Estudio piloto sobre la utilidad clínica y aceptabilidad del Protocolo Unificado para el tratamiento transdiagnóstico de trastornos emocionales en formato online y grupal en Argentina
DOI:
https://doi.org/10.5944/ap.19.2.37004Palabras clave:
Protocolo Unificado, Intervención grupal, Intervención online, Trastornos emocionales, ArgentinaResumen
El objetivo del presente estudio fue aportar evidencia sobre la utilidad clínica preliminar y la satisfacción con el tratamiento del Protocolo Unificado (PU) de Barlow et al. (2011), aplicado en formato grupal y online en adultos con trastornos emocionales en Argentina. Para tal fin se realizó un estudio no controlado con medidas pre y post-tratamiento. El grupo estuvo formado por siete participantes con sintomatología del espectro ansioso-depresiva. La intervención consistió en 11 sesiones semanales sincrónicos de 90 minutos realizados en una plataforma virtual. Los resultados mostraron una reducción significativa en los niveles de depresión, desesperanza, dificultades en la regulación emocional y afecto negativo, y un aumento significativo en la calidad de vida. A su vez, se observaron tamaños del efecto grandes para depresión, ansiedad, desesperanza, dificultades en la regulación emocional y afecto negativo. Los resultados preliminares del presente estudio sobre la utilidad clínica y aceptabilidad del uso del PU en formato grupal y online en población argentina son prometedores
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American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Author.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Author.
Ato, M., López-García, J. J., & Benavente, A. (2013). A Classification System for Research Designs in Psychology. Anales de Psicología/Annals of Psychology, 29(3), 1038–1059. https://doi.org/10.6018/analesps.29.3.178511
Barlow, D. H. (2000). Unraveling the Mysteries of Anxiety and its Disorders from the Perspective of Emotion Theory. American Psychologist, 55(11), 1247–1263. https://doi.org/10.1037/0003-066x.55.11.1247
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2011). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. Oxford University Press.
Barlow, D. H., Allen, L. B., & Choate, M. L. (2016). Toward a unified Treatment for Emotional Disorders–Republished Article. Behavior Therapy, 47(6), 838–853. https://doi.org/10.1016/j.beth.2016.11.005
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., Bentley, M. A., Thompson-Hollands, J., Conklin, L. R., Boswell, J. F., Ametaj, A., Carl, J. R., Bottcher, H. T. & Cassiello-Robbins, C. (2017). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared with Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry, 74(9), 875–884. https://doi.org/10.1093/med-psych/9780190255541.003.0001
Beck, A. T., Weissman, A., Lester, D. & Trexler, L. (1974). The Measurement of Pessimism: The Hopelessness Scale. Journal of Consulting and Clinical Psychology 42(6), 861–865. https://doi.org/10.1037/h0037562
Beck, A. T., Kovacs, M., & Weissman, A. (1975). Hopelessness and Suicidal Behavior: An Overview. JAMA, 234(11), 1146–1149. https://doi.org/10.1001/jama.1975.03260240050026
Bentley, K. H., Sauer-Zavala, S., Cassiello-Robbins, C. F., Conklin, L. R., Vento, S., & Homer, D. (2017). Treating Suicidal Thoughts and Behaviors within an Emotional Disorders Framework: Acceptability and Feasibility of the Unified Protocol in an Inpatient Setting. Behavior Modification, 41(4), 529–557. https://doi.org/10.1177/0145445516689661
Boettcher, H., & Barlow, D. H. (2019). The Unique and Conditional Effects of Interoceptive Exposure in the Treatment of Anxiety: A Functional Analysis. Behaviour Research and Therapy, 117, 65–78. https://doi.org/10.1016/j.brat.2018.12.002
Bullis, J. R., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Carl, J. R., & Barlow, D. H. (2015). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Preliminary Exploration of Effectiveness for Group Delivery. Behavior Modification, 39(2), 295–321. https://doi.org/10.1177/0145445514553094
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), Article e12278. https://doi.org/10.1111/cpsp.12278
Burlingame, G. M., MacKenzie, K. R., & Strauss, B. (2004). Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change. Handbook of Psychotherapy and Behavior Change, 5, 647–696.
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Effects of Suppression and Acceptance on Emotional Responses of Individuals with Anxiety and Mood Disorders. Behaviour Research and Therapy, 44(9), 1251–1263. https://doi.org/10.1016/j.brat.2005.10.001
Carl, J. R., Gallagher, M. W., Sauer-Zavala, S. E., Bentley, K. H., & Barlow, D. H. (2014). A Preliminary Investigation of the Effects of the Unified Protocol on Temperament. Comprehensive Psychiatry, 55(6), 1426–1434. https://doi.org/10.1016/j.comppsych.2014.04.015
Celleri, M., Koutsovitis, F., Cremades, C., & Garay, C. J. (2020). Application of the Unified Protocol in Patients with Irritable Bowel Syndrome in a Group in a Public Hospital in CABA. In XII Congreso Internacional de Investigación y Práctica Profesional en Psicología. XXVII Jornadas de Investigación. XVI Encuentro de Investigadores en Psicología del MERCOSUR. II Encuentro de Investigación de Terapia Ocupacional. II Encuentro de Musicoterapia. Faculty of Psychology-University of Buenos Aires.
Cremades, C. F., Garay, C. J., Etchevers, M. J., Muiños, R., Peker, G. M. & Gómez Penedo, J. M. (2021). Difficulties in Emotion Regulation Scale (Escala de Dificultades en la Regulación Emocional [DERS]; Gratz y Roemer, 2004): Adaptation, Validation, and Standardization for Use in Adults of the AMBA [not published]. Faculty of Psychology-University of Buenos Aires.
Crespo-Delgado, E., Martínez-Borba, V. & Osma, J. (2020). The Unified Protocol for Transdiagnostic Treatment of Perinatal Depression: A Case Study. Clinical Case Studies, 19, 1–18. https://doi.org/10.1177/1534650120951266
Davidson, J. R., Dawson, S., & Krsmanovic, A. (2019). Effectiveness of Group Cognitive Behavioral Therapy for Insomnia (CBT-I) in a Primary Care Setting. Behavioral Sleep Medicine, 17(2), 191–201. https://doi.org/10.1080/15402002.2017.1318753
De Ornelas Maia, A. C. C., Sanford, J., Boettcher, H., Nardi, A. E., & Barlow, D. (2017). Improvement in Quality of Life and Sexual Functioning in a Comorbid Sample after the Unified Protocol Transdiagnostic Group Treatment. Journal of Psychiatric Research, 93, 30–36. https://doi.org/10.1016/j.jpsychires.2017.05.013
Eustis, E. H., Gallagher, M. W., Tirpak, J. W., Nauphal, M., Farchione, T. J., & Barlow, D. H. (2020). The Unified Protocol Compared with Diagnosis-Specific Protocols for Anxiety Disorders: 12-Month follow-up from a Randomized Clinical Trial. General Hospital Psychiatry, 67, 58–61. https://doi.org/10.1016/j.genhosppsych.2020.08.012
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
Fernández-Sánchez, H., Guzmán-Facundo, F. R., Herrera-Medina, D., & Sidani, S. (2021). Importance of the pilot study in an intervention project. Index de enfermería, (Preedicion), e12860
Ferrando, L., Bobes, J., Gibert, J., Soto, M., & Soto, O. (2000). MINI International Neuropsychiatric Interview, Instrumentos de Detección y Orientación Diagnóstica, 1–25.
First, M., Spitzer, R., Gibbon, M., Williams, J., & Benjamin, L. (1994). Structured Clinical Interview for DSM-IV Axis II personality disorders (SCID II). Biometric Research Department.
Gallagher, M. W., Sauer-Zavala, S. E., Boswell, J. F., Carl, J. R., Bullis, J., Farchione, T. J., & Barlow, D. H. (2013). The Impact of the Unified Protocol for Emotional Disorders on Quality of Life. International Journal of Cognitive Therapy, 6(1), 57–72. https://doi.org/10.1521/ijct.2013.6.1.57
Garay, C., Keegan, E. y Korman, G. (2008). Cognitive Behavioral Therapy in Group Format for Anxiety Disorders and Mood Disorders. Subjetividad y Procesos Cognitivos, 12, 61–72.
Garfan, S., Alamoodi, A. H., Zaidan, B. B., Al-Zobbi, M., Hamid, R. A., Alwan, J. K., Ahmaro, I., Khalid, E. T., Jumaah, F. M., Albahri, O. S., Zaidan, A. A., Albahri, A. S., Al-Qaysi, Z. T., Ahmed, M. A., Shuwandy, M. L., Salih, M. M., Zughoul, O., Mohammed, K. I., & Momani, F. (2021). Telehealth Utilization during the COVID-19 Pandemic: A Systematic Review. Computers in Biology and Medicine, 138, Article 104878. https://doi.org/10.1016/j.compbiomed.2021.104878
Grill, S. S., Castañeiras, C., & Fasciglione, M. P. (2017). Group application of the Unified Protocol for the transdiagnostic treatment of emotional disorders in the Argentine population. Revista de Psicopatología y Psicología Clínica, 22(3), 171–181. https://doi.org/10.5944/rppc.vol.22.num.3.2017.18122
Grilo, C. M., Anez, L. M., & McGlashan, T. H. (2003). The Spanish-Language Version of the Diagnostic Interview for DSM-IV Personality Disorders: Development and Initial Psychometric Evaluation of Diagnoses and Criteria. Comprehensive Psychiatry, 44(2), 154–161.
Harvey, A. G., Watkins, E., & Mansell, W. (2004). Cognitive behavioural Processes across Psychological Disorders: A Transdiagnostic Approach to Research and Treatment. Oxford University Press.
Jacobson, N.S. y Truax, P. (1991). Clinical Significance: a Statistical Approach to Defining Meaningful Change in Psychotherapy Research. Journal of Consulting and Clinical Psychology, 59, 12–19.
Keles, S. & Idsoe, T. (2018). A Meta-analysis of Group Cognitive Behavioral Therapy (CBT) Interventions for Adolescents with Depression. Journal of Adolescence, 67, 129–139. https://doi.org/10.1016/j.adolescence.2018.05.011
Klinar, D., Gago, P., & Alonso, M. M. (2019). Occupational Distribution of Psychologists in the Argentine Republic – survey 2019. In XI Congreso Internacional de Investigación y Práctica Profesional en Psicología. XXVI Jornadas de Investigación. XV Encuentro de Investigadores en Psicología del MERCOSUR. I Encuentro de Investigación de Terapia Ocupacional. I Encuentro de Musicoterapia. Faculty of Psychology, University of Buenos Aires.
Laposa, J. M., Mancuso, E., Abraham, G., & Loli-Dano, L. (2017). Unified Protocol Transdiagnostic Treatment in Group Format: A Preliminary Investigation with Anxious Individuals. Behavior Modification, 41(2), 253–268. https://doi.org/10.1177/0145445516667664
Martínez-Borba, V., Osma, J., Crespo-Delgado, E., Andreu-Pejo, L., & Monferrer-Serrano, A. (2022). Emotional Disorders and Symptoms Prevention Under Health Conditions: a Pilot Study using the Unified Protocol in a Fertility Unit. Anales de Psicología/Annals of Psychology, 38(1), 25–35.
Macbeth, G., Razumiejczyk, E., & Ledesma, R. D. (2010). Cliff's Delta Calculator: A Non-parametric Effect Size Program for two Groups of Observations. Universitas Psychologica, 10(2), 545–555. https://doi.org/10.11144/javeriana.upsy10-2.cdcp
Mansell, W., Harvey, A., Watkins, E. D., & Shafran, R. (2009). Conceptual Foundations of the Transdiagnostic Approach to CBT. Journal of Cognitive Psychotherapy, 23(1), 6–19. https://doi.org/10.1891/0889-8391.23.1.6
McDermut, W., Miller, I. W., & Brown, R. A. (2001). The Efficacy of Group Psychotherapy for Depression: A Meta-Analysis and Review of the Empirical Research. Clinical Psychology: Science and Practice, 8, 98–116. https://doi.org/10.1093/clipsy.8.1.98
Mikulic, I. M., Cassullo, G. L., Crespi, M. C., & Marconi, A. (2009). BHS Hopelessness Scale (A. Beck, 1974): Study of the Psychometric Properties and Scale of the Argentine Adaptation. Anuario de Investigaciones, 16, 365–373.
National Institute for Health and Care Excellence. (2013). Anxiety disorders (NICE Quality standard No. 53). https://www.nice.org.uk/guidance/qs53
Norton, P. J., Hayes, S. A., & Hope, D. A. (2004). Effects of a Transdiagnostic Group Treatment for Anxiety on Secondary Depression. Depression and Anxiety, 20, 198–202. https://doi.org/10.1002/da.20045
Osenbach, J. E., O'Brien, K. M., Mishkind, M., & Smolenski, D. J. (2013). Synchronous Telehealth Technologies in Psychotherapy for Depression: A Meta‐analysis. Depression and Anxiety, 30(11), 1058–1067. https://doi.org/10.1002/da.22165
Osma, J., Castellano, C., Crespo, E., & García-Palacios, A. (2015). The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Group Format in a Spanish Public Mental Health Setting. Psicología Conductual/Behavioral Psychology, 23(3), 447–466.
Osma, J., Peris-Baquero, O., Suso-Ribera, C., Farchione, T. J., & Barlow, D. H. (2021a). Effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Group Format in Spain: Results from a Randomized Controlled Trial with 6-Months Follow-Up. Psychotherapy Research, 32(3), 329–342. https://doi.org/10.1080/10503307.2021.1939190
Osma, J., Peris-Baquero, O., Suso-Ribera, C., Sauer-Zavala, S. & Barlow, D. H. (2021b). Predicting and Moderating the Response to the Unified Protocol: do Baseline Personality and Affective Profiles Matter? Cognitive Therapy and Research, 45, 817–830. https://doi.org/10.1007/s10608-021-10208-6
Quilez-Orden, A., Ferreres-Galán, V., & Osma, J. (2020). Feasibility and Clinical Usefulness of the Unified Protocol in Online Group Format for Bariatric Surgery Candidates: Study Protocol for a Multiple Baseline Experimental Design. International Journal of Environmental Research and Public Health, 17(17), Article 6155. https://doi.org/10.3390/ijerph17176155
Rees, C. S. & Maclaine, E. (2015). A Systematic Review of Videoconference‐delivered Psychological Treatment for Anxiety Disorders. Australian Psychologist, 50(4), 259–264. https://doi.org/10.1111/ap.12122
Sauer-Zavala, S., Bentley, K. H., Steele, S. J., Tirpak, J. W., Ametaj, A. A., Nauphal, M., Cardona, N., Wang, M., Farchione, T. J., & Barlow, D. H. (2020). Treating Depressive Disorders with the Unified Protocol: A Preliminary Randomized Evaluation. Journal of Affective Disorders, 264, 438-445. https://doi.org/10.1016/j.jad.2019.11.072
Sauer-Zavala S., Fournier J.C., Jarvi Steele S., Woods B.K., Wang M., Farchione T.J., Barlow D.H. (2020). Does the Unified Protocol Really Change Neuroticism? Results from a Randomized Trial. Psychological Medicine, 51,1–10. https://doi.org/10.1017/S0033291720000975
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R. & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): The Development and Validation of a Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(20), 22–33.
Stagnaro, J. C., Cía, A., Vázquez, N., Vommaro, H., Nemirovsky, M., Serfaty, E., Sustas, S.E., Medina Mora, M.E., Benjet, C., Aguilar-Gaxiola, S., & Kessler, R. (2019). Epidemiological Study of Mental Health in the General Population of the Argentine Republic.Vertex Revista Argentina de Psiquiatría, 29(142), 275–299.
Suárez, L. M., Bennett, S. M., Goldstein, C. R., & Barlow, D. H. (2009). Understanding Anxiety Disorders from a "Triple Vulnerability" Framework. In M. M. Antony & M. B. Stein (Eds.), Oxford Handbook of Anxiety and Related Disorders (pp. 153–172). Oxford University Press.
The World Bank Group. (2022). Low & Middle Income. The World Bank. https://data.worldbank.org/country/XO
Varker, T., Brand, R. M., Ward, J., Terhaag, S., & Phelps, A. (2019). Efficacy of Synchronous Telepsychology Interventions for People with Anxiety, Depression, Posttraumatic Stress Disorder, and Adjustment Disorder: A Rapid Evidence Assessment. Psychological Services, 16(4), 621–635. https://doi.org/10.1037/ser0000239
Whitfield, G. (2010). Group Cognitive–Behavioural Therapy for Anxiety and Depression. Advances in Psychiatric Treatment, 16(3), 219–227. https://doi.org/10.1192/apt.bp.108.005744
World Health Organization. (2017). Depression and other Common Mental Disorders: Global Health Estimates. https://www.who.int/publications/i/item/depression-global-health-estimates
Zemestani, M., Ommati, P., Rezaei, F., & Gallagher, M. W. (2021). Changes in Neuroticism-Related Constructs over the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Patients on an Optimal dose of SSRI. Personality Disorders: Theory, Research, and Treatment. Advance online publication. https://doi.org/10.1037/per0000482
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