RESUMO

INTRODUCTION: Severe mental disorders can cause significant and lasting distress for patients and their families and generate high costs through the need for care and loss of productivity. This study tests DIALOG+, an app-based intervention to make routine patient-clinician meetings therapeutically effective. It combines a structured evaluation of patient satisfaction with a solution-focused approach. METHODS: We conducted a qualitative study, based on a controlled clinical trial, in which 9 psychiatrists and 18 patients used DIALOG+ monthly over a six-month period. Semi-structured interviews were used to explore the experiences of participants and analysed in an inductive thematic analysis focusing on the feasibility and effects of the intervention in the Colombian context. RESULTS: Experiences were grouped into five overall themes: a) impact of the intervention on the consultation and the doctor-patient relationship; b) impact on patients and in promoting change; c) use of the supporting app, and d) adaptability of the intervention to the Colombian healthcare system. CONCLUSIONS: DIALOG+ was positively valued by most of the participants. Participants felt that it was beneficial to the routine consultation, improved communication and empowered patients to take a leading role in their care. More work is required to identify the patient groups that most benefit from DIALOG+, and to adjust it, particularly to fit brief consultation times, so that it can be rolled out successfully in the Colombian healthcare system.

Assuntos

RESUMO

RESUMEN Introducción: Las enfermedades mentales graves producen un impacto significativo en términos de sufrimiento de los pacientes y sus familias, costos de atención y arios de vida perdidos por discapacidad. Este estudio pone a prueba la herramienta DIALOG+, una intervención basada en una App que combina una evaluación estructurada referente a 11 dominios, con un abordaje centrado en soluciones. Métodos: Estudio cualitativo anidado en un ensayo clínico controlado en el que 9 psiquiatras y una muestra intencional de 18 pacientes que utilizaron la aplicación DIALOG+ en controles mensuales durante 6 meses realizaron entrevistas semiestructuradas sobre su experiencia. Resultados: El análisis se enfocó en determinar la aceptabilidad, la viabilidad y la efectividad de la intervención en el contexto colombiano mediante el método de análisis temático inductivo propuesto por Braun y Clarke. Los resultados fueron: a) impactos en la consulta y la relación médico-paciente; b) impactos en los pacientes y promoción del cambio; c) uso de la aplicación, y d) adaptabilidad al sistema de salud. Conclusiones: El instrumento DIALOG+ fue valorado positivamente por la mayoría de los participantes, dado que aporta al seguimiento de los pacientes con enfermedad mental grave porque incluye un componente psicoterapéutico en las consultas habituales y mejora la comunicación y el paciente se apropia de su proceso. Sin embargo, es pertinente delimitar la población que podría percibir los mayores beneficios y ajustar su esquema, sobre todo en relación con el tiempo de consulta, para que resulte exitosa su adaptación al sistema de salud colombiano.

ABSTRACT Introduction: Severe mental disorders can cause significant and lasting distress for patients and their families and generate high costs through the need for care and loss of productivity. This study tests DIALOG+, an app-based intervention to make routine patient-clinician meetings therapeutically effective. It combines a structured evaluation of patient satisfaction with a solution-focused approach. Methods: We conducted a qualitative study, based on a controlled clinical trial, in which 9 psychiatrists and 18 patients used DIALOG+ monthly over a six-month period. Semistructured interviews were used to explore the experiences of participants and analysed in an inductive thematic analysis focusing on the feasibility and effects of the intervention in the Colombian context. Results: Experiences were grouped into five overall themes: a) impact of the intervention on the consultation and the doctor-patient relationship; b) impact on patients and in promoting change; c) use of the supporting app, and d) adaptability of the intervention to the Colombian healthcare system. Conclusions: DIALOG+ was positively valued by most of the participants. Participants felt that it was beneficial to the routine consultation, improved communication and empowered patients to take a leading role in their care. More work is required to identify the patient groups that most benefit from DIALOG+, and to adjust it, particularly to fit brief consultation times, so that it can be rolled out successfully in the Colombian healthcare system.

RESUMO

Resumen: La falta de seguimiento del tratamiento por parte del paciente para el control y mantenimiento del peso representa un problema para el sistema de salud. Este estudio evalúa los resultados de una intervención para aumentar la adherencia terapéutica en mujeres con sobrepeso y obesidad por medio de la entrevista motivacional y la terapia breve centrada en soluciones cognitivo-conductuales. Se diseñó un estudio cuasi experimental, con evaluación pre y post tratamiento. Participaron 16 mujeres que padecían sobrepeso u obesidad y que llevaban un tratamiento para bajar de peso, divididas en grupo de intervención (10) y grupo control (6). Los instrumentos utilizados fueron: Cuestionario para evaluación de la adherencia terapéutica MBG, Cuestionario para medir adherencia a dieta y ejercicio (diseñado para el estudio) y cuestionario de sobreingesta alimentaria OQ. Los resultados muestran una tendencia a aumentar la adherencia en las mujeres del grupo de intervención, las cuales también mostraron mayor implicación personal y percepción de apoyo social. Estas variables, en conjunto con el apoyo psicológico, favorecen la adherencia terapéutica. Es necesario ampliar la muestra y el número de sesiones y controlar algunas de las condiciones de la aplicación de la intervención para obtener resultados concluyentes.

Abstract: Lack of follow up treatment for weight control and maintenance by Mexican women represents a serious problem for the health system. This study assess an intervention to increase adherence in women with overweight and obesity through motivational interviewing combined with brief therapy centered in problem solving cognitive behavioral. A quasi-experimental study was designed, with pre and post treatment evaluation. The sample was composed of 16 overweight or obese women who were in nutritional treatment in a public clinic. They were assigned to an experimental group (10) or to a control group (6). They were assessed by the Questionnaire for evaluation of therapeutic adherence MBG; Questionnaire to measure adherence to diet and exercise (designed for the study); and OQ overeating food questionnaire. The results show a tendency to increase adherence in the experimental group, which also showed greater personal involvement and perceived social support. These variables, along with psychological support, promote adherence. It is necessary to broaden the sample, the number of sessions and control some of the conditions of implementation of the intervention to obtain more conclusive results.

RESUMO

La psicología positiva estudia el funcionamiento óptimo de las personas, utiliza el método científico para investigar las experiencias, rasgos e instituciones positivas. Las terapias "constructivas", que incluyen la terapia centrada en soluciones, la narrativa y la colaborativa, se centran en construir sobre las excepciones a los problemas, indagan sobre las fortalezas y recursos de los clientes y parten de la base de que las personas quieren tener buenas relaciones y vidas plenas. Este artículo plantea por qué y cómo, a pesar de provenir de tradiciones intelectuales diferentes, la psicología positiva y las terapias constructivas pueden integrarse y enriquecerse mutuamente en la práctica terapéutica.

Positive psychology studies people's optimal functioning. It uses the scientific method to research positive experiences, traits and institutions. "Constructive therapies" include solution focused, narrative and collaborative therapies. These approaches focus on building upon exceptions to problems, inquire about clients' strengths and resources and are based on the premise that people want to have good relationships and full lives. This article discusses why and how positive psychology and constructive therapies, despite coming from different intellectual traditions, can enrich each other and be integrated in clinical work.

Assuntos

RESUMO

Buscando contribuir com a reflexão sobre a constituição heterogênea da clínica construcionista social, marcada por diferentes vocabulários e posturas terapêuticos, este artigo analisa as relações entre o discurso construcionista social e os conceitos e práticas da Terapia Focada na Solução, descrita por alguns autores como partilhando ênfases promovidas pelo construcionismo. Por meio de seleção da literatura e da análise conceitual e comparativa, identificam-se pontos de convergência - especialmente a ênfase nas potencialidades e na ação e o abandono da procura por descrições essencialistas sobre a realidade do cliente -, e também de divergência -, a postura terapêutica diretiva e de especialidade, o foco em mudanças comportamentais e a concepção individualista de self presentes na Terapia Focada na Solução. Conclui-se que a Terapia Focada na Solução pode ser uma opção discursiva útil e convida-se a uma reflexão sobre suas implicações para cada contexto terapêutico situado.

The aim of this study is to contribute to the reflection regarding the heterogeneous constitution of social constructionist psychotherapy, characterized by different vocabularies and postures. This article analyses the relationship between the social constructionist discourse and Solution-focused Therapy concepts and practices, which are described by some authors as sharing the emphasis promoted by social constructionism. Through a selection of the literature and conceptual and comparative analysis, we identified points of similarity - especially the emphasis in potentialities and action and the abandoning of the quest for essential descriptions about the client's reality - and also differences - the directive and specialist therapeutic stance, the focus on behavioral changes and the individualist concept of self sustained by Solution-focused Therapy. We concluded that Solution-focused Therapy can be a useful discursive option and we invite a reflection about its implications in each therapeutic context.

Assuntos

RESUMO

Buscando contribuir com a reflexão sobre a constituição heterogênea da clínica construcionista social, marcada por diferentes vocabulários e posturas terapêuticos, este artigo analisa as relações entre o discurso construcionista social e os conceitos e práticas da Terapia Focada na Solução, descrita por alguns autores como partilhando ênfases promovidas pelo construcionismo. Por meio de seleção da literatura e da análise conceitual e comparativa, identificam-se pontos de convergência - especialmente a ênfase nas potencialidades e na ação e o abandono da procura por descrições essencialistas sobre a realidade do cliente -, e também de divergência -, a postura terapêutica diretiva e de especialidade, o foco em mudanças comportamentais e a concepção individualista de self presentes na Terapia Focada na Solução. Conclui-se que a Terapia Focada na Solução pode ser uma opção discursiva útil e convida-se a uma reflexão sobre suas implicações para cada contexto terapêutico situado.(AU)

The aim of this study is to contribute to the reflection regarding the heterogeneous constitution of social constructionist psychotherapy, characterized by different vocabularies and postures. This article analyses the relationship between the social constructionist discourse and Solution-focused Therapy concepts and practices, which are described by some authors as sharing the emphasis promoted by social constructionism. Through a selection of the literature and conceptual and comparative analysis, we identified points of similarity - especially the emphasis in potentialities and action and the abandoning of the quest for essential descriptions about the client's reality - and also differences - the directive and specialist therapeutic stance, the focus on behavioral changes and the individualist concept of self sustained by Solution-focused Therapy. We concluded that Solution-focused Therapy can be a useful discursive option and we invite a reflection about its implications in each therapeutic context.(AU)

Assuntos

RESUMO

In Mexico, excess drinking constitutes one of the main public health challenges nationwide. The 2002 National Addictions Survey documented the existence of 11 035 262 heavy drinkers, 3 226 490 habitual drinkers, 2 841 303 persons with alcohol dependence and 2 343 71 0 persons who started arguing with their spouse or partner when drunk. Illnesses that are directly or indirectly associated with drinking are among the ten leading causes of death in Mexico among the general population: specifically, men die from attacks or homicide, self-inflicted wounds, alcoholic liver disease and other chronic diseases of the liver and alcohol dependence syndrome. Although there are various intervention strategies that attempt to influence this problem, it is not known whether these interventions are a causal factor in the change produced by the consumer and the way in which this change is produced after treatment; one way of determining this is by evaluating their results. Although Solution-Focused Therapy constitutes a different alternative to those that have traditionally been used for treating alcohol consumption, most research conducted in Mexico and other countries is carried out using a social learning model. Although the results of the Solution-Focused Therapy have been documented in various countries in America and the European Community, the findings are insufficient for it to be regarded as an optimal treatment for modifying excess alcohol consumption among the Mexican population. Objective To evaluate the results of the Solution-Focused Therapy in ethanol-dependent persons and to determine the differences between those that seek to modify problems associated with alcohol consumption and those that seek to change their drinking styles. Method A comparative O1-X-O2 longitudinal design was used, with a 12-month follow-up. The sample comprised 60 intentionally selected alcohol consumers, ages 18 to 50, who attended the Center of Assistance for Alcoholics and Their Relatives (CAAF) at the Ramón de la Fuente National Institute of Psychiatry. They had consumed alcohol in the past year, met the Alcohol Dependence Criteria according to the DSM-IV and gave their written consent. The sample was divided into 30 ethanol-dependent persons who attended the CAAF in an attempt to modify their drinking levels and 30 ethanol-dependent persons who sought to modify problems associated with their consumption. In this study, the results of the intervention were defined on the basis of the time elapsed between an ethanol-dependent person's last therapy session and the time when he or she experiences a relapse and continues with the problems associated with alcohol consumption. The subjects' history of alcohol consumption was characterized by their pattern of consumption, level of dependence, number of DSM-IV criteria, history of treatment, problems of alcohol consumption in the previous two generations of their families of origin, and alcohol-related problems. The number of additional sessions, services and treatments were regarded as mediators of the results of the intervention. The information was obtained through various instruments, such as the pre-consultation and initial consultation cards, the Scale of Ethanol-Dependence and a version of the Index of the Severity of Addiction drawn up by the Center of Assistance for Alcoholics and their Relatives. The procedure was carried out in three stages: the baseline, the application of Solution-Focused Therapy and a follow-up beginning twelve months after the last therapy session. The field operation began in April 2002 and ended in August 2004, with the last phase being carried out on both the subjects that had completed their treatment and on those that had interrupted it and requested assistance again at any of the services offered by the CAAF. Results Seventy-eight per cent of the sample were married; 38% had completed elementary school; the average age was 35.5, and most had a low socio-economic level. A total of 39% were heavy drinkers; 43% displayed a substantial level of dependence, and 70% had a record of treatment. The highest need for treatment was recorded in family problems associated with alcohol consumption, totaling 48%. Sixty-three per cent of the sample attended one to three sessions, while the remainder attended over three. A follow-up study of 83% of the sample showed that most sought assistance at two of the Center's treatment services, while 55% of the dependents received treatment at the CAAF alone. Thirty per cent cut short their treatment because they did not want to stop drinking or did not need help or were annexed; 28% stopped for work or financial reasons, while only 2% reported that the treatment failed to cover their expectations. Fifty-six per cent of the sample did not relapse, and successfully modified the problems associated with alcohol consumption; 32% relapsed and failed to modify their alcohol-related problems, while the remainder relapsed yet managed to modify the problems associated with alcohol consumption (12%) with a value of χ² = 29.94 and p equivalent to 0.00. The heterogeneity tests did not display statistically significant differences between the subjects that relapsed and continued with their alcohol-related problems (44%) and those that did not relapse and modified their alcohol-related problems (56%) by either alcohol consumption characteristics or the factors mediated by the results of the intervention. The study showed that the first four months after the last therapy session are those during which subjects experience the highest risk of relapsing and continuing with problems associated with alcohol consumption. Just 47% of the patients that cited modifying their drinking levels as the reason for seeking treatment proved not to have relapsed and to have successfully modified the problems associated with their drinking at the 1 2-month follow-up as opposed to 83% of those that sought to modify the problems associated with their drinking, with a statistical significance of less than 0.01 in the log-rank test. The intervention was observed to achieve better results among alcohol-dependent persons that sought to modify problems associated with alcohol consumption, had a lower socio-economic level, a record of treatment for their alcohol consumption, high levels of dependence, a medium-high need for treatment in psychological, work problems, and did not receive any form of treatment outside the CAAF. The article discusses the role of the demand for treatment as a predictor not only of the search for services, as supported by international literature, but also of the results of the intervention. It confirms the importance of conceiving alcoholism as a symptom resulting from relational systems the drinker maintains with his/her surroundings, rather than as a problem that can be solved by ensuring that the drinker remains sober. The article suggests including a control group with another type of therapeutic intervention in order to compare the results of the Solution-Focused Therapy and have more elements for making evidence-based decisions.

En México, el consumo excesivo de alcohol representa uno de los principales retos de salud pública a escala nacional. Aunque existen diversas estrategias de intervención que pretenden incidir en este problema también hay un gran vacío con respecto a si dichas intervenciones son un factor causal en el cambio producido por el consumidor y la manera en que dicho cambio se produce después del tratamiento. Una vía para conocerlo es evaluar sus resultados. La Terapia Centrada en Soluciones (TCS) constituye una alternativa a las que tradicionalmente se utilizan para tratar el consumo de alcohol. Sus resultados se han documentado en diferentes países de América y de la Comunidad Europea, pero no en población hispana. Objetivo Evaluar los resultados de la Terapia Centrada en Soluciones en dependientes al etanol y determinar las diferencias entre quienes buscaban modificar los problemas asociados al consumo de alcohol y los que pretendían cambiar su manera de beber. Método Se trabajó con un diseño longitudinal de tipo O1-X-O2, comparativo, con un seguimiento a doce meses. La muestra se integró con 60 consumidores de alcohol de 18 a 50 años de edad que acudieron al Centro de Ayuda al Alcohólico y sus Familiares (CAAF) del Instituto Nacional de Psiquiatría Ramón de la Fuente. Todos fueron seleccionados de manera intencional, consumieron alcohol en el último año, cubrieron los criterios de dependencia al alcohol según el DSM-IV y brindaron por escrito su consentimiento informado. La muestra se dividió en 30 dependientes al etanol que acudieron al CAAF en busca de modificar su nivel de consumo y 30 dependientes que pretendían modificar los problemas asociados a su consumo. En la presente investigación, los resultados de la intervención se definieron a partir del tiempo transcurrido desde que un dependiente asistía a la última sesión de terapia hasta que presentaba una recaída y continuaba con los problemas asociados al consumo de alcohol. La historia de consumo de alcohol de los sujetos se caracterizó por medio del patrón de consumo, nivel de dependencia, número de criterios del DSM-IV, antecedentes de tratamiento, problemas de consumo de alcohol en la familia de origen en dos generaciones previas y problemas asociados al consumo de alcohol. El número de sesiones, servicios y tratamientos adicionales se consideró como mediador de los resultados de la intervención. Resultados Del total de la muestra, 78% era casado; 38% tenía instrucción básica; la edad promedio fue de 35.5 años; la mayoría pertenecía a un nivel socioeconómico bajo; 39% era consumidor de alto nivel; 43% se ubicó en un nivel de dependencia sustancial y 70% contaba con antecedentes de tratamiento. La necesidad de tratamiento más alta se registró en los problemas familiares asociados al consumo de alcohol con 48%. Del total de la muestra, 63% asistió de una a dos sesiones y los restantes asistieron a más de dos, con un seguimiento de 83% de la muestra. En el análisis de sobrevida, los primeros cuatro meses después de tratamiento se identificaron como los meses de mayor riesgo para recaer. Se observó que la TCS tuvo mejores resultados en dependientes que buscaban modificar los problemas asociados al consumo de alcohol. Éstos se ubicaron en los niveles socioeconómicos más bajos y presentaron un nivel de deterioro importante por el consumo de alcohol.