Prevalence and treatment of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and co-morbid severe health anxiety

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a debilitating condition that affects 0.2–0.4% of the population. Health focussed anxiety is common across medical conditions, and may be relevant in CFS/ME. This study sought to identify the prevalence and impact of health anxiety (HA) in CFS/ME and evaluate the effectiveness of Cognitive Behavioural Therapy for HA in CFS/ME. Cross-sectional questionnaire methods and case-series design were used to achieve study aims. Analysis indicated that 41.9% of the CFS/ME clinic sample experienced threshold levels of health anxiety, which was associated with elevated symptom severity across several dimensions. Stepwise multiple regression indicated physical functioning and depression accounted for 23.8% of variance in fatigue; depression, fatigue and HA, accounted for 32.9% of variance in physical functioning. Large effect sizes and clinically significant changes were generated in the treatment study. HA is common in CFS/ME and likely to exacerbate fatigue and physical functioning. This study identifies HA as an important target for treatment, trial findings should be further replicated on a larger scale.     

Aportaciones del conductismo a la salud mental comunitaria

Resumen

St analiza el movimiento de salud mental comunitaria dentro del contexto de la politica general de la OMS, y las posibles aportaciones del conductismo a dicho movimiento. A juicio del autor, éstas son, fundamentalmente, dos: a) de tipo metodológico, al permitir el seguimiento, evaluación, comparación y replication de experiencias; b) de tipo ideológico, al facilitar la participación activa de los miembros de la comunidad y la desmedicalización de los problemas de salud. Existen, al menos, cinco razones para llevar a cabo dicha desmedicalización: 1.^a) Disminuir los costos sanitarios; 2.^a) Disminuir el peligro de yatrogenia; 3.^a) Permitir que otros profesionales no médicos puedan actuar con plenitud de autoridad profesional y conseguir, de esta manera, una interdisciplinariedad auténtica; 4.^a) Evitar las connotaciones marginadoras de muchos etiquetajes médicos y psiquiátricos; y 5.^a) Aumentar la participación activa del paciente y de sus familiares en el proceso curador, hecbo que, en muchos casos, potencia la eficacia de los tratamientos. Conseguir esta desmedicalización es, esencialmente, un problema de ingeniería conductual: cómo cambiar nuestras actuales pautas sanitarias. En el trabajo se proporcionan algunas normas para tratar de conseguirlo. Finalmente, se discute el papel del psicólogo clínico en el campo sanitario.     

Mapas cognitivos: Revisión crítica

Resumen

El artículo propone, desde una perspectiva cognitiva, una estructura conceptual para interpretar la amalgama de resultados obtenidos por la investigación sobre mapas cognitivos. Se describe y discute su carácter interdisciplinar, su semejanza con otros conceptos, los elementos de que consta, el tipo de información que contiene, así como sus imprecisiones e inconsistencias. Finalmente, se aportan argumentos acerca de la ventaja que supone partir de una concepción del mapa cognitivo como una estructura multirrepresentacional, dirigida a la acción, y se esbozan algunas sugerencias para la investigación futura.     

Effectiveness of Couple Therapy in Practice Settings and Identification of Potential Predictors for Different Outcomes

Even though couple therapy is efficacious, there is no improvement in up to 50% of the couples. Also effect sizes found in effectiveness studies in real-world settings are considerably lower than those found in efficacy studies. There is a need to understand more about couple therapy effectiveness in practice settings and the factors responsible for different outcomes. A German nationwide study on the effectiveness of couple counseling including 554 couples applied the same methodology as two earlier studies in the same field. A remarkable consistency was found over the three independent studies in the burden with individual and relationship distress as well as in the rates of improvement. This supports the insight that the improvements reached through couple therapy in practice settings are only about half of the effect sizes reached in efficacy trials. Additionally this study investigated 64 factors, which were found to be influential for relationship quality and stability in earlier studies, for their impact on outcome. Factors present at initiation and termination of therapy were found, which correlate significantly with outcome and with separation of the couple in the follow-up. These factors could be included in prediction models for improvement and separation of the couple. The implications for the practice of couple therapy and for future research are discussed.