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Corpas J, Moriana JA, Venceslá JF, Gálvez-Lara M. Cognitive processes associated with emotional disorders: implications for efficient psychological treatments. J Ment Health 2023; 32:54-62. [PMID: 33989506 DOI: 10.1080/09638237.2021.1922651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments. AIMS To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments. METHODS We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses. RESULTS Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied. CONCLUSIONS For "pure" disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.
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Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Juan A Moriana
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Jose F Venceslá
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
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Plamondon J, Provencher MD. Integrated group treatment for anxiety disorders: a transdiagnostic effectiveness and feasibility study in a mental health hospital setting. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2061341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Jónsdóttir MK, Kristófersdóttir KH, Runólfsdóttir S, Kristensen ISU, Sigurjónsdóttir HÁ, Eggertsdóttir Claessen LÓ, Kristjánsdóttir H. Concussion among female athletes in Iceland: Stress, depression, anxiety, and quality of life. NORDIC PSYCHOLOGY 2021. [DOI: 10.1080/19012276.2021.2004916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- María K. Jónsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
- Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland
| | | | - Silja Runólfsdóttir
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | - Ingunn S. U. Kristensen
- Department of Psychology, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
| | - Helga Á. Sigurjónsdóttir
- Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
| | - Lára Ósk Eggertsdóttir Claessen
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland
- Hamraborg Primary Health Care Center, Kópavogur, Iceland
| | - Hafrún Kristjánsdóttir
- Physical Activity, Physical Education, Sport and Health (PAPESH) Research Centre, Sports Science Department, School of Social Sciences, Reykjavik University, Reykjavík, Iceland
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Sighvatsson MB, Salkovskis PM, Sigurdsson E, Valdimarsdottir HB, Thorsdottir F, Sigurdsson JF. Evaluation of mechanism of change in transdiagnostic cognitive behaviour therapy using single case experimental design. J Behav Ther Exp Psychiatry 2021; 71:101634. [PMID: 33388441 DOI: 10.1016/j.jbtep.2020.101634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/07/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Transdiagnostic mechanisms of change (txMOC) specific to cognitive behaviour therapy are poorly understood. Salkovskis (1996) proposed one such mechanism in terms of the shift towards an alternative, less negative view of their problems or cognitive flexibility. This hypothesis has been described as involving a shift in beliefs, from "theory A″ to "theory B". The objective of this research was to evaluate this hypothesis. METHODS Effectiveness of a novel txCBT and temporal changes in process and symptom measures were evaluated using a non-concurrent multiple baseline design and Tau-U calculations with thirteen participants (five with obsessive-compulsive disorder, two with panic disorder with agoraphobia and six with major depressive disorder). As a secondary analysis authors calculated Kendall's - Tau correlation between process and symptom measures, performed the Wilcoxon signed-rank test to assess treatment modules effect on negative thought and calculated Reliable change index (RCI). RESULTS The txCBT was clearly effective for eight participants. The results varied dependent on the stimuli evaluated as negative or threatening. Level and trend of the ratings of belief in theory A followed the level and trend of symptom measures to a greater extent than the (inverse) level and trend of belief in theory B. LIMITATIONS Only thirteen participants were recruited and evaluated. CONCLUSIONS The results are consistent with the view that effective treatment may involve a txMOC characterized by the ability to shift from a relatively fixed negative view of their experience to a less negative psychologically focused alternative.
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Affiliation(s)
- Magnus Blondahl Sighvatsson
- Faculty of Medicine, University of Iceland, Saemundargotu 2, 101, RVK, Iceland; Faculty of Psychology, Reykjavik University, Menntavegi 1, 101, RVK, Iceland.
| | - Paul M Salkovskis
- Faculty of Psychology, Reykjavik University, Menntavegi 1, 101, RVK, Iceland; Oxford Centre for Psychological Health, Oxford Institute of Clinical Psychology Training and Oxford Cognitive Therapy Center, Warneford Hospital, Oxford University, Oxford, OX3 7JX, UK.
| | - Engilbert Sigurdsson
- Faculty of Medicine, University of Iceland, Saemundargotu 2, 101, RVK, Iceland; Landspitali-The National University Hospital of Iceland, Iceland.
| | - Heiddis B Valdimarsdottir
- Faculty of Psychology, Reykjavik University, Menntavegi 1, 101, RVK, Iceland; Mount Sinai School of Medicine, USA.
| | - Fanney Thorsdottir
- Faculty of Psychology, University of Iceland, Saemundargotu 2, 101, RVK, Iceland.
| | - Jon Fridrik Sigurdsson
- Faculty of Medicine, University of Iceland, Saemundargotu 2, 101, RVK, Iceland; Faculty of Psychology, Reykjavik University, Menntavegi 1, 101, RVK, Iceland.
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Cano-Vindel A, Muñoz-Navarro R, Moriana JA, Ruiz-Rodríguez P, Medrano LA, González-Blanch C. Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: the results of the PsicAP randomized controlled trial. Psychol Med 2021; 52:1-13. [PMID: 33550995 PMCID: PMC9772911 DOI: 10.1017/s0033291720005498] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/28/2020] [Accepted: 12/30/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Emotional disorders are highly prevalent in primary care. We aimed to determine whether a transdiagnostic psychological therapy plus treatment-as-usual (TAU) is more efficacious than TAU alone in primary care adult patients. METHODS A randomized, two-arm, single-blind clinical trial was conducted in 22 primary care centres in Spain. A total of 1061 adult patients with emotional disorders were enrolled. The transdiagnostic protocol (n = 527) consisted of seven 90-min sessions (8-10 patients) delivered over a 12-14-week period. TAU (n = 534) consisted of regular consultations with a general practitioner. Primary outcome measures were self-reported symptoms of anxiety, depression, and somatizations. Secondary outcome measures were functioning and quality of life. Patients were assessed at baseline, post-treatment, and at 3, 6, and 12 months. Intention-to-treat and per-protocol analyses were performed. RESULTS Post-treatment primary outcomes were significantly better in the transdiagnostic group compared to TAU (anxiety: p < 0.001; Morris's d = -0.65; depression: p < 0.001; d = -0.58, and somatic symptoms: p < 0.001; d = -0.40). These effects were sustained at the 12-month follow-up (anxiety: p < 0.001; d = -0.44; depression: p < 0.001; d = -0.36 and somatic symptoms: p < 0.001; d = -0.32). The transdiagnostic group also had significantly better outcomes on functioning (d = 0.16-0.33) and quality of life domains (d = 0.24-0.42), with sustained improvement at the 12-month follow-up in functioning (d = 0.25-0.39) and quality of life (d = 0.58-0.72). Reliable recovery rates showed large between-group effect sizes (d > 0.80) in favour of the transdiagnostic group after treatment and at the 12-month follow-up. CONCLUSIONS Adding a brief transdiagnostic psychological intervention to TAU may significantly improve outcomes in emotional disorders treated in primary care. TRIAL REGISTRATION isrctn.org identifier: ISRCTN58437086.
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Affiliation(s)
- Antonio Cano-Vindel
- Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Social and Human Sciences, University of Zaragoza, C/Cdad. Escolar, S/N, 44003, Teruel, Spain
| | - Juan A. Moriana
- Department of Psychology, University of Córdoba/ Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC/Reina Sofía University Hospital, Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Calle Teruel, 4, 28941 Fuenlabrada, Madrid, Spain
| | | | - César González-Blanch
- Mental Health Centre, University Hospital “Marqués de Valdecilla”- IDIVAL, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain
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Sighvatsson MB, Salkovskis PM, Sigurdsson E, Valdimarsdottir HB, Thorsdottir F, Sigurdsson JF. 'You should always look at the washing machine without actually being in it!' Thematic framework analysis of patients' understanding of transdiagnostic cognitive behaviour therapy and its mechanisms. Psychol Psychother 2020; 93:258-275. [PMID: 30734461 DOI: 10.1111/papt.12220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 01/07/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Transdiagnostic cognitive behaviour therapy (TCBT) is an efficacious treatment for anxiety and depression, but its mechanisms of change remain poorly understood. The current study used thematic framework analysis to analyse how patients, recruited in a recent trial on transdiagnostic group CBT (TGCBT), understood the treatment and its mechanisms. DESIGN Cross-sectional thematic framework analysis. METHOD The sample included 24 participants suffering from anxiety and/or depression, divided into two groups by treatment efficacy (i.e., group doing well and group doing not so well) in order to evaluate whether different understandings of the treatment affected its efficacy. The participants were interviewed and completed self-report measures. They were encouraged to discuss what they believed to be helpful and unhelpful in the TGCBT and what they believed to be the mechanisms of change in the treatment. Each interview was recorded, transcribed verbatim and themes were identified. RESULTS The analysis revealed four overarching themes and 18 subthemes. The overarching themes were as follows: Cognitive and behavioural flexibility, Awareness/understanding of symptoms and triggers, Therapeutic alliance and engagement, and finally Attitudes towards treatment. Four of the 18 subthemes corresponded to a differentiation between the groups: Cognitive flexibility and Comparison with others in the group on the one hand and Cognitive inflexibility and Negative attitudes towards treatment on the other. CONCLUSION The most important difference between the groups appeared to be CBT-specific, that is, cognitive flexibility that characterized the group doing well where thematic analysis did not indicate that other themes were important. PRACTITIONER POINTS Findings The analysis revealed four overarching themes and 18 subthemes, four of which corresponded to the difference between the two groups of participants based on treatment efficacy. The four differentiating subthemes were cognitive flexibility and comparison with others, which characterized the group doing well, and cognitive inflexibility and negative attitude towards treatment, which characterized the group doing less well. The theme evaluated as the most important for the efficacy of the transdiagnostic cognitive behaviour therapy and patients' understanding of the treatment was cognitive flexibility, which characterized the group doing well. Limitations Use of qualitative methodology restricts the generalizability of our results. Data are built on answers from only 24 participants.
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Affiliation(s)
| | | | - Engilbert Sigurdsson
- University of Iceland, Reykjavík, Iceland.,Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland
| | | | | | - Jon Fridrik Sigurdsson
- University of Iceland, Reykjavík, Iceland.,Reykjavik University, Iceland.,Landspitali-The National University Hospital of Iceland, Reykjavík, Iceland
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Comparative Responsiveness and Minimally Important Difference of Common Anxiety Measures. Med Care 2019; 57:890-897. [DOI: 10.1097/mlr.0000000000001185] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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