Background: There is a paucity of research into Cluster C personality disorders, however there is increasing recognition that they are highly prevalent, associated with significant distress and frequently present alongside co-occurring axis I disorders. Research has led to significant progress in the understanding of the psychological mechanisms and has guided the development of evidence based treatment for borderline personality disorder and therefore it is likely that increased focus on Cluster C personality disorders may lead to similar developments. This thesis aimed to examine and evaluate current research on psychological interventions for the treatment of Cluster C personality disorders. It also sought to explore psychological factors involved in the development and maintenance of cluster C personality disorder. Method: A systematic literature review examining the effectiveness of psychological treatments for cluster C personality disorder identified 16 studies. The empirical study recruited individuals identified by clinicians as meeting criteria for Cluster C personality disorders. Participants completed a range of self-report measures of personality psychopathology, interpersonal problems and axis I disorders and a series of interviews exploring adult attachment style, reflective function, autobiographical memories. These were completed at 2 time points, 4 months apart. Participants also provided responses to a semi-structured qualitative interview to gain insight into their beliefs about their difficulties. Additional information was also gained through participants’ psychiatric notes. Results: The systematic review results indicate that psychological interventions are effective in the treatment of cluster C personality disorders however studies generally focused on cognitive behavioural or psychodynamic approaches. There is a lack of clarity over which treatment components are most effective in treating particular features of cluster C personality disorders. The empirical paper identifies no significant changes in personality psychopathology, anxiety and depressive symptoms, interpersonal problems, reflective function and autobiographical memory across time. Participants demonstrated insecure adult attachment styles. Conclusions: Results from the systematic review and empirical study identify a need for more research to explore the complexity of personality psychopathology and co-occurring axis I and axis II disorders. It is also necessary for research to identify psychological factors involved in the development and maintenance of Cluster C personality disorders in order to guide evidence based treatments. The systematic review highlights the need for research to identify the most effective psychological treatments for cluster C personality disorders and to establish which components of treatment are most effective in targeting particular symptoms associated with cluster C personality disorder.

Neuropsychotherapy is a new philosophy in the treatment of mental disorders that bases its principles in the application of the information we have about the brain activations and brain functioning to adjust the therapy to them, in order to center the process in how the brain evolves to its normal activations. New tools in the field of neuroimaging have helped in this process, providing accurate and detailed information about how the particular brain of each patient works. Between the many neuroimaging techniques available nowadays, the functional magnetic resonance (fMRI) stands out by its high spatial resolution, which allows a better knowledge of which brain area is activated before each stimulus or while performing each activity. The disadvantages this technique presents in terms of size of the scanner and restriction of movements give light to another technique, more suitable in certain domains: the electroencephalography (EEG), which provides a greater freedom of movement and higher temporal resolution. For the purposes of this PhD Thesis, both techniques will be compared, in order to find which one better suits our interests. For doing so, another factor will be taken into account. Due to the limitations the neuroimaging techniques have in terms of presentation of the stimuli, we are not able to expose the subject to certain kinds of real life situations. There is where the virtual reality (VR) enters the scene. With VR we are able to move the subject to a virtual world where any kind of stimulus is possible. In the case of neuropsychotherapy, it will allow the exposition of the patient to a situation related to his disorder, in a safer and more controlled environment. In fact, virtual reality has been widely used for the treatment of psychological disorders; but, until now, it has not been applied during the assessment of the disease. For the aims of this Thesis, virtual environments will be used for the assessment of subjects before and after undergoing a psychological treatment for a specific disorder, using neuroimaging techniques to find useful information that could help during the therapeutic process. As an example of disorder, the phobia to small animals (spiders and cockroaches) has been chosen, although the conclusions of this study could be extended to other kinds of psychological disorders. Before being able to assure that the brain activations obtained are related to the disorder and not to other issues, it is needed to measure the sense of presence the subjects felt during the virtual experience. This is why before the assessment of a psychological disorder, a study of the sense of presence in a virtual environment was introduced. This study also helped in the decision of which neuroimaging technique apply in the second part of the Thesis. EEG and fMRI were used for the measure of presence in the same virtual environments, and the results in terms of brain activations were compared. Presence was also measured by means of questionnaires, the traditional subjective way of measuring it. As a result of this study it is expected to check if VR could effectively stimulate presence and which neuroimaging technique is more appropriate for the targets of this Thesis. To sum up, the initial hypotheses of this Thesis are that: 1- The new neuroimaging techniques can provide of useful information to use during neuropsychotherapy. 2- Virtual reality would help in the assessment of the disorder, improving the accuracy in the way the subjects are exposed to the stimuli. 3- The environments used would be immersive enough so the patient will feel present in them and feel them as real. For fulfilling these objectives, each of the two courses of work (study of presence and assessment of a mental disorder) was divided in two parts. In total, four studies were developed: 1- Study of the sense of presence in a virtual environment using fMRI: the aim of this part of the Thesis was to check if the environments were able to stimulate the sense of presence, correlating the results with those given to questionnaires. 2- Study of the sense of presence in a virtual environment using EEG: the aim here was to compare the brain activations obtained with EEG with those from the previous study, and if the responses of the questionnaires were equivalent despite being in a less intrusive scanner. As a result of these two studies, it was decided that the environments were immersive enough to induce the sense of presence, and that the best neuroimaging technique for the next part of the Thesis was the fMRI, due to the higher spatial resolution it brought. 3- Assessment of a psychological disorder, pre-treatment: once decided the study will continue with fMRI, the areas related to a specific disorder (small animals¿ phobia) were studied using VR as stimulus. Until now, the assessment has been done using real animals as stimuli but not using VR, which here is hypothesized to allow a better approach to the phobic experience than the view of photographs or videos of real animals. 4- Assessment of the state of subjects with a psychological disorder, post-treatment: once the patients had underwent a treatment to cure the disorder, they were assessed again to check if the brain areas related to the phobia stopped being activated after it. As a result of this second part of the Thesis, the brain areas related to the phobia (that stopped being activated after the treatment) were obtained, and this information is hoped to be useful in future neuropsychotherapeutic works, for the better adjustment of the disorder. In conclusion, this PhD Thesis studies the advantages that the new neuroimaging techniques and virtual reality could bring to the study of neuropsychotherapy. / Clemente Bellido, M. (2014). Contributions to Neuropsychotherapy of the Combined Use of Neuroimaging and Virtual Exposure for Assessment in Psychological Treatments [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/37234

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Attitudes toward mental illness and the willingness to seek psychological treatment for their children among ethnic minority group parents were investigated. Participants consisted of black, Hispanic, Native American and Asian parents. All parents were given the Terrell and Terrell Cultural Mistrust Inventory, Cohen and Struening Opinions About Mental Illness Scale, Reid-Gundlach Social Services Satisfaction Scale, Fischer-Turner Attitudes Toward Seeking Professional Help Scale, and Ahluwalia Parents' Psychological Help-Seeking Inventory. A multiple regression model was used to explore the purpose of this study. Parental mistrust level, ethnicity, education, income level, and opinions about mental illness served as predictor variables. The criterion variables consisted of scores on the Social Services Satisfaction Scale and Attitudes Toward Seeking Professional Psychological Help Scale. The results indicated that the most significant predictor of psychological help-seeking was parental cultural mistrust level. Parents with higher cultural mistrust levels were less likely to seek help. Education was also predictive of black and Native American parents' help-seeking attitude and willingness to seek psychological help for their children. Black and Native Americans with lower levels of education were less willing to seek treatment for their children than members of those ethnic groups with higher levels of education. Ethnicity was also related to parental willingness to seek help for their children. Hispanic and black parents expressed more willingness to seek help than Native American and Asian parents. Finally, parents' opinions about mental illness were found to be significantly related to help-seeking attitude. Parents with positive opinions about mental illness were more likely to utilize professional psychological help than those parents with negative opinions about mental illness. Some clinical and theoretical implications of these findings are discussed.

The present study sought to determine whether a dietary and multi-element psychological treatment (DMPT) approach in combination with standard medical treatment would offer a more efficacious therapeutic package to irritable bowel syndrome (IBS) patients than would standard medical treatment (SMT) employed alone. The DMPT group (N = 19) received a stress management training package for a 2 week period consisting of relaxation training, imagery, and bowel sound biofeedback training via a stethoscope, in addition to instructions to increase their daily consumption of dietary fiber. They also were to continue the implementation of whatever standard medical treatment they were currently receiving, be it a bulking agent, or anti-anxiety, anti-cholinergic, or anti-depressant medications, etc. The SMT group (N = 19) simply received whatever conventional medical treatment they had been prescribed.

To provide a comprehensive meta-analysis on the efficacy of psychological and medical treatments for binge-eating disorder (BED), including those targeting weight loss. Method: Through a systematic search before March 2018, 81 published and unpublished randomized-controlled trials (RCTs), totaling 7,515 individuals with BED (Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition [DSM–IV] and Fifth Edition [DSM–5]), were retrieved and analyzed using random-effect modeling. Results: In RCTs with inactive control groups, psychotherapy, mostly consisting of cognitive-behavioral therapy, showed large-size effects for the reduction of binge-eating episodes and abstinence from binge eating, followed by structured self-help treatment with medium-to-large effects when compared with wait-list. Pharmacotherapy and pharmacological weight loss treatment mostly outperformed pill placebo conditions with small effects on binge-eating outcome. These results were confirmed for the most common treatments of cognitive-behavioral therapy, self-help treatment based on cognitive-behavioral therapy, and lisdexamfetamine. In RCTs with active control groups, there was limited evidence for the superiority of one treatment category or treatment. In a few studies, psychotherapy outperformed behavioral weight loss treatment in short- and long-term binge-eating outcome and led to lower longer-term abstinence than self-help treatment, while combined treatment revealed no additive effect on binge-eating outcome over time. Overall study quality was heterogeneous and the quality of evidence for binge-eating outcome was generally very low. Conclusions: This comprehensive meta-analysis demonstrated the efficacy of psychotherapy, structured self-help treatment, and pharmacotherapy for patients with BED. More high quality research on treatments for BED is warranted, with a focus on long-term maintenance of therapeutic gains, comparative efficacy, mechanisms through which treatments work, and complex models of care.

Este trabajo de investigación, consiste en crear un servicio innovador, rentable y accesible al público objetivo. De acuerdo al análisis e investigación de mercado realizado a un grupo de padres de familia, que tienen hijos entre los 6 y 12 años de edad. Logramos identificar, que unos de los problemas por los que atraviesan en estos momentos de pandemia, es el déficit de atención, estrés, ansiedad y falta de atención de sus menores hijos, adicional a estos problemas, está el miedo por parte del padre de familia en poder trasladarse a un consultorio clínico y solicitar tratamientos con un especialista, ya que se corre el riesgo de contagio de La Covid-19. Por todos estos resultados arrojados en la investigación, nace MENTESANA, un servicio dirigido a nuestro público objetivo padres de familia con hijos menores que tienen problemas psicológicos. MENTESANA ofrece un servicio de asesoría psicológica infantil de niños de 6 a 12 años de manera virtual, asignando psicólogos profesionales de manera personalizada, analizando el perfil psicológico de tu niño e identificando el problema, para luego brindar la terapia correspondiente. Para desarrollar este proyecto nos juntamos 5 compañeros aportando cada uno de nosotros nuestra experiencia educativa y laboral. La rentabilidad que ofrece el proyecto es de 22.60%. Asimismo, el proyecto requiere una inversión total de S/. 28,946.00 soles, de los cuales el 30% es capital propio y el 70% es préstamo financiero. El TIR nos arroja una rentabilidad proyectada del 170% y el retorno de nuestra inversión está en 1.27 años. / This research work consists of creating an innovative, profitable, and accessible service to the target audience. According to market research analysis and research conducted on a group of parents, who have children between 6 and 12 years old. We were able to identify that one of the problems they are going through at this time of pandemic, is the attention deficit, stress, anxiety and interest of attention of the minor children, in addition to these problems, there is the fear on the part of the family parent to be able to move to a clinical office and request treatments with specialist, as there is a risk of contagion of Covid-19. For all their results yielded in the research, MENTESANA is born, a service aimed at our target audience of parents with minor children who have psychological problems. MENTESANA offers a child psychological counseling virtual service for children from 6 to 12 years old, assigning professional psychologists in a personalized way, analyzing the psychological profile of your child, and identifying the problem, to then provide the corresponding therapy. To develop this project, we joined 5 colleagues contributing each of us our educational and work experience. The profitability offered by the project is 22.60%. The project also requires a total investment of S/. 28,946.00 soles, of which 30% is equity and 70% is financial loan. The IRR gives us a projected return of 170% and the return on our investment is at 1.27 years. / Trabajo de investigación