Efficacy of a cognitive and behavioural psychotherapy applied by primary care psychologists in patients with mixed anxiety-depressive disorder: a research protocol

Background: In contrast with the recommendations of clinical practice guidelines, the most common treatment for anxiety and depressive disorders in primary care is pharmacological. The aim of this study is to assess the efficacy of a cognitive-behavioural psychological intervention, delivered by primary care psychologists in patients with mixed anxiety-depressive disorder compared to usual care. Methods/Design: This is an open-label, multicentre, randomized, and controlled study with two parallel groups. A random sample of 246 patients will be recruited with mild-to-moderate mixed anxiety-depressive disorder, from the target population on the lists of 41 primary care doctors. Patients will be randomly assigned to the intervention group, who will receive standardised cognitive-behavioural therapy delivered by psychologists together with usual care, or to a control group, who will receive usual care alone. The cognitive-behavioural therapy intervention is composed of eight individual 60-minute face-to face sessions conducted in eight consecutive weeks. A follow-up session will be conducted over the telephone, for reinforcement or referral as appropriate, 6 months after the intervention, as required. The primary outcome variable will be the change in scores on the Short Form-36 General Health Survey. We will also measure the change in the frequency and intensity of anxiety symptoms (State-Trait Anxiety Inventory) and depression (Beck Depression Inventory) at baseline, and 3, 6 and 12 months later. Additionally, we will collect information on the use of drugs and health care services. Discussion: The aim of this study is to assess the efficacy of a primary care-based cognitive-behavioural psychological intervention in patients with mixed anxiety-depressive disorder. The international scientific evidence has demonstrated the need for psychologists in primary care. However, given the differences between health policies and health services, it is important to test the effect of these psychological interventions in our geographical setting.

Low Effort L-i Nuclear Fusion Plasma Control Using Model Predictive Control Laws

One of the main problems of fusion energy is to achieve longer pulse duration by avoiding the premature reaction decay due to plasma instabilities. The control of the plasma inductance arises as an essential tool for the successful operation of tokamak fusion reactors in order to overcome stability issues as well as the new challenges specific to advanced scenarios operation. In this sense, given that advanced tokamaks will suffer from limited power available from noninductive current drive actuators, the transformer primary coil could assist in reducing the power requirements of the noninductive current drive sources needed for current profile control. Therefore, tokamak operation may benefit from advanced control laws beyond the traditionally used PID schemes by reducing instabilities while guaranteeing the tokamak integrity. In this paper, a novel model predictive control (MPC) scheme has been developed and successfully employed to optimize both current and internal inductance of the plasma, which influences the L-H transition timing, the density peaking, and pedestal pressure. Results show that the internal inductance and current profiles can be adequately controlled while maintaining the minimal control action required in tokamak operation.