Resumen de Teràpia sistèmica breu integrada (tsbi) en l’atenció primària. Exploració de la seva efectivitat amb pacients i metges de capçalera
The general purpose of this article-based thesis is to examine the Integrated Brief Systemic Therapy (IBST)’ effectiveness both for (a) patients and (b) general practitioners (GPs), in primary care. The IBST is challenging, comprehensive, integrative and research-informed approach. It aggregates three post-structuralist models of brief therapy models that are well-known separately (from a clinical perspective) but still lack of solid empirical evidence. We focused in in primary care because it is where the evidence-based psychotherapies are especially scarce and the IBST (form our point of view) has a great potential.
The evaluation of interventions’ effectiveness took place with high ecological validity standards; they were also carried out within a Collaborative Care Models (CCMs) framework. Through our thesis, we conducted two main quasi-experimental studies, both with two non-randomised groups; pre and post-intervention measurements were registered among studies’ participants.
Results: (a) in our first study we tested the potential of IBST as an effective and efficient treatment in a public mental health setting, by comparing it to Cognitive-Behavioural Therapy (CBT) in routine clinical outpatient practice. The results showed that both therapy models were found to be (in general) equivalent in treatment outcome measures (in terms of the percentage of therapeutic discharges, drop-outs, relapses and the use of other mental health services during the follow-up period). The similarity between the groups was also confirmed when analyzing the data through the psychiatric diagnosis. Nonetheless, in our sample the IBST did not prove to be any shorter than CBT. (b) In the second study, we investigated the effectiveness of a multimodal training programme (MTP) with an IBST approach to improve GPs’ levels of burnout, job satisfaction and psychological well-being. We first evaluated the indicators relating to how GPs managed their mental-health patients. The results obtained indicated that MTP, when compared with the routine clinical mental health support programme for primary care, produced statistically significant improvements in certain administrative health parameters, but not in opinions and attitudes toward mental illness. Secondly, regarding the GPs management of their own burnout, job satisfaction and psychological well-being, the MTP participants showed better scores on global psychopathological state and better evolution of work satisfaction. Psychopharmacology use dropped in both groups; in contrast, the MTP did not improve burnout levels.
Our general results auspices a potential for ISBST in primary care for both collectives. Nonetheless, we are still far from concluding that ISBT has a robust effectiveness in primary care or in other clinical domains.
