Intervención desde el enfoque cognitivo comportamental en una paciente con trastorno de estrés postraumático en comorbilidad con distimia y trastorno de personalidad dependiente: un estudio de caso
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Fecha
2024
Autores
Acosta Bolívar, Lucia Margarita
Sarmiento Castillo, Katleen
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Ediciones Universidad Simón Bolívar
Facultad de Ciencias Jurídicas y Sociales
Facultad de Ciencias Jurídicas y Sociales
Resumen
El trastorno de estrés postraumático (TEPT) es uno de los trastornos de mayor prevalencia a nivel mundial que aflige a millones de personas. El presente estudio de caso tuvo como objetivo describir el proceso de intervención desde el enfoque cognitivo comportamental en una paciente con diagnóstico principal de Trastorno de Estrés Postraumático (TEPT), en comorbilidad con Trastorno Depresivo Persistente (Distimia) y Rasgos del Trastorno de la Personalidad Dependiente. Se desarrollaron nueve (9) sesiones durante el proceso de atención, comprendidas inicialmente por la evaluación clínica, posteriormente por la recopilación de información, así como el diseño y plan de intervención y finalmente, el análisis de los resultados. Se utilizaron varias técnicas de evaluación tales como la entrevista clínica y autorregistros de situaciones, pensamiento, emoción, conducta y consecuencia. Así mismo, de escalas de evaluación psicométrica como: El inventario de Ansiedad de Beck (BAI), Inventario de Depresión de Beck (BDI-2) y Cuestionario de Esquemas - segunda edición (YSQ-L2). En el proceso de intervención se utilizaron técnicas cognitivas, conductuales y algunas técnicas emocionales. Dentro de las técnicas cognitivas se destacan la psicoeducación, el diálogo socrático y la reestructuración cognitiva, y dentro de las técnicas conductuales destaca el entrenamiento en comunicación asertiva, entrenamiento en relajación muscular progresiva de Jacobson y entrenamiento en respiración diafragmática, la programación de actividades placenteras con dominio y agrado. Así como la exposición simbólica a estímulos temidos. Finalmente, se intervino con una técnica emocional conocida como “la silla vacía”. Así mismo, se realizó al final de la intervención psicoeducación en esquemas maladaptativos tempranos a través de la lectura y análisis del capítulo “Trampas vitales” de Jeffrey Young. En los resultados se logró evidenciar la estabilización del estado de ánimo en la paciente, mediante la activación conductual se incrementaron la realización de actividades placenteras, aumento del nivel de autonomía al iniciar un emprendimiento lo que a su vez impactó de forma positiva en su autoeficacia. Así mismo, se logró la reducción de la intensidad, frecuencia y duración de las respuestas de ansiedad a nivel cognitivo, conductual, fisiológico y emocional, la mejora de los hábitos de higiene del sueño, exposición a algunos estímulos que generaban temor, como realización de exámenes médicos y consumo de medicamentos, modificación de algunos pensamientos automáticos negativos asociados a minusvalía y desesperanza, desarrollo positivo de las relaciones interpersonales con amigos y familia a través de establecimiento de límites y comunicarse de manera asertiva. Por otro lado, se destaca una buena alianza/vínculo terapéutico, lo cual fue pieza clave para el éxito en las siguientes etapas de la intervención. Los resultados expuestos hasta aquí muestran cómo desde el modelo cognitivo comportamental se pueden desarrollar prácticas de intervención clínica basadas en la evidencia científica, dando respuesta y apoyando la efectividad de este modelo. Lo anterior, puede ayudar a otros profesionales de la salud mental a contar con una orientación y norte para la intervención de casos similares y también, generar procesos de promoción de la salud mental y prevención de psicopatologías.
Post-traumatic stress disorder (PTSD) is one of the most prevalent disorders worldwide, afflicting millions of people. The present case study aimed to describe the intervention process from the cognitive-behavioral approach in a patient with a primary diagnosis of Posttraumatic Stress Disorder (PTSD), in comorbidity with Persistent Depressive Disorder (Dysthymia) and Traits of Dependent Personality Disorder. Nine (9) sessions were developed during the care process, comprised initially by the clinical assessment, subsequently by the collection of information, as well as the design and intervention plan and finally, the analysis of the results. Several evaluation techniques were used, such as clinical interview and self-registers of situations, thought, emotion, behavior and consequence. Also, psychometric evaluation scales such as: The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-2) and Schema Questionnaire - second edition (YSQ-L2). Cognitive, behavioral and some emotional techniques were used in the intervention process. Cognitive techniques included psychoeducation, Socratic dialogue and cognitive restructuring, and behavioral techniques included assertive communication training, Jacobson's progressive muscle relaxation training and diaphragmatic breathing training, programming of pleasurable activities with mastery and pleasure. As well as symbolic exposure to feared stimuli. Finally, an emotional technique known as "the empty chair" was used. Also, at the end of the intervention, psychoeducation in early maladaptive schemas was carried out through the reading and analysis of the chapter "Life Traps" by Jeffrey Young. The results showed the stabilization of the patient's mood, through behavioral activation increased the performance of pleasurable activities, increased the level of autonomy when starting an undertaking, which in turn had a positive impact on her self-efficacy. Likewise, there was a reduction in the intensity, frequency and duration of anxiety responses at the cognitive, behavioral, physiological and emotional levels, improvement of sleep hygiene habits, exposure to some stimuli that generated fear, such as medical examinations and medication consumption, modification of some negative automatic thoughts associated with handicap and hopelessness, positive development of interpersonal relationships with friends and family through the establishment of limits and assertive communication. On the other hand, a good alliance/therapeutic bond is highlighted, which was key to success in the following stages of the intervention. The results presented so far show how the cognitive-behavioral model can be used to develop clinical intervention practices based on scientific evidence, providing answers and supporting the effectiveness of this model. This can help other mental health professionals to have an orientation and guidance for the intervention of similar cases and also to generate processes of mental health promotion and prevention of psychopathology.
Post-traumatic stress disorder (PTSD) is one of the most prevalent disorders worldwide, afflicting millions of people. The present case study aimed to describe the intervention process from the cognitive-behavioral approach in a patient with a primary diagnosis of Posttraumatic Stress Disorder (PTSD), in comorbidity with Persistent Depressive Disorder (Dysthymia) and Traits of Dependent Personality Disorder. Nine (9) sessions were developed during the care process, comprised initially by the clinical assessment, subsequently by the collection of information, as well as the design and intervention plan and finally, the analysis of the results. Several evaluation techniques were used, such as clinical interview and self-registers of situations, thought, emotion, behavior and consequence. Also, psychometric evaluation scales such as: The Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-2) and Schema Questionnaire - second edition (YSQ-L2). Cognitive, behavioral and some emotional techniques were used in the intervention process. Cognitive techniques included psychoeducation, Socratic dialogue and cognitive restructuring, and behavioral techniques included assertive communication training, Jacobson's progressive muscle relaxation training and diaphragmatic breathing training, programming of pleasurable activities with mastery and pleasure. As well as symbolic exposure to feared stimuli. Finally, an emotional technique known as "the empty chair" was used. Also, at the end of the intervention, psychoeducation in early maladaptive schemas was carried out through the reading and analysis of the chapter "Life Traps" by Jeffrey Young. The results showed the stabilization of the patient's mood, through behavioral activation increased the performance of pleasurable activities, increased the level of autonomy when starting an undertaking, which in turn had a positive impact on her self-efficacy. Likewise, there was a reduction in the intensity, frequency and duration of anxiety responses at the cognitive, behavioral, physiological and emotional levels, improvement of sleep hygiene habits, exposure to some stimuli that generated fear, such as medical examinations and medication consumption, modification of some negative automatic thoughts associated with handicap and hopelessness, positive development of interpersonal relationships with friends and family through the establishment of limits and assertive communication. On the other hand, a good alliance/therapeutic bond is highlighted, which was key to success in the following stages of the intervention. The results presented so far show how the cognitive-behavioral model can be used to develop clinical intervention practices based on scientific evidence, providing answers and supporting the effectiveness of this model. This can help other mental health professionals to have an orientation and guidance for the intervention of similar cases and also to generate processes of mental health promotion and prevention of psychopathology.
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Palabras clave
Diagnóstico, Intervención, Adultos, Salud mental, Modelo cognitivo comportamental, Distimia, Estrés postraumático, Personalidad, Dependencia
