Azucena García-Palacios’s research while affiliated with University of Zaragoza and other places

Family members of people with Borderline Personality Disorder (BPD) often experience high levels of psychological symptoms such as depression, anxiety, or burden. Family Connections (FC) is a pioneer program designed for relatives of people with BPD, and it is the most empirically supported treatment thus far. The aim of this study was to carry out a randomized clinical trial to confirm the differential efficacy of FC versus an active treatment as usual (TAU) in relatives of people with BPD in a Spanish population sample. The sample consisted of 121 family members (82 family units) and a total of 82 patients who participated in a two‐arm randomized controlled trial (RCT). The primary outcome was burden of illness. Secondary outcomes were depression, anxiety, stress, family empowerment, and quality of life. This is the first study to evaluate relatives and patients in an RCT design comparing two active treatment conditions of similar durations. Although no statistically significant differences were found between conditions. However, the adjusted posttest means for FC were systematically better than for TAU, and the effect sizes were larger in burden, stress, depression, family functioning, and quality of life in the FC intervention. Patients of caregivers who received the FC condition showed statistically significant improvements in stress, depression, and anxiety. Results indicated that FC helped both patients and relatives pointing to the importance of involving families of patients with severe psychological disorders.

This article presents a case study of a 31‐year‐old woman with a dual diagnosis of Borderline Personality Disorder (BPD) and Eating Disorder Not Otherwise Specified (EDNOS). Paula received a 12‐month Dialectical Behavior Therapy (DBT) outpatient treatment. DBT is considered a transdiagnostic treatment approach to address emotion dysregulation, which shifts the therapy focus traditionally placed only on behavioral change toward including also validation and acceptance and dialectical strategies. DBT addresses eating symptomatology as a dysfunctional form of emotional regulation and has shown promising results regarding its efficacy for the treatment of BPD and EDNOS comorbidity. Given the growing evidence, a standard DBT treatment plan was developed for this case. Specifically, pretreatment and phase 1 of the DBT program are described. During pretreatment and phase 1, individual therapy aims to improve and maintain client's motivation to change and engage in treatment, as well as to establish and prioritize treatment goals. As for group therapy, the main goal of the skills training in DBT is to enhance individual's capability by increasing skillful behavior (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness skills). Paula received 24 weekly skills training sessions over a year. The results after a 12‐month standard DBT treatment showed that Paula no longer met criteria for BPD, she had a significant decrease in difficulties in emotional regulation and impulsiveness and in EDNOS symptomatology. This case study may enhance learning about how to apply a transdiagnostic treatment to address BPD and EDNOS together in clinical practice.

Background One of the obstacles to seeking help for suicide is its social stigma. The literature suggests that suicide knowledge could impact this stigma. The present study aims to examine levels and predictors of suicide stigma and suicide literacy among Spanish‐speaking individuals from Spain and Latin America. Method A total of 678 adults completed an online survey conducted from December 2021 to May 2022. The survey assessed sociodemographic and clinical variables, including the Literacy of Suicide Scale (LOSS‐SF) and Stigma of Suicide Scale (SOSS‐SF). Results Results showed the presence of stigmatization and a moderate level of suicide literacy. Latin Americans presented significantly more stigmatizing attitudes and lower levels of suicide literacy than Spaniards. Older age and stronger religious/spiritual beliefs were correlated with lower suicide literacy. Suicide stigma was regressed on lower suicide literacy, gender (men), stronger religious/spiritual beliefs, and lacking knowledge about how to find help. Furthermore, the region was significantly associated with the suicide glorification subscale, reporting Latin Americans' greater glorification. Conclusions By examining these factors, we aim to foster a deeper understanding of the attitudes and beliefs toward suicide. This understanding is crucial, as it may inform the development of effective interventions and prevention strategies that are culturally sensitive and tailored to diverse populations.

Augmented Reality (AR) is helpful for overcoming the challenges of in vivo exposure therapy for Specific Phobia (SP). Specifically, Projection-based AR exposure therapy (P-ARET) allows the individual to face the feared animal without intrusive hardware, the phobic stimulus can be controlled, and it can maximize “variability”, producing a positive effect in the generalization of the results. The goal of this work is to assess the feasibility of P-ARET for SP, comparing multiple stimuli (MS) versus single stimulus (SS) conditions and evaluating the participants’ user experience. Adherence to a daily monitoring app (Emotional Monitor) and preliminary efficacy of the P-ARET treatment were assessed. Four participants diagnosed with SP of cockroaches (DSM-5) were randomly assigned to different baselines. Episodic and daily evaluations were performed. Participants considered the MS condition more aversive but more effective than the SS condition. Adherence to the mobile app was 83% for three participants and 55% for the remaining person. Analyses of non-overlap of all pairs and changes in the functionality levels showed a decrease in the SP symptoms at post-treatment and follow-ups. This study offers preliminary feasibility results for a novel form of P-ARET to treat participants with cockroach phobia, which may also apply to other phobias.

Background Improving mental health within correctional facilities, specifically to address self-harm behaviors, is a crucial endeavor. However, significant challenges arise when implementing evidence-based programs within this complex setting. Despite these hurdles, the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program has garnered recognition, notably in the United States, for its efficacy in tackling such issues. This study aimed to examine inmate profiles in prisons located in Catalonia, Spain, and to investigate the STEPPS program's effectiveness and implementation process. Method Forty-one inmates participated in the study and completed measures covering self-harm behaviors, emotion regulation, impulsivity, mental health symptoms, and satisfaction with the intervention. Twenty-four professionals who implemented the STEPPS program completed satisfaction, normalization process, burnout, acceptability, appropriateness, and feasibility measures. Results The results suggest that the STEPPS program significantly reduced symptoms of emotional dysregulation, motor impulsivity, and compulsive symptomatology among inmates. The intervention was well-received by professionals, and perceived as appropriate and feasible. The perception of feasibility decreased after implementation, likely due to contextual factors such as inmate and organization characteristics. Additionally, professionals remained committed to the implementation, dedicating time and effort to the process and engaging in thorough evaluations, without increasing their levels of burnout. Conclusions These findings deepen the understanding of self-harm behaviors in prisons and demonstrate the effectiveness of the program. However, improvements in the STEPPS program are still necessary to enhance its implementation in this setting. Trial Registration NCT06297460 (ClinicalTrials.gov, retrospectively registered, 2022/01/01).