{"id":2360,"date":"2021-11-25T14:38:11","date_gmt":"2021-11-25T14:38:11","guid":{"rendered":"https:\/\/practicalhealthpsychology.com\/?p=2360"},"modified":"2025-11-04T14:06:19","modified_gmt":"2025-11-04T14:06:19","slug":"helping-patients-manage-their-condition-illness-representations-matter","status":"publish","type":"post","link":"https:\/\/practicalhealthpsychology.com\/es\/2021\/11\/helping-patients-manage-their-condition-illness-representations-matter\/","title":{"rendered":"Ayudar a los pacientes a gestionar su enfermedad: Las representaciones de la enfermedad importan"},"content":{"rendered":"<p><strong>Por Yael Benyamini, Universidad de Tel Aviv, Israel y Evangelos C. Karademas, Universidad de Creta, Grecia<\/strong><\/p>\n<p><span style=\"font-weight: 400;\">Anna y Mary son dos mujeres sanas de 45 a\u00f1os que viven en una gran ciudad europea. Cada una de ellas conoce a varias personas que han contra\u00eddo COVID-19 y oyen y lee constantemente sobre esta cuesti\u00f3n. Anna cree que es una enfermedad muy grave y le preocupa mucho que, si la contrae, aunque cree que dada su edad se recuperar\u00e1, probablemente sufrir\u00e1 s\u00edntomas molestos a largo plazo. Trabaja desde casa en la medida de lo posible, nunca sale a la calle sin mascarilla y est\u00e1 esperando la siguiente dosis de vacunaci\u00f3n. <\/span><\/p>\n<p><!--more--><\/p>\n<p><span style=\"font-weight: 400;\">Mary cree que la COVID-19 es &#8220;la gripe con buenas relaciones p\u00fablicas&#8221;. A su edad, y sin problemas m\u00e9dicos subyacentes, cree que, aunque la contraiga, lo m\u00e1s probable es que no sienta mucho o, en el peor de los casos, que pase unos d\u00edas en casa, sinti\u00e9ndose como cuando est\u00e1 resfriada. Se cruza con mucha gente en el trabajo y en eventos sociales y s\u00f3lo lleva mascarilla cuando es absolutamente necesario. No ve ninguna raz\u00f3n para vacunarse y teme sus efectos secundarios.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Anna y Mary comparten una caracter\u00edstica com\u00fan. Aunque no ven las cosas de la misma manera, ambas intentan dar sentido a la misma situaci\u00f3n amenazante. Cuando nos enfrentamos a una amenaza para la salud, ya sea el COVID-19, una enfermedad card\u00edaca, un dolor en las articulaciones o cualquier otro problema, todos recopilamos informaci\u00f3n sobre ella a partir de nuestras propias sensaciones corporales, nuestra historia personal, el resto de personas que nos rodea y los medios de comunicaci\u00f3n. Nuestro objetivo es formar una historia coherente de la enfermedad. Para ello, intentamos averiguar y combinar cinco componentes principales de la percepci\u00f3n de la enfermedad o representaci\u00f3n de la misma: <\/span><b>su identidad, las causas, las consecuencias, la cronolog\u00eda y la capacidad de curar o controlar la enfermedad<\/b><span style=\"font-weight: 400;\">.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00bfImporta lo que pensamos sobre la enfermedad? Aunque nuestras representaciones de la enfermedad no sean m\u00e9dicamente exactas, determinar\u00e1n c\u00f3mo nos sentimos y qu\u00e9 haremos al respecto: c\u00f3mo afrontaremos la enfermedad, qu\u00e9 haremos para prevenir los s\u00edntomas, c\u00f3mo controlarla o curarla, o integrarla en nuestra vida, si es posible. Los estudios han demostrado que las representaciones negativas de la enfermedad (por ejemplo, la percepci\u00f3n de que la enfermedad es muy amenazante, duradera o incontrolable\/imposible de tratar) est\u00e1n relacionadas con las conductas de afrontamiento y con resultados como una peor calidad de vida, una recuperaci\u00f3n m\u00e1s lenta de la enfermedad y un peor estado funcional en varias enfermedades, como el c\u00e1ncer o la diabetes.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400;\">Como profesionales, deber\u00edamos preguntar a los pacientes sobre su percepci\u00f3n sobre la enfermedad que padecen, o de la que corren el riesgo de padecer, sin juzgarlos. Podr\u00edamos preguntarles simplemente qu\u00e9 piensan de su enfermedad con sus propias palabras; qu\u00e9 creen que la ha causado o cu\u00e1les son los s\u00edntomas m\u00e1s preocupantes; si su tratamiento funciona o qu\u00e9 hacen para afrontar o gestionar la enfermedad. Incluso podemos pedirles que dibujen su enfermedad, ya que el dibujo puede revelar mucho sobre lo que piensan y sienten al respecto. No se suele preguntar a los pacientes sobre su propia visi\u00f3n, pero la mayor\u00eda de las veces est\u00e1n abiertos a esa discusi\u00f3n. Indagar sobre las representaciones de los pacientes tambi\u00e9n es importante para los m\u00e9dicos u otros proveedores de atenci\u00f3n sanitaria, ya que comprender y abordar las opiniones de los pacientes sobre su enfermedad y su relaci\u00f3n con el comportamiento (por ejemplo, el cumplimiento de los consejos) puede facilitar la adaptaci\u00f3n de los pacientes. Por ejemplo, ayudar a Mar\u00eda a darse cuenta de que los posibles efectos secundarios de la vacuna no son comparables al impacto real del COVID-19, en caso de que lo contraiga, tambi\u00e9n podr\u00eda ayudarla a cambiar su decisi\u00f3n inicial sobre la vacunaci\u00f3n. Este puede ser un primer paso hacia una intervenci\u00f3n individual o de grupo m\u00e1s sistem\u00e1tica, adaptada a las representaciones de los pacientes, para lograr la m\u00e1xima eficacia.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Animar a los pacientes a compartir su visi\u00f3n de la enfermedad tambi\u00e9n puede ayudar a identificar las percepciones inadaptadas. Sin embargo, hay que tener cuidado con la decisi\u00f3n de intentar cambiar las representaciones de la enfermedad de los pacientes. Por ejemplo, un paciente puede tener una representaci\u00f3n no muy precisa de la identidad de la enfermedad, pero esto puede ser \u00fatil para aliviar su ansiedad. El profesional debe tener en cuenta que las representaciones de la enfermedad son s\u00f3lo una parte de un sistema de autorregulaci\u00f3n m\u00e1s amplio y din\u00e1mico, que tambi\u00e9n incluye conductas de afrontamiento y planes de acci\u00f3n, valoraciones de resultados, etc. Por lo tanto, el profesional probablemente deber\u00eda coexaminar todos estos aspectos de la experiencia y el estado del paciente, y luego determinar, en colaboraci\u00f3n con el paciente, c\u00f3mo y con respecto a qu\u00e9 representaciones intervenir. Pueden utilizarse con \u00e9xito tanto estrategias de intervenci\u00f3n descendentes (es decir, abstractas\/cognitivas) como ascendentes (es decir, concretas\/conductuales). A menudo, es igualmente importante examinar y discutir las representaciones de los miembros de la familia -padres, c\u00f3nyuges y otros-, ya que \u00e9stas pueden influir en las propias representaciones y comportamientos de los pacientes.<\/span><\/p>\n<p><b>Recomendaciones pr\u00e1cticas\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b><\/p>\n<ol>\n<li><b>Evaluar las representaciones de la enfermedad &#8211; <\/b><span style=\"font-weight: 400;\">entender c\u00f3mo el paciente da sentido a su condici\u00f3n: Deje que cuente su historia del problema de salud con sus propias palabras, no en t\u00e9rminos m\u00e9dicos, y siga indagando sin juzgar, utilizando preguntas abiertas o dibujos. Puede preguntar a la pareja o a otros familiares o cuidadores su opini\u00f3n (que puede diferir de la del paciente y afectar al apoyo que le prestan).<\/span><\/li>\n<li><b>Evaluar las representaciones del tratamiento &#8211; <\/b><span style=\"font-weight: 400;\">los pacientes tienen su propia opini\u00f3n sobre la eficacia, los beneficios, los riesgos y las consecuencias del tratamiento, lo que a menudo influye en la adhesi\u00f3n a los consejos m\u00e9dicos.<\/span><\/li>\n<li><b>Identificar las representaciones inexactas o disfuncionales o las creencias &#8220;irracionales&#8221;, as\u00ed como sus v\u00ednculos con el comportamiento o el bienestar.<\/b><span style=\"font-weight: 400;\"> Recuerde que la forma en que un paciente entiende su condici\u00f3n es &#8220;psicol\u00f3gicamente correcta&#8221;, es decir, tiene sentido para \u00e9l. Por lo tanto, una representaci\u00f3n puede parecer &#8220;inexacta&#8221; para usted, pero no para el paciente.\u00a0<\/span><\/li>\n<li><b>Ayude al paciente a cambiar su visi\u00f3n de la enfermedad &#8211;<\/b><span style=\"font-weight: 400;\"> si las representaciones de la enfermedad est\u00e1n relacionadas con comportamientos disfuncionales o amenazan el bienestar a largo plazo, puede ayudar a los pacientes a modificarlas (a) proporcionando informaci\u00f3n precisa, (b) utilizando ejemplos de otros pacientes que tengan representaciones m\u00e1s funcionales (o dejando que su paciente interact\u00fae con ellos), (c) utilizando t\u00e9cnicas de intervenci\u00f3n espec\u00edficas. \u00a1Incluso los textos cortos pueden hacer el trabajo!\u00a0<\/span><\/li>\n<li><b>Apoyar al paciente en el desarrollo de planes de acci\u00f3n funcionales<\/b><span style=\"font-weight: 400;\"> relacionados con la enfermedad que sean coherentes con sus representaciones (igualmente funcionales) y relevantes para su vida. Las representaciones de la enfermedad no son f\u00e1ciles de cambiar, sobre todo en las \u00faltimas fases de la enfermedad. Por ello, a veces es mejor centrarse en el comportamiento que en las representaciones.\u00a0\u00a0<\/span><\/li>\n<\/ol>\n<p><i><span style=\"font-weight: 400;\">Traducido por Luis Garc\u00eda-Gonz\u00e1lez y Alberto Aibar Solana<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Yael Benyamini, Tel Aviv University, Israel and Evangelos C. Karademas, University of Crete, Greece Anna and Mary are both healthy 45-year-old women, living in a large European city. 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