Scielo RSS <![CDATA[Salud mental]]> http://www.scielo.org.mx/rss.php?pid=0185-332520090003&lang=es vol. 32 num. 3 lang. es <![CDATA[SciELO Logo]]> http://www.scielo.org.mx/img/en/fbpelogp.gif http://www.scielo.org.mx <![CDATA[<b>Psicoterapia y psiquiatría: una relación paradójica</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300001&lng=es&nrm=iso&tlng=es <![CDATA[<b>Eros y Tánatos</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300002&lng=es&nrm=iso&tlng=es Eros and Thanatos, respectively, love and death, are universal subjects in which human beings have been interested since the beginning of history and also probably, their access to language. The greatest philosophers, poets and novelists have focused on these subjects in their reflections and/or their own development. Fully conscious of the lack of moderation of the task proposed, the author intends to make a modest contribution to these two concepts and what they represent, inspired by two sources: classical myths, on the one hand, and the work of some poets and thinkers, mainly Plato, Goethe and Rilke, on the other hand. Eros or love In most ancient Greek myths, eros is considered as one of the great constitutive and constituent principles of the universe, as the irresistible force allowing the continuity of life in human beings and animals, in the earth and in the waters. But eros is also a god and his legend shows us some essential features of love: 1. Love is involuntary, it occurs, it happens, like a disease. Eros had the mission of punishing Psyche for her beauty, thus avenging the jealous Aphrodite, his mother. And however, it was enough for him to look upon her only once to become impassioned by her. But this passion goes together with its opposite, liberty, because love always carries implicit a choice. 2. Love, unlike friendship, which is slowly shaped, appears in a sudden way, represented by the arrows used by Eros (Cupid) to inflame lovers' hearts. Safo described this phenomenon of suddenness superbly. 3. The myth also teaches us the exclusive character of love. This feature separates love from erotism. Some verses by the poet Gonzalo Rojas are quoted to illustrate what he calls <<condemnation>> to exclusiveness. 4. Another characteristic of love inferred from the myth is transgression, which almost always accompanies it. Eros did not have the right to fall in love with a mortal woman and, however, he is not able to withdraw from the feeling invading him. Great loves in the history of literature, such as Romeo and Juliet, Werther or Anna Karenina, are essentially presented in a background of transgression. 5. In mythical narrative there are two other elements, though not essential, which are worthy of interest in this context: that Psyche, the beautiful woman in love, be the representative of the human soul, and that one of her attributes be curiosity. The subject of eros cannot be approached without mentioning <<The Banquet>> by Plato. From this memorable text the author underlines part of the content of two of the speeches, the one by Aristophanes and the one by Socrates. From the myth of the androgyne, narrated by the former, at least three teachings are deduced: first, that the strength of eros would derive from the nostalgia felt by the lover for the loved one, or vice versa, since in a remote past their bodies would have been merged, to be violently separated by Zeus in some moment; second, love would consist of a search and eventual recognition of that <<other half>>; and third, this recognition would occur through a symbolon, a sort of countersign that humans gave each other on the moment of being separated. Thanatos or death The etymological root of the word thanatos is tha and it is curious that the only other Greek word with the same root is thalamon, the nuptial chamber. The thalamon is the place of the house where the wife lives, and it is the most central room but also the darkest. Thanatos or death appears, then, related on the one hand to darkness and confinement, and on the other hand, to woman and love. The love and death context is illustrated by a beautiful poem by Gonzalo Rojas, simply named <<Love>>. In the realm of psychology and psychiatry, Sabine Spiel rein, but particularly Sigmund Freud, counterposed the death impulse or instinct (Todestrieb) to a life instinct. However, philosophers like Hegel and Heidegger have conceived death as an essential part of life. Heidegger even states that it is the most proper possibility of human existence. In order to deepen the context of love (or life) and death, this author proceeds to analyze the famous poem by Goethe <<Selige Sehnsucht>> (Blessed longing), inspired by the love of the butterfly for the flame, which will mean its death. It is here where Goethe postulates his famous principle of Stirb-werde (dying and becoming). But who has taught us the most about the harmony between life and death is the Prague-born German poet, Rainer Maria Rilke, particularly in his famous Duino Elegies and in his requiems. Before analyzing some of these poems, the author quotes a letter written by Rilke to his editor in Polish, where he affirms, among other things, the following: <<Death is the withdrawn side of life, which has not been illuminated by us. We have to make the attempt to reach the maximum awareness of our existence, which is domiciled in both unlimited regions and is inexhaustibly nourished from both [...]>>. In the elegies the poet teaches us regarding our subject: first, that the human being is the only being in the universe aware of death, because neither animals nor gods know it; second, that awareness of death is the origin of anxiety, but at the same time, what gives meaning to life; third, that the mission of the human being in life is twofold: <<to give a name>> to things, that is to say, to make them be born from nothingness, and then <<to save>> them from their mortality, from death, to make them <<invisible>>, that is to say, making them eternal. Now, if the mission of human being in relation to the things is to name and to save them, with respect to him/herself, his/her task will be <<to prepare with time the master piece of a noble and supreme death, of a death in which hazard does not take part, a consummated, happy and enthusiastic death, as only the saints could imagine [...]>>. In sum, thanatos does not mean destruction nor is the source of all our misfortunes, but an essential part of life itself. As ethimology taught us, thanatos has a common origin with thalamon, that place in the house where the mother and wife lives. It is perhaps the darkest, but at the same time the most central part of the house. Human life can be conceived as the way from this center and back to it.<hr/>Eros y Tánatos, o el amor y la muerte, son temas universales que han preocupado al hombre desde los comienzos de la historia. Los más grandes filósofos, poetas y novelistas han puesto estos temas en el centro de su reflexión o desarrollo. El autor se propone hacer un modesto aporte a estos conceptos, inspirado en dos fuentes: los mitos clásicos, por una parte, y la obra de algunos poetas y pensadores, como Platón, Goethe y Rilke, por otra. Eros o el amor En los mitos griegos más antiguos, el eros es considerado como uno de los grandes principios constitutivos y constituyentes del universo. Pero al mismo tiempo es un dios y su leyenda nos muestra algunos rasgos esenciales del amor: 1. El amor es involuntario, ocurre, pasa, como una enfermedad. Eros tenía la misión de castigar a Psiquis por su belleza, para vengar así a la celosa Afrodita, su madre. Y sin embargo, le bastó mirarla una vez para caer encendido en el sentimiento amoroso. 2. El amor, a diferencia de la amistad -que se va forjando lentamente-, aparece en forma súbita, hecho representado en las flechas que emplea Eros o Cupido para encender el corazón de los amantes. 3. El mito nos enseña también el carácter exclusivo del amor. Este rasgo distancia al amor del erotismo. 4. Otra característica del amor que se desprende del mito es la trasgresión que casi siempre lo acompaña. Eros no tenía derecho de enamorarse de una mortal y, sin embargo, no es capaz de sustraerse al sentimiento que lo invade. 5. Hay otros dos elementos en el relato mítico que, aunque no esenciales, son de interés en este contexto: que Psiquis, la bella enamorada, sea la representante del alma humana y que uno de sus atributos sea la curiosidad. No se puede abordar el tema del eros sin mencionar <<El Banquete>> de Platón. De este texto memorable, el autor destaca dos de los discursos, el de Aristófanes y el de Sócrates. Del primero se desprenden al menos tres enseñanzas: 1. Que la fuerza del eros derivaría de la añoranza que siente el amante por la amada, o viceversa, puesto que en un pasado remoto sus cuerpos habrían estado unidos, para ser violentamente separados por Zeus. 2. El amor consistiría en una búsqueda y eventual reconocimiento de esa <<otra mitad>>. 3. Este reconocimiento ocurriría a través de un symbolon, una suerte de contraseña que nos dimos los humanos unos a otros antes de ser separados. Tánatos o la muerte La raíz etimológica de thanatos es tha y la única otra palabra griega con la misma raíz es thalamon, el tálamo nupcial. El thalamon es el lugar de la casa donde habita la esposa y es la habitación más central, pero también la más oscura. Thanatos o la muerte aparece vinculada entonces, por un lado, a la oscuridad y al encierro y, por otro, a la mujer y al amor. En el ámbito de la psicología y la psiquiatría, Sabine Spielrein y sobre todo Sigmund Freud contrapusieron, al instinto de vida, el impulso o instinto de muerte (Todestrieb). Sin embargo, filósofos como Hegel y Heidegger han concebido la muerte como parte esencial de la vida. En orden a profundizar el contexto vida (o amor) y muerte, el autor procede a analizar el famoso poema de Goethe, <<Selige Sehnsucht>> (<<Feliz anhelo>>), donde postula su famoso principio del Stirb-werde (muere para llegar a ser), poema inspirado en el amor de la mariposa por la llama, que significará su muerte. Pero quien más nos ha enseñado la armonía de la vida y de la muerte es el poeta Rainer Maria Rilke, particularmente en sus famosas Elegías del Duino y en sus réquiems. En las elegías, el poeta nos enseña al respecto: 1. Que el hombre es el único ser en el universo que tiene conciencia de la muerte. 2. Esa conciencia de la muerte es el origen de la angustia pero, al mismo tiempo, lo que le da sentido a la vida. 3. Que la misión del hombre en su vida es doble: <<dar un nombre» a las cosas y luego <<salvarlas>> de su caducidad, de la muerte, haciéndolas <<invisibles>>, es decir, eternizándolas. Ahora, si la misión del hombre con respecto a las cosas es nombrarlas y salvarlas, con respecto a sí mismo su tarea será <<preparar con tiempo la obra maestra de una muerte noble y suprema, de una muerte en que el azar no tome parte, una muerte consumada, feliz y entusiasta, como sólo los santos supieron concebir...>>. En suma, tánatos no significa destrucción ni tampoco es la fuente de todas nuestras desgracias, sino que es parte esencial de la vida misma. Como nos enseña la etimología, thanatos tiene el mismo origen que thalamon, el lugar de la casa donde habita la madre y esposa: quizás el más oscuro, pero también el más central. La vida humana es el camino desde y hacia ese centro. <![CDATA[<b>Asociación entre el hábito de fumar y la sintomatología depresiva mínima leve en fumadores fuertes</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300003&lng=es&nrm=iso&tlng=es The World Health Organization (WHO) estimates that by the year 2020 tobacco addiction will be responsible for 10 million deaths, seventy percent of which will occur in underdeveloped countries. On the other hand, depression affects about 121 million people worldwide, and is projected to reach a second place in the ranking of Disability Adjusted Life Years (DALYs) calculated for all ages and both sexes by the year 2020. In Mexico, 14 million people are current smokers and 9.6 million are former smokers, according to the 2002 National Addictions Survey, and almost four million people are diagnosed with depression. Both disorders are classified among the main causes of mortality and disability in Mexico. By gender, major depression in females is the second most prevalent disorder. Two percent of the Mexican population (two million people) present at least one major depressive episode before reaching the age of 18. Several studies have found an important link between depression and smoking. More recently, it was reported that the manifestation of depressive symptomatology predicts smoking addiction. Although the strong association between affective disorders and drug abuse has been documented, they are generally treated independently. For this reason, the need for integral management of comorbid diseases has been highlighted. Little is known about specific populations of patients that simultaneously manifest both disorders, and more knowledge is needed in order to design precise integral treatments for this kind of patients, taking into consideration the gender, severity of depression and level of nicotine dependence. The aim of this study was to describe the association between depressive symptoms, sociodemographic characteristics, and pattern of tobacco consumption of heavy smokers with minimal-mild depressive symptomatology in order to adjust for these relations in a later longitudinal regression analysis after these subjects have been assigned to different conditions of a new integral treatment to quit smoking. A total of 89 heavy smokers were assessed; 74 of them (83%) had minimal-mild depressive symptomatology; there were 35 females and 39 males, with an average age of 44.3 yrs. Level of tobacco addiction was determined by the Fagerström Test for Nicotine Dependence, and the Beck Depression Inventory was used to assess depressive symptomatology. By means of regression models, we found an increase of the depressive symptomatology related to the severity of tobacco addiction (p= .025). Those with a bachelor's educational level, had less depressive symptomatology (p= .025). The high frequency of depressive symptomatology and the protective factor of schooling concur with findings reported in other studies. The better understanding of the characteristics of smokers with different levels of tobacco consumption and depressive symptomatology is suggested. It is important to gain knowledge on the particular characteristics of specific groups of smokers for the development of new treatments that can simultaneously treat smoking addiction and depression, and can also help to norm criteria for their treatment.<hr/>La Organización Mundial de la Salud (OMS) estima que para el año 2020 la adicción al tabaco será responsable de 10 millones de muertes, 70% de las cuales ocurrirá en los países subdesarrollados. La mitad de los fumadores actuales, aproximadamente 650 millones de personas, morirá debido a una causa relacionada con el consumo de tabaco. Por otro lado, actualmente la depresión afecta a cerca de 121 millones de personas en el mundo, y se ha proyectado que para el año 2020 ocupará el segundo lugar en Años de Vida Ajustados por Discapacidad (AVAD) en todos los grupos de edad y en ambos sexos. En México, 14 millones de personas son fumadores actuales y 9.6 millones son ex fumadores, según la Encuesta Nacional de Adicciones (ENA) 2002, y casi cuatro millones de personas padecen depresión. Ambos trastornos se clasifican entre las principales causas de morbimortalidad en nuestro país. En cuanto a las diferencias por sexo, en las mujeres, la depresión es el segundo trastorno más frecuente. El dos por ciento de la población mexicana (dos millones de personas) ha padecido por lo menos un episodio de depresión importante antes de alcanzar la edad de 18 años. Varios estudios han encontrado una asociación importante entre la depresión y el tabaquismo. Recientemente se reportó que la manifestación de la sintomatología depresiva predice la adicción al tabaco. De acuerdo con varios estudios, se sabe que la nicotina reduce la incidencia y la gravedad de los síntomas depresivos y que la abstinencia del tabaco puede desencadenar síntomas depresivos, por lo que se ha sugerido que las personas con depresión fuman a manera de automedicación contra la sintomatología depresiva. A pesar de que ha sido documentada la fuerte asociación entre los trastornos afectivos y las adicciones, estos trastornos se atienden generalmente de manera independiente. Por esta razón, se ha subrayado la necesidad de generar tratamientos integrales para los trastornos comórbidos. Hasta el momento, se sabe poco sobre poblaciones específicas de pacientes que de manera simultánea son adictos al tabaco y padecen sintomatología depresiva, por lo se requiere de mayor entendimiento de sus características para diseñar tratamientos integrales específicos para este tipo de pacientes. Para ello se debe tomar en consideración el sexo, la gravedad de la depresión y el nivel de dependencia de la nicotina. El objetivo del presente estudio fue describir la relación que existe entre los síntomas depresivos, las características sociodemográficas y el patrón de consumo de tabaco en fumadores fuertes con sintomatología depresiva mínima leve para ajustar dichas relaciones mediante un modelo de regresión longitudinal, en un estudio posterior, donde los pacientes serán asignados a diversas condiciones terapéuticas de un nuevo tratamiento integral contra el tabaquismo. Un total de 89 fumadores fuertes fueron evaluados; 74 de ellos (83%) padecían sintomatología depresiva mínima leve; había 35 mujeres y 39 hombres, con una media de edad de 44.3 años. El nivel de adicción al tabaco fue determinado por la prueba de Fagerström para la dependencia a la nicotina, y se usó el Inventario de Depresión de Beck para determinar el nivel de sintomatología depresiva. Mediante un modelo de regresión, encontramos un aumento de la sintomatología depresiva relacionada con la gravedad de la dependencia al tabaco (p = .025). Aquellos con nivel de enseñanza de licenciatura presentaron menos sintomatología depresiva (p = .025). Los principales resultados de este estudio son la asociación significativa entre el nivel de dependencia al tabaco y la sintomatología depresiva en fumadores fuertes. Tanto la alta incidencia de la sintomatología depresiva como el factor protector de la enseñanza concuerdan con los reportes de otros estudios con fumadores. Es importante conocer las características particulares de grupos específicos de fumadores para desarrollar nuevos tratamientos que pueden tratar simultáneamente la adicción al tabaco y la depresión, así como para ayudar a normar criterios para su tratamiento. Se sugiere continuar ahondando en el conocimiento de las características de los fumadores con diversos niveles de consumo de tabaco y sintomatología depresiva. <![CDATA[<b>Validez factorial del <<Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo>> (CESQT) en una muestra de maestros mexicanos</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300004&lng=es&nrm=iso&tlng=es Since the term burnout began to be used in the mid 1970's to refer to the process of deterioration in the care and professional attention given to users of human service organizations (public service, volunteer, medical, human social service, educational organizations, etc.), a variety of instruments have been developed to measure this phenomenon. A review of the literature makes it possible to conclude that among these measurement instruments the Maslach Burnout Inventory (MBI) has been used with the greatest frequency to measure the burnout syndrome, regardless of the occupational characteristics of the sample or the source of the burnout. While the most commonly employed burnout measure has been the MBI, researchers have been troubled by some of the psychometric limitations of this scale: a number of authors have suggested that a three-factor structure might not be appropriate; some items are not associated with their factors; Cronbach's alpha values are low for the Depersonalization subscale; different versions of the instrument evaluate the same phenomenon, etc. Other instruments used to evaluate burnout (for example Burnout Measure) do not satisfactorily operationalize the definition of the syndrome. The deficiencies in the instruments used for evaluating burnout have led to the development of the <<Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo>> (CESQT) (Spanish Burnout Inventory). The theoretical model underlying the CESQT is based on the concept that burnout is a response to chronic job stress that stems from problematic interpersonal work relationships, and it develops in those individuals who work with people, quite frequently in service sector professionals who are in direct contact with the end-users. It is characterized by cognitive deterioration (loss of enthusiasm toward the job), emotional deterioration, and attitudes and behaviours of indifference, indolence, withdrawal and sometimes, abusive attitudes toward the client. In some cases, feelings of guilt appear. The psychometric model of the CESQT contains twenty items distributed in four dimensions such as: 1. enthusiasm toward the job (five items), defined as the individual's desire to achieve goals at work because it is a source of personal pleasure; 2. psychological exhaustion (four items), defined as the appearance of emotional and physical exhaustion due to the fact that at work s/he must deal daily with people who present or cause problems; 3. indolence (six items), defined as the appearance of negative attitudes of indifference and cynicism toward the organization's clients; 4. guilt (five items), defined as the appearance of feelings of guilt for negative attitudes developed on the job, especially toward the people with whom s/he establishes work relationships. The purpose of this study is the validation of the CESQT in Mexican primary education teachers. A four factor model, like that of the original model presented, was hypothesized. Materials and method The sample consisted of 698 primary education public school teachers in the area of Iztapalapa of the Federal District (Iztapalapa, Mexico). With regard to gender, 133 (19.10%) were men and 541 (77.50%) women. In the remaining 24 questionnaires (3.40%) gender was not identified. The mean age was 42.49 years. The <<Cuestionario para la Evaluación del Síndrome de Quemarse por Trabajo>> was applied, using the version for professionals working in education (CESQT-PE). This instrument contains 20 items distributed into four dimensions called: enthusiasm toward the job (5 items) (α=.76), psychological exhaustion (4 items) (α=.82), indolence (6 items) (α=.73), and guilt (5 items) (α=.79). Low scores on Enthusiasm toward the job, together with high scores on psychological exhaustion and indolence, as well as on guilt, indicate high levels of burnout. The questionnaire was applied in 51 schools. Results The <<corrected item-total correlation>> was high for all the items, with values superior to .40. All of the items contributed to increasing the internal consistency of the subscales they were part of. All of the subscales presented Cronbach's alpha values superior to .70. The factorial model obtained an adequate data fit for the sample: Chi²(164) = 481.01 (p<.001), AGFI = .91, RMSEA=.055, NNFI = .91, CFI = .92, and ECVI(.60-6.16) = .86. The results confirmed the hypothesis formulated. All of the factorial loadings were significant with high values, superior to .50. All of the relationships between the dimensions of the CESQT were significant for p< .001. The subscales of the CESQT presented values of skewness and kurtosis within the range of normality, with the exception of Enthusiasm toward the job, which presented asymmetry values outside the range ± 1, although the values were not extreme (S = -1 .71, K=3.96). Discusión The purpose of the study was to analyze the psychometric quality of the CESQT and its subscales in Mexican teachers, in order to evaluate the transnational validity of the instrument. The <<corrected item-total correlation>> values obtained for the items are relatively high, which indicates that each of the dimensions of the CESQT-PE can be considered as a lineal function of the items that make it up. Therefore, all of the items make it possible to adequately predict the score of the scale and distinguish between individuals with high vs. low scores in the respective subscales. The results confirmed the hypothesized factorial structure. The four-factor structure fit the model according to all the fit indices considered, except the Chi-square test, which is an index that depends on sample size and finds a poor model fit with large samples. Based on the results obtained, it can be concluded that the factorial model adequately reproduces the theoretical model of the CESQT. The final scale is made up of four dimensions that evaluate the cognitive impairment (lack of enthusiasm about the job), emotional and physical deterioration (Psychological exhaustion), and attitudinal deterioration (Indolence), of the individual, together with the appearance of guilt feelings. These results confirm the results obtained in Spain, Chile and Portugal, and in Mexico with a sample of doctors. The Cronbach's alpha values obtained indicate that the internal consistency is good for the four subscales, and for the entire CESQT-PE scale. The skewness and kurtosis values were also good for the subscales, as values inferior to ±1 were obtained, except for the Enthusiasm toward the job subscale. The values obtained for the percentiles recommend using the 90th percentile instead of the 66th to draw conclusions about the individuals with high levels of burnout. The results of the study contribute to the psychometric validation of the theoretical model with four dimensions originating from the questionnaire, and to the transnational validation of the instrument. These results also make it possible to conclude that the CESQT, in its version for education professionals (CESQT-PE), is a reliable and valid instrument for evaluating burnout in Mexico. A slight deficiency of the instrument in this study has to do with the skweness value obtained for the Enthusiasm toward the job subscale, although further studies are necessary before conclusions can be drawn about possible modifications.<hr/>El <<Síndrome de quemarse por el trabajo>> (burnout) (en adelante SQT) ha sido definido como una respuesta al estrés laboral crónico al que están sometidos los profesionales de servicio que trabajan en contacto directo con humanos. En las investigaciones realizadas sobre el SQT, el instrumento para la medición que más se ha utilizado es el Maslach Burnout Inventory (MBI). Pero, este instrumento presenta insuficiencias psicométricas, y otros instrumentos de evaluación del SQT no operacionalizan de manera adecuada la definición del síndrome. Las insuficiencias en los instrumentos utilizados en la actualidad para la evaluación del SQT han llevado al desarrollo del <<Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo>> (CESQT). El CESQT está formado por cuatro dimensiones denominadas: 1. Ilusión por el trabajo, definida como el deseo del individuo de alcanzar las metas laborales porque supone una fuente de placer personal. 2. Desgaste psíquico, definida como la aparición de agotamiento emocional y físico debido a que en el trabajo se tiene que tratar a diario con personas que presentan o causan problemas. 3. Indolencia, definida como la aparición de actitudes negativas de indiferencia y cinismo hacia los clientes de la organización. 4. Culpa, definida como la aparición de sentimientos de culpa por el comportamiento y las actitudes negativas desarrolladas en el trabajo, en especial hacia las personas con la que se establecen relaciones laborales. El objetivo de este estudio es la validación del CESQT en maestros mexicanos de educación básica. Se hipotetizó un modelo de cuatro factores como el del modelo original. Material y método La muestra la formaron 698 profesores de educación primaria de escuelas públicas. Según el género, 133 participantes fueron hombres (19.10%) y 541 mujeres (77.50%). En 24 cuestionarios (3.40%) no se respondió a la pregunta sobre el género. Asimismo, se aplicó el <<Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo>>, en su versión para profesionales que trabajan en la educación (CESQT-PE). Es importante señalar que bajas puntuaciones en ilusión por el trabajo (cinco reactivos, (α=.76), junto a altas puntuaciones en desgaste psíquico (cuatro reactivos, (α=.82), indolencia (seis reactivos, α=.73) y en Culpa (cinco reactivos, α=.79) indican altos niveles del SQT. El cuestionario se aplicó en 51 escuelas. Resultados Para todos los reactivos la homogeneidad corregida fue alta, con valores superiores a .40. El modelo factorial obtuvo un ajuste adecuado a los datos para la muestra: Chi²(164) = 481.01 (p<.001), AGFI = .91, RMSEA=.055, NNFI = .91, CFI = .92 y ECVI(.60-6.16) = .86. Los resultados confirmaron la hipótesis formulada. Todas las cargas factoriales resultaron significativas con valores altos, superiores a .50. Discusión Los valores de homogeneidad corregida obtenidos para los reactivos son relativamente altos, lo que indica que cada una de las dimensiones del CESQT-PE se puede considerar como una función lineal de los reactivos que la componen. Los resultados han confirmado la estructura factorial hipotetizada. La estructura de cuatro factores ha alcanzado el ajuste del modelo a través de diversos índices de ajuste considerados. Todas las dimensiones presentan valores adecuados de consistencia interna. Los valores de asimetría también han sido buenos para las subescalas, excepto para la subescala de Ilusión por el trabajo que ha excedido ligeramente el criterio de ±1. Los resultados del estudio contribuyen a la validación psicométrica del modelo teórico de cuatro dimensiones origen del cuestionario, y a la validación transnacional del instrumento, y permiten concluir que el CESQT, en su versión para profesionales de la educación (CESQT-PE), resulta un instrumento fiable y válido para evaluar el SQT en México. <![CDATA[<b>Efecto de una intervención psicoeducativa para disminuir el Síndrome Burnout en personal de confianza de la Comisión Federal de Electricidad</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300005&lng=es&nrm=iso&tlng=es Modern life imposes several different labor demands on human beings; thus, bringing about stressing situations. All those events perceived as threatening bringing about tension are called stressors. A stressing situation comes about when there exists a discrepancy between environment demands and adequate resources to cope with them. All these factors lead to physiological, cognitive and motor responses which enhance perception and create the need of better solutions to allow appropriate adaptation behaviors. When stress is present at the workplace in a recurrent fashion, it is known as Labor Stress (LS), an alarming circumstance affecting individuals and organizations. Main causes of LS are: physical conditions, schedule, work position, interpersonal relations and other organizational variables. Labor Stress is a public health and a labor health problem, for it is related to an increase in labor accident, morbidity and absenteeism rates; thus, generating negative attitudes that yield economic loss to institutions. The Burnout Syndrome (BS) is a response to chronically labor stress manifested through emotional exhaustion, depersonalization, as well as hostile and aggressive attitudes toward workmates and service users, resulting in a feeling of poor personal development. Objective Assess the effect of a psycho-educative intervention to decrease BS in managing or directive employees from one sector of CFE Guadalajara, Jalisco, Mexico. Materials and methodology A quasi-experimental study was carried out; this included measurements prior and after educative intervention carried out on confidence employees from CFE Guadalajara from February through September 2005. The study sample was made up of 29 managing or directive employees, conforming four groups; one random-selected group received educative intervention; the other three were control groups; different questionnaires were applied: personal data, psycho-social factors and BS through the Maslach Burnout Inventory Scale (MBI). From a participative-educational view point, encouraged by the Pan-American Health Organization (PHO), the educative intervention sought health promotion through the betterment and consistency of mental and physical wellbeing. All BS concepts as well as psychological factors were analyzed. Other workshop included the development of preventing, coping and treatment strategies at individual and social levels. Finally, a corrective program directed to decreasing psychological risk factors in the organization was encouraged. Also, a post-intervention assessment was applied. Results Subjects had an average age of 31.5 ± 6.8 years; 52% were females; group 1 decreased for all indicators; emotional exhaustion from 71% to 29%; depersonalization from 43% to 14%; lack of personal development from 57% to 14%. However, no significant difference was found in both groups by sex. Discussion In personnel with specific responsibilities, obligations, opportunities, challenges and rewards based on their performance work environment often drives them to frustration and despair. When the employee believes that gives more than he receives, he becomes emotionally exhausted and more even if he do not have the resources to cope with the prospect of work. Also, it is documented that at younger age there is an increased risk of presenting the Burnout. This is because interpersonal relationships are more contentious because of the lack of experience in management. In the series reported, on both groups we were not able to document this relationship, but still, there is a lack of an international consensus to recognize this as a risk factor. Mingote describes that when the employee has less than five years working, they are often idealistic, utopian dreamers, unlike those with more than ten years in the job and are in risk of experiencing monotony at work, loss of interest and the downgrade. Also, this type of workers is subject to overtime. This excess produces physical and mental stress and leads to lower feelings of personal accomplishment. Even though there could be resources for coping with the monotony at work and that provides resources for better interpersonal communication and support networks at work. If the worker feels happy with the work carried out, and feels as an autonomous decision maker able to practice his skills, then he will have the protective factors to cope with the Syndrome of Burnout at work and it is unlikely that he will found in his work a monotonous and a routine activity with little opportunity to practice their skills. The emotional exhaustion related to fatigue and tiredness are caused by excessive wear at work and very demanding work environments with little autonomy and control of work situations. Depletion causes difficulties with daily responsibilities, these factors are related to the work system and the social interactions in the workplace, which after the educative intervention modifies the emotional exhaustion level in the experimental group (29% of group). The depersonalization causes people to be treated as objects (coldness and insensitivity) causing the worker indifference and little empathy with the task of work. Although the level of depersonalization was low in the groups, it decreased in the experimental group, which may be caused by the coping mechanisms embedded in the educational intervention. The lack of personal accomplishment includes the limitations to understand the feelings and emotions of fellow workers and also have a positive influence for them to create pleasant environments (these completion rates increased in the intervention group). In developing countries, there is now general agreement on the importance of the behaviors and lifestyles in the generation of health problems as well as the importance of early healthy lifestyles. All countries have agreed to launch health and educational programs to prevent the modification of human behavior. This study provides a useful educational methodology that responds to how to bring workers to participate in their care, as well as a significant contribution to addressing a problem of this magnitude and importance to public health and health services in Latin America. Conclusion The psycho-educative program sensitized employees when developing strategies to decrease and control labor stressors that affects them, the same stressors that bring about BS.<hr/>La vida actual impone diversas demandas a los seres humanos provocando en ellos situaciones de estrés. Estos sucesos son percibidos como amenazantes, llegan a ocasionar tensión y se denominan estresores. La situación de estrés se presenta al existir una discrepancia entre las demandas del medio y los recursos para enfrentarlo; esto ocasiona en el organismo respuestas fisiológicas, cognitivas y motoras que agudizan la percepción y, de esta manera, originan una mayor búsqueda de soluciones; entre ellas las conductas de adaptación. Cuando el estrés está presente en el área de trabajo de forma recurrente se le conoce como Estrés Laboral (EL), circunstancia alarmante que afecta al individuo y a la organización. Las principales fuentes de EL son: condiciones físicas, horario y puesto de trabajo, además de las relaciones interpersonales y otras variables organizacionales. Ese síndrome representa un problema de salud pública y de salud laboral, ya que se relaciona con un aumento en la tasa de accidentes laborales. Además genera ausentismo laboral que se traduce en pérdidas económicas para las instituciones. El Síndrome de Burnout (SB), es una respuesta al estrés laboral crónico que se manifiesta a través del agotamiento emocional, despersonalización, actitudes hostiles y agresivas con sus compañeros y usuarios del servicio, que finaliza en un sentimiento de pobre realización personal. El objetivo de este estudio fue evaluar el efecto de una intervención psicoeducativa para disminuir el Burnout en el personal directivo de un Sector de la Comisión Federal de Electricidad en Guadalajara, Jalisco. Se realizó un estudio cuasi experimental con una medición pre y post a la intervención educativa. Ésta se efectuó en el personal de confianza de la Comisión Federal de Electricidad de Guadalajara, Jalisco; durante los meses de febrero a septiembre del 2005. La muestra de trabajadores se integró por 29 sujetos que ejercen un puesto directivo, conformando cuatro grupos; un grupo elegido al azar recibió la intervención educativa y los otros fueron de control. A los grupos se les aplicaron diferentes cuestionarios: 1. Datos personales, 2. Factores psicosociales, 3. Escala de Maslach Burnout Inventory para medir el síndrome de Burnout (MBI). Desde la perspectiva de la educación participativa que impulsa la Organización Panamericana de la Salud (OPS), la intervención educativa buscó la promoción de la salud por medio de diversos talleres con el fin de mejorar y mantener su bienestar físico y mental. En uno de los talleres se analizaron los conceptos del Síndrome de Burnout y sus factores psicosociales. Posteriormente se analizaron los factores que modulan y desencadenan el síndrome. Otro taller consintió en desarrollar estrategias de prevención, afrontamiento y manejo del Burnout a nivel individual y social. Fina l mente se impulsó un programa correctivo orientado a disminuir los factores de riesgo psicosocial de la organización y se aplicó la evaluación postintervención. Se muestra una edad promedio de 31.5±6.8 años, el 52% fueron del sexo femenino. El grupo uno disminuyó en todos los indicadores: agotamiento emocional de 71 % a 29%, la despersonalización de 43% a 14%, la falta de realización personal de 57% a 14%. Sin embargo, no se encontraron diferencias significativas en ambos sexos. El programa psicoeducativo sensibilizó al personal para fomentar el desarrollo de estrategias para disminuir y controlar los estresores laborales que les afectan, mismos que originan el Síndrome de Burnout. <![CDATA[<b>La Terapia Centrada</b><b> en Soluciones</b>: <b>Una opción de tratamiento para la dependencia al alcohol</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300006&lng=es&nrm=iso&tlng=es 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 &chi;² = 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.<hr/>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. <![CDATA[<b>Asociación entre el perfil sensorial, el funcionamiento de la relación cuidador-niño y el desarrollo psicomotor a los tres años de edad</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300007&lng=es&nrm=iso&tlng=es Since the beginning of the last century there were some differences in child-related difficulties in regulation that could not be included in the categories of diagnosis were counted, so they fitted within the learning problems, coordination problems and sometimes until the epilepsy. Decades later, each problem was subject of a separate diagnostic category, which favored the study of diseases, but fragmented the diagnosis for children who had a variety of symptoms that some of them were due to a single source. Then the diagnoses increased in coordination disorder, attention deficit disorder with and without hyperactivity (ADHD), the sensory integration dysfunction, language disorders, and so on. In order to complete the criteria of DSM-IV, in the case of children the Zero to Three/National Center for Clinical Programs for Infants developed a diagnostic classification for children from 0 to 3 years old (DC: O-3). The DC: 0-3, consists of five axes. The Axis I refers to the primary diagnosis, and includes the regulatory disorders and developmental disorders that affect different systems. Regulatory disorders are constitutional in nature, based on sensory problems, or sensorimotor processing, characterized by difficulties of the child to regulate their behavior, sensory, attention, motor and/or emotional, to organize positive affective states, warning or actions to calm down. The objective of the present research was to establish the association between the characteristics of the Sensory Profile, the parent-infant relationship and the psychomotor development of children. Materials and methods To assess the level of development of children was used the Conduct Development Profile, as revised (PCD-R). For the parent-infant relationship was used the Parent-Infant Relationship Global Assessment Scale (PIR-GAS). Thus, to recognize a regulatory disorder it was used the Sensory Profile which assess the child's sensory processing and its impact on the daily lives of children. To fit the relationship style in one of the categories, the children and their caregiver play for about 15 minutes with three types of toys, according to the classification of Florey. Statistical analysis For data analysis were conducted descriptive statistics of the general variables and those of primary interest, test Chi² for contingence tables test, correspondence analysis and comparison one-way variance analysis. Analyses conducted using SPSS 12.0 statistical software. Results The children had an average age of 43.2 ± 4.2 months, 50% were girls, development showed ratios of around 105 ± 15 points. The average ratios of development were higher in girls than in boys in all areas except manual skill. The characteristics of sensory profile were established on the basis of results obtained in the SP: 1 7 children (31 %) were located in the group with <<normal>> sensory profile, which refers to the scores within the parameters of typical performance or have up to two factors with likely difference; 21 children (39%) were located in the <<suspected>> group when the subjects likely to exceed two factors with difference and up to 1 factor with definitive difference, and 1 6 children (30%) in the <<regulatory disorder>> group formed by the cases that are more than three factors likely to dispute and/ or difference with more than two final (over four factors outside of the typical performance). Sections of <<auditory processing>>, <<vestibular processing>>, <<results in the behavior of sensory processing>> and <<modulation of the entry of sensory stimuli that affect the emotional responses>> were those that had a higher frequency of profiles of children outside typical behavior (50%). The section of <<modulating the entry of visual stimuli>> was the most frequent typical behavior among children (78%). In relation to the factors, the proportion of children who had values within the typical range in each of the factors of SP was 41 % to 83%, <<sensory seeking>> and <<inatention/ distractibility>> were the most affected by having more than a half of the cases outside of the typical range, while <<poor record>> and <<sensory sensitivity>> were the least altered, being over 75% of cases characterized as typical performance. At the regulatory disorders assessment boys showed more frequent regulatory disruptions, 44% respect to girls 15% (p <0.05). Additionally areas of PCD-R showed some degree of correlation with at least two areas of the SP, the <<emotional/social>> and <<expressive language>> areas of the PCD-R showed more significant correlations with sections of the SP, while <<sensory processing related to the resistance/tone>> and <<modulation related to the position of the body and movement>> sections, which were correlated with most of the development areas explored with the PCD-R. The variance analysis comparing the averages of development reached in the PCD-R, according to the SP results showed statistical differences between the averages in six of nine factors evaluated, being the regulatory disorder the group that makes a difference for the respect to two others. The results of the evaluation about the relationship between caregiver and child valued by the scale Parent-Infant Relationship Global Assessment Scale (PIR-GAS) DC: 0-3, did not show differences in the average ratios of development in the PCD-R among the three groups that were conducted. Nevertheless was noted that children with affected sensory profile presented problems more frequent in relation to the caregiver. Discussion Data from the study population showed values close to those reported by the respective instruments, discreetly above the expected variance similar to that described in the standardized tests. In the most of the development areas, the group of girls had the highest averages ratios. This results are similar with that are described in the literature. We also found an increased frequency of regulatory disorders in boys, 3:1 or 2:1, which could be related with by patterns of socialization. Respect the parent-infant relationship there not found differences that affect significantly the child development, evaluated with the PCD-R, unless when the relatioship was significantly affected. Differences in integrating sensory stimuli, when impact the daily life of children are related to development in different areas. The functioning of the parent-infant relationship was not a variable that changed the effect of the association between sensory profile and development, as it showed no relations with psychomotor development, but shows relations with the sensory profile of the child. In conclusion, differences in the integration of sensory stimuli, when impacting on the daily lives of children at three years old, have an association with the development so that there are areas of development that appear to be more sensitive than others in a any child who presents regulatory disorder. The functioning of the mother-child relationship showed no relations with psychomotor development, however it did with the sensory profile of the child.<hr/>Con la intención de complementar los criterios del DSM-IV, en el caso de los niños pequeños, el Zero to Three/Centro Nacional para Programas Clínicos para Infantes, desarrolló la Clasificación Diagnóstica para los niños de cero a tres años (DC: O-3). El DC: 0-3, constó de cinco ejes. El eje I se refiere al diagnóstico primario, e incluyó los trastornos regulatorios y los trastornos del desarrollo que influyen en diferentes sistemas. Los trastornos regulatorios son de naturaleza constitucional y de maduración, basados en problemas sensoriales, sensoriomotores o de procesamiento; se caracterizan por dificultades que presenta el niño para regular su comportamiento sensorial, atencional, motor y/o afectivo, así como para organizar estados afectivos positivos, de alerta o acciones para calmarse. El objetivo de la presente investigación fue establecer la asociación entre las características del perfil sensorial con el desarrollo psicomotor del niño. Metodología Para valorar el nivel de desarrollo de los niños se utilizó el Perfil de Conductas de Desarrollo, en su versión revisada (PCD-R). Para reconocer un trastorno regulatorio se utilizó el Sensory Profile que valora el procesamiento sensorial del niño y su repercusión en la vida cotidiana. También analizó el nivel de funcionamiento de la relación cuidador-niño con la escala Parent-Infant Relationship Global Assessment Scale (PIR-GAS) del DC: 0-3. Resultados Los niños tuvieron una edad de 43.2+4.2 meses, 50% fueron niñas, el desarrollo mostró coeficientes aproximados de 105+15 puntos y fueron más altos en las niñas que en los niños en todas las áreas excepto habilidad manual, con diferencias significativas en lenguaje expresivo, alimentación y praxis. De manera global el Perfil Sensorial (SP) mostró 17 niños (31 %) con perfil sensorial <<normal>>; 21 (39%) con sospecha y 16 (30%) en el grupo de <<trastorno regulatorio>>. La relación de trastornos regulatorios entre niños y niñas se dio en una razón de 3:1. Las secciones <<procesamiento auditivo>>, <<procesamiento vestibular>>, <<resultados en el comportamiento del procesamiento sensorial>> y <<modulación de la entrada de estímulos sensoriales que afecta las respuestas emocionales>> presentaron mayor frecuencia de perfiles de los niños por fuera del comportamiento típico (50%). Los factores <<búsqueda sensorial>> e <<inatención/ distractibilidad>> fueron los más afectados con más del 50% de casos por fuera del rango típico. Todas las áreas del PCD-R tuvieron algún grado de correlación al menos con dos secciones del SP, siendo las áreas emocional/ social y lenguaje expresivo del PCD-R las que mostraron mayor número de correlaciones significativas con las secciones y factores del SP. Las secciones de <<procesamiento sensorial relacionado a la resistencia/ tono>> y <<modulación relacionada a la posición del cuerpo y movimiento>>, fueron las que se correlacionaron con la mayoría de áreas del PCD-R. En el análisis de varianza entre los resultados globales del SP y las medias de los coeficientes del desarrollo mostró diferencias significativas en seis de las nueve áreas evaluadas. La relación cuidador-niño valorada con la escala (PIR-GAS) del DC: 0-3, mostró relación adaptada en 20 casos (37%), relación levemente afectada en 15 casos (28%) y relación disfuncional en 19 casos (35%), no se observó asociación entre los coeficientes del desarrollo del PCD-R según estos tres grupos de funcionamiento de la relación. Mediante análisis de correspondencia se corroboró que a mayor afectación del perfil sensorial, mayor alteración en la relación cuidador-niño. Las diferencias en la integración de estímulos sensoriales, cuando impactan en la vida cotidiana de los niños, guardan una asociación con el desarrollo en diferentes áreas. El funcionamiento de la relación cuidador-niño no fue una variable que modificase el efecto de la asociación entre el perfil sensorial y el desarrollo, ya que no mostró relaciones con el desarrollo psicomotor, pero sí con el perfil sensorial del niño. <![CDATA[<b>Estudio comparativo de psicoterapia de grupo para el tratamiento de pacientes con trastorno límite de la personalidad</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300008&lng=es&nrm=iso&tlng=es Nowadays, psychotherapy is regarded as the treatment of choice for patients with Borderline Personality Disorder(BPD). A consensus has yet to be reached, however, despite various controlled studies undertaken to determine the most suitable form of treatment. At both public and private mental health institutions, there is a growing number of BPD patients seeking treatment. These patients pose a challenge for institutional programs because their demands usually exceed the <<therapeutic capacity>> of conventional forms of psychiatric treatment. Due to this heavy demand, various strategies have been examined in order to treat this type of patients properly. These include short group therapy. This article presents the results of a controlled clinical study comparing the effectiveness of treatment according to the composition of the groups: a homogeneous group, consisting solely of borderline patients and another in which only half had been diagnosed with BPD while the others only had Axis 1 disorders, with no serious personality pathology. The study considered the variables of psychiatric symptomatology, quality of life, self-esteem, <<ego strength>>, perceived social support, social adjustment and inter-personal problems. Both groups contained female subjects only. The quantitative results of the mixed group show significant changes in the psychiatric symptoms as well as the evolution of interpersonal problems and current quality of life. At the same time, the homogeneous group showed changes in the ideal quality of life and the self-esteem scale. A comparison of the base and final scores showed that the BPD group showed no reduction in psychiatric symptomatology, nor was there a positive evolution in inter-personal relations. At the same time, when other groups were compared, it was obvious that patients in the mixed group showed greater changes in interpersonal problems and depression, anxiety, paranoid and hostility symptoms. As for qualitative results, the BPD group constituted a failed experience from the psychotherapeutic point of view. An analysis of the development of the process in the BPD group reveals three different stages. The first was characterized by the early emergence of numerous transfers based on the idealization/devaluation of colleagues and therapists. The splitting mechanism was clearly observed. This stage saw the emergence of high expectations of a <<magical cure.>> In Bion's terms, the group was experiencing a moment of dependency. At that point, the issue of sexuality emerged, triggering an apparent process of identification linked to experiences of early sexual abuse among patients. The bases of incipient group cohesion seemed to be emerging. Nevertheless, <<attacks>> began to take place, together with the need to exclude the <<healthiest>> group member. Group members subsequently began to complain to the therapists about their <<lack of sensitivity>> and the fact that they failed to provide <<solutions.>> Negative transference became obvious, with hatred and suspicion prevailing. This stage may correspond to the process described by Bion as the attack and flight phase, characterized by intensely paranoid attitudes. The prevailing links were based on hatred, with nearly all expressions of love being stifled. The group eventually succumbed due to the spread of hostility triggered by the attacks of patients that participated in destructive alliances. This prevented the group from achieving cohesion and the stage of camaraderie, characterized by Bion as the emergence of loving feelings that usually neutralize hostile components. Two patients in this group, however, showed favorable changes in their attitudes that implied a process of elaborating conflicts primarily derived from feelings of dependence, passivity and anger in relation to parental figures. From the start, patients in the mixed group with and without BPD showed different degrees of participation. Patients with severe personality pathology participated less in the initial sessions, acting as spectators. They gradually joined the group and participated more actively. Patients without BPD, however, took the initiative regarding the issues to be dealt with during the sessions. In our view, this helped establish a <<containment framework>> for borderline patients. Later on, these patients' conflicts became more obvious, being characterized by powerful ambivalence and the activation of primitive defense mechanisms, such as splitting, projective identification and denial. These expressions, however, found a cohesive group that provided them with acceptance and contention. This group evolved like other psycho-therapeutic groups of <<neurotic patients>> but with differences due to the problems commonly expressed by patients with BPD: suicidal ideation, sexual abuse, severe conflicts in their relationships with their partners, etc. Nevertheless, due to the atmosphere of camaraderie established, these patients were fully integrated, and in fact, their colleagues were unable to determine which ones belonged to which category. By the end of the treatment, group cohesion and positive dominant transference were obvious. The experience yielded by this study showed that in a psycho-therapeutic group solely comprising BPD patients, situations arise that are extremely difficult to handle. The most important factor was negative transference, which created a hostile atmosphere that neutralized the psychotherapeutic interventions. This generalization should be viewed with caution, however, due to the small number of patients included in this study. The severity of the psycho pathology of the patients included in each group was probably not the same. A propos of this last mechanism, it has been suggested that certain socio-demographic characteristics are associated with better social functioning. The homogeneous group contained more unemployed and single patients and/or patients with highly conflictive interpersonal relations. From the outset, patients in the mixed group displayed higher levels of social performance. Despite the fact that they all met the diagnostic characteristics for BPD according to the SCID-II, a more detailed personality study that would reveal significant differences in the patients' psychic structure was not carried out. A retrospective analysis showed that histrionic, narcissistic and anti-social traits predominated in the homogeneous group; these traits may be included in the category of the malignant narcissistic syndrome described by Kernberg, in which the combination of these three traits produces a poor therapeutic prognosis. It has been established that these subjects tend to develop paranoid transferences and are unable to relate to others due to their inability to invest them with libidinal energy. At the same time, in the mixed group, borderline patients have phobic, dependent features, characteristics associated with a better prognosis, since better functioning is associated with a less primitive psychic structure and the capacity to establish less chaotic relationships. In any case, it seems quite clear that group therapy that combines a restricted number of borderline patients and subjects with Axis I disorders without serious personality disorders could prove a viable option in the search for institutional strategies for the psychotherapeutic treatment of patients with BPD.<hr/>En la actualidad se acepta que el tratamiento de elección para los pacientes con Trastorno Límite de la Personalidad (TLP) es la psicoterapia. Sin embargo, a pesar de los diversos estudios controlados que se han realizado con el propósito de determinar cuál es la modalidad de tratamiento más adecuada, no se ha logrado alcanzar consenso. En las instituciones de atención a la salud mental, tanto públicas como privadas, es creciente el volumen de pacientes con TLP que buscan tratamiento. Debido a estas fuertes demandas que operan sobre las instituciones, se han buscado diferentes estrategias para tratar adecuadamente a este tipo de pacientes. Entre ellas se destaca la terapia de grupo breve. La mayoría de los estudios que han respaldado los tratamientos psicoterapéuticos para el TLP derivan de observaciones provenientes de ensayos clínicos individuales. Sin embargo, también existen trabajos entre los que se reseñan algunos que consideramos relevantes y que muestran los beneficios de los tratamientos grupales. En este artículo se presentan los resultados de un estudio clínico controlado comparando dos tipos de conformación de grupos terapéuticos: un grupo homogéneo, constituido únicamente por pacientes limítrofes, y otro heterogéneo en el que se incluyeron además de pacientes con TLP, otros sin patología grave de la personalidad. El objetivo del estudio fue comparar la efectividad del tratamiento en función de la composición de los grupos. El tipo de estudio fue comparativo pre-test post-test. En él se consideraron las variables de sintomatología psiquiátrica, la calidad de vida, la autoestima, la <<fuerza del Yo>>, el apoyo social percibido, el ajuste social y los problemas interpersonales. Para el análisis estadístico se utilizaron pruebas no paramétricas. El diagnóstico de TLP se realizó de acuerdo a los criterios del DSM IV. Se excluyeron sujetos con diagnóstico de trastorno agudo en Eje I o trastorno neurológico que afectara de manera significativa su capacidad cognitiva, y sujetos con una probada historia de deserción de sus tratamientos. En ambos grupos sólo se reunieron sujetos del sexo femenino. Los resultados cuantitativos mostraron que las pacientes incluidas en el grupo heterogéneo tuvieron mayores cambios benéficos en las distintas escalas psicológicas y psicopatológicas aplicadas, mientras que las pacientes del grupo homogéneo tuvieron pocos o ningún cambio. En cuanto a los resultados cualitativos, se observó que las pacientes del grupo heterogéneo desarrollaron transferencias positivas que influyeron en un mejor desarrollo del grupo y en la obtención de cambios positivos, mientras que en el grupo homogéneo se vieron transferencias negativas que dificultaron el desarrollo adecuado de la terapia grupal, creando un ambiente caótico y con poca cohesión grupal. El desarrollo del proceso terapéutico fue notoriamente distinto en ambos grupos. El grupo homogéneo se caracterizó por una elevada competitividad y rivalidad entre las participantes quienes se disputaban el papel protagónico, además de hostilizar a los terapeutas. En contraste, el grupo heterogéneo alcanzó un nivel de funcionamiento más armónico que posibilitó cambios favorables en las pacientes con TLP. Debido al tamaño tan reducido de la muestra, no se puede afirmar categóricamente que las diferencias en los resultados obedecieron exclusivamente a la composición de los grupos. Es posible que el nivel <<inicial>> de psicopatología fuera más grave en las pacientes incluidas en el grupo homogéneo, lo cual se puede inferir de su nivel de funcionamiento social en el momento de la inclusión en la terapia y otras observaciones clínicas colaterales. Los resultados sugieren que la composición de los grupos sí resultó ser una variable significativa, que se deberá tomar en cuenta para futuras investigaciones. Al mismo tiempo, estos resultados nos permiten sugerir que los pacientes con diagnóstico de TLP pueden ser tratados exitosamente mediante psicoterapia de grupo, siempre y cuando la composición del grupo incluya otros pacientes sin trastorno severo de la personalidad. <![CDATA[<b>Aplicación de la terapia de afrontamiento del estrés en dos poblaciones con alto estrés: pacientes crónicos y personas sanas</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300009&lng=es&nrm=iso&tlng=es Introduction Stress is currently considered a health risk factor. Numerous studies have shown that people with high levels of perceived stress present a greater number of complaints at both the physical and psychological levels. In this context, programs have been developed directed toward adequately coping with stress, and the effectiveness of these programs on the symptomatology of a psychological nature in healthy persons with a high level of perceived stress has been shown. However, there have been fewer studies that have shown whether this type of therapy affects the somatic symptomatology of healthy people in any way. On the other hand, programs for chronically ill patients directed toward achieving a better adaptation to their life conditions are equally effective. A population that presents considerably high levels of stress is the one consisting of people suffering from a chronic illness. Thus, through the immunological modulation it produces, the stress may be exacerbating the course of the disease. One prototype of this is systemic lupus erythematosus (SLE). SLE is a syndrome whose clinical expression depends on the degree to which there is a convergence of an immune regulation disorder and a strong genetic base, hormonal influence, and various exogenous agents. SLE can be manifested by general malaise, fever, fatigue, weight loss, skin rashes, joint inflammation, anemia, inflammation of the lymphatic glands, lowering of the defenses against infection, and cardiac, kidney, neurological, and pulmonary alterations. This autoimmune disease is usually associated with high levels of pain and impairment in different systems, producing high levels of stress in the patients who suffer from it. Nevertheless, although stress has already been shown to be one environmental factor that can produce a worsening in lupus symptoms, there have been no studies carried out with the objective of testing the effectiveness of stress management therapy and its physical and emotional consequences in these patients. For this reason, this study has a double objective: on the one hand, to corroborate, once again, the efficacy of cognitive-behavioural stress management therapy in the control of certain psychological processes and, on the other hand, to take one more step by testing whether there is a reduction in the perception of self-reported somatic symptoms both in healthy people and in those with a chronic disease. Material and method Fifty-two people participated in this study. Twenty-two were patients with lupus from the University Hospital in Granada. The other 30 were people without chronic diseases who attended the Psychological Attention Service at the University of Granada to receive therapy for coping with stress, as they claimed to have high levels of it. To evaluate the level of stress, we used the Stress Vulnerability Inventory by Beech, Burns and Scheefield, and the Scale of Recent Life Experiences (SRLE) by Kohn and Macdonald. To evaluate depression, we used the Beck Depression Inventory (BDI), and for anxiety, the Trait Anxiety Inventory (STAI-R) by Spielberger, Gorsuch and Lushene. For the self-reported somatic symptoms, we used the Revised Somatic Symptoms Scale (SSS-R) by Sandín, Valiente and Chorot. In addition, in the patients with SLE, the SLEDAI index, or Index of Activity of the Disease, was obtained. The therapy received was cognitive-behavioural in nature, and it was carried out during 13 sessions which were grouped in the following blocks: Conceptualization of the stress, cognitive restructuring; Deactivation techniques; Approaching the self-management of the pain; Social skills; Time control and organization; Personality pattern and its relationship with health; Anger management; Humour and optimism as coping strategies. Results Results showed that both groups presented a statistically significant reduction in stressful life experiences [F(1 .50) = 28.6; p<.000], vulnerability to stress [F(1 .50) = 1 05.25; p<0.000], depression [F(1 .50) = 68.33; p<0.000], and anxiety [F(1 .49) = 54.53; p<0.000] after the treatment. Moreover, the effect size of these variables was high in the group of patients with lupus and in the group of healthy patients, although it was higher in the latter group. Likewise, both groups presented a statistically significant improvement in the physical function, producing a reduction in the perceived somatic symptoms [F(1 .48) = 37.7; p<0.000] after the treatment. Furthermore, the effect of the treatment was high in both groups. Discussion This paper addresses a critically important issue: the effectiveness of cognitive-behavioral intervention in ameliorating psychosocial stress and enhancing the well-being of individuals with lupus and the group of people with high stress. In this improvement, there was not only a significant reduction in the score on vulnerability to stress and stressful life experiences, but a reduction in the levels of anxiety and depression and somatic symptoms. The findings of improvements in somatic symptoms suggest that this intervention might facilitate coping and change the cognitive appraisals of symptoms. Likewise, the impact of the intervention on psychosocial outcomes (depression, anxiety and perceived vulnerability to stress) may have implications for longer-term health behaviors and health outcomes. Although this reduction is significant in both groups, the effect size is greater in the group of people with high stress than in the group of lupus patients. Specifically, the somatic symptoms where a lower effect of the therapy was observed were the immunological, respiratory, musculoskeletal, and dermatological symptoms, which coincide with the most characteristic symptoms of lupus. This study supports, therefore, the importance of stress management programs not only to reduce the amount of stress, but also to improve the emotional variables and physical condition, both in people with chronic diseases and in healthy people with a high level of stress. The cognitive-behavior therapy is a new effective line of action in dealing with lupus, being necessary an overall integrated view of the patients with lupus, treating the clinical and psychological aspects.<hr/>Introducción Actualmente, el estrés se considera un factor de riesgo para la salud. Diversos estudios ponen de manifiesto que altos niveles de estrés presentan mayor número de quejas, tanto en el nivel físico como psicológico. En este contexto, se han desarrollado programas dirigidos a un adecuado afrontamiento del estrés, que han resultado eficaces en la modificación de variables emocionales. Sin embargo, no se ha estudiado la eficacia de la terapia en la mejoría de síntomas somáticos. Por otra parte, existen enfermedades en que, por la modulación inmunológica que produce, el estrés puede actuar exacerbando el curso de ésta. Un prototipo de lo anterior es el lupus eritematoso sistémico (LES), enfermedad de carácter autoinmune que suele conllevar importantes niveles de dolor y deterioro de diferentes sistemas, con lo que a su vez produce altos niveles de estrés en los pacientes que lo padecen. También está ampliamente demostrado que el estrés puede actuar como exacerbador de la enfermedad. Pese a ello, no se ha llevado a cabo ningún estudio que tenga como objetivo comprobar la eficacia de la terapia de afrontamiento al estrés por sus consecuencias físicas y emocionales. Por ello, el objetivo de este estudio ha sido valorar la eficacia de la terapia cognitivo-conductual en el manejo del estrés para comprobar si disminuye la percepción de los síntomas somáticos autoinformados, tanto en personas sanas como en personas con lupus. Material y método En este estudio han participado 52 personas, de las cuales 22 eran pacientes con lupus y 30 eran personas con alto estrés. Para evaluar el nivel de estrés hemos utilizado el Inventario de Vulnerabilidad al Estrés y la Escala de Experiencias Vitales Recientes (SRLE); para evaluar la depresión, el Inventario de Depresión de Beck (BDI); para la ansiedad, el Inventario de Ansiedad Rasgo (STAI-R); y para los síntomas somáticos autoinformados, la Escala de Síntomas Somáticos-Revisada (ESS-R). Además, en los pacientes con LES, se obtuvo el índice SLEDAI o índice de actividad de la enfermedad. Ambos grupos se evaluaron en las diferentes variables psicológicas descritas previamente antes y después del tratamiento. La terapia recibida fue de tipo cognitivo-conductual y se desarrolló a lo largo de 13 sesiones de hora y media. Resultados Los resultados mostraron que ambos grupos presentaban una reducción estadísticamente significativa en experiencias vitales estresantes [F(1 .50) = 28.6; p<0.000], vulnerabilidad al estrés [F(1.50) = 105.25; p<0.000], depresión [F(1.50) = 68.33; p<0.000] y ansiedad [F(1 .49)=54.53; p<0.000] después del tratamiento. El tamaño del efecto en estas variables fue alto tanto en el grupo de pacientes con lupus como en el grupo de personas sanas, siendo mayor en este último. Asimismo, ambos grupos presentaron una mejora estadísticamente significativa de la función física y se produjo una disminución de los síntomas somáticos percibidos [F(1 .48) = 37.7; p<0.000] después del tratamiento. Además, aunque es alto en ambos grupos, el efecto del tratamiento es mayor en el grupo de personas con alto estrés percibido. Discusión Nuestros datos indican que la terapia de afrontamiento del estrés influye positivamente tanto en el grupo de personas con alto estrés como en el grupo de pacientes de lupus. En dicha mejoría disminuyen de forma significativa las puntuaciones de vulnerabilidad al estrés, experiencias vitales estresantes, ansiedad y depresión. Por otro lado, con respecto a los síntomas somáticos experimentados por ambos grupos, los resultados muestran un descenso de la percepción de los mismos. Aunque esta disminución es significativa, el tamaño del efecto es mayor en el grupo de personas con alto estrés. Este estudio apoya, por tanto, la importancia de un programa de afrontamiento del estrés no sólo para disminuir la cantidad de estrés, sino para mejorar las variables emocionales y el estatus físico tanto en personas con enfermedades crónicas como en personas sanas, pero con alto estrés. <![CDATA[<b>Actualidad del pensamiento de Henri Ey (1900-1977)</b>]]> http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0185-33252009000300010&lng=es&nrm=iso&tlng=es Introduction Stress is currently considered a health risk factor. Numerous studies have shown that people with high levels of perceived stress present a greater number of complaints at both the physical and psychological levels. In this context, programs have been developed directed toward adequately coping with stress, and the effectiveness of these programs on the symptomatology of a psychological nature in healthy persons with a high level of perceived stress has been shown. However, there have been fewer studies that have shown whether this type of therapy affects the somatic symptomatology of healthy people in any way. On the other hand, programs for chronically ill patients directed toward achieving a better adaptation to their life conditions are equally effective. A population that presents considerably high levels of stress is the one consisting of people suffering from a chronic illness. Thus, through the immunological modulation it produces, the stress may be exacerbating the course of the disease. One prototype of this is systemic lupus erythematosus (SLE). SLE is a syndrome whose clinical expression depends on the degree to which there is a convergence of an immune regulation disorder and a strong genetic base, hormonal influence, and various exogenous agents. SLE can be manifested by general malaise, fever, fatigue, weight loss, skin rashes, joint inflammation, anemia, inflammation of the lymphatic glands, lowering of the defenses against infection, and cardiac, kidney, neurological, and pulmonary alterations. This autoimmune disease is usually associated with high levels of pain and impairment in different systems, producing high levels of stress in the patients who suffer from it. Nevertheless, although stress has already been shown to be one environmental factor that can produce a worsening in lupus symptoms, there have been no studies carried out with the objective of testing the effectiveness of stress management therapy and its physical and emotional consequences in these patients. For this reason, this study has a double objective: on the one hand, to corroborate, once again, the efficacy of cognitive-behavioural stress management therapy in the control of certain psychological processes and, on the other hand, to take one more step by testing whether there is a reduction in the perception of self-reported somatic symptoms both in healthy people and in those with a chronic disease. Material and method Fifty-two people participated in this study. Twenty-two were patients with lupus from the University Hospital in Granada. The other 30 were people without chronic diseases who attended the Psychological Attention Service at the University of Granada to receive therapy for coping with stress, as they claimed to have high levels of it. To evaluate the level of stress, we used the Stress Vulnerability Inventory by Beech, Burns and Scheefield, and the Scale of Recent Life Experiences (SRLE) by Kohn and Macdonald. To evaluate depression, we used the Beck Depression Inventory (BDI), and for anxiety, the Trait Anxiety Inventory (STAI-R) by Spielberger, Gorsuch and Lushene. For the self-reported somatic symptoms, we used the Revised Somatic Symptoms Scale (SSS-R) by Sandín, Valiente and Chorot. In addition, in the patients with SLE, the SLEDAI index, or Index of Activity of the Disease, was obtained. The therapy received was cognitive-behavioural in nature, and it was carried out during 13 sessions which were grouped in the following blocks: Conceptualization of the stress, cognitive restructuring; Deactivation techniques; Approaching the self-management of the pain; Social skills; Time control and organization; Personality pattern and its relationship with health; Anger management; Humour and optimism as coping strategies. Results Results showed that both groups presented a statistically significant reduction in stressful life experiences [F(1 .50) = 28.6; p<.000], vulnerability to stress [F(1 .50) = 1 05.25; p<0.000], depression [F(1 .50) = 68.33; p<0.000], and anxiety [F(1 .49) = 54.53; p<0.000] after the treatment. Moreover, the effect size of these variables was high in the group of patients with lupus and in the group of healthy patients, although it was higher in the latter group. Likewise, both groups presented a statistically significant improvement in the physical function, producing a reduction in the perceived somatic symptoms [F(1 .48) = 37.7; p<0.000] after the treatment. Furthermore, the effect of the treatment was high in both groups. Discussion This paper addresses a critically important issue: the effectiveness of cognitive-behavioral intervention in ameliorating psychosocial stress and enhancing the well-being of individuals with lupus and the group of people with high stress. In this improvement, there was not only a significant reduction in the score on vulnerability to stress and stressful life experiences, but a reduction in the levels of anxiety and depression and somatic symptoms. The findings of improvements in somatic symptoms suggest that this intervention might facilitate coping and change the cognitive appraisals of symptoms. Likewise, the impact of the intervention on psychosocial outcomes (depression, anxiety and perceived vulnerability to stress) may have implications for longer-term health behaviors and health outcomes. Although this reduction is significant in both groups, the effect size is greater in the group of people with high stress than in the group of lupus patients. Specifically, the somatic symptoms where a lower effect of the therapy was observed were the immunological, respiratory, musculoskeletal, and dermatological symptoms, which coincide with the most characteristic symptoms of lupus. This study supports, therefore, the importance of stress management programs not only to reduce the amount of stress, but also to improve the emotional variables and physical condition, both in people with chronic diseases and in healthy people with a high level of stress. The cognitive-behavior therapy is a new effective line of action in dealing with lupus, being necessary an overall integrated view of the patients with lupus, treating the clinical and psychological aspects.<hr/>Introducción Actualmente, el estrés se considera un factor de riesgo para la salud. Diversos estudios ponen de manifiesto que altos niveles de estrés presentan mayor número de quejas, tanto en el nivel físico como psicológico. En este contexto, se han desarrollado programas dirigidos a un adecuado afrontamiento del estrés, que han resultado eficaces en la modificación de variables emocionales. Sin embargo, no se ha estudiado la eficacia de la terapia en la mejoría de síntomas somáticos. Por otra parte, existen enfermedades en que, por la modulación inmunológica que produce, el estrés puede actuar exacerbando el curso de ésta. Un prototipo de lo anterior es el lupus eritematoso sistémico (LES), enfermedad de carácter autoinmune que suele conllevar importantes niveles de dolor y deterioro de diferentes sistemas, con lo que a su vez produce altos niveles de estrés en los pacientes que lo padecen. También está ampliamente demostrado que el estrés puede actuar como exacerbador de la enfermedad. Pese a ello, no se ha llevado a cabo ningún estudio que tenga como objetivo comprobar la eficacia de la terapia de afrontamiento al estrés por sus consecuencias físicas y emocionales. Por ello, el objetivo de este estudio ha sido valorar la eficacia de la terapia cognitivo-conductual en el manejo del estrés para comprobar si disminuye la percepción de los síntomas somáticos autoinformados, tanto en personas sanas como en personas con lupus. Material y método En este estudio han participado 52 personas, de las cuales 22 eran pacientes con lupus y 30 eran personas con alto estrés. Para evaluar el nivel de estrés hemos utilizado el Inventario de Vulnerabilidad al Estrés y la Escala de Experiencias Vitales Recientes (SRLE); para evaluar la depresión, el Inventario de Depresión de Beck (BDI); para la ansiedad, el Inventario de Ansiedad Rasgo (STAI-R); y para los síntomas somáticos autoinformados, la Escala de Síntomas Somáticos-Revisada (ESS-R). Además, en los pacientes con LES, se obtuvo el índice SLEDAI o índice de actividad de la enfermedad. Ambos grupos se evaluaron en las diferentes variables psicológicas descritas previamente antes y después del tratamiento. La terapia recibida fue de tipo cognitivo-conductual y se desarrolló a lo largo de 13 sesiones de hora y media. Resultados Los resultados mostraron que ambos grupos presentaban una reducción estadísticamente significativa en experiencias vitales estresantes [F(1 .50) = 28.6; p<0.000], vulnerabilidad al estrés [F(1.50) = 105.25; p<0.000], depresión [F(1.50) = 68.33; p<0.000] y ansiedad [F(1 .49)=54.53; p<0.000] después del tratamiento. El tamaño del efecto en estas variables fue alto tanto en el grupo de pacientes con lupus como en el grupo de personas sanas, siendo mayor en este último. Asimismo, ambos grupos presentaron una mejora estadísticamente significativa de la función física y se produjo una disminución de los síntomas somáticos percibidos [F(1 .48) = 37.7; p<0.000] después del tratamiento. Además, aunque es alto en ambos grupos, el efecto del tratamiento es mayor en el grupo de personas con alto estrés percibido. Discusión Nuestros datos indican que la terapia de afrontamiento del estrés influye positivamente tanto en el grupo de personas con alto estrés como en el grupo de pacientes de lupus. En dicha mejoría disminuyen de forma significativa las puntuaciones de vulnerabilidad al estrés, experiencias vitales estresantes, ansiedad y depresión. Por otro lado, con respecto a los síntomas somáticos experimentados por ambos grupos, los resultados muestran un descenso de la percepción de los mismos. Aunque esta disminución es significativa, el tamaño del efecto es mayor en el grupo de personas con alto estrés. Este estudio apoya, por tanto, la importancia de un programa de afrontamiento del estrés no sólo para disminuir la cantidad de estrés, sino para mejorar las variables emocionales y el estatus físico tanto en personas con enfermedades crónicas como en personas sanas, pero con alto estrés.