Intervenciones familiares en el tratamiento de los pacientes con esquizofrenia: aproximaciones recientes

Resumen

Después de mencionar los postulados básicos que subyacen a los modelos tradicionales de terapia familiar a los que se han planteado serias críticas, se revisan nuevos modelos que superan estas limitaciones. Estos nuevos modelos de intervención familiar comparten dos características principales: considerar a los familiares aliados naturales del proceso de rehabilitación del paciente y basarse en el empleo de estrategias terapéuticas claramente operacionalizadas. Se describen brevemente cuatro de estas estrategias y se revisa la evidencia que apoya su eficacia: la terapia familiar orientada a la crisis de Goldstein, el paquete de intervenciones psicosociales desarrollado por Leff y cols., la terapia familiar conductual de Falloom y el programa de psicoeducación familiar de Anderson y cols. Su eficacia es analizada en términos de la disminución observada en las tasas de recaídas y en la consecución de otros beneficios para el paciente y la familia. Se señalan un conjunto de principios generales que deben presidir las intervenciones con estas familias. Por último, se hace una reflexión acerca de algunas deficiencias que estudios futuros han de subsanar para poder alcanzar unas conclusiones más sólidas sobre la eficacia de estos nuevos procedimientos terapéuticos.     

The role of cognitive appraisal in media-induced presence and emotions

In the present study, we applied Valins’ (1966) bogus bodily feedback paradigm to investigate the roles of cognitive appraisal (tele)presence, and emotion in the context of media usage. Participants (N=30) viewed short sequences of a TV show, whereby false heart rate feedback was provided. In line with Valins’ paradigm, the manipulation we used in this study included two levels: high vs. low false heart rate feedback. We assessed presence, enjoyment, and the real heart rate. Participants reported stronger experiences of presence and enjoyed the clips more when they wrongly believed that they had been aroused. Since bogus feedback increases the sensation of presence, the results indicate that presence—like emotions—can be influenced by cognitive appraisals. It is likely that the false heart rate feedback was attributed to the stimulus, which in turn enhanced the sensation of presence.     

Performance in Autobiographical Memory of Older Adults with Depression Symptoms

The aim of this study was to compare the performance in the Autobiographical Memory Test in older adults with high scores on depression symptoms (HDS) compared with a matched group with low scores on depression symptoms (LDS) according to the clinical cut‐off of the Centre for Epidemiological Studies Depression Scale. Participants were asked to generate specific autobiographical memories in response to a series of positive and negative cue words. Latencies of responses for each item were also scored. LDS participants showed a higher proportion of specific memories than HDS participants. Latencies of responses to positive and negative cues were greater for HDS than LDS. Specific autobiographical memory was positively associated with Life Satisfaction. Cognitive emotional changes in the function of memory with age are suggested as a possible explanation for the findings. Copyright © 2012 John Wiley & Sons, Ltd.     

Revisions and Regret: The Cost of Changing your Mind

Decision reversals often imply improved decisions. Yet, people show a strong resistance against changing their minds. These are well‐established findings, which suggest that changed decisions carry a subjective cost, perhaps by being more strongly regretted. Three studies were conducted to explore participants' regret when making reversible decisions and to test the hypothesis that changing one's mind will increase post‐outcome regret. The first two studies employed the Ultimatum game and the Trust game. The third study used a variant of the Monty Hall problem. All games were conducted by individual participants playing interactively against a computer. The outcomes were designed to capture a common characteristic of real‐life decisions: they varied from rather negative to fairly positive, and for every outcome, it was possible to imagine both more and less profitable outcomes. In all experiments, those who changed their minds reported much stronger post‐outcome regret than those who did not change, even if the final outcomes were equally good (Experiments 2 and 3) or better (Experiment 1).This finding was not because of individual differences with respect to gender, tendency to regret, or tendency to maximize. Previous studies have found that those who change from a correct to wrong option regret more than those who select a wrong option directly. This study indicates that this finding is a special case of a more general phenomenon: changing one's mind seems to come with a cost, even when one ends up with favorable outcomes. Copyright © 2011 John Wiley & Sons, Ltd.     

Prospective and concurrent correlates of emotion perception in psychotic disorders: A naturalistic,longitudinal study of neurocognition,affective blunting and avolition

This naturalistic study investigated longitudinal and cross‐sectional symptomatic and neurocognitive correlates of social cognition indexed by emotion perception. Participants were 31 persons admitted to a psychiatric emergency ward due to acute psychosis. Positive and negative (i.e., affective blunting and avolition) symptoms were assessed at baseline and 12‐month follow‐up using the Positive and Negative Syndrome Scale. Participants completed neuropsychological assessments with alternative versions of the Repeatable Battery for the Assessment of Neuropsychological Status at baseline and at 12‐month follow‐up. Emotion perception was measured using the Face/Voice Emotion Test at 12‐month follow‐up. Correlational analyses (Spearman's rho) revealed strong and statistically significant associations between neurocognition and emotion perception (baseline r = 0.58, follow‐up r = 0.43). Associations between positive symptoms and emotion perception were weak or non‐existent (baseline r = 0.13, follow‐up r  =  –0.01). Emotion perception was moderately, but not significantly, associated with affective blunting at follow‐up (r = 0.33), but not at baseline (r = 0.21). The association with avolition was non‐existent (baseline r  =  –0.05, follow‐up r = 0.01). This study supports the notion that emotion perception has neurocognitive correlates. The cross‐sectional trend level association with affective blunting suggests that the ability to perceive emotions might be related to, but dissociable from the ability to express emotions.     

Personal values and prosocial behaviour in strategic interactions: Distinguishing value‐expressive from value‐ambivalent behaviours

Relying on the framework provided by Schwartz's theory of personal values, we investigated whether values can help explain prosocial behaviour. We first distinguished value‐expressive behaviours from value‐ambivalent behaviours. The former are compatible with primarily one value or with congruent values, the latter with mutually conflicting values. In Study 1, an analysis over all 41 (39 unpublished) samples in which we measured personal values and prosocial behaviour in monetarily incentivized strategic interactions (N = 1289; data collected between 2007 and 2010 in China, Finland, Germany, Israel, and the West Bank) supported our idea that personal values, universalism in particular, predict value‐expressive (prisoner's dilemma cooperation and trust game back‐transfers) but not value‐ambivalent behaviours (trust game transfers and ultimatum game proposals and responses). Study 2 (N = 56) focused on dictator game behaviours, which we expected and found to be strongly value‐expressive. The findings contribute to the ongoing discussion on whether and under which circumstances values shape behaviour. Copyright © 2013 John Wiley & Sons, Ltd.     

Do core self-evaluations and coping style influence the perception of job insecurity?

Over the last few decades, increased flexibility and lack of stability in employment has made job insecurity a work stressor that affects more and more employees. Since worrying about potential job loss (quantitative job insecurity) or possible loss of valued job features (qualitative job insecurity) constitutes a subjective perception, it has been claimed that personality factors may be decisive for job insecurity perceptions. Furthermore, the perception of a stressor, in this case job insecurity, could be argued to be dependent on appraisals of available coping resources. This study investigates whether core self-evaluations predict job insecurity perceptions, and whether coping mediates this relationship, in a two-wave data set from a Swedish sample of white-collar workers (N = 425). The results show that core self-evaluations had a negative total effect on both qualitative and quantitative job insecurity. Core self-evaluations were positively related to problem-focused coping but not to emotion-focused coping. However, there was no mediating effect of coping style on the association between core self-evaluations and job insecurity.     

Investigating the relationship between employability and self-efficacy: A cross-lagged analysis

The construct of employability has been conceptually related to self-efficacy in different ways. Employability has sometimes been regarded as an equivalent to self-efficacy, or as a distinct but related phenomenon. Since the relationship between the two phenomena has not been subjected to empirical scrutiny, the aim of the present study is to analyze whether self-efficacy and employability are two distinct but related constructs, and if they are, to investigate the direction of their relationship. The data (N = 1730) were collected through a two-wave longitudinal survey with one year between each data collection (2005 and 2006). The results of confirmatory factor analysis showed that the measures of employability and self-efficacy were distinct from one another, within and over measurement points, indicating that these are related but separate constructs. The results of latent variable cross-lagged analysis showed that employability predicted subsequent self-efficacy, even after controlling for age, gender, educational level, and regional differences. Thus, employability is not an expression of efficacy beliefs, but rather, the strengthening of employability perceptions may have beneficial effects on more general efficacy beliefs.     

Daily Functioning, Health Status, and Happiness in Older Adults

The hypothesis that the degree to which disease disrupts daily functioning is inversely associated with happiness is widely accepted, yet existing literature offers little direct evidence in its support. This paper explores the hypothesized association in a community-based sample of 383 older adults. To assess the degree to which disease disrupts daily functioning we developed a measure—called the freedom-from-debility score—based on four Short Form-12 (SF-12) Health Survey questions explicitly designed to represent “limitations in physical activities because of health problems” and “limitations in usual role activities because of physical health problems.” The results were consistent with the hypothesis. When participants were divided into categories based on their freedom-from-debility score, median happiness scores were monotonically increasing across categories. Controlling for demographic and socio-economic factors as well as health status (measured both subjectively and objectively), a one-point increase in freedom-from-debility score (on a scale from 0 to 100) was associated with a three-percent reduction in the odds of lower-quartile happiness. The results support the contention that health status is one of the most influential predictors of happiness, that the association between health status and happiness depends greatly on the manner in which health status is measured, and that the degree to which disease disrupts daily functioning is inversely associated with happiness.