Fernando García

Group Versus Individual Cognitive Treatment for Obsessive-Compulsive Disorder: Changes in Severity at Post-Treatment and One-Year Follow-up

BACKGROUND Very few studies have compared the efficacy of individual and group cognitive behaviour therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) by taking into consideration the change in OCD severity in both the short and long term. AIMS To conduct an open trial of individual versus group CBT for OCD, comparing the clinical and statistically significant changes in severity both at post-treatment and one year later. METHOD Forty-two OCD subjects were assigned to individual (n = 18) or group CBT (n = 24, in four groups). Sixteen and 22 subjects completed the treatment in the individual and group conditions, respectively. The Yale-Brown Obsessive Compulsive Scale was recorded at pre-treatment, post-treatment and at the one-year follow-up. RESULTS At the end of treatment, the clinically significant change was comparable for the two treatment conditions and remained stable at the one-year follow-up. Of the 16 participants who completed the individual CBT treatment, 68.75% were classified as recovered at post-treatment, compared to 40.9% of those receiving group CBT. At follow-up the rate of recovery decreased to 62.5% in individual CBT and to 31.8% in group CBT. CONCLUSIONS Group CBT is effective in decreasing OCD severity. The post-treatment changes were maintained one year later. Nevertheless, these changes were higher in the individual delivery of CBT.

The research program at AIGLE.

The purpose of this work is to present the research program of a Clinical Center, the AIGLE Foundation in Buenos Aires, Argentina. It describes the potentialities and advantages of research in this context. It also describes the institute, the types of patients treated and its professional staff. The program covers four areas: determining the demand for psychotherapeutic care in the population at large, studying the conditions making participation in community mental health possible, analyzing and follow-up on the outcomes and studying the personal styles of the therapists. Finally, this work discusses the usefulness and applicability of these results for clinical practice.

Group versus individual cognitive treatment for Obsessive-Compulsive Disorder: Changes in non-OCD symptoms and cognitions at post-treatment and one-year follow-up

Current cognitive approaches postulate that obsessions and compulsions are caused and/or maintained by misinterpretations about their meaning. This assumption has led to the development of cognitive therapeutic (CT) procedures designed to challenge the dysfunctional appraisals and beliefs patients have about their obsessions. Nonetheless, few studies have compared the efficacy of individual and group CT in changing the dysfunctional cognitions that hypothetically underlie Obsessive-Compulsive Disorder (OCD). In this study, 44 OCD patients were assigned to individual (n=18) or group (n=24) CT. Sixteen completed the individual CT, and 22 completed the group CT. The effects of the two CT conditions on depression and worry tendencies were comparable. Individual treatment was more effective than group treatment in decreasing scores on dysfunctional beliefs (responsibility, overestimation of threat, and intolerance to uncertainty) and the use of suppression as a thought control strategy. The post-treatment changes were maintained one year later. The correlations between symptom improvement (OCD severity change) and belief changes were moderate: in the individual treatment the greatest associations were with beliefs about thoughts (importance and control), whereas in the group treatment the greatest associations were with beliefs related to anxiety in general (threat overestimation and intolerance to uncertainty).

Bridging the gap between research and practice in a clinical and training network: Aigle's Program

Abstract The aim of this article is to share our experience at the Aiglé Foundation in fostering research that can conducted by (or in collaboration with) clinicians within a specific type of naturalistic setting—one that not only provides psychological services but also trains psychotherapists. After presenting the structure of Aiglé and the implementation of its scientific-practitioner philosophy, we describe some of the research that has been conducted with our network of clinicians and the benefits of connecting clinical practice and academic work. We then discuss some of the obstacles that we have encountered in conducting such studies, as well as a number of strategies that we adopted in attempting to address these challenges. We end this article by briefly describing the current state of our practice-research network, and by offering some recommendations to facilitate the conduct of research by and for clinicians.

Evaluación del Estilo Personal del Terapeuta: Presentación de una Versión Abreviada del Cuestionario EPT-C

El Estilo Personal del Terapeuta (EPT) se conceptualiza como un constructo multidimensional que esta presente en todo proceso terapeutico. El objetivo principal de este trabajo es presentar una version abreviada del cuestionario EPT-C y proporcionar nuevas pruebas sobre la validez de este instrumento como herramienta para la evaluacion del constructo. Se administro el EPT-C a una muestra de 461 psicoterapeutas argentinos. Se analizo la validez de constructo del cuestionario mediante Analisis Factorial Confirmatorio, se estudio la relacion entre la version breve y la original, y se evaluo la capacidad del instrumento para discriminar a los diferentes grupos de terapeutas en variables de relevancia para el proceso y los resultados de la psicoterapia. Los resultados indicaron un buen ajuste entre el modelo de medida pentafactorial del EPT-C y las dimensiones del constructo teorico. El cuestionario EPT-C aporta una medida sensible para detectar diferencias entre grupos de terapeutas a partir de varias caracteristicas de los mismos.

Estilo personal de terapeutas que trabajan con pacientes severamente perturbados: un estudio cuantitativo y cualitativo

Estudio comparativo entre terapeutas de distintas orientaciones teoricas que asisten o no a pacientes severamente perturbados, con el objetivo de evaluar las caracteristicas del estilo personal consideradas optimas

Presentación de una Guía para la Observación y Clasificación de la Conducta Verbal de los Terapeutas

El articulo presenta una guia de observacion y clasificacion de la conducta verbal de los terapeutas, la Guia de Observacion de Terapeutas Aigle (GOTA-v). Se revisan los estudios sobre la variable del terapeuta, especialmente el Estilo Personal y sus procedimientos de evaluacion. Este nuevo instrumento fue aplicado a la transcripcion de 44 sesiones de 12 terapeutas de Argentina con diferente orientacion teorico-tecnica y distinto grado de experiencia (bajo, medio y alto). Se delimitaron los textos de las sesiones en unidades de analisis y se clasificaron esas unidades con categorias pertenecientes a tres clases de actos de habla: Preguntas, afirmaciones e indicaciones. Se calculo el indice de acuerdo inter jueces de Kappa para cada clase. Se discuten los alcances y limitaciones del instrumento y sus posibilidades para la investigacion en psicoterapia.

Psicoterapia cognitiva individual del TOC

SUMMARY A case study is presented in which cognitive therapy is applied to a case of obsessive-compulsive disorder, with contamination and verification rituals. The treatment emphasizes the importance of intervening on the specific metacognitive biases that patients have on their intrusive thoughts. The center of the intervention is not in the obsessions, but in the biased assessments. The post treatment evaluation showed a moderate improvement, a reduction of the biases, and a notable improvement of the functionality of the patient.

Procesos de cambio en el trastorno obsesivo compulsivo: análisis cualitativo de alos resultados de un tratamiento cognitivo desde la experiencia subjetiva de los pacientes

This qualitative study explores the impact of a cognitive therapy program on the subjective experience of patients suffering from obsessive–compulsive disorder (OCD). The accounts given by patients were compared with the results obtained from quantitative measures of symptom improvement. A distinction is made between the impact of treatment on patients’ behavior and on their lived experience. An individual’s experience is seen as a synthesis of his or her mental states (internal representations) expressed through metacognitive processes. Most of the patients organized their subjective experience of change in terms of improvement, not recovery. This was consistent with reduced scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Obsessive Intrusive Thoughts Inventory (INPIOs). We conclude that all the patients’ stories showed a positive evaluation of their therapeutic process, irrespective of quantitative assessment results. Patients tended to describe changes more in terms of symptoms rather than in terms of experience. The advantages and limitations of using qualitative and quantitative methodologies in this context are also discussed.

ESTILO PERSONAL DEL TERAPEUTA: COMPARACIÓN ENTRE TERAPEUTAS COGNITIVOS POST-RACIONALISTAS Y SISTÉMICOS

espanolEl Estilo Personal del Terapeuta (EPT) es un constructo multidimensional que esta presente en todo proceso terapeutico. El objetivo de la investigacion consistio en estudiar la influencia de las orientaciones psicoterapeuticas (Cognitiva Post-racionalista y Sistemica) en el EPT. Se administro el cuestionario EPT-C a una muestra de 67 terapeutas chilenos con formacion en ambas escuelas terapeuticas. Se realizo un analisis de corte transversal, con el fin de comparar el EPT respecto a las dos orientaciones. Para esto se utilizo la prueba t de Student para comparar a ambos grupos, respecto a las cinco dimensiones del estilo personal del terapeuta. Posteriormente se realizo una comparacion de items con una prueba no parametrica (U Mann-Whitney). Los resultados indicaron diferencias significativas en las funciones operativa y atencional. Tambien se encontraron diferencias significativas en 5 items del cuestionario. EnglishThe Personal Style of the Therapist (PST) is a multidimensional construct that is present in all therapeutic processes. The aim of the research was to study the influence of psychotherapeutic orientations (Post-rationalist and Systemic Cognitive) on the PST. The EPT-C questionnaire was administered to a sample of 67 Chilean therapists trained in both therapeutic schools. A cross-sectional analysis was conducted to compare the PST with respect to the two orientations. For this purpose, the Student t-test was used to compare both groups, with respect to the five dimensions of the therapists personal style. A comparison of items was then made with a non-parametric (Mann-Whitney) test. The results indicated significant differences in operational and attentional functions. Significant differences were also found in 5 items of the questionnaire.