OBJECTIVE: The objective of the present work is to present the pilot project of the development of a tool, with mobile and web components, to support psychological treatment via Cognitive-Behavioral Therapy. Specifically, the research development methodology and software design, presentation of the developed technological solution, evaluation of the solution and final considerations will be discussed. METHODOLOGY: The methodology adopted was Design Science Research (DSR), which proposes the resolution of problems through the creation of artifacts. RESULTS: As a result, a centralized and effective technological solution was obtained, through a Software as a Service (SAAS), composed of a web system that allows the psychotherapist to manage psychological treatment through Cognitive-Behavioral Therapy and a mobile application that provide the patient with an accurate record of daily cognitive-behavioral functioning, symptom frequency, gamified activities, and management techniques. CONCLUSION: The integration between areas of psychology and technology has been increasin, however, it is essential to conduct studies that describe from its conception to its application, with the aim to a validation based on scientific evidence.

INTRODUCCIÓN: Actualmente, los enfoques que utilizan aplicaciones tecnológicas para solucionar transtornos mentales son cada vez más comunes, por lo que múltiples estudios han demostrado una efectividad bien establecida en este tipo de intervenciones. OBJETIVO: El objetivo del presente estudio es presentar el proyecto piloto del desarrollo de una herramienta, con componentes móviles y web, para apoyar el tratamiento psicológico a través del uso de Terapia Cognitivo-Conductual. Específicamente, se discutirá la metodología de desarrollo de la investigación y el diseño del software, presentación de la solución tecnológica desarrollada, evaluación de la solución y consideraciones finales. METODOLOGÍA: La metodología adoptada fue Design Science Research (DSR), que propone la resolución de problemas a través de la creación de artefactos. RESULTADOS: Como resultado se obtuvo una solución tecnológica centralizada y eficaz, a través de un Software como Servicio (SaaS), compuesta por un sistema web que permite al psicoterapeuta gestionar el tratamiento psicológico a través de la Terapia Cognitivo-Conductual y una aplicación móvil que permite al paciente un registro preciso del funcionamiento cognitivo-conductual diario, la frecuencia de los síntomas, las actividades gamificadas y las técnicas de manejo. CONCLUSIÓN: La integración entre áreas de la psicología y la tecnología han sido cada vez más comunes, sin embargo es fundamental realizar estudios que describan desde su concepción hasta su aplicación, buscando una validación basada en evidencia científica.

A Randomized Clinical Trial in a Public Health Context: Inclusion of Emotional Techniques in Group Therapy for Anxiety Disorders / Un estudio clínico aleatorizado en un contexto de sanidad pública: inclusión de técnicas emocionales en una terapia grupal para trastornos de ansiedad

Se realizó un ensayo clínico aleatorio con dos grupos de tratamiento: uno que recibió terapia cognitivo-conductual (TCC) y otro con la inclusión de técnicas emocionales (TCCE), ambos de 20 sesiones. La muestra consistió en 237 pacientes, todos ellos con diagnóstico principal de trastornos de ansiedad, y todos remitidos por sus médicos de cabecera. Hubo mejoras significativas en la sintomatología (rasgo de ansiedad, depresión, sintomatología clínica), pero la única diferencia significativa encontrada en la comparación intergrupal fue para la variable "satisfacción vital subjetiva" (p= .017), que fuemayor en el grupo de TCCE. Este grupo también mostró una mayor adherencia al programa de tratamiento (p= .019). Esto refuerza la conveniencia de incluir el tratamiento de terapia de grupo con componentes emocionales en los entornos de atención primaria, destacando la importancia de hacer hincapié en la autoestima.(AU)

A randomized clinical trial was carried out with two treatment groups: one receiving cognitive-behavioral therapy (CBT) and the other with the inclusion of emotional techniques (CEBT), both lasting 20 sessions. The sample consisted of 237 patients, all of them with principal diagnoses of anxiety disorders, and all referred by their general practitioners. There were significant improvements in symptomatology (anxiety trait, depression, clinical symptomatology), but the only significant difference found in the intergroup comparison was for the variable “subjective life satisfaction” (p = .017), which was greater in the CEBT group. This group also displayed better adherence to the treatment program (p = .019). This reinforces the case for including group therapy treatment with emotional components in primary care settings, highlighting the importance of emphasizing self-esteem.(AU)

[Anti-smoking intervention in the acute phase of acute coronary syndrome: Is there additional benefit in patients included in a cardiac rehabilitation program?] / Intervención antitabaco en fase aguda del síndrome coronario agudo: ¿existe beneficio adicional en pacientes incluidos en un programa de rehabilitación cardiaca?

BACKGROUND: Smoking is a challenge in secondary prevention after acute coronary syndrome (ACS). The objective was to assess whether the early anti-smoking intervention (ASI), in the acute hospitalization phase, improves the abstinence rate obtained during a cardiac rehabilitation program (CRP). METHODS: Multicenter clinical trial in which smoker patients admitted for ACS were randomized 1:1 to receive or not ASI from the first day of admission. Upon discharge, both groups were referred to the CRP, performing abstinence controls using co-oximetry. Patients lost were considered smokers. RESULTS: 72 patients were included, 58 men (80.5%), mean age 53 ± 8.1 years. They were admitted for ST elevation myocardial infarction 42 (58%), non-ST elevation myocardial infarction 29 (40%) and unstable angina 1 (1.3%). They smoked an average of 22 ± 11.3 cigarettes/day (pack-year index 37 ± 20). They completed the Richmond test (8.8 ± 1.3) and Fagestrom (5.69 ± 2.1). 36 patients (50%) were randomized to ASI, with no differences in the baseline characteristics of both groups. The dropout rate at the time of inclusion in CRP was higher in the ASI group (69 vs. 44%; p 0.034; OR 2.84), without statistical significance at discharge from the CRP (58 vs. 50%; p 0.478; OR 1.4) or at 12 months (58 vs. 44%; p 0.24; OR 1.75). CONCLUSIONS: The ASI during admission significantly improves the smoking cessation rate at the time of inclusion in the CRP. Part of these beneficial effects are reduced in the follow-up losing statistical significance with respect to the control group.

Masturbación compulsiva en adolescente / Compulsive Masturbation in Adolescents

Introducción: La masturbación compulsiva provoca una cascada de sentimientos y emociones que pueden recorrer desde la culpabilidad y el rechazo a la satisfacción hasta el bienestar más placentero y deseado. Objetivo: Exponer una forma de presentación poco frecuente de un adolescente con masturbación compulsiva. Presentación del caso: Adolescente masculino de 14 años de edad, de procedencia rural y antecedentes de salud física. Evaluado en consulta de psiquiatría infanto - juvenil por realizar masturbaciones en sitios públicos, que resultaban cada vez más frecuentes, y al final de esta se producía expulsión de materia fecal. Los estudios clínicos y psicométricos confirmaron el diagnóstico de masturbación compulsiva. Conclusiones: El tratamiento se basó en el modelo cognitivo-conductual y farmacológico con imipramina. Se disminuyó la frecuencia e intensidad, así como la duración de la conducta problema. El caso clínico expuesto resulta de interés por ser poco frecuente la presencia de este trastorno dentro de la población adolescente(AU)

Introduction: Compulsive masturbation provokes a cascade of feelings and emotions that can range from guilt and refusal to satisfaction to the most pleasurable and desired well-being. Aim: To present a rare presentation of an adolescent with compulsive masturbation. Case presentation: 14-year-old male adolescent from a rural area with a history of previous physical health. He was evaluated in a child and adolescent psychiatry clinic for masturbation in public places, which became increasingly frequent and ended with the expulsion of fecal matter. Clinical and psychometric studies confirmed the diagnosis of compulsive masturbation. Conclusions: Treatment was based on the cognitive-behavioral and pharmacological model with imipramine. The frequency and intensity, as well as the duration of the problem behavior was reduced. The clinical case presented was of interest due to the infrequent presence of this disorder in the adolescent population(AU)

Revisión sistemática sobre el manejo clínico del dolor crónico y el trastorno por uso de opioides simultáneo / Systematic review on the clinical management of chronic pain and comorbid opioid use disorder

La crisis causada por los opioides recetados y sus efectos secundarios relacionados son un problema de salud pública en todo el mundo. La mayoría de estos medicamentos se recetan para el afrontamiento del dolor crónico. La coexistencia del trastorno por uso de opioides (TUO)en pacientes con dolor crónico representa un desafío complejo debido ala necesidad de controlar tanto el dolor como el TUO. El objetivo de esta revisión sistemática es evaluar la eficacia de los tratamientos posibles para dicha población con TUO y dolor crónico. Se ha realizado una revisión sistemática usando las bases de datos Cochrane Library, MEDLINE, PsycINFO y ClinicalTrials.gov, conforme a las pautas PRISMA. Los artículos elegibles abordaron los resultados en pacientes con dolor crónico y diagnóstico comórbido de TUO, después de aplicar una intervención. De593 artículos identificados, nueve eran elegibles para la revisión cualitativa(n = 7 intervenciones farmacológicas; n = 2 intervenciones psicológicas). Lametadona, la buprenorfina, la terapia cognitivo-conductual y el mindfulness mostraron resultados prometedores, pero los datos no eran concluyentes (<2ECA con bajo riesgo de sesgo). No está claro si el tratamiento con agonistas opioides debe mantenerse o disminuirse y qué fármaco debe prescribirse para la terapia de sustitución de opioides (metadona o buprenorfina/naloxona). El mindfulness y la terapia cognitivo-conductual tienen un efecto discreto en la mejora del afecto negativo, pero no del dolor. El enfoque terapéutico podría individualizarse sobre la base de una toma de decisiones conjunta. (AU)

The crisis caused by prescribed opioids and their related side effects area public health problem worldwide. Most of these are prescribed forcoping with chronic pain. The coexistence of opioid use disorder (OUD)in patients with chronic pain represents a complex challenge due tothe need for managing both pain and OUD. The aim of this systematic review is to evaluate the efficacy of feasible treatments for this population with OUD and comorbid chronic pain for both conditions. A systematic database search has been performed using Cochrane Library, MEDLINE, PsycINFO and ClinicalTrials.gov in compliance with PRISMA guidelines. Eligible articles addressed the outcomes in chronic pain patients with comorbid opioid use disorder after treatment interventions were applied. Of 593 identified articles, nine were eligible for qualitative review (n = 7pharmacological interventions; n = 2 psychological interventions). Methadone, buprenorphine, cognitive-behavioral and mindfulness showed promising results, but data were inconclusive (<2 RCT with low risk of bias). It is unclear whether the opioid agonist treatment should be maintained ortapered and which drug should be prescribed for the opioid substitution therapy (methadone or buprenorphine/naloxone). Mindfulness andcognitive behavioral therapy have a discrete effect on improving negativeaffect but not pain. The therapeutic approach might be individualized under a shared decision-making basis. (AU)

Medo do parto: uma revisão das intervenções baseadas na Terapia Cognitivo-Comportamental / Fear of childbirth: a review of interventions based on Cognitive Behavioral Therapy / Miedo al parto: una revisión de intervenciones basadas en Terapia Cognitivo-Conductual

O medo do parto vaginal é bastante comum e pode ter impactos relevantes na saúde materno-infantil. O objetivo deste estudo foi investigar de que forma a Terapia Cognitivo-Comportamental (TCC) tem sido aplicada em casos de medo do parto e avaliar a eficácia dessas intervenções. Realizou-se uma revisão sistemática da literatura através das bases de dados BVS Brasil, Scopus e PubMed, no período de fevereiro de 2019 a abril de 2019. Após a análise dos critérios de inclusão e exclusão, um total de oito textos completos constituíram a amostra final. Técnicas terapêuticas como a reestruturação cognitiva, a exposição e a atenção plena demonstraram ser relevantes para a elaboração de uma percepção menos catastrófica do parto e para o desenvolvimento de maior confiança nas próprias habilidades de enfrentamento do trabalho de parto. Conclui-se que as intervenções em TCC apresentam potencial benefício para o tratamento do medo do parto.

Fear of childbirth is a very common phenomenon among women and may significantly impact maternal-infant health. The goal of this study is to investigate how Cognitive Behavioral Therapy (CBT) has been applied in cases of fear of childbirth and assess the efficacy of such interventions. A systematic review of these practices was made using the BVS Brazil, Scopus, and PubMed databases, from February to April 2019. After analyzing the inclusion and exclusion criteria, a total of six full studies were selected as the final sample for this research. Therapeutic techniques such as cognitive restructuring, exposure, and mindfulness have proven to be important means of developing a less catastrophic perception of childbirth along with greater self-confidence in the abilities to cope with labor. The review led to the conclusion that CBT does have the potential to treat fear of childbirth.

El miedo al parto es muy común y puede afectar significativamente la salud materno-infantil. El objetivo de este estudio fue investigar cómo se ha aplicado la Terapia Cognitivo-Conductual (TCC) en casos de miedo al parto y evaluar la eficacia de las intervenciones. Se realizó una revisión sistemática a través de las bases de datos BVS Brasil, Scopus y PubMed, de febrero a abril de 2019. Después de analizar los criterios de inclusión y exclusión, un total de seis textos completos constituyeron la muestra final. Las técnicas terapéuticas como la reestructuración cognitiva, la exposición y la atención plena demostraron ser relevantes para la elaboración de una percepción menos catastrófica del parto y para el desarrollo de una mayor confianza en las capacidades propias para enfrentar el parto. La revisión llevó a la conclusión de que la TCC tiene potencial benéfico para tratar el miedo al parto.

Adaptação cultural do Family Foundations: Programa de intervenção em coparentalidade para casais em transição para a parentalidade / Cultural adaptation of Family Foundations: a coparenting intervention program for couples during the transition to parenthood / Adaptación cultural de lo Family Foundations: programa de intervención de coparentalidad para parejas en transición a la paternidad

A relação coparental envolve interações entre os pais, ou outras figuras parentais, para educar uma criança. Essa relação emerge na transição para a parentalidade, uma janela crítica para o desenvolvimento humano por afetar tanto o bem-estar dos pais quanto o desenvolvimento socioemocional do bebê. O objetivo do presente estudo foi reportar e avaliar o processo sistemático de escolha e adaptação (cultural e de formato) do programa Family Foundations, que tem como foco aprimorar a qualidade da relação coparental de casais durante a transição para a parentalidade. As avaliações positivas dos pais evidenciam alta aceitabilidade do programa. Em estudos futuros, será importante aumentar o número de participantes e analisar a eficácia e efetividade do programa.

The coparenting relationship involves interactions between parents, or other parental figures, to raise a child. This relationship emerges during the transition to parenthood, a critical period in human development that affects parents’ well-being and the child’s social-emotional development. The objective of this paper was to report and evaluate the systematic process of selecting and adapting (considering culture and format) the Family Foundations program, which focuses on improving the quality of the coparental relationship of couples during the transition to parenthood. Positive parent evaluations indicate high acceptability of the program. In future studies, the efficacy and effectiveness of the program should be evaluated.

La relación coparental envuelve interacciones entre los padres u otras figuras parentales, para la crianza de un niño. Esta relación surge en la transición para la parentalidad, etapa crítica para el desarrollo humano por afectar el bienestar de los padres y el desarrollo socioemocional del bebé. El objetivo de este artículo fue relatar e evaluar el proceso sistemático de elección y adaptación (cultural y del formato) del programa Family Foundations, que tiene como objetivo mejorar la calidad de la relación coparental de las parejas en transición a la paternidad. Los resultados positivos muestran la alta aceptabilidad del programa. En estudios futuros, será importante analizar la eficacia y efectividad del programa.

Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa / Anxiety and Autism Spectrum Disorders: Notes for Psychoeducational Intervention

Se analizan de forma narrativa las relaciones entre comportamiento sensorial atípico, intolerancia a la incertidumbre y regulación emocional como generadores de los trastornos de ansiedad en niños y niñas autistas. El objetivo es estudiar el origen de la ansiedad en los niños y niñas autistas con la finalidad de determinar cuál o cuáles pueden ser los procedimientos de intervención más adecuados. Se han revisado algunos de los programas de intervención cognitivo-conductuales más utilizados en niños y niñas autistas y las adaptaciones realizadas a los mismos. Se observa un divorcio entre los programas psicoeducativos escolares y los programas clínicos de intervención para el tratamiento de la ansiedad. Como conclusión, se recomienda que en los programas psicoeducativos escolares se incorporen acciones proactivas en forma de programas de intervención cognitivo-conductuales para evitar o aminorar los efectos negativos de la ansiedad en el aprendizaje e inclusión escolar de los niños y las niñas autistas. (AU)

The relationships between atypical sensory behavior, intolerance to un-certainty and emotional regulation as generators of anxiety disorders in autistic chil-dren are analyzed in narrative form. The aim is to study the origin of anxiety in autistic children in order to determine the most appropriate intervention procedures. Some of the most widely used cognitive-behavioral intervention for autistic children and the ad-aptations made to them have been reviewed. A gap is observed between school psych-oeducational programs and clinical intervention programs for the treatment of anxiety. In conclusion, it is recommended that school psychoeducational programs incorporate proactive actions in the form of cognitive-behavioral intervention programs to prevent or reduce the negative effects of anxiety on the learning and school inclusion of autistic children. (AU)