Beatriz Molinuevo

Under the tip of the iceberg: Psychological factors in incontinence†‡

To highlight two main psychological factors (cognitive barriers and safety‐behaviors) involved in the development and maintenance of emotional distress in patients with urinary incontinence (UI) and thus facilitate a better understanding of this condition and contribute to a more comprehensive treatment.

Testing the temporal stability of individual differences in the acquisition and generalization of fear.

We studied the temporal stability of individual differences in the acquisition and generalization of fear. Seventy-one participants were tested in two almost identical fear-acquisition and fear-generalization sessions (separated by 8 months). Acquisition and generalization were measured by the fear-potentiated startle, the skin conductance response, and online expectancies of the unconditioned stimulus. To control for the effects of previous experience, different stimuli were used for half of the participants in Session 2. Acquisition and generalization did not differ across sessions or as a function of the stimuli used in Session 2, and a significant proportion of individual differences in these processes was stable over time (generalizability coefficients ranged from 0.17 to 0.38). When the same stimuli were used, acquisition measures showed compromised stability. The results are discussed in terms of their theoretical and applied implications.

On the implications of the virtual storyteller’s point of view

This paper deals with the implications of showing the storyteller’s perspective when telling stories in virtual environments. The paper proposes an open and reusable architecture for the construction of virtual guides who tell stories about the worlds they inhabit from their own perspective. The system consists of two main components: the structure of a knowledge base to code the narrative knowledge about the worlds and a novel hybrid algorithm for the generation of narratives showing the storyteller’s viewpoint. The complete architecture has been developed. Furthermore, we carried out a study with users in order to both validate the implemented storytelling system and test whether the users consider it significantly better or worse (in terms of several aspects related to believability) adding the virtual guide perspective (as both text and animations showing emotions) to the guide discourse. The interesting results are discussed.

Internet-based self-help treatment for panic disorder: a randomized controlled trial comparing mandatory versus optional complementary psychological support

Abstract Panic disorder (PD) is one of the most common psychiatric disorders. Web-based self-help treatments for PD have had promising results. These online treatments seem to have larger effect sizes (ESs) when professional support is added. However, the amount of support or how it should be administered is not yet clear. The aim of this trial was to study two ways of administering psychological support provided by phone as a part of Internet-based self-help treatment for PD based on cognitive behavioral therapy. Seventy-seven participants diagnosed with PD were randomly assigned to one of three experimental conditions: a waiting list control group; a treatment group with non-scheduled psychological support; or a treatment group with scheduled psychological support. PD symptoms of participants who received treatment improved significantly compared to the control group (mean ES d = 1.18, p < .05). In addition, there were statistically and clinically significant differences between treatment groups (Mean difference = −3.20, p = .005, 95% CI [−5.62, −.79]). The scheduled group showed a larger ES, a lower dropout rate, and better adherence to treatment than the non-scheduled group. Scheduled support seems to be indicated for patients who seek Web-based treatment for PD, and their symptoms of panic, anxiety, and depression improve at post-treatment and six-month follow-up. In contrast, when support depends on patient demand, they receive less support and so, the therapeutic effect is poorer.

How we train undergraduate medical students in decoding patients' nonverbal clues

Background: Communication skills (CS) and the psychosocial dimensions of patient care are currently considered core competencies in medical schools. CS programs have focused on verbal communication rather than the nonverbal communication. Aim: To present a training program aimed to decode patients’ nonverbal clues for second year medical students implemented at the School of Medicine of the Autonomous University of Barcelona. Method: A description of a theoretical framework, principles, general and specific goals, learning settings, strategies, skills, and assessment tools. Results: A model of training for preclinical medical students in decoding patients’ nonverbal clues is shown. The students have shown satisfaction with the program. Conclusions: The detection of patients’ nonverbal clues can be regarded as a humanistic skill that can be defined, trained, and evaluated. The program can be transferable to other institutions on health sciences and adapted to other academic levels or, even, clinical specialties.

A comparison of medical students', residents' and tutors' attitudes towards communication skills learning

Background: The consensus about the importance of communication skills in patient-care does not guarantee that students and faculty perceive the usefulness of these skills. This study evaluated and compared medical students′, residents′ and tutors′ attitudes towards learning communication skills, and examined the association with gender and year of residency. Methods: We conducted a cross-sectional survey with 492 participants (282 second-year students, 131 residents and 79 tutors). They completed the Communication Skills Attitude Scale (CSAS) and demographic/educational information. Results: In general, participants showed positive attitudes towards learning communication skills. Medical students, residents and tutors did not differ on the Positive Attitudes Scale (CSAS-PAS). Residents scored higher than medical students on the Negative Attitudes Scale (CSAS-NAS) (P < 0.01). Females showed higher scores on the CSAS-PAS (P < 0.05) and lower scores on the CSAS-NAS (P < 0.01) than males in all subsamples. The effect sizes were medium. There were no significant differences according to year of residency. Discussion: Medical students, residents and tutors consider training in communication skills an essential component for clinical practice and they agree about the need to learn these communication skills. Attention should be paid to measuring attitudes at all three levels of medical education in the design of communication skills courses.

Web-based screening for Panic Disorder: Validity of a single-item instrument

BACKGROUND Panic Disorder (PD) is a common mental disorder with an important social and economic cost. Web-based screening tools for early detection of PD are useful for clinical and research purposes. However, there is a paucity of instruments that specifically measure PD online. The aim of this study is to analyze the validity of one item from the Web Screening Questionnaire designed to detect PD symptoms (WSQ-Panic). METHODS A total of 171 participants completed the WSQ-Panic online and were assessed by telephone using the Structured Clinical Interview for DSM Disorders (SCID-I). The sensitivity, the specificity, predictive values (PPV, NPV), and area under the ROC curve (AUC) were calculated, and the optimal cut-off point was determined. RESULTS The WSQ-Panic showed a sensitivity of 0.83 and a specificity of 0.74. The PPV was 0.46 and NPV was 0.94. The AUC was 0.82 (95% CI: 0.74-0.90), which indicates a moderate accuracy. The optimal cut-off point is ≥2. LIMITATIONS The representativeness of the sample is limited. All the interviews were conducted by phone. Six-month prevalence according to SCID-I criteria was considered, whereas the WSQ-Panic assesses current symptoms. CONCLUSION The WSQ-Panic accuracy is acceptable as an Internet screening tool, comparable to longer instruments for PD detection. This instrument is valid to quickly identify patients who suffer from panic symptoms, which can cause important distress and possibly lead to PD. It can also be very useful for screening participants in online self-help treatments and for research purposes.

Memories of parenting practices are associated with psychopathy in juvenile male offenders

Despite the large body of research documenting parenting practices as risk factors for the development of child and adolescent disruptive behaviour, the association with psychopathy is notably less known. The goal was to examine, in 75 institutionalized juvenile male offenders, the association between self-reported memories of parenting practices during childhood (Alabama Parenting Questionnaire) and psychopathy (Psychopathy Checklist: Youth Version). Results showed that ineffective parenting practices as inconsistent discipline and poor monitoring/supervision were significantly associated with increased levels of psychopathic traits. Interestingly, only two of the four facets of the construct, lifestyle and antisocial, were associated with these parenting behaviours. Findings highlight the importance of considering parenting practices in the study of the early development of psychopathy and suggest that the facets could be rooted in distinct underlying etiologic-dispositional factors with differentiated developmental pathways and different psychosocial correlates. The study lends support to the multidimensional approach of psychopathy as a syndrome.

Religious upbringing and current religiosity in Spanish nursing and medicine students

The influence of religious education in the family upon current spiritual and religious tendencies was assessed in a sample of 599 Spanish nurse and medicine students using a religiosity scale and answers to a series of belief/disbelief statements. Results showed that nursing and medicine students were equally low-religious, with no differences in religiosity total scores between participants coming from religious families; however, medical students coming from nonreligious families showed higher religiousness than the corresponding nursing trainees. This distinction appeared both across religiosity items and in a variety of responses to belief/disbelief of Christian/secular assertions. Regression analysis showed that religious family background was a consistent predictor of religious beliefs at young adulthood, and its influence was higher for medical students. In addition to establish religious upbringing as an important factor modulating enduring religiosity, these findings provide distinctions between nurse and medical trainees, and reproduce, in a Spanish mainly catholic sample, the structure of religiosity factors previously found on North American mainline protestants.

Formación en habilidades comunicativas desde la perspectiva de residentes y tutores en medicina

Resultados. Un 74% de residentes y un 67% de los tutores habian recibido formacion en habilidades comunicativas. Residentes y tutores coincidieron en la valoracion del area en la que la formacion es adecuada (entrevista clinica) y en las areas susceptibles de mejora (manejo de emociones, gestion de situaciones dificiles y comunicacion con familiares y cuidadores) durante el programa de MEF. Ambos manifestaron una alta predisposicion a participar en futuros programas de formacion.