Arturo Bados

The State-Trait Anxiety Inventory, Trait Version: Does It Really Measure Anxiety?

To clarify what is actually measured by the trait version of the State-Trait Anxiety Inventory (STAI; Spielberger, Gorsuch, & Lushene, 1970), we conducted a confirmatory factor analysis of various models and evaluated convergent and discriminant validity. The best fit was obtained with both a bifactor model, comprising 2 specific factors plus a general factor, and a 1-construct, 2-method model. The total score and the 2 method subscales of the STAI trait version were more strongly correlated with depression than with anxiety. In the bifactor model with 2 specific factors, the depression subscale showed stronger correlations with measures of depression than with measures of anxiety. The correlation of the hypothetical anxiety subscale with measures of depression was equivalent to or higher than its correlation with measures of anxiety. These results suggest that the questionnaire does not strictly evaluate anxiety but, rather, negative affect.

Outcome of cognitive‐behavioural therapy in training practice with anxiety disorder patients

OBJECTIVES This study aims to assess the effectiveness of cognitive-behavioural therapy applied by trainee therapists in patients with anxiety disorders seen in a private university service and to examine whether this effectiveness is comparable to that observed in controlled studies. DESIGN We compared the effectiveness of cognitive-behavioural therapy at a private centre with that observed in meta-analyses and reviews of controlled studies. METHODS Out of the 96 initial patients with anxiety disorder, 64 completed the cognitive-behavioural treatment and 59 also answered a series of questionnaires pre- and post-treatment. The effect size of the intervention was calculated, as were the percentages of patients who improved and those who recovered. RESULTS The pre-post effect size (1.09) was large, although somewhat lower than those observed in a meta-analysis of Spanish studies and in a range of international meta-analyses; moreover, twice as many hours of treatment were administered (M=27.4) and the drop-out rate was higher (33.3%). The percentages of patients who improved (61%) and those who recovered (52.5%) were roughly comparable to those reported in various reviews of studies performed in anxiety disorders. CONCLUSIONS Cognitive-behavioural therapy applied by trainee therapists in a private university service appears effective, although this efficacy may be somewhat lower than that in controlled studies. Moreover, the duration of treatment and the drop-out rate may be higher.

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

BackgroundDepression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence.Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression.DesignA therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions).MethodParticipants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used.DiscussionWe expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression.Trial registrationISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Dimensionality of three versions of the Eating Disorder Inventory in adolescent girls.

OBJECTIVES To analyze the dimensionality of three versions of the Eating Disorder Inventory (EDI) in adolescent girls. METHOD The sample comprised 738 participants. The Spanish adaptation of the EDI-2 was used. The EDI-2 contains the 64 items of EDI and has the same items as EDI-3. The dimensional structures hypothesized by Garner for the three EDI versions were assessed via a series of Confirmatory Factor Analyses (CFAs). RESULTS The CFA did not confirm Garners proposed structure in any of the three versions. Consequently it was decided to perform Exploratory Factor Analyses (EFA) of the EDI-2 and the EDI-3 to try to identify the underlying structure. The best theoretical and empirical fit was provided by a 7-factor structure. DISCUSSION This article presents a shortened version of the EDI-2 which may prove more suitable for use with adolescent girls in the general population than the original questionnaire. Certain practical suggestions for optimizing the use of the different versions of the EDI are also presented.

Are obsessive–compulsive symptom dimensions familial in nonclinical individuals?

Background: Obsessive–compulsive disorder (OCD) is a heterogeneous condition, which can be expressed as various potentially overlapping symptom dimensions. In clinical samples, some of these dimensions are associated with increased familial risk for OCD and appear to be familial (intercorrelated within pairs of affected family members), whereas others are not. The goal of this study was to determine whether obsessive–compulsive (OC) symptom dimensions are familial in a nonclinical sample. Methods: OC symptom dimensions and negative affect were assessed in 184 female undergraduate students and their parents using the Obsessive–Compulsive Inventory—Revised (OCI‐R) and the Positive and Negative Affect Scales, respectively. Bivariate correlations and multiple regression models controlling for age and negative affect were employed to examine the familiarity of OC symptom dimensions. Results: The OCI‐R total scores were significantly correlated in both mother–daughter and father–daughter dyads but the magnitude of these correlations tended to be greater for the mother–daughter dyads. Multiple regression models showed that the Ordering and Hoarding subscales of the OCI‐R breed true in mother–daughter dyads. Ordering scores in mothers were also predictive of other symptoms in the daughters (Washing and Checking). Conclusions: These results are broadly consistent with the findings in clinical samples and suggest that Ordering and Hoarding are more strongly familial than other symptom dimensions and that high Ordering scores in mothers are associated with increased levels of symptoms in daughters in a less specific manner. Depression and Anxiety, 2009.

Psychometric properties of the Spanish version of the Clinical Outcomes in Routine Evaluation - Outcome Measure.

Objective The objective of this paper is to assess the reliability and validity of the Spanish translation of the Clinical Outcomes in Routine Evaluation – Outcome Measure, a 34-item self-report questionnaire that measures the client’s status in the domains of Subjective well-being, Problems/Symptoms, Life functioning, and Risk. Method Six hundred and forty-four adult participants were included in two samples: the clinical sample (n=192) from different mental health and primary care centers; and the nonclinical sample (n=452), which included a student and a community sample. Results The questionnaire showed good acceptability and internal consistency, appropriate test–retest reliability, and acceptable convergent validity. Strong differentiation between clinical and nonclinical samples was found. As expected, the Risk domain had different characteristics than other domains, but all findings were comparable with the UK referential data. Cutoff scores were calculated for clinical significant change assessment. Conclusion The Spanish version of the Clinical Outcomes in Routine Evaluation – Outcome Measure showed acceptable psychometric properties, providing support for using the questionnaire for monitoring the progress of Spanish-speaking psychotherapy clients.

Factorial structure and validity of the Multicultural Quality of Life Index

PurposeTo study the internal structure and the convergent and divergent validity of the Multicultural Quality of Life Index (MQLI) in a Spanish sample.MethodsThe MQLI, along with another quality of life instrument—the World Health Organization Quality of Life, brief version (WHOQOL-BREF)—and the Depression, Anxiety and Stress Scales (DASS-21), was administered to 356 students, 159 people from the general population and 65 psychiatric patients.ResultsThe value of Cronbach’s α was .90. The confirmatory factor analysis showed a good fit for both the one- and two-factor structures. The overall mean score of the MQLI correlated between .61 and .78 with the domains of the WHOQOL-BREF and between -.55 and -.70 with the DASS-21 scales.ConclusionsThe MQLI has high internal consistency, can be interpreted in terms of a single factor, and has an adequate convergent validity, although its absolute correlations with depression and with the WHOQOL-BREF were equally high.

A DILEMMA-FOCUSED INTERVENTION FOR DEPRESSION: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL WITH A 3-MONTH FOLLOW-UP.

Since long ago it has been asserted that internal conflicts are relevant to the understanding and treatment of mental disorders, but little research has been conducted to support the claim. The aim of this study was to test the differential efficacy of group cognitive behavioral therapy (CBT) plus an intervention focused on the dilemma(s) detected for each patient versus group individual CBT plus individual CBT for treating depression. A comparative controlled trial with a 3‐month follow‐up was conducted.

Coping styles and vulnerability to eating disorders in adolescent girls, by age

The main goal of the study is to explore the relationship between coping styles and vulnerability to eating disorders in a sample of adolescent girls, according to their age. The sample comprises 1396 girls, aged 13 to 18, who completed the Eating Disorders Inventory-3 (EDI-3) and the Adolescent Coping Scale (ACS). The regression analysis shows that the coping strategy most closely linked to the likelihood of developing an ED in all age groups is Intropunitive Avoidance. The scales of the Intropunitive Avoidance dimension that have the most explanatory power are Tension Reduction and Self-Blame. Girls aged 13 and 17 are identified as the highest risk groups. Physical and social changes are proposed as the hypothetical explanation for the difference between age groups. Emphasis is placed on the need for specific prevention programs for adolescents, particularly those at high risk.

Predictors of tonic immobility during traumatic events

Tonic immobility (TI) is a possible reaction to danger that is fa-cilitated by intense fear, physical restraint and perceived inability to escape. Other variables that could affect TI, such as the type and characteristics of traumatic events and personal characteristics have been little or no studied. The present study evaluated the power of these variables to predict TI in a sample of 273 college students who had experienced at least one traumatic event. Of the sample, 7.7% and 13.2% responded with TI according to the two stricter definitions adopted. Most of the variables were significantly as-sociated with TI in univariate analyses. However, in a multiple regression analysis, only certain features of the events (occurrence of physical/sexual abuse, number of different types of events experienced) and certain reac-tions to them (perception of how traumatic were the events, severe fear re-sponse) were significant predictors of TI. Since these predictors explained only 25% of the variance, the influence of other variables �such as neuroti-cism, negative affectivity and perceived lack of personal control or re-sources to cope with traumatic events� should be investigated