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El modelo híbrido dimensional-categorial para el diagnóstico de los trastornos emocionales propone la existencia de un conjunto de dimensiones compartidas asociadas a la etiología y mantenimiento de los diferentes trastornos emocionales (trastornos de ansiedad, del estado de ánimo y otros trastornos relacionados). El Inventario Multidimensional para los Trastornos Emocionales (MEDI) se desarrolló para evaluar de manera eficiente las dimensiones propuestas por este modelo híbrido (neuroticismo, afecto positivo, estado de ánimo deprimido, activación autónoma, ansiedad somática, ansiedad social, intrusiones cognitivas, reexperimentación traumática y evitación) y cuenta con pruebas de validez en España. El objetivo del presente artículo es describir esta herramienta de evaluación dimensional y comparar sus resultados con los obtenidos siguiendo los criterios del DSM-5 en una serie de casos clínicos. Se discuten las virtudes del MEDI y las ventajas de una perspectiva dimensional transdiagnóstica en la personalización del tratamiento psicológico.

Introduction Routine outcome monitoring or systematic client feedback (SCF) continues to garner empirical support. The Partners for Change Outcome Management System (PCOMS) is one application of SCF with significant research support but no studies have been conducted in Spain. This investigation describes the effects of PCOMS in routine practice via a comparison to published PCOMS studies. Material and methods In a retrospective observational study, PCOMS was implemented with 42 clients treated in routine psychotherapy. Outcomes were measured by the Outcome Rating Scale (ORS) and descriptively compared to PCOMS studies included in a meta-analysis and a PCOMS benchmarking study regarding reliable and/or clinically significant change, no change, and deterioration. Results The current study achieved similar rates of reliable and clinically significant change (73.8%) to the benchmarking study (65.6%) and the RCTs (67.5%). Regarding no change rates, the current study (23.8%) mirrored results of the RCTs (25.6%) and was better than the benchmarking study (35.4%). The current study incurred a low 2.4% deterioration rate compared to a 10.7% and 7.0% rate of the benchmarking study and RCTs, respectively. Conclusions While not without flaws, this pilot study offers some evidence that the improved outcomes associated with PCOMS may also occur in psychotherapy settings in Spain.

Evidence-Based Psychological Treatments for Adults: A Selective Review.Psychological treatments have shown their efficacy, effectiveness, and efficiency in dealing with mental disorders. However, considering the scientific knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically supported psychological treatments. The main goal was to carry out a selective review of the main empirically supported psychological treatments for mental disorders in adults.Levels of evidence and degrees of recommendation were collected based on the criteria proposed by the Spanish National Health System (Clinical Practice Guidelines) for different psychological disorders.The results indicate that psychological treatments have empirical support for the approach to a wide range of psychological disorders. These levels of empirical evidence gathered range from low to high depending on the psychological disorder analysed. The review indicates the existence of certain fields of intervention that need further investigation.Based on this selective review, psychology professionals will be able to have rigorous, up-to-date information that allows them to make informed decisions when implementing empirically based psychotherapeutic procedures based on the characteristics of the people who require help.

Empirically Supported Psychological Treatments for Children and Adolescents: State of the Art.The empirical evidence accumulated on the efficacy, effectiveness, and efficiency of psychotherapeutic treatments in children and adolescents calls for an update. The main goal of this paper objective was to carry out a selective review of empirically supported psychological treatments for a variety of common psychological disorders and problems in childhood and adolescence.A review was carried out of the psychological treatments for different psychological disorders and problems in social-emotional or behavioral adjustment in the child-adolescent population according to the Spanish National Health System (Clinical Practice Guidelines) levels of evidence and degrees of recommendation.The findings suggest that psychological treatments have empirical support for addressing a wide range of psychological problems in these developmental stages. The degree of empirical support ranges from low to high depending on the phenomenon analyzed. The review suggests unequal progress in the different fields of intervention.From this update, psychologists will be able to make informed decisions when implementing those empirically supported treatments to address the problems that occur in childhood and adolescence.

La brecha entre investigación y práctica clínica constituye uno de los rasgos distintivos de la psicoterapia. Esta brecha se ha conceptualizado históricamente como un problema de diseminación unidireccional. Sin embargo, existen razones consistentes para considerar que la desarticulación entre ciencia y práctica también responde al modo en que se ha venido produciendo el conocimiento científico en el campo. En el presente artículo se desarrollan algunos de los principales aspectos que, hasta la fecha, han obstaculizado la construcción de una ciencia integrada de la psicoterapia y la implementación de la mejor investigación disponible en los entornos clínicos naturales. En particular, se presenta el paradigma de la Investigación Orientada por la Práctica (IOP) como una aproximación que aporta propuestas específicas para articular la brecha entre investigación y práctica con el doble propósito de mejorar tanto la calidad de los proyectos de investigación que se realizan como la práctica clínica habitual The gap between research and clinical practice constitutes one of the distinctive features of psychotherapy. This gap has historically been conceptualized as a problem of unidirectional dissemination. However, there are compelling reasons to consider that the disarticulation between science and practice also responds to the way in which scientific knowledge has been produced. This article describes some of the main aspects that, to date, have hindered the development of an integrated science of psychotherapy and its implementation in naturalistic clinical settings. The paradigm of practice-oriented research (POR) is presented as an approach that provides specific proposals to bridge the gap between research and practice with the dual purpose of improving the quality of both research projects that are carried out and routine clinical practice.

The heterogeneity of national regulations in clinical psychology and psychological treatment across Europe requires a detailed description of every regulation to start a shared discussion. In the current paper, we describe the history, legal regulations, a specialized training program, the current status and some future challenges for clinical psychology in Spain. The evolution of clinical psychology in the Spanish National Health System (NHS) towards a health specialty regulated by law, exemplifies a balanced process of expansion, social recognition and professional settlement. Overall, the growth of clinical psychology in Spain may depend on access to leadership and management positions in the NHS that would allow a better organization of care resources to improve citizens’ access to psychological treatment. Spanish regulation of clinical psychology is mediated by socio-cultural and political changes that occurred in the late 70's and 80’s in the country. Recognition as a licensed clinical psychologist is obtained through a 4-year training system as an intern resident psychologist (PIR). PIR is a training system of supervised internships, with increasing autonomy in various healthcare departments in the National Health System (NHS). Achieving independent Clinical Psychology Services within the NHS in order to organize, implement and deliver evidence-based practices is currently one of our biggest challenges in the near future. Spanish regulation of clinical psychology is mediated by socio-cultural and political changes that occurred in the late 70's and 80’s in the country. Recognition as a licensed clinical psychologist is obtained through a 4-year training system as an intern resident psychologist (PIR). PIR is a training system of supervised internships, with increasing autonomy in various healthcare departments in the National Health System (NHS). Achieving independent Clinical Psychology Services within the NHS in order to organize, implement and deliver evidence-based practices is currently one of our biggest challenges in the near future.

Resumen La pericia y la excelencia en Psicologia Clinica estan siendo objeto de renovado interes en el panorama internacional. Como hacen su trabajo los psicologos clinicos, respecto a que tratamientos psicologicos aplican, explica gran parte de la variabilidad de los resultados al finalizar el tratamiento. La evidencia relativa a los efectos de la pericia es contradictoria; en gran parte, debido a la ausencia de una definicion operativa de consenso. La presente revision narrativa opinatica analiza el estado de la cuestion, presenta una propuesta de definicion y busca estimular el debate para que academicos y clinicos contemplen la pericia como una variable clave de la efectividad de los tratamientos. Finalmente, se reflexiona sobre el modelo formativo en Psicologia Clinica de nuestro entorno y la forma de sistematizar el entrenamiento y la supervision promoviendo la excelencia en el desempeno clinico a lo largo de todo el ciclo profesional.

The person of the therapist: Spanish validation of the Personal Style of the Therapist Questionnaire (PST-Q). The Personal Style of the Therapist Questionnaire (PST-Q) is an instrument with more than 20 years of theoretical and empirical developments at the international scenario, especially in Latin America. The main goal of the study was to provide preliminary evidence on its psychometric properties and factorial structure in a sample of Spanish licensed clinical psychologists (N = 350). 7 confirmatory factor analysis were performed to found a 20-item and 5-factor solution that had the best fit indices and internal consistency values. The original abbreviated model of the PST-Q was partially confirmed, since item 28 had to be eliminated because it had a factor weight less than .30. The alpha values were slightly lower than the original, but equivalent to those of the Portuguese validation. The implications of the findings for training and research in psychotherapy and clinical psychology are discussed.Keywords: Personal style of the therapist; PST-Q; practice-oriented research; clinical psychology; psychotherapy. Resumen: El Cuestionario de Evaluación del Estilo Personal del Terapeuta (EPT-C) es un instrumento con más de 20 años de desarrollos teóricos y empíricos a nivel internacional, especialmente en Latinoamérica. El objetivo del estudio consistió en proporcionar evidencia preliminar sobre sus propiedades psicométricas y estructura factorial en una muestra de psicólogos clínicos españoles debidamente acreditados (N = 350). Se realizaron 7 análisis factoriales confirmatorios hasta dar con una solución de 5 factores y 20 ítems que resultó ser la que presentó los mejores índices de ajuste y de consistencia interna. Se confirmó parcialmente el modelo abreviado original del EPT-C, ya que tuvo que eliminarse el ítem 28 por presentar una carga factorial inferior a .30. Los valores alfa fueron ligeramente inferiores al original, pero equivalentes a los de la validación portuguesa. Se discuten las implicaciones de los hallazgos para la formación e investigación en psicoterapia y psicología clínica. Palabras clave: Estilo personal del terapeuta; EPT-C; investigación orientada por la práctica; psicología clínica; psicoterapia.

Background: Social cognition includes a range of cognitive processes that help individuals understand how others think and feel. Recent proposals outline the relevance of this cognitive domain in a broad set of clinical pictures, as well as its diagnostic and prognostic value. In this study, we present the Spanish validation of the Reading the Mind in the Voice (RMV-SV) task, (Rutherford et al., 2002), an instrument for the recognition of mental states and complex emotions through prosody. Method: A group of adults diagnosed with autism spectrum disorders (ASD, n = 45) were compared to a control group from the general population (n = 51) in several emotion-recognition tasks. Results: The ASD group performed worse than controls overall on complex emotion and mental state recognition from voices (ŋ2 =.322; p

espanolLa Practica (Clinica) Basada en la Evidencia se define como la integracion de la mejor investigacion disponible con la pericia clinica y las caracteristicas, preferencias y cultura del paciente. Del mismo modo, la variable terapeuta empieza a mostrar su influencia decisiva en el resultado de los tratamientos psicologicos. En este trabajo se pone el enfasis en la figura del terapeuta en el contexto del programa de formacion PIR de especialistas en Psicologia Clinica de nuestro Sistema Nacional de Salud. Se revisan los constructos pericia, efectos del terapeuta y se presenta la Practica Deliberada como un sistema de entrenamiento que puede ayudar a mejorar los resultados de los clinicos y sus tratamientos. Se realizan recomendaciones concretas para mejorar el modelo de supervision durante la residencia PIR y se discuten algunas de las implicaciones y limitaciones del estado actual de la cuestion EnglishEvidence-based (clinical) practice is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences. Similarly, the therapist factor is beginning to show its decisive influence on the outcome of psychological treatments. This paper emphasizes the therapist factor in the context of the PIR training program of Clinical Psychology specialists within our National Health System. Expertise and therapist effects are reviewed and deliberate practice is presented as a training system that can help clinical psychologists to improve their outcomes and treatments. Specific recommendations are made to improve the supervision model during PIR training and the implications and limitations of the topic are discussed.

Avoidant personality disorder is a common, heterogeneous and disabling mental health problem. Despite this, few studies have specifically focused on avoidant personality disorder treatment, and clinical guidelines have not been developed. Therefore, the main purpose of this work is to critically review the available literature on this topic, and propose a specialized treatment for patients with severe avoidant personality disorder in the Spanish National Health System. The Galatea program is an intensive and longer treatment that combines individual therapy based on Mentalization-Based Therapy and Metacognitive Interpersonal Group Therapy. In order to illustrate the treatment, a clinical case treated within the program is presented. Finally, Galatea's healthcare implications in the specialized treatment of severe avoidant personality disorder in the public mental health settings are discussed. El trastorno de la personalidad por evitación es un problema de salud mental común, heterogéneo y altamente incapacitante. Sin embargo, muy pocos trabajos se han centrado específicamente en su tratamiento y no se dispone de guías clínicas para su abordaje. En consecuencia, el principal objetivo de este trabajo es revisar la literatura disponible en este campo y presentar una propuesta de tratamiento especializado para pacientes con trastorno de la personalidad por evitación grave en la sanidad pública española. El programa Galatea es un tratamiento intensivo y prolongado que combina la terapia individual basada en la mentalización y la terapia metacognitiva interpersonal en grupo. Con el fin de ilustrar el tratamiento, se presenta un caso clínico tratado dentro del programa. Por último, se discuten las implicaciones asistenciales de Galatea en el tratamiento especializado del trastorno de la personalidad por evitación grave en el ámbito público.c

espanolEn el campo de la investigacion en psicoterapia existe una intensa dialectica entre el enfoque centrado en los resultados y el enfoque centrado en el proceso psicoterapeutico. La Practica Basada en la Evidencia integra ambas posturas junto a las caracteristicas del paciente y la pericia de los clinicos. De este modo, las variables de proceso tienen una mayor visibilidad en la ultima decada. En este trabajo se aborda una de ellas: la monitorizacion sistematica de resultados y el uso del feedback del paciente en psicoterapia. Se realiza una presentacion del tema en nuestro entorno y se ilustra mediante la exposicion de 5 casos clinicos. Se revisa el estatus empirico de la cuestion, sus principales virtudes y algunos inconvenientes para su generalizacion en la practica clinica. EnglishThere is a passionate dialectic between outcome-based and process-based psychotherapeutic approaches in the field of psychotherapy research. Evidence-based practice integrates both positions with patient characteristics and clinical expertise. Thus, process factors have had increased visibility over the past decade. This paper examines one of them: routine outcome monitoring and collecting patient feedback. The topic is presented in our context and it is illustrated by exposing five clinical cases. We review the empirical status on the topic and the main strengths and barriers for its generalization in clinical practice are discussed

A pilot study of the effects of metacognition-oriented social skills training (MOSST) on social functioning in patients with schizophrenia spectrum disorders (SSDs) reported promising results. The main purpose of the current trial was to compare the effectiveness and potential benefits of MOSST vs conventional social skills training (SST). Single-blind randomized controlled trial with 2 groups of patients aged 18-65 with SSDs on partial hospitalization. Participants were randomly assigned (1:1) to receive 16 group sessions with MOSST or conventional SST, both in addition to standard care, over 4 months, with a 6-month follow-up. Psychosocial functioning, metacognition, and symptom outcomes were measured by blind assessors. Statistical analyses used mixed models to estimate treatment effects in each postrandomization time point. Thirty-six patients were randomly assigned to the MOSST group and 33 patients to the conventional SST group. Between-group differences were significant in favor of MOSST on Social and Occupational Functioning Assessment Scale (SOFAS) and Personal and Social Performance Scale (PSP) total scores at post-treatment and follow-up. Concerning PSP subscales, there were significant between-group differences in favor of MOSST at follow-up on socially useful activities, personal and social relationships, and disturbing and aggressive behaviors. Metacognition only improved following MOSST group. For people with SDDs, MOSST appears to have short- and long-term beneficial effects on social functioning and symptoms. Further studies are required to replicate the current results in other samples.

Background: In preparation for a randomized controlled trial, a pilot study was conducted to investigate the feasibility, acceptability and effectiveness of a psychotherapy group based on metacognitive-oriented social skills training (MOSST). Methods: Twelve outpatients with schizophrenia were offered 16 group-sessions of MOSST. Effect sizes were calculated for changes from baseline to treatment end for both psychosocial functioning and metacognitive abilities measured by the Personal and Social Performance Scale (PSP) and the Metacognition Assessment Scale-Abbreviated (MAS-A) respectively. Results and discussion: Ten patients finished the full treatment protocol and nonsignificant moderate effect sizes were obtained on PSP and MAS-A scores. To date, this is the first study in Spain to suggest that outpatients with schizophrenia will accept metacognitive therapy for social skills training and evidence improvements in psychosocial functioning and metacognition. Conclusion: Despite limitations inherent in a pilot study, including a small sample size and the absence of a control group, sufficient evidence of effectiveness was found to warrant further investigation. Trial registration:ISRCTN10917911. Retrospectively registered 30 November 2016. © 2017 The Author(s).

Metacognition-oriented Social Skills Training (MOSST): Theoretical Framework, Working Methodology and Treatment Description for Patients with Schizophrenia. The presence of social deficits in schizophrenia has been widely described in literature as well as the negative impact of these deficits on psychosocial functioning. As a result, social skills training (SST) has emerged as a well-validated intervention that is recommended in several treatment guidelines for schizophrenia. However, different studies have found that the effects and generalizability of current SST programmes are limited regarding the potential benefits on daily psychosocial functioning of these patients. This paper aims to describe a newly developed intervention model that integrates metacognitive remediation into SST for patients affected by schizophrenia: metacognition-oriented social skills training (MOSST). Theoretical model of MOSST is based on recent findings suggesting the central role of metacognitive deficits to successful psychosocial functioning in schizophrenia. Thereby, MOSST focuses not only on train interpersonal skills but also on improving the understanding of one’s own mental states and those of the others as well as the connection between mental states and effective social behaviour. In order to facilitate the treatment description, a case report of an adult diagnosed by schizophrenia who successfully completed the programme is presented. Finally, clinical implications and limitations of available evidence on MOSST are discussed, and future research directions with this programme are pointed out.

Research Network on Preventative Activities and Health Promotion Health Sciences Institute of Aragon (IACS) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Background: Burnout occurs when professionals use ineffective coping strategies to try to protect themselves from work-related stress. the dimensions of 'overload', 'lack of development' and 'neglect', belonging to the 'frenetic', 'under-challenged' and 'worn-out' subtypes, respectively, comprise a brief typological definition of burnout. the aim of the present study was to estimate the explanatory power of the different coping strategies on the development of burnout subtypes.Methods: This was a cross-sectional survey with a random sample of university employees, stratified by occupation (n = 429). Multivariate linear regression models were constructed between the 'Burnout Clinical Subtypes Questionnaire', with its three dimensions - overload, lack of development and neglect-as dependent variables, and the 'Coping Orientation for Problem Experiences', with its fifteen dimensions, as independent variables. Adjusted multiple determination coefficients and beta coefficients were calculated to evaluate and compare the explanatory capacity of the different coping strategies.Results: the 'Coping Orientation for Problem Experiences' subscales together explained 15% of the 'overload' (p

Burnout is associated with a poor perception of health status, psychosomatic disorders and physical illness. The aim of this study is to construct a comprehensive theoretical proposal for a therapeutic intervention that is sensitive to the different clinical manifestations of this state. In order to do this, the frenetic, under-challenged and worn-out subtypes of burnout are presented in a systematic manner, together with the interventions that may provide suitable management for each subtype. Said clinical profiles may represent different stages in the progression of burnout, and have specific dysfunctional mechanisms that require a choice of adjusted intervention strategies according to the characteristics of each particular case. Finally, the degree of dedication to work and its clinical repercussions are put forward as a hypothesis to explain the progressive impairment caused by burnout, and as a target on which primary, secondary and tertiary prevention strategies could be founded. Resumen: Subtipos de burnout e implicaciones clinicas: Una propuesta teorica basada en abordajes terapeuticos especificos. El burnout se asocia con un peor estatus de salud percibida, trastornos psicosomaticos y enfermedades fisicas. El objetivo del presente trabajo es articular una propuesta teorica comprehensiva de intervencion terapeutica sensible a las diferen­tes manifestaciones clinicas de dicho estado. Para ello, se presentan de forma sistematica los subtipos de burnout frenetico, sin-desafios y desgastado, asi como las intervenciones que pueden proporcionar un adecuado manejo de cada subtipo. Dichos perfiles clinicos parecen representar momentos diferentes en la progresion del burnout, con mecanismos disfuncionales especi­ficos, que obligan a optar por estrategias de intervencion ajustadas a las caracteristicas de cada caso en particular. Finalmente, se propone el grado de dedicacion en el trabajo, y sus repercusiones clinicas, como hipotesis para explicar la progresiva erosion que supone el burnout, y como eje sobre el que fundamentar las estrategias de prevencion primaria, secundaria y terciaria.

There is a broad consensus that the core of psychopathology implicated in personality disorders (PDs) consists of dysfunctions related to the self and chronic and inflexible interpersonal patterns. The design of treatments for PDs requires a high degree of complexity, the use of different interventions and special attention to the therapeutic alliance. Interpersonal-cognitive therapy (ICT) is a treatment option to consider because of specific characteristics consistent with some of the dysfunctional patterns involved in PDs. Therefore, the objective of this exhaustive analysis of two cases is to confirm the efficacy of ICT. The results warrant the efficacy of ICT in achieving certain symptomatic changes, fundamental for the first sessions.

Background Burnout is the result of prolonged workplace exposure to chronic stress factors and may present itself in one of the following subtypes: “frenetic”, “under-challenged” and “worn-out”. The aims of the present study were to identify the causes of workplace discomfort that affect employees in large organizations and to determine the predictive power of these causes with regard to the burnout subtypes. Method We employed a qualitative and quantitative analysis (QQA), using a cross-sectional design with an online survey administered to a randomly selected sample of University workers (n = 409). To determine the causes of discomfort, we raised the following open question: “What aspects of your work generate discomfort for you?”. The responses were subjected to content analysis and categorized by three independent referees. The concordance between the responses was estimated with the kappa coefficient (k). Subtype classification was assessed according to the “Burnout Clinical Subtype Questionnaire” (BCSQ-36). The degree of association between the motives for the complaint and the burnout profiles was evaluated using adjusted odds ratio (OR), which was based on multivariate logistic regression models. Results The causes of discomfort included: physical environment (setting aspects, material conditions, journey/access), organization (schedules, structure, functions, interpersonal relations) and individual conditions (workload, powerlessness, rewards, negligence). The concordance index between the referees was k = 0.80. Employees who were upset with the hierarchical structure were more likely to be classified as frenetic (OR = 4.32; 95% CI = 1.43-13.06; p = 0.010); those who complained of routine duties were more likely to be classified as under-challenged (OR = 5.33; 95% CI = 1.84-15.40; p = 0.002); those whose discomfort was caused by structure control systems were more likely to be classified as worn-out (OR = 6.13; 95% CI = 1.57-23.91; p = 0.009). Conclusions The causes of discomfort among the different burnout subtypes are primarily attributable to the organization itself, in response to the structure and functions. The associations observed between the different subtypes and motives for complaint are consistent with the clinical profile-based syndrome definition, which suggests that interventions should be case-specific.

Examination of the significant interpersonal interactions that occur during psychotherapy is essential to understanding the change processes of psychotherapy. These interactions are micromoments that occur between therapist and patient, which yield therapeutic effects. Psychotherapy difficulties can be conceptualized by analyzing the working alliance and the concept of alliance ruptures. We present a description of psychotherapeutic process of a patient with Narcissistic Personality Disorder, who had two past unsuccessful experiences with previous interventions. We discuss the difficulties encountered in the successful implementation of Interpersonal-Cognitive Therapy and the importance of re-conceptualizing psychotherapy difficulties in a constructive way as key factor in improving our insight into the value of the techniques implemented.