María Crespo

The meaning of psychological symptoms: effectiveness of a group intervention with hypochondriacal patients

A group treatment for hypochondriasis was administered to 14 subjects. It was based on Barsky, Geringer and Wool (1988) [General Hospital Psychiatry, 10, 322-327] cognitive-behavioral formulation and presented as an educational course to explain the origins of an enhanced perception of somatic symptoms. Initially, one experimental group (N = 9) and a waiting list control (N = 8) were formed. Experimental subjects showed significant reductions in illness fears and attitudes, reported somatic symptoms and dysfunctional beliefs. Waiting-list controls also changed some illness attitudes, but showed no change in somatic symptoms and increased the number of visits to doctors. Experimental and control subjects differed on several change measures. Afterwards, part of the waiting list subjects (N = 5) received treatment. Overall, treatment was effective for the target measures and produced long-term positive effects on other fears, dysphoric mood and well-being. After treatment, subjects were significantly more extroverted, open and warm. The clinical impression was that treatment was not limited to less severe cases.

Assessment of the Efficacy of a Psychological Treatment for Women Victims of Violence by their Intimate Male Partner

This study evaluates the long-term efficacy of a brief psychotherapeutic cognitive-behavioral program in group format for female victims of violence by their intimate partner. 53 battered women were randomized into one of two intervention programs: one including among others exposure technique (n = 28) and another one in which exposure procedures were substituted by communication skills training (n = 25). Additionally, both programs included: psycho-education, breath control, training to improve self-esteem, cognitive restructuring, problem-solving, planning pleasant activities, and relapse prevention. The treatment was carried out in 8 weekly sessions. Measures of posttraumatic symptoms, anxiety, depression, self-esteem and anger expression were analyzed at pre- and post-treatment, and at 1-, 3-, 6- and 12-months follow-ups. Results show a pronounced decrease of posttraumatic, depressive and anxiety symptoms, which maintained in the different measure moments, with scarce difference between the two programs. The results and their clinical implications are discussed.

Homelessness Effects on Men's and Women's Health

This article reports the main health status differences between a representative sample of homeless people and an at-risk for homelessness group consisting of people who use services for the homeless such as soup kitchens and public baths but have and maintain a home. The variables analyzed include health problems by system, risk habits and behaviors, substance use, alcohol problems, general health status, suicidal thoughts and perceived health status. Because of the gender differences between groups, the data were analyzed independently for men and women. The results show that the homeless have worse health status compared with the at-risk group. Homeless men had significantly more risk habits and behaviors, substance use, and mental health problems. Homeless women had similar tendencies, although they also had significantly more general health illnesses (by systems and over the past year). Almost no differences were found in drug use (especially alcohol use) or in mental health—except for depression, which was significant. These results shed light on new data regarding the correlation between homelessness and health issues.

Memory and narrative of traumatic events: A literature review.

This study presents a literature review of 22 studies published since 2004 that use linguistic procedures to evaluate narratives by persons who had suffered any traumatic event. The aim is to analyze the features of traumatic memories and, thus, how individuals construct and integrate their recall of what happened with other autobiographical memories. It uses cognitive theoretical models of posttraumatic stress disorder (PTSD) and their hypotheses about trauma memories as a framework. Findings reveal that trauma narratives are dominated by sensorial/perceptual and emotional details. The study of other narrative aspects (i.e., fragmentation, length, temporal context, and references to self) provides heterogeneous results. Results are discussed in light of the current state of PTSD research, exploring the principal hypotheses that have been proposed in cognitive theories to explain clinical findings.

Support groups for caregivers of Alzheimer patients: A historical review

Support groups (SG) for family caregivers are an intervention frequently used by associations and institutions. But their extensive use does not correspond to the current scientific interest in them. The aim of this paper is to make a historical review of the use and study of SGs for family caregivers of Alzheimer patients, describing their main features and variations, with special emphasis on data about their efficacy. In this analysis, three stages were differentiated: an initial stage (late 1970s – 1985) with studies based on subjective impressions and questionnaires showing high satisfaction among caregivers; a second stage (1985–1995) with more rigorous methodology, which led to doubts about SGs’ efficacy; and a third stage (1995 – present) in which qualitative methodology focused on group process has led to renewed interest. At the end some proposals regarding the future of research on caregiver SGs are discussed.

Early Psychological Consequences of the March 11, 2004, Terrorist Attacks in Madrid, Spain

On March 11, 2004, Al-Qaeda set off 10 bombs on several train routes in Madrid. 192 people were killed and 2,000 wounded. In this study, 1,179 questionnaires were administered Week 2 after the attacks to residents 18 years and over from the affected geographical areas. The questionnaire included items about sociodemographic variables and exposure to the attacks. Psychological effects were assessed as presence of acute stress and depressive symptomatology and functional impairment. 46.7% of the sample presented symptomatology of acute stress and 49.6% depressive symptoms. Among the symptoms of acute stress, the most frequent were re-experiencing (72.5%) and dissociative symptoms (71.8%). The chief predicting variables in symptomatology were being female, over 65 yr. old, and a habitual train user. The large number of affected people was refined with an item analysis and the consideration of severity of interference in psychosocial functioning.

Analysis of the efficacy of a psychotherapeutic program to improve the emotional status of caregivers of elderly dependent relatives

Objectives: This study examined the long-term impact of a psychotherapeutic cognitive-behavioral program with two intervention formats (traditional weekly sessions (TWS) and minimal therapist contact (MTC)) in caregivers who suffered from emotional problems due to caring for elderly dependent relatives. Method: The 86 participants, who lived with the older persons at home, were randomized into one of the two intervention formats. The individual treatment program was carried out during an 8-week interval. Measures of anxiety, depression, burden, coping, social support, and self-esteem were analyzed at pre- and post-treatment, and at 1-, 3-, 6-, and 12-month follow-ups. Results: Significant effects were found in the expected direction in most of the measures analyzed. The participants in the intervention reduced significantly their levels of anxiety, depression, and burden, and they improved the levels of problem-focused coping, social support, and self-esteem. The two intervention formats had different evolutions, with better effects in the TWS format, especially at the first post-test measurements, but the differences tended to decrease over time. Conclusion: These data suggest that individual psychotherapeutic interventions with caregivers are efficient to reduce their emotional problems, and that this effect is mediated by improvement both in their appraisal of the situation and in their personal resources.

Educating the ‘Worried Well’: Description of a Structured Programme and Implications for Treatment and Prevention

This paper describes the contents of a cognitive-behavioural treatment for hypochondriasis and health anxiety based on Barsky et al.s (1988) proposal. Five types of factors that may account for the enhanced experience of physical symptoms—selective and inadequate attention, muscle tension and bad breathing, environmental factors, stress and dysphoric mood and misinterpretation of somatic symptoms—were presented in the form of a group of educational training. Special emphasis was given to the form in which psychological information should be provided to initially resistant patients and to the contexts in which training should occur. The evidence obtained with an heterogeneous group of 14 subjects supports the utility of the programme, not only for target behaviours, but also for other related areas. Finally, the implications of this type of intervention for treatment and prevention are discussed.

Dimensional structure of DSM-5 posttraumatic stress symptoms in Spanish trauma victims

Background Confirmatory factor analytic studies have shown that posttraumatic stress disorder (PTSD) symptoms included in the fifth edition of the Diagnostic and Statistical Manual Disorders (DSM-5) may be better explained by two 6-factor models (the Externalizing Behaviours model and the Anhedonia model) and a 7-factor Hybrid model. The latter model comprises the symptom clusters of intrusion, avoidance, negative affect, anhedonia, externalizing behaviours, and anxious and dysphoric arousal. This model has received empirical support mainly in American samples. Of note, there have been a limited number of studies conducted on samples from other countries. Objective This study aimed to examine the underlying dimensionality of DSM-5 PTSD symptoms in a Spanish clinical sample exposed to a range of traumatic events. Method Participants included 165 adults (78.8% females) seeking treatment in trauma services in the Madrid area (Spain). PTSD was assessed using the Global Assessment of Posttraumatic Stress Scale 5, a Spanish self-report instrument assessing posttraumatic symptoms according to the DSM-5 criteria. Confirmatory factor analyses were conducted in Mplus. Results Both the 7-factor Hybrid model and the 6-factor Anhedonia model demonstrated good and equivalent fit to the data. Conclusions The findings of this study replicate and extend previous research by providing support for both the 7-factor Hybrid model and the 6-factor Anhedonia model in a clinical sample of Spanish trauma survivors. Given equivalent fit for these two models and the fewer number of latent factors in the Anhedonia model, it was selected as optimal in a traumatized Spanish sample. Implications and future research directions are discussed. Highlights of the article The 7-factor Hybrid model (which comprises the intrusion, avoidance, negative affect, anhedonia, externalizing behaviours, and anxious and dysphoric arousal symptoms clusters) and the 6-factor Anhedonia model (in which the externalizing behaviour symptoms are part of the dysphoric arousal symptom cluster) provided equivalent fit to the data. The Anhedonia model is the most parsimonious and thus the optimal-fitting model in the current sample. The findings support the distinctiveness between dysphoric arousal, anxious arousal, negative affect, and anhedonia factors. The separation of the externalizing behaviour symptoms from the dysphoric arousal symptoms does not improve the model fit in the current sample.

Narrative Length and Speech Rate in Battered Women.

Narrative length and speech rate of traumatic recollections have been previously associated with different emotions and adjustment trajectories after trauma. However, the evidence is limited and the results are mixed. The present study aimed to evaluate length (i.e., word count) and speech rate (i.e., words per minute) in narratives of events with different valence (i.e., neutral, positive, and negative/traumatic) by 50 battered women (trauma group) and 50 non-traumatized women (controls). The results showed that traumatic narratives by the trauma group were longer than those by the control group. Moreover, they were inversely related to time since the event and anxiety during disclosure, whereas the speech rate was also inversely associated with anxiety, as well as with peritraumatic dissociation and avoidance. The shorter narratives for positive events and a decelerated speech pattern for traumatic experiences predicted psychological symptoms. Additionally, the individual’s emotional state predicted narrative aspects, with bidirectional effects. Our findings showed that linguistic characteristics of traumatic narratives (but also of narratives of positive events) revealed information about how the victims elaborated autobiographical memories and coped with the trauma.