Author: Alex Asensi

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Eating Disorders – Evaluation Protocol

Evaluation

“All the information contained in this section is for guidance only. Psious environments are therapy supporting tools that must be used by the healthcare professional within an evaluation and intervention process designed according to the characteristics and needs of the user.

Also remember that you have the General Clinical Guide in which you have more information on how to adapt psychological intervention techniques (exposure, systematic desensitization, cognitive restructuring, chip economy…) to Psious environments.”

Objectives
  • Evaluate the concern for body image, eating habits, diet and physical exercise, the perception of one’s body figure, self-image and self-esteem.
  • Evaluate the presence of altered eating behaviors (food restriction, binge eating, compensatory behavior…).
  • Evaluate the presence of distorted thoughts in relation to food / body image.
  • Evaluate possible comorbidities (depression, anxiety, self-injurious behavior, etc.).
  • Define stimulation configurations feared by the patient and to what degree: Elaboration of the exposure hierarchy.
Some useful instruments for the Eating Behavior Disorders evaluation

Taking into account the objectives of the evaluation, we will list some tools and instruments that may be useful to obtain relevant information about the characteristics of your user. Remember that a good definition of objectives, characterization of the patient and planning of the intervention are important for the efficiency and therapeutic efficacy, as well as for the satisfaction of your patients. In the bibliography you will find the articles in which to review the characteristics of the instruments proposed below:

  • Structured Clinical Interview for disorders of Axis I of the DSM-IV (First, Spitzer, Williams, Gibbon, 1997)
  • Diagnostic Interview for Children and Adolescents (Shaffer, Fisher, Lucas, Dulcan, Schwab, 2000; Bravo et al, 2001; Ezpeleta L, et al., 1997)
Autoreports

Body Image

  • Gardner’s Body Image Evaluation Scale (Gardner, Stark, Jackson, Friedman, 1999).
  • (Body Weight, Image and Self-Esteem Evaluation Scale, B-WISE (Awad, Voruganti, 2004)..
  • Body Attitude Test (BAT) (Probst, 1995; Gila, et al., 1999).
  • Body Shape Questionnaire (BSQ) (Cooper, et al.,1988; Raich, et al., 1996).
  • Body Image Avoidance Questionnaire (BIAQ) (Rosen, Srebrik, Saltzberg y Wendt, 1991)

Nuclear psychopathology: Common symptoms and behaviors in eating behavior disorders

  • Eating Disorders Inventory -3 (EDI-3) (Garner, 2004).
  • Eating Attitudes Test (EAT-40) (Garner and Garfinkel, 1979; Castro, Toro, Salmero, Guimera, 1991).
  • Eating Disorders Exam – Questionnaire (EDE-Q) (Fairburn & Beglin, 1994; Elder y Grilo, 2007).
  • Edinburgh Bulimia Test (BITE) (Henderson and Freeman, 1987).
  • Bulimia Test (BULIT) (Smith and Thelen, 1984; Vázquez-Morejón et aL, 2007).

Desire / impulse towards food

  • State and Trait Food Cravings Questionnaires (FCQ-S, FCQ-T)(Cepeda et al, 2000).

Motivation for the treatment

  • Attitudes Questionnaire against Change in Eating Disorders (ACTA) (Beato Fernández, Rodríguez Cano, 2003).
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TCA – Protocolo de Evaluación

Evaluación

“Toda la información contenida en este apartado es de carácter orientativo. Los entornos de Psious son herramientas de apoyo terapéutico que deben ser utilizadas por el profesional de la salud dentro de un proceso de evaluación e intervención diseñado según las características y necesidades del usuario.

Recuerda además que dispones de la Guía Clínica General en la que tienes más información sobre cómo adaptar las técnicas de intervención psicológica (exposición, desensibilización sistemática, reestructuración cognitiva, economía de fichas…) a los entornos de Psious.”

Objetivos
  • Evaluar la preocupación por la imagen corporal, los hábitos alimentarios, la dieta y el ejercicio físico, la percepción de la propia figura corporal, la autoimagen y la autoestima.
  • Evaluar la presencia de conductas alimentarias alteradas (restricción alimentaria, atracones, conductas compensatorias…). 
  • Evaluar la presencia de pensamientos distorsionados en relación a la comida/imagen corporal. 
  • Evaluar posibles comorbilidades (depresión, ansiedad, conductas autolesivas, etc.). 
  • Definir configuraciones estimulares temidas por el paciente y en qué grado: Elaboración de la jerarquía de exposición.
Algunos instrumentos útiles para la evaluación de los Trastornos de la Conducta Alimentaria

Teniendo en cuenta los objetivos de evaluación, pasamos a enumerar algunas herramientas e instrumentos que pueden ser útiles para obtener información relevante sobre las características de tu usuario. Recuerda que una buena definición de objetivos, caracterización del paciente y planificación de la intervención son importantes para la eficiencia y eficacia terapéutica, así como para la satisfacción de tus pacientes. En la bibliografía encontrarás los artículos en los que revisar las características de los instrumentos propuestos a continuación:

  • Entrevista Clínica Estructurada para los trastornos del Eje I del DSM-IV (First, Spitzer, Williams, Gibbon, 1997 )
  • Entrevista Diagnóstica para Niños y Adolescentes (Shaffer, Fisher, Lucas, Dulcan, Schwab, 2000; Bravo et al, 2001; Ezpeleta L, et al., 1997) 
Autoinformes

Imagen corporal

  • Escala de Evaluación de la Imagen Corporal de Gardner (Gardner, Stark, Jackson, Friedman, 1999). 
  • Escala de Peso, Imagen Corporal y Autoestima (E-PICA) (Body Weight, Image and SelfEsteem Evaluation Scale, B-WISE) (Awad, Voruganti, 2004).
  • Cuestionario de Actitud Corporal (BAT) (Probst, 1995; Gila, et al., 1999).
  • Cuestionario sobre Forma Corporal (BSQ) (Cooper, et al.,1988; Raich, et al., 1996).
  • Cuestionario de Evitación debida a la Imagen Corporal (BIAQ) (Rosen, Srebrik, Saltzberg y Wendt, 1991).

Psicopatología nuclear: Síntomas y conductas comunes en los TCA

  • Inventario de Trastornos de la Alimentación-3 (EDI-3) (Garner, 2004). 
  • Test de Actitudes Alimentarias (EAT-40) (Garner y Garfinkel, 1979; Castro, Toro, Salmero, Guimera, 1991).
  • Cuestionario Examen de Trastornos de la Conducta Alimentaria (EDE-Q) (Fairburn y Beglin, 1994; Elder y Grilo, 2007).
  • Test de Bulimia de Edimburgo (BITE) (Henderson y Freeman, 1987).
  • Test de Bulimia (BULIT) (Smith y Thelen, 1984; Vázquez-Morejón et aL, 2007).

Deseo/impulso hacia la comida

  • State and Trait Food Cravings Questionnaires (FCQ-S, FCQ-T) (Cepeda et al, 2000).

Motivación para el tratamiento

  • Cuestionario de Actitudes frente al Cambio en los Trastornos de la Conducta Alimentaria (ACTA) (Beato Fernández, Rodríguez Cano, 2003).

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Eating Disorders and Virtual Reality

Eating Disorders
and virtual reality

Virtual Reality (VR) is a beneficial tool for the treatment of Eating Disorders, also known as Eating Behavior Disorders (EBD), especially Bulimia Nervosa (BN), Nervous Anorexia (AN) and Binge Eating Disorder (BED).

Several studies demonstrate the effectiveness of VR as an exposure therapy to reduce the desire or impulse towards food and to normalize eating patterns, as well as to help patients to be aware of their distortion of their own body image, to confront and correct such distortion, to get a more realistic perception and to reduce dissatisfaction with one’s own body (Gutiérrez-Maldonado et al., 2016; Lafond, Riva, Gutierrez-Maldonado, & Wiederhold, 2016; Lozano et al, 2002; Marco, Perpiñá & Botella, 2013; Manzoni et al, 2013; Manzoni et al, 2016; Perpiñá, Botella & Baños, 2003; Perpiñá et al., 2013; Pla-Sanjuanelo et al., 2015; Riva, 2011: Riva et al, 1999; Wiederhold, Riva, & GutiérrezMaldonado, 2016).

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Desórdenes alimenticios y Realidad Virtual

Desórdenes alimenticios
y realidad virtual

La Realidad Virtual (RV) es una herramienta beneficiosa para el tratamiento de los Desórdenes Alimenticios, también conocidos como Trastornos de la Conducta Alimentaria (TCA), especialmente la Bulimia Nerviosa (BN), la Anorexia Nerviosa (AN) y el Trastorno por Atracón (TA).

Diversos estudios demuestran la eficacia de la RV como terapia de exposición para reducir el deseo o impulso hacia la comida y para normalizar los patrones alimentarios, así como para ayudar a los pacientes a ser conscientes de su distorsión de la propia imagen corporal, confrontar y corregir dicha distorsión, conseguir una percepción más realista y reducir la insatisfacción con el propio cuerpo (Gutiérrez-Maldonado et al., 2016; Lafond, Riva, Gutierrez-Maldonado, & Wiederhold, 2016; Lozano et al, 2002; Marco, Perpiñá & Botella, 2013; Manzoni et al, 2013; Manzoni et al, 2016; Perpiñá, Botella & Baños, 2003; Perpiñá et al., 2013; Pla-Sanjuanelo et al., 2015; Riva, 2011: Riva et al, 1999; Wiederhold, Riva, & Gutiérrez-Maldonado, 2016). 

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Pain Management – Appendix

Appendix

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Manejo del dolor – Apéndice

Apéndice

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Pain Management – Bibliography

Bibliography

  • Badia X, Muriel C, Gracia A, Núñez-Olarte J, Perulero N, Gálvez R, et al. (2003). Spanish validation of the Brief Pain Inventory questionnaire in patients with pain of neoplastic cause. Med Clin, 120, 52-9
  • Beck, AT, Brown, G, Epstein, N, Steer, RA (1988). An inventory to measure clinical anxiety: psychometric properties. Journal of consulting and clinical psychology, 56, 893-897.
  • Bennett, M. (2001). The LANSS pain scale: the Leeds assessment of neuropathic symptoms and signs, Pain, 92, 147-157.
  • Bouhassira, D., Attal, N., Alchaar, H., Boureau, F., Brochet, B., Bruxelle, J. , Cunin, G., Fermanian, J., Ginies, P., Grun-Overdyking, A., JafariSchluep, H., Lantéri-Minet, L., Laurent, B., Mick, G., Serrie, A., Valade, D., Vicaut, E. (2005). Comparison of pain syndromes associated with nerve or somatic lesions and development of a new diagnostic questionnaire for neuropathic pain (DN4). Pain, 114, 29-36. 10.1016 / j. Pain. 2004.12.010
  • Brown, TA, Di Nardo, PA and Barlow, DH (1994). Interview schedule for anxiety disorders for DSM-IV (ADIS-IV). San Antonio: The Psychological Corporation.
  • Cabas Hoyos, Kattia; Cárdenas López, Georgina; Gutiérrez Maldonado, José; Ruiz Esquivel, Fernanda; Torres Villalobos, Gonzalo; (2015). Clinical use of virtual reality for distraction and reduction of postoperative pain in adult patients. Tesis Psicológica, July-December, 38-50.
  • Carlsson, AM (1983). Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain, 16, 87-101.
  • Cid, J., Acuña, JP, Andrés, J., Díaz, J., and Gómer-Caro, L. (2014) What and how to assess the chronic pain patient? Assessment of the patient with chronic pain. RDO. MEDICINE. CLIN. CONDES, 25 (4), 687-697.
  • Freynhagen, R., Baron, R., Gockel, U. and Tölle, TR (2006). Pain DETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Current Medical Opinion and Research, 22 (10), 1911-1920.
  • Garcia-Palacios, A., Hoffman, HG, Richards, TR, Siebel, EJ, and Sharar, SR (2007). Use of virtual reality distraction to reduce claustrophobia symptoms during a simulated magnetic resonance imaging brain scan: a case report. CyberPsychology & Behavior, 10 (3), 485-488. doi: 10.1089 / cpb. 2006.9926
  • Gold, JI, Kant, AJ, Kim, SH, and Rizzo, AS (2005). Virtual anesthesia: the use of virtual reality to distract pain during acute medical interventions. Seminars in Anesthesia, Perioperative Medicine, and Pain, 24 (4), 203-210. https://doi-org.sire.ub.edu/10.1053/j.sane.2005.10.005.
  • Hamilton M. (1959). The assessment of anxiety states by rating. Br J Med Psychology; 32, 50-55. http://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf
  • Jones, T., Moore, T., & Choo, J. (2016). The impact of virtual reality on chronic pain. PLoS ONE, 11 (12), 1-10.
  • Julian, LJ (2011) Measures of ansiedad. Arthritis Care Res (Hoboken), 63 (11). doi: 10.1002 / acr. 20561
  • Kato, J., Agalave, NM, and Svensson, CI (2016). Pattern recognition receptors in chronic pain: mechanisms and therapeutic implications. European journal of pharmacology, 788, 261-273. http://doi.org.sire.ub.edu/10.1016/j.ejphar.2016.06.039.
  • Krause, SJ and Backonja, M. (2003). Development of a neuropathic pain questionnaire. Clin J Pain, 19, 306-14.
  • Melzack R and Torgerson WS. (1971). On the language of pain. Anesthesiology, 34 (1), 50-59.
  • Melzack, R. and Wall, PD (1965). Mechanisms of pain: a new theory. Science, 150 (3699), 971-979.
  • Monsalve V, Soriano J and De Andrés J (2006). Usefulness of the Lattinen Index (IL) in the assessment of chronic pain: relationships with coping and quality of life. Rev Soc Esp Dolor, 13, 216-29.
  • Ríos, EM, Herrera, RA, and Rojas AG (2014). Dental anxiety: assessment and treatment. Advances in Odontostomatology, 30 (1), 39-46.
  • Spielberger, CD, Gorsuch, RL, Lushene, RE and Cubero, NS (1999). STAI: State-Trait Anxiety Questionnaire: Manual. Madrid: TEA Ediciones.
  • Tanja-Dijkstra, K., Pahl, S., White, MP, Andrade, J., Qian, C., Bruce, M.,… Moles, DR (2014). Enhancing dental experiences using distracting virtual reality: a simulation study. PLoS One, 9 (3), 1-11. Doi: http://dx.doi.org.sire.ub.edu/10.1371/journal.pone.0091276
  • Zigmond, AS and Snaith, RP (1983). Hospital scale of anxiety and depression. Acta Psychiatrica Scandinavica, 67, 361-70. (Main reference).

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Manejo del dolor – Bibliografía

Bibliografía

  • Badia X, Muriel C, Gracia A, Núñez-Olarte J, Perulero N, Gálvez R, et al. (2003). Validación española del cuestionario Inventario breve de dolor en pacientes con dolor de causa neoplásica. Med Clin, 120, 52-9
  • Beck, AT, Brown, G, Epstein, N, Steer, RA (1988). An inventory to measure clinical anxiety: psychometric properties. Journal of consulting and clinical psychology, 56, 893-897.
  • Bennett, M. (2001). The LANSS pain scale: the Leeds assessment of neuropathic symptoms and signs, Pain, 92, 147-157.
  • Bouhassira, D., Attal, N., Alchaar, H., Boureau, F., Brochet, B., Bruxelle, J. , Cunin, G., Fermanian, J., Ginies, P., Grun-Overdyking, A., JafariSchluep, H., Lantéri-Minet, L., Laurent, B., Mick, G., Serrie, A., Valade, D., Vicaut, E. (2005). Comparison of pain syndromes associated with nerve or somatic lesions and development of a new diagnostic questionnaire for neuropathic pain (DN4). Pain, 114, 29-36. 10.1016 / j. Pain. 2004.12.010
  • Brown, TA, Di Nardo, PA and Barlow, DH (1994). Interview schedule for anxiety disorders for DSM-IV (ADIS-IV). San Antonio: The Psychological Corporation.
  • Cabas Hoyos, Kattia; Cárdenas López, Georgina; Gutiérrez Maldonado, José; Ruiz Esquivel, Fernanda; Torres Villalobos, Gonzalo; (2015). Clinical use of virtual reality for distraction and reduction of postoperative pain in adult patients. Tesis Psicológica, July-December, 38-50.
  • Carlsson, AM (1983). Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain, 16, 87-101.
  • Cid, J., Acuña, JP, Andrés, J., Díaz, J., and Gómer-Caro, L. (2014) What and how to assess the chronic pain patient? Assessment of the patient with chronic pain. RDO. MEDICINE. CLIN. CONDES, 25 (4), 687-697.
  • Freynhagen, R., Baron, R., Gockel, U. and Tölle, TR (2006). Pain DETECT: a new screening questionnaire to identify neuropathic components in patients with back pain. Current Medical Opinion and Research, 22 (10), 1911-1920.
  • Garcia-Palacios, A., Hoffman, HG, Richards, TR, Siebel, EJ, and Sharar, SR (2007). Use of virtual reality distraction to reduce claustrophobia symptoms during a simulated magnetic resonance imaging brain scan: a case report. CyberPsychology & Behavior, 10 (3), 485-488. doi: 10.1089 / cpb. 2006.9926
  • Gold, JI, Kant, AJ, Kim, SH, and Rizzo, AS (2005). Virtual anesthesia: the use of virtual reality to distract pain during acute medical interventions. Seminars in Anesthesia, Perioperative Medicine, and Pain, 24 (4), 203-210. https://doi-org.sire.ub.edu/10.1053/j.sane.2005.10.005.
  • Hamilton M. (1959). The assessment of anxiety states by rating. Br J Med Psychology; 32, 50-55. http://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf
  • Jones, T., Moore, T., & Choo, J. (2016). The impact of virtual reality on chronic pain. PLoS ONE, 11 (12), 1-10.
  • Julian, LJ (2011) Measures of ansiedad. Arthritis Care Res (Hoboken), 63 (11). doi: 10.1002 / acr. 20561
  • Kato, J., Agalave, NM, and Svensson, CI (2016). Pattern recognition receptors in chronic pain: mechanisms and therapeutic implications. European journal of pharmacology, 788, 261-273. http://doi.org.sire.ub.edu/10.1016/j.ejphar.2016.06.039.
  • Krause, SJ and Backonja, M. (2003). Development of a neuropathic pain questionnaire. Clin J Pain, 19, 306-14.
  • Melzack R and Torgerson WS. (1971). On the language of pain. Anesthesiology, 34 (1), 50-59.
  • Melzack, R. and Wall, PD (1965). Mechanisms of pain: a new theory. Science, 150 (3699), 971-979.
  • Monsalve V, Soriano J and De Andrés J (2006). Usefulness of the Lattinen Index (IL) in the assessment of chronic pain: relationships with coping and quality of life. Rev Soc Esp Dolor, 13, 216-29.
  • Ríos, EM, Herrera, RA, and Rojas AG (2014). Dental anxiety: assessment and treatment. Advances in Odontostomatology, 30 (1), 39-46.
  • Spielberger, CD, Gorsuch, RL, Lushene, RE and Cubero, NS (1999). STAI: State-Trait Anxiety Questionnaire: Manual. Madrid: TEA Ediciones.
  • Tanja-Dijkstra, K., Pahl, S., White, MP, Andrade, J., Qian, C., Bruce, M.,… Moles, DR (2014). Enhancing dental experiences using distracting virtual reality: a simulation study. PLoS One, 9 (3), 1-11. Doi: http://dx.doi.org.sire.ub.edu/10.1371/journal.pone.0091276
  • Zigmond, AS and Snaith, RP (1983). Hospital scale of anxiety and depression. Acta Psychiatrica Scandinavica, 67, 361-70. (Main reference).

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Attention Training – Recommendations

Recommendations for use

The “Attention Training” environment can be used with patients who have to go through a painful intervention or have to undergo a  process that causes them mild anxiety such as an intervention at the dentist, removal of a cast…

Managing the focus of attention can actually decrease the adverse feeling and help in the management of mild anxiety.

The healthcare professional should explain to the patient that the environment consists of a game and encourage him to be immersed in the environment of tranquility, without thinking of anything else. Disconnecting from reality to try to achieve the goals required in the game, progress and earn rewards.

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Entrenamiento de la atención – Recomendaciones

Recomendaciones de uso

El entorno de “Entrenamiento de Atención” se puede utilizar con pacientes que tienen que pasar por una intervención dolorosa o tienen que pasar por un proceso que les genera una leve ansiedad como una intervención en el dentista, retiro de un yeso…

Manejar el foco de atención en realidad puede disminuir las emociones desagradables y ayudar en el manejo de la ansiedad leve.

El profesional de la salud debe explicar al paciente que el entorno consiste en un juego y animarle a que se sumerja en el entorno de tranquilidad, sin pensar en nada más. Desconectarse de la realidad para intentar alcanzar las metas requeridas en el juego, progresar y ganar recompensas.