Intervención comportamental-cognitiva en un caso de trastorno por estrés postraumático
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Fecha
2024
Autores
Niño Cordón, Karen Yurley
González Ortega, Jesús David
García Uzcátegui, Florencio Luciano
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias Jurídicas y Sociales
Facultad de Ciencias Jurídicas y Sociales
Resumen
El trastorno por estrés postraumático (TEPT) es un tipo de trastorno de ansiedad que se relaciona con alteraciones cerebrales funcionales y fisiológicas. Este trastorno tiene un impacto significativo en la atención, la memoria y el autocontrol, y se manifiesta a través de comportamientos evitativos, pensamientos angustiantes, flashbacks o reexperimentación de eventos traumáticos, y agitación fisiológica propia de la ansiedad. Los reportes indican que el TEPT afecta negativamente tanto la salud mental como la física de la persona, generando malestar en contextos laborales, familiares y sociales. Se ha reconocido la necesidad de intervenciones psicoterapéuticas, especialmente desde la perspectiva de la psicoterapia cognitiva. Además, estudios han demostrado que las terapias de tercera generación basadas en Mindfulness pueden ser efectivas para reducir los síntomas del TEPT. Estas terapias han llevado a la aceptación y superación de la evitación experiencial en pacientes afectados.
En un caso específico, se intervino con una mujer de 18 años, hospitalizada en una clínica psiquiátrica. Durante 15 sesiones, se utilizaron técnicas de psicoeducación, reestructuración cognitiva y exposición emocional. La valoración psicológica incluyó la operacionalización del motivo de consulta, análisis sincrónico y diacrónico, y la exploración de contextos de funcionamiento. Los hallazgos revelaron evidencias de anhedonia, pensamientos intrusivos relacionados con el abuso, sueños recurrentes sobre el abuso, sensación de dificultad para respirar y déficit en habilidades sociales. La evaluación diacrónica también señaló el consumo de psicoactivantes a los 15 años, el duelo por el fallecimiento de un hermano menor y la inserción en un sistema de responsabilidad penal para adolescentes.
Post-traumatic stress disorder is part of the anxiety disorders, and is associated with functional and physiological brain alterations, showing impact on attention, memory and self-control, as well as manifestations of avoidant behavior, distressing thoughts, flashbacks or re-experiencing and physiological agitation. typical of anxiety. Reports conclude that post-traumatic stress disorder negatively impacts the mental and physical health of the person, causing discomfort in the work, family and social context, which has raised the need for psychotherapeutic interventions, generally from cognitive psychotherapy. Likewise, other studies related to therapeutic effectiveness have reported success of third-generation Mindfulness-based therapies in reducing the symptoms of post-traumatic stress disorder (Wagner & Cáceres Melillo, 2023), leading to acceptance and expiration of experiential avoidance.The intervention was carried out on an 18-year-old woman, hospitalized in a psychiatric clinic, with a secondary school education, single, of Catholic religion, who was operated on during 15 sessions using psychoeducation techniques, cognitive restructuring and emotional exposure. The psychological assessment involved operationalization of the reason for consultation, synchronic and diachronic analysis, contexts of functioning from the clinical case formulation model, finding as findings in the synchronic analysis evidence that indicates that the client has presented anhedonia, intrusive thoughts about abuse, recurring dreams about abuse, feeling of not being able to breathe, deficits in social skills. From the diachronic evaluation, it is concluded that the consultant: consumption of psychoactive substances at the age of 15, mourning the death of a younger brother, insertion for 3 months in the criminal liability system for adolescents for a crime against the person. Regarding the degree of affectation in the consultant, physical, emotional, cognitive and social effects were reported; strong tendency or impulse to want to control and/or regulate them through self-harm; physical, emotional, cognitive and social effects. It increases the feeling of feeling constant worry, fear, dread; and physical, emotional, cognitive and social effects. She tends to perceive the same challenges as insurmountable, increasing the belief of not being able to endure and/or overcome the difficulties that arise. From the intervention, significant decreases were found in indicators of anxiety and depression measured with the HAD Scale, reaching in the case of depression the remission of symptoms, while, in anxiety, despite the significant decrease, the remission was not yet achieved. decrease below the cut-off point. The findings give evidence of the need to develop clinical protocols with a greater number of sessions, or contrasting therapeutic effects from different methods and techniques, demonstrating greater effectiveness. The case addressed becomes relevant by noting the psychological impact of post-traumatic stress disorder, which shows an association with physiological deregulation of the cerebral cortex and other psychosomatic symptoms, recognizing that there are validated methods that allow the improvement of the quality of life of patients, especially in behavior modification and cognitive restructuring treatments. This case study adds to the line of specialization in clinical psychology aimed at behavioral therapy, also reflecting the need to explore and validate other methods from the same psychological paradigm as third generation therapies, including acceptance and commitment therapy, psychotherapy. functional analytic, and dialectical behavioral therapy. It is expected that studies will continue with larger sample sizes and contrast between different intervention methodologies
Post-traumatic stress disorder is part of the anxiety disorders, and is associated with functional and physiological brain alterations, showing impact on attention, memory and self-control, as well as manifestations of avoidant behavior, distressing thoughts, flashbacks or re-experiencing and physiological agitation. typical of anxiety. Reports conclude that post-traumatic stress disorder negatively impacts the mental and physical health of the person, causing discomfort in the work, family and social context, which has raised the need for psychotherapeutic interventions, generally from cognitive psychotherapy. Likewise, other studies related to therapeutic effectiveness have reported success of third-generation Mindfulness-based therapies in reducing the symptoms of post-traumatic stress disorder (Wagner & Cáceres Melillo, 2023), leading to acceptance and expiration of experiential avoidance.The intervention was carried out on an 18-year-old woman, hospitalized in a psychiatric clinic, with a secondary school education, single, of Catholic religion, who was operated on during 15 sessions using psychoeducation techniques, cognitive restructuring and emotional exposure. The psychological assessment involved operationalization of the reason for consultation, synchronic and diachronic analysis, contexts of functioning from the clinical case formulation model, finding as findings in the synchronic analysis evidence that indicates that the client has presented anhedonia, intrusive thoughts about abuse, recurring dreams about abuse, feeling of not being able to breathe, deficits in social skills. From the diachronic evaluation, it is concluded that the consultant: consumption of psychoactive substances at the age of 15, mourning the death of a younger brother, insertion for 3 months in the criminal liability system for adolescents for a crime against the person. Regarding the degree of affectation in the consultant, physical, emotional, cognitive and social effects were reported; strong tendency or impulse to want to control and/or regulate them through self-harm; physical, emotional, cognitive and social effects. It increases the feeling of feeling constant worry, fear, dread; and physical, emotional, cognitive and social effects. She tends to perceive the same challenges as insurmountable, increasing the belief of not being able to endure and/or overcome the difficulties that arise. From the intervention, significant decreases were found in indicators of anxiety and depression measured with the HAD Scale, reaching in the case of depression the remission of symptoms, while, in anxiety, despite the significant decrease, the remission was not yet achieved. decrease below the cut-off point. The findings give evidence of the need to develop clinical protocols with a greater number of sessions, or contrasting therapeutic effects from different methods and techniques, demonstrating greater effectiveness. The case addressed becomes relevant by noting the psychological impact of post-traumatic stress disorder, which shows an association with physiological deregulation of the cerebral cortex and other psychosomatic symptoms, recognizing that there are validated methods that allow the improvement of the quality of life of patients, especially in behavior modification and cognitive restructuring treatments. This case study adds to the line of specialization in clinical psychology aimed at behavioral therapy, also reflecting the need to explore and validate other methods from the same psychological paradigm as third generation therapies, including acceptance and commitment therapy, psychotherapy. functional analytic, and dialectical behavioral therapy. It is expected that studies will continue with larger sample sizes and contrast between different intervention methodologies
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Palabras clave
Trastorno por estrés postraumático, Psicoterapia, Terapia cognitivo-conductual, Trastornos de ansiedad, Post-traumatic stress disorder, Psychotherapy, Cognitive-behavioral therapy, Anxiety disorders