TEMA 3: TRASTORNOS DE ANSIEDAD EN NIÑOS Y ADOLESCENTES TEMA 3

1. INTRODUCCIÓN

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2. DEFINICIÓN DE LOS TRASTORNOS

2.1. Trastorno de ansiedad de separación TAS

2.1.1. Características clínicas

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TCCI 24
2.1.2.Epidemiología y comorbilidad
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##################DIAGNÓSTICO DIFERENCIAL DEL TAS Y OTROS TRASTORNOS ASOCIADOS:

Fobia escolar: rechazo a ir al colegio x motivos vinculados a la escuela (miedo al profesor, al acoso, a los suspensos)

TAG: las preocupaciones son varias, no estando unica/ centradas en la separación de las figuras de apego
O del hogar

T de pánico: el miedo principal es sufrir una crisis y no tener a nadie q pueda socorrer. Evitar la separación es x
Ese motivo, no x la separación misma

TCCI 24
2.2.Trastorno de ansiedad generalizada TAG

2.2.1. Características clínicas

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%G+)%3"7"A#%.%-"71&#8#."#3"(,6%&+"2,=(#7%#'("#preocupación excesiva "2%)2"#7%.#7%&"))1..1#7%#"&*%2+1&#
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"&12,"7"&#".#3%(1&#"#'("#7%#."&#".+%)"2,1(%&#&13F+,2"&#J,3*"2,%(2,"9#6"+,>"9#,)),+"H,.,7"79#+%(&,=(#3'&2'.")9#
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*'(+'".,7"7#8#%.#%G2%&1#7%&3%&')"71#7%#%G,>%(2,"#)%&*%2+1#7%#."&#+")%"&#%&21.")%&L9#%&+"71#7%#&".'7#
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S !"#$#%G2%&,-"#1#>%(%)".,@"7"#&%#*'%7%#21(&,7%)")#2131#'("#61)3"#2)=(,2"#7%#$#7%#+,*1#*)%713,("(+%A#21>#
8#7%#("+#,(21(+)1."H.%9#2'81#7,">#%(#."#,(6"(2,"#)%0',%)%#0#%.#(,M1#3"(,6,%&+%#%&"#$#8#*)%12'*"2,=(#%G2%&,-"#
al menos durante#6 meses )%&*%2+1#"#'("#>)"(#7,-%)&,7"7#7%#&,+#1#313%(+1&.
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+)"(0',.,@"71&#G#&'&#*)%12'*"2,1(%&9#..%>"(71#"#7%&21(6,")#7%#%..1&#3,&31&4#R%H,71#"#0#.1&#(,M1&#(1#&'%.%(#
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,3*4

TCCI 24
$7%3F&#7%#.1&#2),+%),1&#*")"#%.#7,">#7%.#5$Q#&%#7%H%(#+%(%)#%(#2'%(+"#%&+"&#indicaciones:
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\ !1&#%*,&17,1&#7%#*)%12'*"2,=(#7%H%(#"*")%2%)#".#3%(1&#3 veces a la semana y durar al menos una
hora.

2.2.2. Epidemiología y comorbilidad

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ambos sexos.

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2.3.FOBIAS ESPECÍFICAS: FE

2.3.1. Características clínicas

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S P%>;(#!"(>9#en el miedo, la fobia y la A se distinguen tres tipos de respuestas:
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\ motoras:#7,),>,7"&#"#%-,+")#1#%&2"*")#7%#."#,(+%)"22,=(#21(#.1&#%&+I3'.1&#6=H,21&4#/(#&,+#7%#7,6,2,.#%&2"*%#*1)#
*)%&,=(#&12,".#2131#%(#%.#)%2:"@1A61H,"#%&21.")#*'%7%(#"*")%2%)#".+#31+1)"&#2131#+%3H.1)%&9#),>,7%@#
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• cognitivas: *%(&"3,%(+1&#%#,3F>%(%&#&1H)%#."#&,+#"+%31),@"(+%9#G#%?#2)%%)#1,)#)',71&#%G+)"M1&9#*%(&")#0#'(#
&%)#3".-"71#&%#"2%)2"9#"(+,2,*")#&,+#21(#21(&%2'%(2,"&#7%&">)"7"H.%&9K

- La A y el miedo se diferencian %(#."#("+#7%#."&#-&#%&+,3'.")%&#8#7%#)%&*'%&+"Y

• /(#."#A#*)%713,("(#."&#C#21>#J*)%12'*"2,1(%&L#"(+%#%&+,3'."2,=(#,(+%)("#J&I(+13"&#6I&,21&L
• /(#%.#miedo#."&#C#31+1)"&#%(+%#%&+,3'."2,=(#%G+%)("9#7%#3171#0#+"(+1#'(#1H&%)-"71)#J*"7)%&9#*)16%&1)%&9#
KL#2131#%.#*)1*,1#(,M1#,7%(+,6,2"(#3F&#6"2,.A#."#&,+#7%&%(2"7%("(+%#%(#%.#3,%71#0#%(#."#$4

/.#+[)3,(1#fobia específica &%#,(+)17'2%#%(#."#2'")+"#%7,2,=(#7%.#RPT9#&'&+,+'8%(71#".#7%#61H,"#&,3*.%9#

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1&2'),7"79K

TCCI 24
R%#,>'".#61)3"#0#&'2%7%#21(#1+)1&#+)"&+1)(1&#,(+%)(".,@"(+%&9#&%#:"#&'H%&+,3"71#%.#3".%&+")#8#."&#
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*&,216,&,1.=>,21&9#21>#8#31+1)9#0#&1(#7%&*)1*1)2,1("71&#8#7%&"7"*+"7"&9#*)1-12"7"&#G#."#*)%&%(+"2,=(#1#
"(+,2,*"2,=(#7%#%&+I3'.1&#%G+%)(1&Y#"(,3".%&9#+1)3%(+"&9#".+')"&9#">'"9#6'%>19#&"(>)%9#:%),7"&9#,(8%22,1(%&9#
7%(+,&+"&9#3[7,21&9#."7)1(%&9#"'+1H'&%&9#+;(%.%&9#*'%(+%&9#"&2%(&1)%&9#"-,1(%&9#212:%&9#)',71&#6'%)+%&9#
1&2'),7"79K
X(#2),+%),1#%G,>,71#*")"#7,">(1&+,2")#61H,"#%&*%2I6,2"#%&#."#*%)&,&+%(2,"#7%#."#".+#%312,1(".#como mínimo
durante 6 meses4#/&+%#)%0',&,+19#3'8#;+,.#*")"#(1#)%2.'+")#6".&1&#*1&,+,-1&#8#3%?1)")#."#2".,7"7#7%#."#
,(-%&+,>"2,=(9#%&#3%(1&#,3*#%(#."#2.I(,2"9#71(7%#%.#+)"+#*&,21.=>,21#&%#7%H%#*)1*1)2,1(")#&,%3*)%#0#."#C#
%312,1(".#(%>#&%"#7%&*)1*1)2,1("7"#8#7%&"7"*+"7"4#

TCCI 24
2.3.2. Epidemiología y comorbilidad

X(1#7%#.1&#*)1H#3F&#*)%-".%(+%&#%(#."#*1H."2,=(#>%(%)".#&1(#."&#61H,"&#%&*%2I6,2"&4#!"#*)%-".%(2,"#"('".#%(#
*1H."2,=(#>%(%)".#%&#7%.#7-9%#"*)1G,3"7"A4#/(#*1H."2,=(#,(6"(+1S?'-%(,.9#."#*)%-".%(2,"#&%#&,+'"#%(#'(#5%#%(#
(,M1&#8#%(#'(#16%#%(+)%#.1&#?=-%(%&#7%#Zb#"#Zc#"M1&4#!"&#+"&"&#&1(#3F&#H"?"&#%(#*%)&1("&#3"81)%&Y#3-5%

P'%.%#&%)#3F&#6)%2'%(+%#%(#%.#sexo#6%3%(,(19#%(#'("#*)1*1)2,=(#NYZ9#"'(0'%#-"),"(#&%>;(#.1&#%&+I3'.1&#
6I&,21&Y
\ !1&##3,%71&#%&21.")%&9#"#&,+'"2,1(%&9#"#"(,3".%&#8#".#%(+1)(1#("+')".9#&1(#3F&#213'(%&#en niñas4
\ !"#61H,"#"#."#&"(>)%S,(8%22,=(S:%),7"#&%#*)%&%(+"#%(#."#3,&3"#*)1*1)2,=(#en ambos sexos.

!"&#61H,"&#&'%.%(#&%)#213=)H,7"&#21(#1+)1&#*)1H#7%#$4#/.#:%2:1#7%#&'6),)#'(#&'H+,*1#7%#61H,"#"'3%(+"#%.#),%&>1#
7%#*"7%2%)#1+)1#+,*1#7%#d/#7%.#3,&31#'#1+)1#&'H+,*14

3. MODELOS EXPLICATIVOS
3.1. Trastorno de Ansiedad por separación

!1&#%&+'7,1&#&1H)%#6"2+1)%&#2"'&".%&#8A1#7%#3"(+%(,3,%(+1#.1&#*17%31&#">)'*")#%(#dos grandes bloquesY#

.1&#*%)&1(".%&#8#.1&#7%#21(+%G+14
S R%(+)1#7%#.1&#factores personales#&%#:"#*'%&+1#"+%(2,=(#".#*%&1#0#*'%7%#+%(%)#."#>%([+,2"#%(#."#"*"),2,=(#
7%.#*)1H4#<")%2%#:"H%)#2,%)+1#21(&%(&1#%(#0#.1#0#&%#:%)%7"#%&#'("#*)%7,&*1&,2,=(#"#."#$#1#"#."#)%"2+,-,7"7#
%312,1(".9#3F&#0#"#'(#5#7%#$#21(2)%+14#P1H)%#%.#temperamento#&%#:"#%&+'7,"71#."#,(:,H,2,=(#21(79#."#
"6%2+,-,7"7#(%>"+,-"#8#.1&#*)12%&1&#21>#0#317'."(#."#*%)2%*2,=(4#!"#+%(7%(2,"#"#)%"22,1(")#21(#$#"(+%#.1&#
2"3H,1&9#.1#7%&21(12,71#8#."#,(2%)+,7'3H)%9#%&#.1#0#:"(#7%(13,(7"71#inhibición conductual9#0#*17%31&#
21(&,7%)").1#2131#'(#)"&>1#%&*%2I6,21#7%.#+%3*%)"3%(+19#&,%(71#%&+%#)"&>1#'(1#7%#.1&#0#3"81)#"*181#
%3*I),21#:"#)%2,H,714#/(#2'"(+1#"#.1&#procesos cognitivos, T')),&#,(61)3=#7%#.1&#&%&>1&#"+%(2,1(".%&#%(#
(,M1&#"(&,1&1&#*)%&+"(71#>)"(#"+%(2,=(#"#.1&#%&+I3'.1&#"3H,>'1&#0#*'%7%(#&%)#,(+%)*)%+"71&#2131#
"3%("@"(+%&9#21(#."#21(&%2'%(2,"#7%#)%21)7")#3F&#."&#&,+#"(&,1&"&4
S !1&#%&+'7,1&#0#"(".,@"(#."#influencia del contexto %(#."#"*"),2,=(#7%.#*)1H9#%(21(+)"31&#.1&#0#"(".,@"(#.1&#
"21(+%2,3,%(+1&#-,+".%&#%&+)%&"(+%&9#.1&#%&+,.1&#7%#2),"(@"#8#7%#)%."2,=(#6"3,.,")E#%&#7%2,)9#."&#-&#0#,(6.'8%(#
%(#%.#,(7,-,7'1#*")"#0#*%)2,H"#%.#21(+%G+1#&%>')1#1#,(21(+)1."H.%#"(+%#&,+#,3*)%7%2,H.%&4

Toro#JN__UL#*)%&%(+=#'(#mod sobre los procesos q intervenían en la aparición y el mantenimiento del

TAS4#/(#21(2)%+1#".>'(1&#)"&>1&#H,1.=>,21&#2131#%.#temperamento dificil y la inhibición conductual#%)"(#
,(7,2"71)%&#7%#".+"#)%"2+,-,7"7#%312,1(".4#/&+19#"7%3F&#7%#)%*)%&%(+")#'("#7,6,2'.+"7#*")"#%.#3"(%?1#7%#
%312,1(%&9#*17,"#&'*1(%)#'(#1H&+F2'.1#%(#."#."H1)#7%.#2',7"71)9#)%0',),%(71#'("#3"81)#213*%+%(2,"#0#"#&'#
-%@9#*17)I"#*)1-12")#%(#.1&#*"7)%&#1#+'+1)%&#)%&*'%&+"&#%312,1(".%&#3F&#,(+%(&"&4

TCCI 24
3.2. Trastorno de ansiedad generalizada

!"#etiología del TAG en niños/adolescentes#%&#H"(+"(+%#7%&21(12,7"#*'%&+1#0#."#3"81)I"#7%#.1&#%&+'7,1&#

&%#:"(#2%(+)"71#%(#*1H."2,=(#"7'.+"4#P%#%&+,3"#0#."#:%)%7"H,.,7"7#>%([+,2"#&'*1(%#ZAb#7%.#),%&>1#7%#&'6),)#%.#
+)"&+1)(19#"'(0'%#%&+"#*)%7,&*1&,2,=(#&%#&'*%)*1(%#21(#%.#),%&>1#7%#(%')1+,2,&319#&,%(71#"3H1&#213*")+,71&#
21(#1+)1&#+)"&+1)(1&#7%#$#8#7%.#%&+"71#7%#F(,314#
Estudios sobre neuroimagen#:"(#7%+%2+"71#3"81)#"2+,-,7"7#%(#."#"3I>7"."#%(#)%&*'%&+"&#"#2")"&#
"3%("@"(+%&#.1#0#&'>,%)%#0#.1&#2,)2',+1&#2%(+)".%&#7%.#3,%71#*'%7%(#%&+")#317'."(71#.1&#*)12%&1&#7%#
"+%(2,=(#7%#%&+1&#*"2,%(+%&4#
/(+)%#.1&#factores de riesgo para el inicio del TAG#*17%31&#%(21(+)")#%.#+%3*%)"3%(+19#.1&#"3H,%(+".%&#8#
>%([+,21&#1#.1&#6,&,1.=>,21&4

FACTORES DE RIESGO Y PRONÓSTICO DEL TAG

Temperamentales Inhibición de cond
Afectividad negativa
Evitación del daño

Ambientales Adversidades en la infancia

Sobreprotección de los padres

Genéticos y fisiológicos Hipersensibilidad neurobiológica

Familiares de pacientes con TAG
Alta herdabilidad mas q un alto componente genético

$7%3F&#7%#.1&#6"2+1)%&#7%#),%&>1#8#*)1(=&+,219#existen dif mod explicativos sobre el TAG4#e"71&#JN_ZUL#

*)%&%(+"#'("#)%-,&,=(#7%#%&+1&Y#%.#317%.1#7%#%-,+"2,=(#7%#Borkovek9#%.#317%.1#7%#."#,(+1.%)"(2,"#"#."#
,(2%)+,7'3H)%#7%#Duglas9#%.#317%.1#T%+"21>(,+,-1#7%#Wells9#%.#317%.1#7%#7%&)%>'."2,=(#%312,1(".#7%#
Mennin#8#%.#317%.1#H"&"71#%(#."#"2%*+"2,=(#7%#Roemer y Orsillo4#5171&#%&+1&#317%.1&#(1#:"(#&,71#"*%("&#
21(+)"&+"71&#%(#*1H."2,=(#,(6"(+1?'-%(,.9#algunos estudios#,(7,2"(#0#."#*)%12'*"2,=(#%(#"7'.+1&#*17)I"#&%>',)#
."#3,&3"#+%(7%(2,"#0#."#*)%&%(+"7"#%(#."#,(6"(2,"4

3.3. Fobias específicas

!"#>[(%&,&#7%#."&#d/#)%0',%)%#+%(%)#%(#2'%(+"#tres tipos de factoresY#-'.(%)"H,.,7"7#H,1.=>,2"9#-'.(%)"H,.,7"7#

*&,21.=>,2"#>%(%)".,@"7"#8#-'.(%)"H,.,7"7#*&,21.=>,2"#%&*%2I6,2"4

\ !"#vulnerabilidad biológica:#(1#%G*.,2"#*1)#&,#&1."#."#"*"),2,=(#7%#."&#61H,"&Y#.1&#%&+'7,1&#)%".,@"71&#21(#
>%3%.1&#31(12,>=+,21&#8#6"3,.,")%&#7%#*),3%)#>)"71#(1#"6%2+"71&#.1#7%3'%&+)"(4#/.#)%&+1#7%#,(6.'%(2,"#
0'%7")I"#%G*.,2"7"#*1)#6"2+1)%&#"3H,%(+".%&#%&*%2I6,21&#7%#2"7"#,(7,-,7'14#!"&#%G*%),%(2,"&#+%3*)"("&#0#
(1&#:"2%(#*%)2,H,)#."&#&,+#%&+)%&"(+%&#2131#,(21(+)1."H.%&#%#,3*)%7%2,H.%&#&%)I"(#."&#0#:"2%(#0#."#*#+%(>"#
'("#3"81)#1#3%(1)#
\ !"#vulnerabilidad psicológica generalizada:#&1(#."&#%G*%),%(2,"&#+%3*)"("&#."&#0#(1&#:"2%(#*%)2,H,)#."&#
&,+#%&+)%&"(+%&#2131#,(21(+)1."H.%&#%#,3*)%7%2,H.%&#8#&%)I"(#."&#0#:"2%(#0#."#*#+%(>"#'("#3"81)#1#3%(1)#
-'.(%)"H,.,7"7#*&,21.=>,2"#>%(%)".,@"7"

TCCI 24
###f"),"H.%&#)%."2,1("7"&#21(#%.#%&+,.1#%7'2"+,-1#8#%-%(+1&#0#*'%7%(#,(6.',)#%(#%.#7%&"))1..1#7%#."&#61H,"&Y
Estilo educativo Sobreprotector
Frialdad afectiva
Rechazo parental

Eventos estresantes o traumáticos Enfermedad grave

Maltrato físico
Abuso sexual
Muerte familiar o amigo
!1&#%-%(+1&#%&+)%&"(+%&#>%(%)")F(#)%&*'%&+"&#317'."7"&#*1)#."#-'.(%)"H,.,7"7#>%([+,2"9#%.#"*181#&12,".#8#."#
*)%&%(2,"#7%#2,%)+"&#2")"2+%)I&+,2"&#7%#*%)&1(".,7"7#2131#."#&%(&,H,.,7"7#"#."#$9#."&#:"H#7%#"6)1(+"3,%(+1#8#."#
"2+,+'7#(%>#09#%(#>)"(#3%7,7"9#&%)F(#317%."7"&#*1)#."&#6,>')"&#7%#"*%>14
#
\ <1)#;.+,319#la vulnerabilidad psicológica específica &%#+)"+"#7%.#"*)%(7,@"?%#G#:"H%)#+%(,71#'("#1#3F&#
%G*%),%(2,"&#(%>#21(#'(#%&+I3'.1#0#&%#21(-%)+,)F#%(#6=H,21#G#21(7,2,1("3,%(+1#7,)%2+14#/&"&#%G*#(%>#&1(#
6)%2'%(+%&#21(#"(,3".%&#2131#*%))1&9#")"M"&9#&%)*,%(+%&#'#1+)"&#2131#3,%71#"#21(7'2,)9#"#"+)">"(+")&%9#"#
."#".+')"9#".#7%(+,&+"9#%+2K!"#>)"-%7"7#8#6)%2#7%#%&+"&#%G*#(%>9#?'(+1#".#)%7'2,71#(g#7%#%G*#*1&,+,-"&#21(#.1&#
%&+I3'.1&#*1+%(2,".A#6=H,21&9#6"2,.,+"#0#."#*#%-,+%#%.#/#+%3,71#8#)%7'@2"#&'#%G*1&,2,1(#"#."#&,+#+)"&#."#
%G*%),%(2,"#"-%)&,-"4#h1#+171&#.1&#/#+%3,71&#+,%(%(#%.#3,&31#*1+%(2,".#*")"#>%(%)")#'("#61H,"9#&,%(71#.1&#/#
0#:"(#)%*)%&%(+"71#6,.1>%(%+,2"A#'("#"3%("@"#"#."#&'*%)-,-%(2,"#7%#."#%&*%2,%#.1&#3F&#6'%)+%&4

/(#2'"(+1#".#mantenimiento de las fobias#."#"(+,2,*"2,=(#7%#."&#&,+#6=H,2"&#7"#.'>")#"#%G*%2+"+,-"&#7%#3,%719#

*F(,21#1#*%.,>)1#"&12,"71#21(#%&+"&#%312,1(%&#"#."#&,+'"2,=(#6=H,2"4#/&+1#%&+")I"#modulado x#."&#
2")"2+%)I&+,2"&#7%.#%&+I3'.1#6=H,219#%.#>)"71#7%#21(+)1.#*%)2,H,71#&1H)%#."#&,+#9#."#*1&,H,.,7"7#*%)2,H,7"#7%#
%&2"*%9#."#*)%&%(2,"#7%#&%M".%&#7%#&%>'),7"79#%.#%&+"71#7%#F(,31#8#."#%G,&+%(2,"#7%#2,)2'(&+"(2,"&#
%&+)%&"(+%&4#!"&#%G*%2+"+,-"&#%.%-"7"&#7%#3,%71A*F(,21A"&21#8#*%.,>)19#?'(+1#21(#."#*%)2%*2,=(#7%#2")%(2,"#7%#
)%2')&1&#*")"#"6)1(+")#."#&,+9#6"2,.,+"#."#%-,+"2,=(#7%#."&#&,+#+%3,7"&4#R%#%&+%#3171#."#21(7#7%#%-,+"2,=(#%&#
reforzada negativamente#8"#0#7,&3,('8%#."#$#8#*%)3,+%#0#%.#*"2,%(+%#&%#&,%(+"#3%?1)#".#*%)2,H,)#3"81)#
&%>'),7"74#D#1+)1#."719#."#%-,+"2,=(#21(+),H'8%#"#3"(+%(%)#."&#%G*%2++,-"&#7%#*%.,>)19#*'%&#(1#*%)3,+%#
213*)1H")#&,#."#"3%("@"#%&#1#(1#)%".4#$#&'#-%@9#."#61H,"#*'%7%#&%)#+H#reforzada positivamente#*1)#*")+%#7%#
1+)"&#*%)&1("&9#21(+),H'8%(71#"&,#"#&'#3"(+%(,3,(+14#!"#1H&%)-"2,=(#7%#%G*%),%(2,"&#6=H,2"&#+H#,(6.'8%#%(#%.#
"*)%(7,@"?%#7%#."&#61H,"&4#

4. EVALUACIÓN
4.1. Consideraciones previas

^"7"#'(1#7%#.1&#*)1H#"0',#+)"+"71&#*)%2,&")F#7%#'("#%-".'"2,=(#+),7,3%(&,1(".#J%&21.")#6"3,.,")9#&12,".9#
*%)&1(".L#3'.+,3[+171#J%(+)%-,&+"&9#1H&%)-"2,=(9#,(-%(+"),1&L#3'.+,6'%(+%#J(,M19#*"7)%&9#1+)"&#*L#8#3'.+,6"&%#
J"(+%&9#7')"(+%#8#7%&*'[&#7%.#+)"+L#"#6,(#7%#"(".,@")#+17"&#."&#-&#)%&*1(&"H.%&#7%.#,(,2,19#7%&"))1..1#8#&1H)%#
+171#3"(+%(,3,%(+1#7%#."&#21(7'2+"&#*)1H.%3"4#<")"#%..1#&%#*)12%7%)F#"#)%".,@")#%.#análisis funcional de la
conducta9#2%(+)F(71(1&#%(#.1&#antecedentes#,(+%)(1&#1#%G+%)(1&#0#*'%7"(#*)%2,*,+")#."&#)%&*'%&+"&S#
*)1H.%3"9#%(#."&#vs organísmicas#0#*'%7%(#%&+")#,(6.'8%(71#?'(+1#".#estudio de las respuestas-problema#
%(#&'#+),*.%#(,-%.Y#21>(,+,-19#*&,216,&,1.=>,21#8#21(7'2+'".A31+1)9#"(".,@"(71#&'#+1*1>)"6I"#8#*")F3%+)1&4#h1#
*17%31&#1.-,7"&#."&#-&#,3*.,2"7"&##%(#&'#mantenimiento#8#."&#21(&%2'"(2,"&#7%#%&+1&#*)1H#%(#%.#(,M1A
"71.%&2%(+%#8#&'#6"3,.,"4#/&#(%2%&"),1#+H#21(&,7%)")#.1&#"21(+%2,3,%(+1&#-,+".%&#0#&%#"&12,"(#"#."#"*"),2,=(#7%.#
+)"&+1)(1#J*)1H#6"3,.,")%&9#&,+#%&+)%&"(+%&#%&21.")%&9#%*,&17,1&#+)"'3F+,21&9KL#"2+'"(71#%(#H"&+"(+%&#
12"&,1(%&#2131#factores precipitantes4
$7%3F&#7%#.1#"(+%),1)9#%.#*&,21.=>1#*)%2,&")F#21(12%)#2;".%&#&1(#."&#pautas normativas del desarrollo#%(#
2"7"#'("&#7%#."&#%7"7%&#1#+)"31&#7%#%7"79#"#6,(#7%#*17%)#,7%(+,6,2")#%(#0'[#3%7,7"#7%+#213*#1#*"+)=(#7%#

TCCI 24
)%&*#7%H%#1#(1#&%)#,7%(+,6,2"71#2131#*)1H.%3F+,21#%(#)%."2,=(#21(#.1&#%&+F(7")%&#7%#&'#>)'*1#7%#)%6%)%(2,"4#i#
"&I#*17%)#,(&+)',)#"#.1&#*"7)%&#&1H)%#.1#0#%&#)%".A#1#(1#'(#*)1H#7%#21(74
<")"#*17%)#:"2%)#'("#-".1)"2,=(#7%#."#>)"-%7"7#7%.#*)1H9#%&+"&#&1(#."&#resp y aspectos más imp a evaluar:

\ Respuestas cognitivas:#,(2)%3%(+1#7%#*%(&"3,%(+1&#8A1#,3F>%(%&#3%(+".%&#(%>"+,-"&#&1H)%#."&#&,+#0#
*)1-12"(#$Y######
###"L#.as autoverbalizaciones#7%.#(,M1A"71.%&2%(+%#*")"#&%>',)#3"(+%(,%(71#."#C#*)1H4#S#(1#&18#2"*"@#7%#
*"&")#2%)2"#7%#'(#*%))19#3,#3"7)%#(1#-"#"#-%(,)#"#*1)#3,9#(1#-18#"#"*)1H")9#8#&,#*"&"K4
###HL#.os pensamientos#7%#.1&#(,M1&A*"7)%&#"2%)2"#7%#2=31#&%#)%&'%.-%#%.#*)1H4#S#(1#&18A%&#2"*"@9#&18#'(#
21H")7%9#(1#*'%7%#[.#&=.19K
###2L#preocupación x las R psicofisiológicas#S#8#&,#3%#7"#'(#"+"0'%#".#21)"@=(9#8#&,#(1#*'%71#21(+)1.")#3,#
)%&*,)"2,=(9#8#&,#-13,+19K
###7L#rumiación x las R de evitación/escap%#S#(1#-18#"#,)#".#21.%>,19#(1#-18#"#&".,)#7%#2"&"9#(1#-18#"#
"*)1H")9K
R%#7,2:"&#C#&%#:"H)F#0#)%>,&+)")#."#6)%2'%(2,"9#."#7')"2,=(9##."#,(+%(&,7"7#1#%.#>)"71#7%#3".%&+")9#%.#.'>")##
71(7%#12'))%9#."&#*#0#%&+F(#*)%&%(+%&9#21(+,(>%(2,"&#1#)%6'%)@1"#0#3"(+,%(%(#1#6"2,.,+"(#."#21(7#16)%2,71&#G#
*")+%#7%#.1&#">%(+%&#0#.%#)17%"(#S#)%6'%)@1&#*1&,+,-1&S#%G*)%&,1(%&#7%#F(,319#21(&'%.19KS#1#(%>"+,-1&4
###%L#expectativas de daño#S#3,#3"7)%#(1#3%#-"#")%21>%)#7%.#21.%>,19#%.#*%))1#3%#-"#"#31)7%)9#-18#"#
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• Respuestas motoras: "L#."#*),3%)"#8#3F&#,3*1)+"(+%#)%&*'%&+"S*)1H.%3"#%&#."#evitación activa#Y#%(#%.#

2"&1#7%#."&#61H,"&#%.#(,M1#)%".,@"#"22,1(%&#*")"#(1#"*)1G,3")&%#"#.1&#%&+I3'.1&#+%3,71&9#G%?#&%#2"3H,"#7%#
2"..%#*")"#(1#*"&")#2%)2"#7%.#*%))1#7%.#-%2,(1E#2'"(71#%.#(,M1A"71.%&2%(+%#*)%&%(+"#"(&,%7"7#*1)#
&%*")"2,=(9#,(+%(+"#H'&2")#%G2'&"&#*")"#0#&'#3"7)%#(1#&%#-"8"#7%#2"&"E#2'"(71#*)%&%(+"#$#>%(%)".,@"7"9#
%-,+"#%(6)%(+")&%#".#%G"3%(4#HL#evitación pasiva: %.'7%#."#&,+#+%3,7"#7%?"(71#7%#%6%2+'")#"22,1(%&#S#G#%?#(1#
,)#".#21.%9#(1#71)3,)#6'%)"#7%#2"&"9#(1#"2'7,)#"#'(#%G"3%(4#2L#escapeY#21)+"#."#)%."2,=(#21(#%.#/#+%3,719#G#%?#
&%#+"*"#."#2")"#2'"(71#-%#'(#*%))19#&%#-'%.-%#7%.#21.%>,1#"(+%&#7%#..%>")#*")"#,)#7%#('%-1#"#2"&"9#&%#&".%#7%.#
%G"3%(#2'"(71#%&+F#"#3%7,1#7%#)%".,@").19K7L#alteración comportamental: 3'%&+)"#,(:,H,2,=(#
21(7'2+'".S#&%#0'%7"#*")".,@"719#H.10'%"719#8A1#213*)1+"3,%(+1#*%)+')H"71)#S#)"H,%+"&9#0'%?"&9#*)1+%&+"&9K
###R%#7,2:"&#)%&*#&%#:"H)F#7%#)%>,&+)")#.1&#*")F3%+)1&#3%(2,1("71&#%(#."&#C#21>4

• Respuestas psicofisiológicas: %(#%.#2"&1#7%#21(+")#21(#%.#3"+%),".#)%0'%),719#8#&,%3*)%#0#(1#)%&'.+%#

,(+)'&,-1#(,#&%#*)17'@2"#%G2%&,-1#%&+)[&#%(#%.#(,M1A"71.%&2%(+%9#*17),"31&#%-".'")#."&#&,>',%(+%&#
)%&*'%&+"&Y#"L#tensión muscular9#HL#tasa cardiaca y respiratoria9#2L#sudoración9#7L#enrojecimiento de
la piel9K$.>'("&#7%#%&+"&#)%&*'%&+"&#*'%7%(#&%)#2'"(+,6,2"7"&#3%7,"(+%#1H&%)-"2,=(#8#)%>,&+)14

• Aspectos ambientales: "L#."#21(7'2+"#"7"*+"+,-"#8#&12,".#7%.#(,M19#HL#."#)%."2,=(#21(#&'&#,>'".%&9#2L#."&#

21(7#7%#"'+12',7"71#7%&"))1.."7"&#G#%.#3%(1)#J#"&%19#-%&+,)&%9#21(+)1.#7%#%&6I(+%)%&9#7L#."#%G,&+%(2,"#7%#
7,-1)2,1#1#&%*")"2,=(#7%#.1&#*"7)%&9#%L#."&#&,+'"2,1(%&#7%#%&+)[&#6"3,.,")9#6L#%.#213*#7%#.1&#*"7)%&#%(#)%."2,=(#
21(#%.#(,M1#J&1H)%*)1+%22,=(9#"H"(71(19KL#>L#."&#:"H#7%#2),"(@"#7%#.1&#*"7)%&9#:L#."#%G,&+%(2,"#7%#1+)1&#
3,%3H)1&#6"3,.,")%&#0#:"8"(#*"7%2,71#%&+%#*)1H#'#1+)1&#7%#+,*1#3%(+".#,L#."#"7%2'"2,=(#%(+)%#%.#31+,-1#7%#."#
21(7#8#."&#-&#*&,21.=>,2"&#0#(%2%&,+"(#7%#+)"+"3,%(+14

• Aspectos médicos y fisiológicosY#"L#%&+'7,1#7%.#(,-%.#7%#7%&"))1..1#3%(+".#7%.#(,M19#&%#1H&%)-")F(#."&#".+#

6I&,2"&#0#*'%7"(#"*")%2%)#J#("'&%"&9#71.1)#7%#H")),>"#8#2"H%@"9#7,"))%"944L

TCCI 24
4.2. Entrevistas

!"#entrevista inicial#%&#%.#*),3%)#21(+"2+1#0#%.#+%)"*%'+"#+,%(%#21(#%.#(,M1#8#&'&#*"7)%&4#P%#&'%.%#)%".,@")#'("#
%(+)%-,&+"#%(#*)16'(7,7"7#21(#.1&#*"7)%&#8#1+)"#3F&#21)+"#21(#%.#(,M19#%(#."#*),3%)"#&%&,=(9#8#*1)#&%*")"719#&,#
%&#*1&,H.%4#!"#6'(2,=(#6'("7"3%(+".#7%#%&+"&#*),3%)"&#%(+)%-,&+"&#%(#identificar las respuestas objeto de
tratamiento y las condiciones q las mantienen#J"(+%2%7%(+%&#8#21(&%2'%(+%&L4#P%#7%H%(#2%(+)")#+"(+1#%(#
."#cond de los niños#2131#de los adultos#8#3F&#%&*%2,6,2"A#%(#"0'%.."&#21(7#0#21(61)3"(#%.#*"+)=(#
,("7%2'"71#7%#,(+%)"22,=(#6"3,.,")4#/..1#,3*.,2"#0#&%#,(+%)-%(7)F#+"(+1#%(#."&#21(7#,("7%2'"7"&#7%#.1&#(,M1&#
2131#&1H)%#".>'("&#7%#.1&#"7'.+1&#,3*.,2"71&#%(#."#,(+%)"22,=(4#5H#%(#."#%(+)%-,&+"#&%#1H+,%(%#,(61)3"2,=(#
"2%)2"#7%.#desarrollo evolutivo del niño9#0#*'%7%#&%)#'+,.#*")"#213*)%(7%)#3%?1)#%.#*)1H9#,(7,2")#."&#
21(7,2,1(%&#H"?1#."&#2'".%&#%.#3,&31#*17)I"#"*")%2%)9#21(+),H',)#".#7,&%M1#7%#'(#*)1>)"3"#7%#,(+%)-%(2,=(#7%#
)%2",7"&9K5H#&%#7%H%#21(&%>',)#,(61)3"2,=(#"2%)2"#7%#.1&#*1&,H.%&#prob médicos#7%.#(,M19#8"#0#%&+1&#
*'%7%(#%&+")#)%."2,1("71&#21(#."&#21(7S*)1H#"0',#+)"+"7"&4#D#1+)1#."719#.a entrevista con los padres#+H#
*%)3,+%#,(-%&+,>")#%.#>)"71#7%#213*)13,&1#7%#%&+1&#:"2,"#."#,(+%)-%(2,=(#8#&'#:"H#*")"#213*)%(7%)#8#%?%2'+")#
*)1>)"3"&#7%#,(+%)-%(2,=(#21(7'2+'".4#$#&'#-%@9#*)1*1)2,1("#'(#3")21#"7%2'"71#*")"#16)%2%)#"#.1&#*"7)%&#
'("#%G*.,2"2,=(#21(2%*+'".#"#2%)2"#7%#%(#0'[#-"#"#21(&,&+,)#."#,(+%)-%(2,=(#8#%&+"H.%2%)#'("#)%."2,=(#
+%)"*%;+,2"#"7%2'"7"#21(#.1&#*"7)%&#8#%.#(,M1A"71.%&2%(+%4

!"#entrevista con el menor "'(0'%#(1#*'%7%#&%)#'+,.#2131#3[+171#7%#)%21>,7"#7%#,(61)3"2,=(#&,#&%#+)"+"#7%#

(,M1&#3'8#*%0'%M1&#J#&,#%&#3%(1)#7%#&%,&#"M1&L#1#&,#*)%&%(+"#'(#7[6,2,+#21>(,+,-19#*%)3,+%#1H&%)-")#".#(,M1#%(#
&'#,(+%)"22,=(#21(#%.#"7'.+14#5H#*%)3,+%#%-".'")#%.#(,-%.#21>#7%#6'(2,1("3,%(+1#8#".>'("&#2")"2+#21(7'2+'".%&#
J:"H,.,7"7%&#&12,".%&#1#-%)H".%&L

$.>'("&#7%#."&#entrevistas más utilizadas con niños y adolescentes#*")"#%-".'")#."#*&,21*"+1.1>I"#%(#

>%(%)".9#%&#7%2,)9#(1#%&+F(#%&*%2,".,@"7"&#%(#'(#+)"&+1)(1#1#>)'*1#7%#+)"&+1)(1&#21(2)%+19#&,(1#0#"H")2"(#.1&#
*)1H#3F&#213'(%&#%(#%&+"&#%7"7%&Y

• The Anxiety Disorders Interview Schedule for DSM-IV-C: %(+)%-,&+"#%&+)'2+')"7"#2%(+)"7"#%(#%.#

7,">(=&+,21#7%#.1&#+)"&+1)(1&#7%#$#8#1+)1&#+)"&+1)(1&#*&,21.=>,21&#*)1*,1&#7%#."#,(6"(2,"#8#"71.%&2%(2,"4#

• Entrevista para trastornos afectivos y esquizofrenia para niños en edad escolar version actual y
vital: *")"#3%(1)%&#7%#W#"#Zj#"M1&

• Entrevista diagnóstica para niños y adolescentes revisadaY#%G,&+%#'("#-%)&,=(#*")"#(,M1&#7%#W#8#ZN#

"M1&#8#1+)"#*")"#"71.%&2%(+%&#7%#Zb#"#Zc#"M1&4

• Entrevista diagnóstica para niños y adolescentes -IV o EDNA-IV: 2'%(+"#21(#'("#-%)&,=(#*")"#(,M1&#

/Rh$SkfS^#8#1+)"#*")"#"71.%&2%(+%&#7%#Zb#"#Zc#"M1&#/Rh$SkfS<4

4.3. Autoinformes sobre ansiedad global

!1&#3F&#'+,.,@"71&#&1(Y

\ Inventario de autoevaluación de ansiedad estado-rasgo para niños o STAICY#%&#'(#"'+1,(61)3%#

7,&%M"71#*")"#%-".'")#."#"(&,%7"7#%&+"71A)"&>1#%(#(,M1&#7%#`#"#ZU#"M1&#

\ Cuestionarío de ansiedad infantil o CASY#*")"#%-".'")#."#$#%(#(,M1&#7%#W#"#j#"M1&4

TCCI 24
\ Escala revisada de ansiedad manifiesta en niños o RCMASY#*)1*1)2,1("#'("#3%7,7"#>.1H".#7%#"(&,%7"7#
8#+)%&#3%7,7"&#%&*%2I6,2"&Y#"(&,%7"7#6,&,1.=>,2"9#3,%71A21(2%(+)"2,=(#8#*)%12'*"2,=(A:,*%)&%(&,H,.,7"74

\ Escala de ansiedad infantil o SCASY#21(&+"#7%#bj#,+%3&#&1H)%#+)"&+1)(1&#7%#"(&,%7"7#,(6"(+,.%&#J+)"&+1)(1#

7%#"(&,%7"7#*1)#&%*")"2,=(9#+)"&+1)(1#7%#"(&,%7"7#>%(%)".,@"7"9#+)"&+1)(1#7%#*F(,21A">1)"61H,"9#+)"&+1)(1#
1H&%&,-1S213*'.&,-19#61H,"#%&*%2I6,2"#8#61H,"#&12,".L#8#&%,&#*1&,+,-1&#*")"#21(+)1.")#%.#&%&>1#7%#)%&*'%&+"#
(%>"+,-14#<")"#(,M1&#7%#W#"#ZN#"M1&#8#*")"#"71.%&2%(+%&#7%#Zb#"#Zc4

• Escala revisada de ansiedad y depresión en niños o RCADS: %-".'"#.1&#&,>',%(+%&#+)"&+1)(1&Y#"(&,%7"7#

*1)#&%*")"2,=(9#61H,"#&12,".9#"(&,%7"7#>%(%)".,@"7"9#"(>'&+,"#1#*F(,219#1H&%&,-1#213*'.&,-1#8#7%*)%&,=(#
3"81)4

4.4. Test conductuales y observación

/(#%&+1&#*)12%7,3,%(+1&#&%#&13%+%#".#(,M1#"#."&#&,+#0#7%&%(2"7%("(#."#$4#P%#+)"+"(#7%#%G*1&,2,1(%&#".#/#
6=H,21#%(#-,-1#%(#."#*)1*,"#21(&'.+"4#T%7,"(+%#%&+1&#+%&+#21(7'2+'".%&#se evaluaY
"L %.#>)"71#7%#$
HL##%.#+#0#%&#2"*"@#7%#+1.%)")#."#%G*1&,2,=(9#>)"71#7%#"*)1G,3"2,=(#".#1H?%+19K

/&#:"H,+'".#'&")#.1&#.."3"71&#test de evitación o aproximación conductual: &%#.%#*,7%#".#3%(1)#0#&%#

"2%)0'%#".#/#"-%)&,-19#G#%?#'(#*%))19#'(#>"+19#1&2'),7"79K8#1H&%)-"31&#2=31#,(+%)"22,1("#21(#[.4#/-".'"31&#
21(#%.#&'?%+1#%.#>)"71#7%#3".%&+")#0#.%#*)17'2%#2"7"#/4#/(#%.#2"&1#7%#$#*1)#&%*")"2,=(9#%.#(,M1#*'%7%#&%)#
%G*'%&+1#"#&,+#7%#2"7"#-%@#3%(1)#*)1G,3,7"7#"#.1&#*"7)%&#8#)%>,&+)")#&'&#)%"22,1(%&#3"(,6,%&+"&#8#&'H?%+,-"&4

!"#observación directa#+H#*'%7%#&%)#'+,.,@"7"#G#.1&#*)1*,1&#*"7)%&#8#*)16%&1)%&4#/&+"#1H&%)-"2,=(#,(2.'8%#
7%&7%#7%&2),*2,1(%&#7%+".."7"&#7%#.1#0#1H&%)-"(#:"&+"#2=7,>1&#%."H1)"71&#G#%.#*&,2=.1>1#0#7%&2),H%(#."&#
)%&*'%&+"&S*)1H.%3"#71(7%#%.#1H&%)-"71)#3")2"#."#6)%2'%(2,"9#7')"2,=(9#."#:1)"#%(#0#&'2%7%9#%+244#P%#
)%0',%)%#0#%.#1H&%)-"71)#7%&2),H"#21(#7%+"..%#."#&,+#%(#."#0#:"#&'2%7,71#."#)%&*'%&+"S*)1H.%3"#8A1#%.#/#0#.1#
:"8"#"(+%2%7,719#."&#21(&%2'%(2,"&#+)"&#&'#)%".,@"2,=(9#.1#0#%.#1H&%)-"71)#1#6"3,.,")%&#:"2%(#1#7,2%(9K

4.5. Instrumentos específicos para cada trastorno

4.5.1. Trastorno de ansiedad por separación

k(&+)'3%(+1&#%&*%2I6,21&#*")"#%-".'")#."#"(&,%7"7#*1)#&%*")"2,=(Y

• La Escala de Ansiedad por separación en la infancia o CASI-N: "'+1,(61)3%#*")"#(,M1&#7%#WSZZ#"M1&4#

^1(&+"#7%#V#&'H%&2"."&Y#*)%12'*"2,=(#&1H)%#."#&%*")"2,=(9#3".%&+")#*1)#."#&%*")"2,=(9#1*1&,2,=(#"#."#
&%*")"2,=(#8#+)"(0',.,7"7#"(+%#."#&%*")"2,=(4

• El Cuestionario de Ansiedad de Separación de Inicio Temprano o CASI-N: *'%7%#&%)#2'3*.,3%(+"71#

*1)#*"7)%&#7%#(,M1&#3%(1)%&#7%#j#"M1&4#/-".;"#."#$#*1)#&%*")"2,=(#7%H,7"#"#&'2%&1&#+)"'3F+,21&9#".#,)#"#
"21&+")&%#8#*1)#"21(+%2,3,%(+1&#21+,7,"(1&#2131#,)#".#21.%>,14

• Escala de evaluación ansiedad por separación SAAS: +,%(%#'("#-%)&,=(#*")"#(,M1&#8#"71.%&2%(+%&#

JP$$PS^L#8#1+)"#*")"#*"7)%&#JP$$PS<L

TCCI 24
4.5.2. Trastorno de ansiedad generalizada

X("#2")"2+%)I&+,2"#*),(2,*".#7%.#+)"&+1(1#%&#."#preocupación4#D#%..19#%G,&+%(#".>'("&#%&2"."&#2%(+)"7"&#%(#
%&+"Y

• Cuestionario de preocupación del estado de Pensilvania o PSWQ: 7,&2),3,("#%.#5$Q#7%#1+)1&#

+)"&+1)(1&#7%#$4#<'%7%#&%)#*".,2"71#"#*")+,)#7%#.1&#W#"M1&4

• El cuestionario ¿Por qué preocuparse? ¿PP?: %."H1)"71#*")"#"7'.+1&9#*'%7%#&%)#"*.,2"71#*")"#

"71.%&2%(+%&4#/.#1H?%+,-1#%&#.12".,@")#(;2.%1&#7%#*)%12'*"2,=(#8#-%)#2=31#&%#-".1)"(#7,2:1&#")>'3%(+1&4

• Cuestionario de preocupación y ansiedad o WAD:#%-".;"#71&#6"2+1)%&Y#%312,1(".,7"79#)%6%),71#"#.1&#&%,&#

&I(+13"&#&13F+,21&#7%.#5$Q#8#*)%12'*"2,=(4#<'%7%#&%)#'+,.,@"71#%(#"71.%&2%(+%&#*%&%#"#0#."#"7"*+"2,=(#:"#
&,71#%(#*1H."2,=(#"7'.+"4

4.5.3. Miedos y fobias infantiles

P%#7,&*1(%#7%#-"),1&#,(-%(+"),1&#1#2'%&+,1("),1&#%(#2"&+%.."(1#&1H)%#3,%71&#%(#>%(%)".#8#1+)1&#2%(+)"71&#%(#
61H,"&#%&*%2I6,2"&4
<")"#miedos#%(#>%(%)".Y
\ Inventario de miedos de PelechanoY#2%(+)"71#%(#."#%-".'"2,=(#7%#(,M1&#7%#V#"#`#"M1&9#"'(0'%#&%#:"#
"*.,2"71#:"&+"#.1&#ZV4#k7%(+,6,2"#.1&#/#7%#3"81)#3".%&+")4

• Cuestionario de miedos para niños revisado o FSSC-R: &%#*'%7%#"*.,2")#"#(,M1&#7%#%(+)%#c#8#ZW#"M1&4#

P%#:"(#,7%(+,6,2"71#2,(21#6"2+1)%&Y#3,%71#".#*%.,>)1#8#"#."#3'%)+%9#3,%71#".#6)"2"&1#8#"#."#2)I+,2"9#3,%71#"#.1#
7%&21(12,719#3,%71#"#.1&#"(,3".%&#8#3,%71&#3[7,21&4

• Inventario de Exploración de miedos para niños-II o FSSC-II: 21(&+"#7%#cU#H%.%3%(+1&#0#%.#(,M1A

"71.%&2%(+%#J7%#c#"#Zj#"M1&L#7%H%#-".1)")4#k(2.'8%#3,%71&#3F&#"2+'".%&#JPkR$9#>'%))"#('2.%")L#0#%.#
2'%&+,1("),1#dPP^SC9#7%.#2'".#%&#'("#)%-,&,=(4#<)%&%(+"#2,(21#6"2+1)%&Y#3,%71#".#*%.,>)1#8#"#."#3'%)+%9#".#
6)"2"&1#8#"#."#2)I+,2"9#"#.1&#7%&21(12,719#"#.1&#"(,3".%&#8#3,%71&#3[7,21&#8#%&21.")%&4

• Inventario de miedos: *")"#(,M1&#7%#`#"#ZU#"M1&4#R,&+,(>'%(#7,%@#+,*1&#7%#3,%71&Y#3'%)+%9#"'+1),7"79#

&1.%7"7S6"(+"&I"9#"(,3".%&9#7%&21(12,719#%-".'"2,=(#7%.#)%(7,3,%(+19#&%*")")&%#7%#.1&#*"7)%&9#21(+"2+1#
6I&,219#6%(=3%(1&#("+')".%&#8#3[7,21&4#P%#1H+,%(%#'("#*'(+'"2,=(#7%#3,%71&#6I&,21&9#1+)"#7%#3,%71&#
&12,".%&#8#'("#*'(+'"2,=(#+1+".#"#*")+,)#7%#."#&'3"#7%#."&#1+)"&#71&4

5H#&%#:"(#%."H1)"71#inventarios específicos#3F&#H)%-%&#para miedos/fobias concretas9#%(+)%#%..1&Y

\ T,%71&#%&21.")%&
\ T,%71&#3[7,21&
\ T,%71#"#."&#".+')"&Y#$l
\ T,%71#"#-1.")Y#%&2"."#7%#3,%71#"#-1.")
\ T,%71#"#,)#".#7%(+,&+"Y#RdPP^
\ T,%71#"#.1&#"(,3".%&#2131#&%)*,%(+%&Y#Ph$l9#")"M"&Y#P<l^
\ T,%71#"#."#1&2'),7"74

TCCI 24
5.TRATAMIENTO

!"#terapia cognitivo-conductual#%&#21(&,7%)"7"#%.#+)"+"3,%(+1#7%#%.%22,=(#*")"#.1&#+)"+1)(1&#7%#$#)%21>,71&#
%(#%&+%#2"*I+'.14#/&+%#+,*1#7%#,(+%)-%(2,=(9#&1."#1#%(#213H,("2,=(#21(#,(+%)-%(2,=(#6"3,.,")#9#&%#:"#31&+)"71#
%6,2"@#6)%(+%#"#21(7,2,1(%&#7%#21(+)1.#8#1+)1&#+)"+"3,%(+1&9#3"(+%(,[(71&%#.1&#.1>)1&#+%)"*%'+,21&#21(#%.#
+,%3*14#!"&#+%2(1.1>I"&#7%#."#,(61)3"2,=(#8#213'(,2"2,=(#JTICL#:"(#*%)3,+,71#"7"*+")#%&+1&#+)"+"3,%(+1&#
&,%(71#".+%)("+,-"&#3'8#-F.,7"&#%(#".>'(1&#7%#%&+1&#+)"&+1)(1&4#$.>'(1&#7%#%&+1&#61)3"+1&#J)%".,7"7#-,)+'".9#
)%".,7"7#"'3%(+"7"#8#+)"+"3%,(+1#1(.,(%L#:"(#)%&'.+"71#%6,2"2%&4

5.1. Principales componentes del tratamiento cognitivo-conductual

• Terapias de exposición:#."#%G*1&,2,=(#%&#'(#*)12%7,3,%(+1#+%)"*%;+,21#HF&,21#,(2.',71#%(#."#3"81)#*")+%#
7%#.1&#+)"+"3,%(+1#*")"#."#)%7'22,=(#8A1#%.,3,("2,=(#7%#."&#)%&*'%&+"&#7%#$4#/&+F#,(7,2"71#2'"(71#%.#
objetivo#%&#&'&+,+',)#."#C#7%#%-,+"2,=(A%&2"*%#7%.#(,M1A"71.%&2%(+%#7%#&,+#1#"21(+%2,3,%(+1#1H?%+,-"A#,(12'1&9#
*1)#."#7%#%G*1&,2,=(4#P%#H"&"#%(#."#*)%&%(+"2,=(#)%*%+,7"#7%.#/#0#%-12"#."#$#:"&+"#0#%&+"#)%3,+"4#!"&#
+[2(,2"&#H"&"7"&#%(#%.#*)12%7,3,%(+1#7%#%G*1&,2,=(#*'%7%(#"7"*+")#7,-%)&"&#61)3"&#0#&%#&,+'"(#"#.1#.")>1#
7%#'(#continuo graduado#%(#6'(2,=(#7%#."#,(+%(&,7"7#7%#.1&#/#1#&,+#+%3,7"&Y

####"L#/(#%.#*1.1#7%#3FG,3"#,(+%(&,7"79#&%#%(21(+)")I"#la inundación: ."#%G*1&,2,=(#&%#)%".,@"#7%#61)3"#3"&,-"##

8#*)1.1(>"7"#"(+%#/#0#&'&2,+"(#".+"#,(+%(&,7"7#7%#$#:"&+"#0#7,2:"#,(+%(&,7"7#7,&3,('8"#"#2%)14
####HL#exposición gradual:##%&#."#%G*1&,2,=(#*)1>)%&,-"#"#/#7%#3%(1)#"#3"81)#,(+%(&,7"79#)%7'2,%(71&%#%&+"#
%(#2"7"#*)%&%(+"2,=(#7%.#/4#^1(&+"#7%#.1&#&,>',%(+%&#*"&1&Y
• /."H1)"2,=(#7%#'(#.,&+"71#7%#&,+'"2,1(%&#%-12"71)"&#7%#)%&*'%&+"&#7%#$
• /G*1&,2,=(#>)"7'".#21(#*)%-%(2,=(#7%#)%&*'%&+"&4
#
/.#3%(1)#&%#%(6)%(+"#)%*%+,7"A#"#."&#&,+#0#.%#*)1-12"(#3,%71#7')"(+%#*%),171&#7%#+#:"&+"#0#&%#*)17'@2"#."#
habituación#8#7,&3,('8"#."#,(+%(&,7"7#7%#."&#)%&*'%&+"&#7%#$#%(#&'#+),*.%#&,&+%3"#7%#)%&*'%&+"E#"7%3F&#&%#
,3*,7%#..%-")#"#2"H1#."#)%&*'%&+"#7%#%&2"*%#1#%-,+"2,=(4#/.#"6)1(+"3,%(+1#&%#)%".,@"#de manera gradual9#
?%)")0',@"(71#."&#&,+#1#*%(&"3,%(+1&#+%3,71&#7%#3"(%)"#0#%.#(,M1A"71.%&2%(+%#&%#%(6)%(+%#*),3%)1#"#.1&#/#0#.%#
>%(%)"(#*12"#1#(,(>'("#$9#*")"#*1&+%),1)A#,)#"'3%(+"(71#."#,(+%(&,7"7#7%#."#%G*1&,2,=(4#/&+"#>)"7'"2,=(#7%#
."&#&,+#&%#)%".,@"#%3*.%"(71#%&2"."&#7%#$#%(#."&#0#&%#7"#'(#-".1)#7%#_#"#Z__#"#.1&#%&+I3'.1&4#/(#%.#2"&1#7%#.1&#
3F&#*%0'%M1&#."&#%&2"."&#&'%.%(#*)%&%(+")#'("#>)"7'"2,=(#3%(1)9#7%#_#"#Z_4#

/G&+%(#7,6#modos de realizar la exposición#"#.1&#%&+I3'.1&A&,+#+%3,7"&Y

• En vivoY#%&#."#3F&#%6,2"@#%(#d/9#(1#1H&+"(+%#%G,&+%(#%G2%*2,1(%&#%(#"0'%..1&#2"&1&#71(7%#."#%G*1&,2,=(#
)%".#&%"#7,6,2,.A#3"(,*'."H.%#G#*")+%#7%.#*&,2=.1>1#J3,%71#"#."&#+1)3%(+"&9#"#-,"?")#%(#"-,=(944L
• !"#%G*1&,2,=(#en imágenes: %(#.1&#2"&1&#%(#0#%.#3%(1)#3'%&+)%#&%),"&#)%+,2%(2,"&#".#+)"+"3,%(+1#7%#
%G*1&,2,=(#%(#-,-14
• Exposición gradual mediante RV: %&+F#&,%(71#'+,.,@"7"#2131#".+#"#."#%G*1&,2,=(#%(#-,-1#J"2)161H,"9#
")"2(161H,"9#61H,"#"#-,"?")#%(#"-,=(9#"(&,%7"7#>%(%)".,@"7"944L#VentajaY#."#)%2)%"2,=(#7%#'(#%(+1)(1#2%)2"(1#
".#)%".#2'"(71#(1#%&#"22%&,H.%#%.#/#1#%G,&+%#)%2:"@1#"#."#%G*1&,2,=(#%(#-,-14#Desventaja: %.#".+1#21&+%#7%.#
:")7m")%#8#7%.#&16+m")%#1#."#7,6,2'.+"7#7%#".>'(1&#*"2,%(+%&A2.,%(+%&#%(#&%(+,)&%#-%)7"7%)"A#,(3%)&1&#%(#%.#
21(+%G+1#-,)+'".4

<)1H.%3"&#0#*'%7%(#"*")%2%)#%(#."#*)F2+,2"#7%#."&#%&+)"+%>,"&#7%#%G*1&,2,=(Y
El niño se niega a realizar la exposicion Se recomienda comenzar con E q eliciten mínima A o añadir otras técnicas
cond como el programa de recompensas o el coste de R

TCCI 24
Niños con escapes encubiertos Es conveniente implementar un programa motivacional para q el niño
reconozca la imp de enfrentarse al E antes de comenzar al exposición

Búsqueda de reaseguración Es imp q tanto padres como psicoterapeuta no proporcionen reaseguración

al niño, sobre todo durante los jercicios de exposición ya q este podría
utilizar la búsqueda de tranquilidad como medio para reducir la A provocada
x los ej de exposición con prevención de R, impidiendo q actúe x sus
propios mec. Para eliminar estas cond, el procedimiento más adecuado es
la extinción.

• Técnicas cognitivas:#!"#5O#21>(,+,-"#7%#."#$#%&+F#H"&"7"#%(#%.#&'*'%&+1#7%#0#.1&#*%(&"3,%(+1&#8#2)%%(2,"&#
,(+)'&,-"&#0#&'6)%(#%&+1&#*"2,%(+%&#(1#&%#7,6%)%(2,"(#%(#>)"71#2'".,+"+,-1#7%#."&#0#%G*%),3%(+"(#.1&#&'?%+1&#
(1)3".%&9#&,(1#%(#."#)%"22,=(#%#,(+%)*)%+"2,=(#0#.1&#&'?%+1&#:"2%(#7%#%&+"&4#/G,&+%#'("#>)"(#-"),%7"7#7%#
+%2(,2"&#21>(,+,-"&#0#&%#:"(#,(21)*1)"71#"#.1&#*"0'%+%&#7%#+)"+##*")"#.1&#*)1H#7%#$9#7%&+"2"(71#%(#.1&#(,M1&A
"71.%&2%(+%&#."&#autoinstrucciones. P'#objetivo#%&#%(&%M")#"#317,6,2")#1#&'&+,+',)#%.#7,F.1>1#,(+%)(1#
7%&"7"*+"+,-19#%&#7%2,)9#."&#"'+1-%)H".,@"2,1(%&#0#*'%7%(#*)%&%(+")&%#"(+%&9#7')"(+%#8#7%&*'[&#7%#
%(6)%(+")&%#"#'("#7%+#+")%"#1#&,+#"-%)&,-"4#P%#%&*%)"#0#7,2:1#2"3H,1#%(#%.#7,F.1>1#,(+%)(1#6"2,.,+%#8#21(7'@2"#
"#'(#2"3H,1#%(#."&#)%&*'%&+"&##7%.#3%(1)4#/.#%(+)%("3,%(+1#%(#"'+1,'(&+)'22,1(%&#%&+F#,(2.',71#%(#
*)1>)"3"&#0#:"(#31&+)"71#&%)#%6,2"2%&9#2131#%.#programa Coping Cat de Kendall#JN_Z_L9#0#:"#31&+)"71#
&'#%6,2"2,"#%(#(,M1&#7%#c#"#ZV#"M1&#21(#61H,"&9#5$Q#8#5$P4#
###!"&#+[2(,2"&#21>#&%#:"(#,(2.',71#2131#complemento#".#213*1(%(+%#*),(2,*".#7%.#+)"+9#."#exposición#21(#####
*)%-%(2,=(#7%#)%&*'%&+"4#/.#+)"+#21>#%&#menos utilizado en edades tempranas#8"#0#)%0',%)%#'(#(,-%.#
3I(,31#7%#7%&"))1..1#21>#*")"#&'#"*.,2"2,=(4#P%#&'%.%(#'+,.,@")#"'+1,(&+)'22,1(%&#-%)H".%&#*")"#"*18")#%.#
"6)1(+"3,%(+1#7%#."&#&,+#9#1H?%+1&9#*%(&"3,%(+1&#1#,3F>%(%&#"(&,=>%("&#0#21(&,&+%(#%(#6)"&%&#7%.#+,*1Y#a&18#
2"*"@#7%#:"2%).1a#1#a#*'%71#">'"(+")#'(#*121#3F&a4#/(#niños mayores y adolescentes#&%#&'%.%(#,(2.',)#
1+)"&#+[2(,2"&#21>#2131#)%%&+)'2+')"2,=(#21>#9#)%&1.'2,=(#7%#*)1H9K

• Tecnicas de relajación y respiración:

###!1&#objetivos de las técnicas de respiració(#&1(Y
####"L#6"2,.,+")#%.#21(+)1.#-1.'(+"),1
####HL"'+13"+,@").1#*")"#0#*'%7"#&%)#"*.,2"71#%(#."&#&,+#>%(%)"71)"&#7%#%&+)[&#8#$9#21(#%.#6,(#7%#21(+)1.")#."#
"2+,-"2,=(#6,&,1.=>,2"4

!"&#fases &1(Y
a) InhalaciónY#)%".,@"#'("#,(&*,)"2,=(#.%(+"#8#*)16'(7"#G#."#("),@#*")"#7,),>,)#%.#",)%#,(&*,)"71#"#."#*")+%#,(6%),1)#
7%#&'&#*'.31(%&4#P%#.%#,(7,2"#".#3%(1)#0#21.0'%#'("#3"(1#%(2,3"#7%.#-,%(+)%#JG#7%H"?1#7%.#13H.,>1L#8#1+)"#
%(2,3"#7%#&'#%&+=3">19#&,#&%#:".."#&%(+"71E#&,#%&+F+'3H"71#&%#*'%7%(#&'&+,+',)#."&#3"(1&#G#)%-,&+"&#1#
.,H)1&#*121#*%&"71&4#
b) RetenciónY#3"(+,%(%#%.#",)%#U#&%>4
c) /xhalación: %G*,)"#%.#",)%#3'8#.%(+"A#G#."#H12"#.,H%)"(71#."#+%(&,=(#.%?1&9#3'8#.%?1&4#/.#)',71#&'"-%#0#
*)17'2%#%.#",)%#".#&".,)#)1@"(71#.1&#."H,1&#:"#7%#&%)#."#&%M".#7%#0#%&+F#)%".,@"(71#21))%2+"A#%.#%?%)2,2,14

/.#efecto de la relajación muscular %&#."#)%7'22,=(A%.,3,("2,=(#7%#."#+%(&,=(#6,&,1.=>,2"#8#."#&%(&"2,=(#

&'H?%+,-"#7%#3".%&+")4#/&+F#%&*%2,".A#,(7,2"7"#*")"#317,6,2")#)%&*'%&+"&#,(+%(&"&#7%#"2+,-"2,=(#"(+%#
7%3"(7"&#"3H,%(+".%&#J,(+%)("&#1#%G+%)("&L#0#,(+%)6,%)%(#."#"*"),2,=(#7%#)%&*'%&+"&#"7"*+"+,-"&9#*)17'2,%(71#
*)1H#7%#&".'7#2.I(,2"A#)%.%-"(+%&9#2131#5$Q9#5$P9#61H,"&9#K#/.#*)12%7,3,%(+1#7%&"))1.."71#G#Jacobson#
JZ`bjL#%G,>%#'(#*%),171#7%#+#.")>1#*")"#"*)%(7%)#."#+[2(,2"4#D#%..19#%(#%.#+)"+#21(#(,M1&9#Koeppen#JZ`cVL#
%."H1)=#%?%)2,2,1&#7%#+%(&,=(#8#7,&+%(&,=(#7%#.1&#7,6#>)'*1&#3'&2'.")%&#"#*")+,)#7%#."#&'>%&+,=(#%#,3F>%(%&#
3%(+".%&4#

TCCI 24
• El modelado y moldeamiento: *'%7%(#)%&'.+")#7%#"8'7"#%(#%.#313%(+1#7%#."#%G*1&,2,=(4#
###T%7,"(+%#%.#modelado,#%.#(,M1#*'%7%#1H&%)-")#2=31#%.#*&,2=.1>1#J1+)1#(,M1#1#6"3,.,")L#(1#&'6)%#
21(&%2'%(2,"&#(%>#".#%(6)%(+")&%#".#/#+%3,714#
##/(#%.#2"&1#7%.#moldeamiento9#%.#(,M1#21(&,>'%#'(#)%6'%)@1#*1)#"*)1G,3")&%#>)"7'".A#".#1H?#*)1*'%&+19#
*)%3,"(71#"&I#&'&#*%0'%M1&#"-"(2%&4#

• Intervención con la familia: %.#%(+)%("3,%(+1#%(#%.#3"(%?1#7%#."#$#7%#.1&#*"7)%&9#%.#)%61)@"3,%(+1#

7,6%)%(2,".#7%.#213*1)+"3,%(+1#8#%.#%(+)%("3,%(+1#%(#&1.'2,=(#7%#*)1H4

5.2. Tratamiento específico en los trastornos de ansiedad

5.2.1. Tratamiento en el TAS y TAG

!1& *)1>)"3"&#7%#+)"+#21>S21(7#3F&#'+,.,@"71&#%(#"3H1&#+)"&+1)(1&#:"(#&,71#%.#Coping Cat#Jn%(7"..#Z``_L#8#

&'&#7,6#"7"*+"2,1(%&4#/(#%&*"M1.#."#+)"7'22,=(#%&#a%.#>"+1#-".,%(+%aY#%&#'(#*)1>)"3"#3'.+,213*1(%(+%9#7,),>,71#
"#niños de entre 7 y 13 años9#0#,(21)*1)"#7,6#*)12%7,3,%(+1&#+%)"*%;+,21&#J#317%."719#%G*1&,2,=(#%(#-,-19#
3"(%?1#7%#21(+,(>%(2,"&9#)%."?"2,=(9#)1.%#*."8,(>#8#"'+1,(&+)'2,1(%&L#
ObjetivosY#)%21(12%)#.1&#&I(+13"&#7%#$#8#."&#)%"22,1(%&#&13F+,2"&9#317,6,2")#.1&#*%(&"3,%(+1&#"(&,1&1&9#
7%&"))1..")#'(#*."(#7%#"6)1(+"3,%(+1#7%#."#$9#8#%-".'")#%.#2'3*.,3,%(+1#8#"73,(,&+)"2,=(#7%#"'+1)%6'%)@19#
"7%3F&#7%#%G*1(%)#%(#-,-1#"#."&#&,+#0#*)1-12"(#$#%(#%.#(,M14
TCCI 24
!"&#diferentes adptaciones#7%#%&+%#*)1>)"3"#%(#.1&#7,&+,(+1&#*",&%&Y#
• /(#^"("7F#El oso valiente9#*1+%(2,"#."#*")+,2,*"2,=(#7%#.1&#*"7)%&#*")"#"8'7")#"#&'&#:,?1&#"#"6)1(+")#%.#3,%714
• /(#$'&+)".,"9#%.#Koala valiente9#0#,(2.'8%#)%21(12,3,(%+1#7%#)%&*'%&+"&#7%#$9#)%%&+)'2+')"2,=(#21>9#
"6)1(+"3,%(+19#7,F.1>1#,(+%)(19#%G*1&,2,=(#"#/#+%3,71&9#%-".'"2,=(#7%.#7%&%3*%M1#8#"73,(,&+)"2,=(#7%#"'+1S
)%6'%)@14
• Cool Kids J^:,21&#+)"(0',.1&L#+,%(%#'("#-%)&,=(#*")"#(,M1&#8#1+)"#*")"#"71.%&2%(+%&4#k(2.'8%#)%21(12,3,%(+1#
7%#%312,1(%&9#)%%&+)'2+')"2,=(#21>9#3"(%?1#7%#21(+,(>%(2,"&9#%(+)%("3,%(+1#%(#:"H#&12,".%&#8#"&%)+,-,7"7#8#
%G*1&,2,=(#>)"7'".4#^1(&+"#7%#Z_#&%&,1(%&#7%#N#:1)"&4#!"&#3%?1)"&#21(#%&+%#*)1>)"3"#&1(#".>1#3%(1)%&#
TCCI 24
 2'"(71#.1&#(,M1&#3'%&+)"(#2131)H,.,7"7#21(#1+)1&#+)"&+1)(1&#7%#"(&,%7"7#1#+)"&+1)(1&#%G+%)(".,@"71&#8#
H"&+"(+%#3%(1)%&#2'"(71#%G,&+%#2131)H,.,7"7#21(#+)"&+1)(1&#7%*)%&,-1&4
• Cool Teens J"71.%&2%(+%&#+)"(0',.1&LY#"*.,2"71#3%7,"(+%#^RSC]T4#<)1>)"3"#"'+1"*.,2"71#7')"(+%#ZN#
&%3"("&#8#21(#%.#"*181#7%#j#H)%-%&#G#*")+%#7%.#+%)"*%'+"#:"#6'(2,1("71#3%?1)#0#."#.,&+"#7%#%&*%)"4
• FRIENDS: *")"#."#dP9#d/9#5$P#8#5$Q4#d'[#%."H1)"71#"#*")+,)#7%#.1&#3"+%),".%&#8#%&+)"+%>,"&#,(2.',71&#%(#
^1*,(>#n1"."#o1)pH11p#7%#e"))%+4#P%#7,&*1(%#7%#2'"+)1#-%)&,1(%&#%."H1)"7"&#%(#6'(2,=(#7%#."#%7"7#7%#
"*.,2"2,=(4#
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###N4#$3,>1&#*")"#&,%3*)%#Jd),%(7&#61)#!,6%LY#*")"#(,M1&#7%#j#"#ZZ#"M1&4
###b4#T,&#"3,>1&#7%#?'-%(+'7#JT8#6),%(7&#81'+:LY#*")"#"71.%&2%(+%&#7%#ZN#"#ZU#"M1&4
###V4#C%&,.,%(2,"#"7'.+"#J$7'.+#)%&,.,%(2%L#Y#*")"#"71.%&2%(+%&#7%#ZW#"#Zj#1#3F&#"M1&4
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###U4#e'%(#+)"H"?19#)%213*[(&"+%#"#+,#3,&31Y##hqh,2%#m1)p9#&1#)%m")7#81')&%.6
###W4#h1#1.-,7%&#*)"2+,2")Y#RqR1(t+#61)>%+#+1#*)"2+,2%u
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213*1(%(+%#7%#,(+%)-%(2,=(#6"3,.,")#0#,(2.'8%#)%%&+)'2+')"2,=(#21>#*")"#*"7)%&9#%(+)%("3,%(+1#%(#"*181#"#."#
*")%?"#8#"(,3"#"#."&#6"3,.,"&#"#21(&+)',)#'("#)%7#7%#"*181#&12,".4#/(6"+,@"#%.#"*181#&12,".#8#%.#"*)%(7,@"?%#
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213'(,2"2,=(9#"*181#"#."#*")%?"#8#)%&1.'2,=(#7%#*)1H4#<")"#."#"*.,2"2,=(#7%.#*)1>)"3"9#.1&#+%)"*%'+"&#
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• FORTIUS: *")"#(,M1&#7%#j#"#ZN#"M1&4#P'#objetivo#%&#*1+%(2,")#."#61)+".%@"#*&,21.=>,2"#8#*)%-%(,)#."&#
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6)1(+")#."&#&,+#7,6,2,.%&#8#"#21(+)1.")#."&#%312,1(%&#(%>9#%&*%2,".A#."#$4#^1(&+"#7%#ZN#&%&,1(%&#?'(+1#"#1+)"&#7%#
61)+".%2,3,(%+19#7%#"*)1G,3"7"A#'("#:1)"#7%#7')"2,=(4#
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1) emocional: 1),%(+"71#"#7,&3,(',)#."#"2+,-"2,=(#-%>%+"+,-"#"#+)"-[&#7%.#%(+)%("3,%(+1#%(#)%."?"2,=(#
3'&2'.")#*)1>)%&,-"9#)%&*,)"2,=(#.%(+"#8#*)16'(7"#8#-,&'".,@"2,=(#+)"(0',.,@"71)"4#
##2) conductual: 7,),>,71#"#*)"2+,2")#."#%&2'2:"#"2+,-"9#."&#:"H#&12,".%&9#"#*."(,6,2")#%.#%&+'7,1#8#*)1>)"3")#%.#+#
.,H)%#,(2.'8%(71#"2+,-,7"7%&#">)"7"H.%&4
##3) cognitivo: 2%(+)"71#%(#317,6,2")#."#*)%12'*"2,=(9#.1&#*%(&"3,%(+1&#(%>"+,-1&#8#."#,(7%2,&,=(9#3%7,"(+%#
)%%&+)'2+')"2,=(#21>9#)%&1.'2,=(#7%#*)1H#8#"'+1,(&+)'22,1(%&4

$7%3F&#7%#%&+1&#programas9#%G,&+%(#1+)1&#específicos sobre el trat de TAS y TAG.

• !1&#+)"+"3,%(+1&#%&*%2I6,21&#*")"#%.#TAS en la infancia &%#H"&"(#%( psicoeducación a los padres y
entrenamiento J%G*.,2"2,=(#7%.#*)1H9#%(&%M"(@"#7%#:%))"3,%(+"&#*")"#:"2%)#6)%(+%#"#."&#&,+LY
- <,(2'&9#P"(+'22,9#/:)%()%,2:#8#/8H%)>#JN__jL#2)%")1(#."#Terapia de interacción padres-niños
modificada PCIT: .1&#*"7)%&#&1(#%(+)%("71&#*")"#"*.,2")#:"H#%&*%2I6,2"&#7%#,(+%)"22,=(#21(#&'&#:,?1&#
J)%7'22,=(#7%#2)I+,2"&9#*)%>'(+"&#8#=)7%(%&9#"'3%(+1#7%#%.1>,1&9#)%6.%G,=(9#,3,+"2,=(9KL4#5H#&1(#%(+)%("71&#
%(#)%6'%)@1#7,6%)%(2,".9#%(#21(&+)'2,,=(#7%#'("#?%)")0',"#7%.#3,%71#?'(+1#"#."#"*.,2"2,=(#7%#+F2+,2"&#8#
:%))"3,%(+"&#*")"#:"2%)#6)%(+%#"#."&#&,+#7%#&%*")"2,=(4#!"&#&%&,1(%&#&1(#&%3"(".%&#21(#'("#7')"2,=(#
"*)1G#7%#'("#:1)"4#
TCCI 24
- /,&%(9#C".%,>:#8#h%':166#JN__jL#Tratamiento preceptivo, 0#,(+%>)"#*&,21%7'2"2,=(9#)%."?"2,=(9#"'+121(+)1.#
8#3"(%?1#7%#21(+,(>%(2,"&4#!"&#&%&,1(%&#Z#8#N#%(6"+,@"(#."#*&,21%7'2"2,=(E#."&#&%&,1(%&#b#"#W#%&+F(#
%(612"7"&#%(#%.#7%&"))1..1#7%#:"H,.,7"7%&#J21(&+)',)#'("#?%)")0',"#7%#$#*1)#&%*")"2,=(9#"*)%(7%)#)%."?"2,=(#
*)1>)%&,-"#8#3%+171&#21>#8#*),(2,*,1&#7%#3"(%?1#7%#21(+,(>%(2,"&L9#."&#&%&,1(%&#c#"#`#21(&,&+%(#%(#
*)"2+,2")#."&#:"HE#8#%(#."&#&%&,1(%&#`#8#Z_#&%#"H1)7"#."#*)%-%(2,=(#7%#)%2",7"&4
- T%(7%@9#])>,.%&#8#/&*"7"#JN_ZcL4#<)%&%(+")1(#'(#manual para la evaluación y el tratamiento del TAS.
!"#,(+%)-%(2,=(#&%#2%(+)"#%(#%.#(,-%.#*&,216,&,1.=>,21#J+[2(,2"&#7%#)%."?"2,=(L9#21>(,+,-1#J2"3H,1#7%#
%&0'%3"&#3%(+".%&#*")"#0#7,&3,('8"#."#,(+%(&,7"7#7%#."&#*)%12'*"2,1(%&L#8#31+1)4#P%#..%-"(#"#2"H1#
*)F2+,2"&#7%#&%*")"2,=(#7%&7%#'(#(,-%.#3I(,31#7%#$#:"&+"#'(#(,-%.#3FG,31#3%7,"(+%#'("#?%)")0'I"4#k(2.'8%#
,(+%)-%(2,=(#21(#*"7)%&#8#*)16%&1)%&#J3"(%?1#21(+,(>%(2,"&9#213'(,2"2,=(#8#)%&1.'2,=(#7%#21(6.,2+1&#8#
+%)"*,"#,(7,-,7'".#8#7%#*")%?"L4
• !1&#*)1>)"3"&#2%(+)"71&#%&*%2,6,2"A#%(#%.#TAG#:"(#&,71#.1&#&,>',%(+%&Y
- Terapia cognitiva puraY#&%#+)"+"#7%#'(#*)1>)"3"#7%#Z_SZU#&%&,1(%&#2%(+)"7"&#%(#,7%(+,6,2")#8#3"(%?")#."&#
*)%12'*"2,1(%&4#/!#+)"+"3,%(+1#21(&+"#7%#W#%+"*"&Y
####Z4#^1(2,%(2,"#7%#."#*)%12'*"2,=(4
####N4#/G*1&,2,=(#"#."#,(2%)+,7'3H)%4
####b4#T17,6,2"2,=(#7%#2)%%(2,"&#7,&6'(2,1(".%&#&1H)%#."#*)%12'*"2,=(4
####V4#C%&1.'2,=(#7%#*)1H.%3"&4
####U4#/G*1&,2,=(#,3">,("),"#"#,3">%(%&#7%&">)"7"H.%&#1#*)%12'*"2,1(%&4
####W4#<)%-%(2,=(#7%#)%2",7"&4
- Terapia metacognitiva para niñosY#j#&%&,1(%&#>)'*".%&#&%3"(".%&#7%#N#:1)"&#*")"#.1&#(,M1&#8#71&#
+"..%)%&#*")"#.1&#*"7)%&4#P%#'+,.,@"#%.#317%.1#3%+"21>(,+,-1##J%(+)%("3,%(+1#7%#."#"+%(2,=(9#)%%(610'%#
"+%(2,1(".#&,+'"2,1(".9#%(+)%("3,%(+1#7%#"+%(2,1(9#7%&"6I1#-%)H".#"#.1&#*%(&"3,%(+1&944L

5.2.2. Tratamientos en miedos y fobias

$2+'".3%(+%9#."#exposición gradual en vivo#%&#%.#;(,21#+)"+"3,%(+1#H,%(#%&+"H.%2,71#*")"#."#61H,"#%&*%2I6,2"

%(#."#,(6"(2,"#8#"71.%&2%(2,"4#P,#&')>%(#7,6#*")"#&'#,3*.%3%(+"2,=(9#%.#+%)"*%'+"#*'%7%#*."(+%")#'("#
,(+%)-%(2,=(#alternativa#2131#,3F>%(%&#%31+,-"&9#3"(%?1#7%#21(+,(>%(2,"&#8#317%."714#!"#%G*1&,2,=(#"#
+)"-[&#7%#realidad virtual#+H#&%#'+,.,@"#%(#2"&1&#7%#61H,"&#,(6"(+,.%&#"#"(,3".%&9#+1)3%(+"&9#K
v'(+1#"#."#%G*1&,2,=(#%(#-,-1#&%#&'%.%#%(+)%(")#%(#Autoinstrucciones de valentía - 21(#%.#6,(#7%#)%7'2,)#%.#
+%31)#"#."#&,+'"2,1(S#8#Autoinstrucciones neutrales. R%#,>'".#31719#."#'+,.,@"2,=(#7%#cuentos#&1H)%#3,%71&#
,(6"(+,.%&#%&#'("#317".,7"7#7%#%G*1&,2,=(#0#,(2.'8%#-"),"&#%&+)"+%>,"&#+%)"*%;+,2"&9#2131#,(61)3"2,=(9#
317%."719#"'+1,(&+)'22,1(%&#8#%G*1&,2,=(#"#&,+'"2,1(%&#7%#3,%714#/G,&+%(#cuentos#*")"#.1&#3,%71&#,(6"(+,.%&Y
]&2")#8#%.#.%=(#7%#21))%1&#7%#T'M1@9#/.#21217),.1#e)%,+3%,%)9#$.%G#%(#'("#3,&,=(#&%2)%+"4
Dos programas para tratar los miedos a la oscuridad:
S Tio Pies Ligeros o Uncle LightfootY#1),%(+"71#"#*"7)%&#7%#(,M1&#7%#V#"#j#"M1&#21(#61H,"#"#."#1&2'),7"74#
^1(&+"#7%#ZN#2"*I+'.1&#%(#.1&#0#T,>'%.9#%.#(,M1#*)1+">1(,&+"9#"2+;"#2131#317%.1#7%#"6)1(+"3,%(+19#8#7%#`#
?'%>1&9#,(2.'8%(71#)%."?"2,=(9#*")"#-%(2%)#%.#3,%714#R')"(+%#%.#+)"+#%.#(,M1#&%#)%."2,1("#*)1>)%&,-"A9#%(#
,3">,("2,=(#J2'%(+1L#8#%(#-,-1#J?'%>1&L9#21(#&,+'"2,1(%&#7%#3"81)#1&2'),7"74#!"&#,(&+)'22,1(%&#*")"#.1&#
*"7)%&#&%#)%6,%)%(#".#'&1#7%.#31.7%"3,%(+1#1#"*)1G,3"2,1(%&#&'2%&,-"&#8#7%.#)%61)@"3,%(+1#&12,".4
S Escenificaciones emotivasY#*)1>)"3"#6.%G,H.%#7%#+)"+"3,%(+1#0'%9#213%(@"(71#G#'(#61)3"+1#HF&,21#7%#
?'%>19#,(21)*1)"#*)1>)%&,-"A#1+)1&#%.%3%(+1&#"7%2'"71&#"#2"7"#2"&1#%&*%2I6,214#^'"(71#%.#(,M1#(1#
*)%&%(+"#."#21(7#7%#"*)1G,3"2,=(9#%.#+%)"*%'+"#.%#*)1*1)2,1("#"8'7"#J,(7'22,=(#-%)H".9#317%."719#>',"#
6I&,2"L#:"&+"#0#%.#(,M1#."#)%".,@"#G#&,#3,&31#8#)%6'%)@1#2'"(71#&%#"*)1G,3"#".#%&+I3'.1#6=H,214w

TCCI 24
Fases de las escenificaciones emotivas

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5.3.Los tratamientos farmacológicos

!1&#%&+'7,1&#3%+""(".I+,21&#,(61)3"(#0#."#*&,21+%)"*,"#".2"(@"#3"81)%&#+"3"M1&#7%#%6%2+1#0#."#
6")3"21+%)"*,"#%(#%.#>)'*1#7%#+)"&+1)(1&#*)%&%(+"71&#%(#%&+%#2"*I+'.14#h1#1H&+"(+%#%(#2"&1#7%#5$Q#8#5$P#
)%&,&+%(+%#".#+)"+"3,%(+19#.1&#kPCP#&1(#.1&#0#*)%&%(+"(#3"81)#"*181#%3*I),21#..%>"(71#"#*)17'2,)#3%?1)I"&#
317%)"7"&4

6. CASO CLÍNICO.
6.1. Descripción del caso.

TCCI 24
TCCI 24
TCCI 24
TCCI 24
CONCLUSIONES Y TENDENCIAS DE FUTURO

!1&#+)"&+1)(1&#7%#$#%(#."#,(6"(2,"#8#"71.%&2%(2,"#&1(#3'8#6)%2'%(+%&9#&,%(71#.1&#3F&#*)%-".%(+%&#.1&#
3%(2,1("71&#%(#%&+%#2"*I+'.14#h1)3".A#(1#)%3,+%(#21(#%.#*"&1#7%.#+#8#*)1-12"(#'("#>)"(#,(+%)6%)%(2,"#+"(+1#%(#
%.#(,M1A"71.%&2%(+%#0#.1#*"7%2%#2131#%(#&'#6"3,.,"4#R%#":I#."#)%.%-"(2,"#7%#."#7%+%22,=(#%#,(+%)-%(2,=(#
+%3*)"("4
$2+'".A#+%(%31&#7,&+,(+1&#,(&+)'3%(+1&#7%#%-".'"2,=(#%(#2"&+%.."(1#*")"#*17%)#%-".'")#+"(+1#."#$#%(#>%(%)".#
2131#%.#5$P9#5$Q#8#."&#d/#%(#(,M1&#8#"71.%&2%(+%&4#h1#1H&+"(+%#."&#,(-%&+,>"2,1(%&#6'+')"&#*17)I"(#7,),>,)&%#
+"(+1#%(#"7"*+")#,(&+)'3%(+1&#".#2"&+%.."(1#2131#%(#%."H1)")#('%-1&#0#(1&#*%)3,+"(#7%+%2+")#7%#61)3"#3F&#
*)%2,&"#%&+1&#+)"&+1)(1&4#
!"#terapia cognitiva-conductual#%&#%.#+)"+"3,%(+1#7%#%.%22,=(#8#%.#;(,21#H,%(#%&+"H.%2,71#*")"#.1&#+)"&+1)(1&#
7%#$#%(#."#,(6"(2,"4#!" exposición gradual %(#-,-1#%&#%.#+)"+"3,%(+1#*),(2,*".4#!1&#cuentos,#.1&#juegos#8#."&#
guias para padres#&1(#)%2')&1&#+%)"*%;+,21&#3'8#'+,.%&#%(#niños más pequeños.
P%)I"#,3*#7,&%M")#*)1+121.1&#"+%(7,%(71#"#."#%7"7#7%#.1&#3%(1)%&#*")"#2"7"#*)1H#9#"(".,@"(71#"7%3F&#."#,3*#
7%#2"7"#213*1(%(+%4#X("#.,3,+"2,=(#%&#."#"'&%(2,"#7%#&%>',3,%(+1&#"#.")>1#*."@1#0#(1&#*%)3,+"(#213*)1H")#
&,#%.#*)1H#)%3,+%9#)%"*")%2%#1#*)%&%(+"#1+)1#*)1H4
dk(".A#9#&%#7%H%)I"#&%>',)#,(-%&+,>"(71#%(#vs predictoras de los trastornos#+".%&#2131#-&#*&,21*"+1.=>,2"&#
7%#.1&#*"7)%&9#"21317"2,=(#7%#.1&#*"7)%&#".#*)1H9#%7"7#8#&%G1#7%.#3%(1)9#(,-%.%&#7%#$9#-&#+%3*%)"3%(+".%&#8#
"3H,%(+".%&#7%.#3%(1)9K

TCCI 24