Estudio piloto sobre la eficacia de un tratamiento transdiagnóstico para trastornos emocionales en Atención Primaria
DOI:
https://doi.org/10.55414/ap.v42i1.1545Palabras clave:
Trastornos emocionales; tratamiento transdiagnóstico; eficacia; atención primaria.Resumen
Este estudio tuvo como objetivo evaluar y determinar la eficacia de un tratamiento transdiagnóstico breve en formato grupal para personas con trastornos emocionales leves y moderados, y establecer correlaciones entre los cambios después del tratamiento en las diferentes variables. Este trabajo tuvo un diseño experimental de grupo único con medidas pre-post. Los participantes (n =18) fueron asignados aleatoriamente para el diseño del proyecto de PsicAP-Cost, de donde se han extraído los datos del grupo experimental. Los participantes fueron evaluados antes y después de la intervención con las siguientes medidas: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B y CERQ-18. Se encontró que la terapia transdiagnóstica breve fue efectiva para reducir los síntomas depresivos (p = .001), síntomas ansiosos (p = .011) y preocupación (p = .018) con tamaños del efecto alto/moderado. Además, se encontraron correlaciones significativas positivas entre los cambios de las variables de síntomas depresivos y preocupación, y entre los cambios en síntomas ansiosos y rumiación. Se concluyó que los tratamientos transdiagnóticos breves pueden ser un tratamiento a tener en cuenta para los pacientes con trastornos emocionales leves y moderados en Atención Primaria debido a su eficacia en algunos síntomas y sus características.
Descargas
Referencias
Aguilera-Martín, Á., Gálvez-Lara, M., Cuadrado, F., Moreno, E., García-Torres, F., Venceslá, J.F., Corpas, J., Jurado-González, F.J., Muñoz-Navarro, R., González-Blanch, C., Ruiz-Rodríguez, P., Barrio-Martínez, S., Prieto-Vila, M., Carpallo-González, M., Cano-Vindel, A., & Moriana, J.A. (2022). Cost-effectiveness and cost-utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP-Costs): A multicentre randomized controlled trial protocol. BMC Psychiatry, 22(1), 99. https://doi.org/10.1186/s12888-022-03726-4
Ausín, B., González-Sanguino, C., Castellanos, M.A., Sáiz, J., Zamorano, S., Vaquero, C., & Muñoz, M. (2022). The psychological impact of the COVID-19 pandemic in Spain: A longitudinal study. Psicothema, 34(1), 66-73. https://doi.org/10.7334/psicothema2021.290
Barlow, D.H., Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L., Allen, L.B., & Ehrenreich-May, J.T. (2010). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. Oxford University Press.
Barlow, D.H., Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L., Payme, L.A., & Ehrenreich-May, J.T. (2011). Unified protocol for transdiagnostic treatment of emotional disorders. Oxford University Press.
Barlow, D.H., Harris, B.A., Eustis, E.H., & Farchione, T.J. (2020). The unified protocol for transdiagnostic treatment of emotional disorders. World Psychiatry: Official journal of the World Psychiatric Association (WPA), 19(2), 245-246. https://doi.org/10.1002/wps.20748
Borkovec, T.D., Ray, W.J., & Stober, J. (1998). Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22(6), 561-576. http://doi.org/10.1023/A:1018790003416
Bullis, J.R., Boettcher, H., Sauer-Zavala, S., Farchione, T.J., & Barlow, D.H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. Clinical Psychology: Science and Practice, 26(2), 1-19. https://doi.org/10.1111/cpsp.12278
Cano-Vindel, A., Muñoz-Navarro, R., Moriana, J.A., Ruiz-Rodríguez, P., Medrano, L.A., & González- Blanch, C. (2022a). Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: The results of the PsicAP randomized controlled trial. Psychological Medicine, 52(15), 3336 - 3348. https://doi.org/10.1017/S0033291720005498
Cano-Vindel, A., Ruiz-Rodríguez, P., Moriana, J.A., Medrano, L.A., González-Blanch, C., Aguirre, E., & Muñoz-Navarro, R. (2022). Improving access to psychological therapies in Spain: From IAPT to PsicAP. Psicothema, 34(1), 18-24. https://doi.org/10.7334/psicothema2021.113
Carlucci, L., Saggino, A., & Balsamo, M. (2021). On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis. Clinical Psychology Review, 87, 101999. https://doi.org/10.1016/j.cpr.2021.101999
Cassiello-Robbins, C., Southward, M.W., Tirpak, J.W., & Sauer-Zavala, S. (2020). A systematic review of unified protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review, 78, 101852. https://doi.org/10.1016/j.cpr.2020.101852
Chambless, D.L. (2014). Can we talk? Fostering interchange between scientists and practitioners. Behavior Therapy, 45(1), 47-50. https://doi.org/10.1016/j.beth.2013.08.002
Chen, J., Liu, X., Rapee, R. M., & Pillay, P. (2013). Behavioural activation: A pilot trial of transdiagnostic treatment for excessive worry. Behaviour Research and Therapy, 51(9), 533-539. https://doi.org/10.1016/j.brat.2013.05.010
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Lawrence Erlbaum Associates, Publishers.
Corpas, J. (2021). La efectividad de los tratamientos psicológicos breves y de enfoque transdiagnóstico para los trastornos emocionales en los sistemas sanitarios Tesis doctoral. Universidad de Córdoba (España). https://helvia.uco.es/bitstream/handle/10396/22196/2021000002354.pdf?sequence=1
Corpas, J., Moriana, J.A., Venceslá, J.F., & Gálvez-Lara, M. (2021a). Brief psychological therapies for emotional disorders in primary care: A systematic review and meta-analysis. Clinical Psychology: Science and Practice, 28(4), 363-376. https://doi.org/10.1037/cps0000009
Corpas, J., Moriana, J.A., Venceslá, J.F., & Gálvez-Lara, M. (2021b). Brief psychological treatments for emotional disorders in primary and specialized care: A randomized controlled trial. International Journal of Health and Clinical Psychology, 21(1), 100203. https://doi.org/10.1016/j.ijchp.2020.11.002
Corpas, J., Moriana, J.A., Venceslá, J.F., & Gálvez-Lara, M. (2022). Effectiveness of brief group transdiagnostic therapy for emotional disorders in primary care: A randomized controlled trial identifying predictors of outcome. Psychotherapy Research, 32(4), 456-469. https://doi.org/10.1080/10503307.2021.1952331
Crittendon, J., & Hopko, D.R. (2006). Assessing worry in older and younger adults: Psychometric properties of an abbreviated Penn State Worry Questionnaire (PSWQ-A). Journal of Anxiety Disorders, 20(8), 1036-1054. https://doi.org/10.1016/j.janxdis.2005.11.006
Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., & van Straten, A. (2014). The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of Affective Disorders, 159, 118-126. https://doi.org/10.1016/j.jad.2014.02.026
Dar, K.A., Iqbal, N., & Mushtaq, A. (2017). Intolerance of uncertainty, depression, and anxiety: Examining the indirect and moderating effects of worry. Asian Journal of Psychiatry, 29, 129-133. https://doi.org/10.1016/j.ajp.2017.04.017
Donahue, J.J., & Wright, T.W. (2019). Considering the emotional disorder construct in context: Science and practice. Clinical Psychology, 26(2), e122884. http://dx.doi.org/10.1111/cpsp.12288
Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L., Thompson-Hollands, J., Carl, J.R., Gallagher, M.W., & Barlow, D.H. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behavior Therapy, 43(3), 666-678. https://doi.org/10.1016/j.beth.2012.01.001
Field, A. P., Psychol, C., y Morgan, J. (2004). Post-event processing and the retrieval of autobiographical memories in socially anxious individuals. Journal of Anxiety Disorders, 18(5), 647-663. https://doi.org/10.1016/j.janxdis.2003.08.004
Gálvez-Lara, M., Corpas, J., Velasco, J., & Moriana, J.A. (2019). El conocimiento y el uso en la práctica clínica de los tratamientos psicológicos basados en la evidencia. Clínica y Salud, 30(3), 115-122. http://dx.doi.org/10.5093/clysa2019a12
González-Blanch, C., Muñoz-Navarro, R., Medrano, L.A., Moriana, J.A., Ruiz-Rodríguez, P., & Cano- Vindel, A. (2021). Moderators and predictors of treatment outcome in transdiagnostic group cognitive-behavioral therapy for primary care patients with emotional disorders. Depression and Anxiety, 38(7), 757-767. https://doi.org/10.1002/da.23164
González-Blanch, C., Umaran-Alfageme, O., Cordero-Andrés, P., Muñoz-Navarro, R., Ruiz-Rodríguez, P., Medrano, L.A., Ruiz-Torres, M., Dongil-Collado, E., Cano-Vindel, A., & Grupo de Investigación PsicAP (2018). Tratamiento psicológico de los trastornos emocionales en atención primaria: el manual de tratamiento transdiagnóstico del estudio PsicAP. Ansiedad y Estrés, 24(1), 1-11. https://doi.org/10.1016/j.anyes.2017.10.005
Holgado-Tello, F., Amor, P.J., Lasa, A., & Domínguez, J. (2018). Two new brief versions of the cognitive emotion regulation questionnaire and its relationships with depression and anxiety. Anales de Psicología, 34(3), 458-464. https://doi.org/10.6018/analesps.34.3.306531
Hong R.Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behaviour Research and Therapy, 45(2), 277-290. https://doi.org/10.1016/j.brat.2006.03.006
Kessler, R.C., Chiu, W.T., Demler, O., Merikangas, K.R., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627. https://doi.org/10.1001/archpsyc.62.6.617
Kroenke, K., Spitzer, R.L., & Williams, J.B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525- 1497.2001.016009606.x
Kroenke, K., Spitzer, R.L., & Williams, J.B. (2002). The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosomatic Medicine, 64(2), 258-266. https://doi.org/10.1097/00006842-200203000-00008
Lamers, F., van Oppen, P., Comijs, H.C., Smit, J.H., Spinhoven, P., van Balkom, A.J., Nolen, W.A., Zitman, F.G., Beekman, A.T., & Penninx, B.W. (2011). Comorbidity patterns of anxiety and depressive disorders in a large cohort study: The Netherlands Study of Depression and Anxiety (NESDA). The Journal of Clinical Psychiatry, 72(3), 341-348. https://doi.org/10.4088/JCP.10m06176blu
Liu, M., & Ren, S. (2018). Moderating effect of emotional intelligence on the relationship between rumination and anxiety. Current Psychology, 37, 272-729. https://doi.org//10.1007/s12144016-9510-7
Makovac, E., Meeten, F., Watson, D.R., Herman, A., Garfinkel, S.N., Critchley, H.D., & Ottaviani, C. (2016). Alterations in amygdala-prefrontal functional connectivity account for excessive worry and autonomic dysregulation in generalized anxiety disorder. Biological Psychiatry, 80(10), 786-795. https://doi.org/10.1016/j.biopsych.2015.10.013
Martín-Jurado, A., de-la-Gándara-Martín, J.J., Castro-Carbajo, S., Moreira-Hernández, A., & Sánchez- Hernández, J. (2012). Concordance analysis of referrals from primary care to mental health. Semergen, 38(6), 354-359. https://doi.org/10.1016/j.semerg.2011.12.005
McEvoy, P.M., Nathan, P., & Norton, P.J. (2009). Efficacy of transdiagnostic treatments: A review of published outcome studies and future research directions. Journal of Cognitive Psychotherapy, 23(1), 20-33. https://doi.org/10.1891/0889-8391.23.1.20
McLaughlin, K.A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49(3), 186-193. https://doi.org/10.1016/j.brat.2010.12.006
Michl, L.C., McLaughlin, K.A., Shepherd, K., & Nolen-Hoeksema, S. (2013). Rumination as a mechanism linking stressful life events to symptoms of depression and anxiety: Longitudinal evidence in early adolescents and adults. Journal of Abnormal Psychology, 122(2), 339-353. https://doi.org/10.1037/a0031994
Möller-Leimkühler, A.M. (2002). Barriers to help-seeking by men: A review of sociocultural and clinical literature with particular reference to depression. Journal of Affective Disorders, 71(1-3), 1-9. https://doi.org/10.1016/s0165-0327(01)00379-2
Montalbán, S.R., Vives, A.C., & Garcia-Garcia, M. (2010). Validation of the Spanish version of the PHQ-15 questionnaire for the evaluation of physical symptoms in patients with depression and/or anxiety disorders: DEPRE-SOMA study. Actas Españolas de Psiquiatría, 38(6), 345-457.
Moreno, E., & Moriana, J.A. (2012). El tratamiento de problemas psicológicos y de salud mental en atención primaria. Salud Mental, 35(4), 315-328.
Moriana, J.A., Gálvez-Lara, M., & Corpas, J. (2017). Psychological treatments for mental disorders in adults: A review of the evidence of leading international organizations. Clinical Psychology Review, 54, 29-43. https://doi.org/10.1016/j.cpr.2017.03.008
Muñoz-Navarro, R., Cano-Vindel, A., Medrano, L.A., Schmitz, F., Ruiz-Rodríguez, P., Abellán-Maeso, C., Font-Payeras, M.A., & Hermosilla-Pasamar, A.M. (2017a). Utility of the PHQ-9 to identify major depressive disorder in adult patients in Spanish primary care centres. BMC psychiatry, 17(1), 291. https://doi.org/10.1186/s12888-017-1450-8
Muñoz-Navarro, R., Cano-Vindel, A., Moriana, J.A., Medrano, L.A., Ruiz-Rodríguez, P., Agüero- Gento, L., Rodríguez-Enríquez, M., Pizà, M.R., & Ramírez-Manent, J.I. (2017b). Screening for generalized anxiety disorder in Spanish primary care centers with the GAD-7. Psychiatry Research, 256, 312-317. https://doi.org/10.1016/j.psychres.2017.06.023
Muñoz-Navarro, R., Medrano, L.A., González-Blanch, C., Carpallo-González, M., Olave, L., Iruarrizaga, I., Ruiz-Rodríguez, Moriana, J.A., & Cano-Vindel, A. (2021). Validity of brief scales for assessing transdiagnostic cognitive emotion regulation strategies in primary care patients with emotional disorders. Eropean Journal of Psychological Assesment, 37(2), 86-94. https://doi.org/10.1027/1015-5759/a000584
Muñoz-Navarro, R., Medrano, L.A., Limonero, J.T., González-Blanch, C., Moriana, J.A., Ruiz- Rodríguez, P., & Cano-Vindel, A. (2022). The mediating role of emotion regulation in transdiagnostic cognitive behavioural therapy for emotional disorders in primary care: Secondary analyses of the PsicAP randomized controlled trial. Journal of Affective Disorders, 303, 206-215. https://doi.org/10.1016/j.jad.2022.01.029
National Institute for Health and Clinical Excellence [NICE] (2011). Common mental health problems: Identification and pathways to care clinical guideline. The Royal College of Psychiatrists.
Newby, J.M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91-110. https://doi.org/10.1016/j.cpr.2015.06.002
Nolen-Hoeksema, S. (1996). Chewing the cud and other ruminations. En R.S. Wyer (Ed.), Ruminative thoughts (pp. 135-144). Lawrence Erlbaum Associates.
Okur, G.Z.E., Sattel, H., Witthöft, M., & Henningsen, P. (2019) Emotion regulation in patients with somatic symptom and related disorders: A systematic review. PlosOne, 14(6), e0217277. https://doi.org/10.1371/journal.pone.0217277
Olfson, M., & Marcus, S.C. (2010). National trends in outpatient psychotherapy. The American Journal of Psychiatry, 167(12), 1456-1463. https://doi.org/10.1176/appi.ajp.2010.10040570
Osma, J., Navarro-Haro, M.V., Peris-Baquero, O., & Suso-Ribera, C. (2022). Unified protocol in a group format for improving specific symptoms of emotional disorders in the Spanish public health system. Psicothema, 34(1), 25-34. https://doi.org/10.7334/psicothema2021.246
Patel, V., Saxena, S., Lund, C., Thornicroft, G., Baingana, F., Bolton, P., Chisholm, D., Collins, P.Y., Cooper, J.L., Eaton, J., Herrman, H., Herzallah, M.M., Huang, Y., Jordans, M., Kleinman, A., Medina-Mora, M.E., Morgan, E., Niaz, U., Omigbodun, O., Prince, M., Rahman, A., Saraceno, B., Sarkar, B.K., DeSilva, M., Singh, I., Stein, D.J., Sunkel, C. & UnÜtzer, J. (2018). The Lancet Commission on global mental health and sustainable development. Lancet, 392(10157), 1553-1598. https://doi.org/10.1016/S01406736(18)31612X
Peris-Baquero, Ó., Osma, J., Gil-LaCruz, M., & Martínez-García, L. (2021). Acceptability of and intention to use the unified protocol delivered in group format in the Spanish public health system. Journal of Evaluation in Clinical Practice, 27(6), 1299-1309. https://doi.org/10.1111/jep.13546
Piraman, M., Tavakoli, M., & Torkan, H. (2016). Rumination and co-rumination: Factors predicting depression. International Journal of Educational and Psychological Research, 2(2), 99-104. https://doi.org/10.4103/2395-2296.178865
Riihimäki, K., Vuorilehto, M., Jylhä, P., & Isometsä, E. (2016). Response style and severity and chronicity of depressive disorders in primary health care. European Psychiatry: The Journal of the Association of European Psychiatrists, 33(1), 1-8. https://doi.org/10.1016/j.eurpsy.2015.12.002
Roca, M., Gili, M., García-García, M., Salva, J., Vives, M., García Campayo, J., & Comas, A. (2009). Prevalence and comorbidity of common mental disorders in primary care. Journal of Affective Disorders, 119(1-3), 52-58. https://doi.org/10.1016/j.jad.2009.03.014
Ruiz-Rodríguez, P., Cano-Vindel, A., Muñoz Navarro, R., Medrano, L., Moriana, J.A., Buiza Aguado, C., Jiménez Cabré, G., & González-Blanch, C. (2017). Impacto económico y carga de los trastornos mentales comunes en España: una revisión sistemática y crítica. Ansiedad y Estrés, 23(2-3), 118-123. https://doi.org/10.1016/j.anyes.2017.10.003
Sandín, B., Chorot, P., & Valiente, R.M. (2012). Transdiagnóstico: nueva frontera en psicología clínica. Revista de Psicopatología y Psicología Clínica, 17(3), 185-203. https://doi.org/10.5944/rppc.vol.17.num.3.2012.11839
Spitzer, R.L., Kroenke, K., Williams, J.B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https://doi.org/10.1001/archinte.166.10.1092
Spokas, M. (2019). Cultural considerations in defining emotional disorders. Clinical Psychological Science, 26(2), e12283. https://doi.org/10.1111/cpsp.12283
Thompson, R.A. (1991). Emotional regulation and emotional development. Educational Psychology Review, 3(4), 269-307. https://doi.org/10.1007/BF01319934
Viberg, N., Forsberg, B.C., Borowitz, M., & Molin, R. (2013). International comparisons of waiting times in health care-limitations and prospects. Health Policy, 112(1-2), 53-61. https://doi.org/10.1016/j.healthpol.2013.06.013
Whiteford, H.A., Ferrari, A.J., Degenhardt, L., Feigin, V., & Vos, T. (2015). The global burden of mental, neurological and substance use disorders: An analysis from the global burden of disease study 2010. PlosOne, 10(2), e0116820. https://doi.org./10.1371/journal.pone.0116820
Wilamowska, Z.A., Thompson-Hollands, J., Fairholme, C.P., Ellard, K.K., Farchione, T.J., & Barlow, D.H. (2010). Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depression and Anxiety, 27(10), 882-890. https://doi.org/10.1002/da.20735
World Health Organization [WHO] (2017). Depression and other common mental disorders: Global health estimates. World Health Organization.
World Health Organization [WHO] (2022). Mental Health and COVID-19: Early evidence of the pandemic´s impact. World Health Organization.
Descargas
Publicado
Número
Sección
Licencia
Derechos de autor 2023 Apuntes de Psicología
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.