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Nisa A, Siddiqui S, Ametaj AA, Khan F. Adaptation of unified protocol treatment for transdiagnostic disorders in Pakistan: A heuristic framework. PLoS One 2024; 19:e0308981. [PMID: 39348342 PMCID: PMC11441672 DOI: 10.1371/journal.pone.0308981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 08/02/2024] [Indexed: 10/02/2024] Open
Abstract
The access to evidence-based treatments for mental health problems is limited in low-resource settings. Transdiagnostic approaches, such as the Unified Protocol (UP), are a potential solution for these settings because they are multi-problem focused, modular, flexible, and have low complexity. This study aimed to adapt UP to the mental health context of an urban speciality clinic in Pakistan using a four-step process of heuristic framework. The study employed an iterative and stakeholder-based approach to align the protocol with local values, language, and needs. Primarily, the proposed modifications focus on language use, matching literacy level, graphical illustrations, and relevance of examples. A multi-method approach including expert review, cognitive interviewing, and adaptation testing ensured cultural equivalence. Participants diagnosed with depression and anxiety were provided culturally adapted treatment (N = 15) at the testing phase. Findings indicated that the participants not only experienced significant reductions in symptoms of depression and anxiety but also found the culturally adapted UP to be easy to understand, culturally relevant, and engaging. This study provides evidence that the UP can be culturally adapted and used in the mental health context of Pakistan. The findings suggest that the UP is a promising intervention for individuals with depression and anxiety in low-resource settings.
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Affiliation(s)
- Asma Nisa
- Department of Behavioral Sciences, School of Social Sciences and Humanities, National University of Sciences and Technology, Islamabad, Pakistan
| | - Salma Siddiqui
- Department of Behavioral Sciences, School of Social Sciences and Humanities, National University of Sciences and Technology, Islamabad, Pakistan
| | - Amantia A. Ametaj
- Institute for Health Equity and Social Justice, Northeastern University, Boston, Massachusetts, United States of America
| | - Fahad Khan
- Khalil Centre, Lombard, Illinois, United States of America
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Paul S, Zhu L, Mizevich J, Slater L. Depression, anxiety, and personal recovery outcomes after group vs individual transdiagnostic therapy: a brief report. Sci Rep 2024; 14:4855. [PMID: 38418570 PMCID: PMC10901779 DOI: 10.1038/s41598-024-55093-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/20/2024] [Indexed: 03/01/2024] Open
Abstract
Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is an evidence-informed treatment utilizing Cognitive Behavioural Therapy (CBT) treatment principles. UP has demonstrated promising treatment effects comparable to single disorder protocol across several mental disorders. Its impact on personal recovery in anxiety and depression has not been examined. This study compares clinical and personal recovery outcomes of UP treatment for depression and anxiety disorders when delivered in a group vs. individual format. Retrospective chart review of outcomes was conducted for outpatients receiving 12-week individual (n = 65) and group (n = 62) UP treatment in a specialized psychiatric hospital. Descriptive and repeated measures ANOVA analyses were conducted on outcomes on Overall Depression Severity and Impairment Scale, Overall Anxiety Severity and Impairment Scale, Recovery Assessment Scale administered pre and post treatment. On average, participants in both group and individual UP treatment showed improvements in anxiety, depression, and recovery scores. Greater proportion of group participants showed improvements on two interpersonal-focused domains of personal recovery. Results indicate group UP treatment is comparably effective compared to individual UP in improving clinical and recovery outcomes, and treatment modality affects the degree of personal recovery. Overall findings offer important clinical promise of UP treatment as a transdiagnostic treatment option for individuals with anxiety and depression.
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Affiliation(s)
- Sayani Paul
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon St, Whitby, ON, L1N 5S9, Canada
| | - Lynn Zhu
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon St, Whitby, ON, L1N 5S9, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Jane Mizevich
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon St, Whitby, ON, L1N 5S9, Canada
| | - Lindsay Slater
- Ontario Shores Centre for Mental Health Sciences, 700 Gordon St, Whitby, ON, L1N 5S9, Canada.
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Vancappel A, Raysseguier C, Coillot H, Jansen E, Bouyer C, Mangolini A, Barbe PG, Debout-Courtault C, Pierre-le Seac'h M, Kazour F, Courtois R, El-Hage W. Development and validation of the Symptomatic Transdiagnostic Test (S2T). L'ENCEPHALE 2024; 50:32-39. [PMID: 36641268 DOI: 10.1016/j.encep.2022.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The categorical approach in psychiatry has received many criticisms. Modern research tends to develop a transdiagnostic approach. However, transdiagnostic works lack an overall understanding and focus mainly on anxiety and depression. The aim of the present study was to develop an easy to use tool to evaluate multiple dimensions opening the way for further research in the transdiagnostic approach. This will allow researchers to quickly assess the efficacy of psychotherapeutic interventions on multiple psychopathological dimensions. METHOD First, we identified the main symptoms of psychopathology in a sample of mental healthcare workers. Second, we developed the Symptomatic Transdiagnostic Test (S2T) to assess the main symptoms of psychopathology. Third, we evaluated its psychometric properties (exploratory and confirmatory factor analysis, internal consistency) in three non-clinical samples and one clinical sample. RESULTS The 66-item S2T included eleven factors referring to: i) negative thoughts and mood; ii) psycho-traumatic and maladaptive symptoms; iii) addiction symptoms; iv) disturbed eating behavior; v) disturbed perception and behavior; vi) panic and agoraphobia; vii) emotional lability; viii) dejection; ix) neurodevelopmental manifestations; x) anxiety and xi) psychic hyperactivity. We found a high internal consistency for the general scale (α=0.96) and the subscales. We found a good concurrent validity. As expected, we found higher levels of symptoms within the clinical population as compared to the non-clinical samples, except for addiction symptoms and disrupted eating behavior. We found negative associations between the symptomatic dimensions and psychological skills. CONCLUSION The S2T is a relevant tool for clinicians and researchers to assess the psychopathological profile. The main psychopathological symptoms are negatively related to the psychological skills.
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Affiliation(s)
- A Vancappel
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France; Département de psychologie, EE 1901 Qualipsy, qualité de vie et santé psychologique, université de Tours, Tours, France; Inserm, UMR 1253, iBrain, université de Tours, Tours, France.
| | - C Raysseguier
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France
| | - H Coillot
- Département de psychologie, EE 1901 Qualipsy, qualité de vie et santé psychologique, université de Tours, Tours, France
| | - E Jansen
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France
| | - C Bouyer
- Pôle cardiovasculaire et métabolique, CHU de Cayenne, Cayenne, France
| | - A Mangolini
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France
| | - P G Barbe
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France
| | | | | | - F Kazour
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France; Inserm, UMR 1253, iBrain, université de Tours, Tours, France
| | - R Courtois
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France; Département de psychologie, EE 1901 Qualipsy, qualité de vie et santé psychologique, université de Tours, Tours, France
| | - W El-Hage
- Pôle de psychiatrie-addictologie, CHRU de Tours, Tours, France; Inserm, UMR 1253, iBrain, université de Tours, Tours, France
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de la Rosa-Gómez A, Hernández Posadas A, Valencia PD, Flores-Plata LA, Serrano Zárate B, Flores Elvira AI, Dominguez-Rodriguez A, Vázquez Sánchez MF, González Santiago E. Online transdiagnostic intervention for emotional, trauma- and stressor-related disorders in the Mexican population: A randomized pilot and feasibility trial. Contemp Clin Trials Commun 2023; 35:101204. [PMID: 37691848 PMCID: PMC10482736 DOI: 10.1016/j.conctc.2023.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/12/2023] Open
Abstract
•Mexican individuals received via telehealth the unified protocol for anxiety, depression, and trauma related disorders.•Online unified protocol reduced depression, anxiety, emotional issues, uncertainty intolerance, and psychological distress.•The transdiagnostic unified protocol is well-suited to train therapists for emotional, trauma, and stressor-related disorders.
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Affiliation(s)
| | | | - Pablo D. Valencia
- Faculty of Higher Studies Iztacala, National Autonomous University of Mexico, Mexico
| | | | - Berenice Serrano Zárate
- Faculty of Health Sciences, Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Spain
| | | | - Alejandro Dominguez-Rodriguez
- Faculty of Behavioural, Management, and Social Sciences, Department of Psychology, Health and Technology, University of Twente, Enschede, the Netherlands
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Peris-Baquero Ó, Moreno-Pérez JD, Navarro-Haro MV, Díaz-García A, Osma J. Emotion dysregulation and neuroticism as moderators of group Unified Protocol effectiveness outcomes for treating emotional disorders. J Affect Disord 2023; 331:313-321. [PMID: 36977435 DOI: 10.1016/j.jad.2023.03.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 02/27/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND The personality dimension neuroticism and difficulties in emotional regulation (ER) are two variables closely related to the onset, course, and maintenance of emotional disorders (EDs). The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a treatment specifically designed to address neuroticism by training in adaptive ER skills and has been shown to be effective in reducing difficulties in ER. However, the specific impact of these variables on treatment outcomes is not entirely clear. The aim of the present study was to explore the moderating role of neuroticism and difficulties in ER regarding the evolution of depressive and anxiety symptoms and quality of life. METHODS This secondary study included 140 participants diagnosed with EDs, who received the UP in group format as part of an RCT being conducted in different Spanish Public Mental Health Units. RESULTS The results of this study found that high scores in neuroticism and difficulties in ER were associated with greater severity of depression and anxiety symptomatology, and with poorer quality of life. In addition, difficulties in ER moderated the efficacy of UP regarding anxiety symptoms, and quality of life. No moderating effects were found for depression (p > 0.5). LIMITATIONS We only evaluated two moderators that may influence UP effectivenes; other key moderators should be analyzed in future. CONCLUSIONS The identification of specific moderators affecting transdiagnostic interventions outcomes will allow the development of personalized interventions and provide useful information to improve the psychopathology and well-being of people with EDs.
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Affiliation(s)
- Ó Peris-Baquero
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | | | - M V Navarro-Haro
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - A Díaz-García
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - J Osma
- Universidad de Zaragoza, Teruel, Spain; Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain.
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Gual-Montolio P, Suso-Ribera C, García-Palacios A, Castilla D, Zaragoza I, Bretón-López J. Enhancing Internet-based psychotherapy for adults with emotional disorders using ecological momentary assessments and interventions: Study protocol of a feasibility trial with "My EMI, Emotional Well-being" app. Internet Interv 2023; 31:100601. [PMID: 36686334 PMCID: PMC9852876 DOI: 10.1016/j.invent.2023.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
Introduction Emotional disorders are the most frequent mental health problems globally. To ensure the dissemination of psychological treatments for these conditions, novel forms of delivery (e.g., Internet or mobile apps) and more scalable forms of psychotherapy (e.g., transdiagnostic interventions) have become increasingly popular. Research, however, shows that a significant number of patients, around 40 % according to some studies, do not respond to the interventions as expected (i.e., not-on-track patients). Ecological momentary assessments (EMAs) and ecological momentary interventions (EMIs) could simplify tailoring treatments to the patients' progress and rapidly respond to undesired outcomes during psychotherapy. Therefore, these would facilitate measurement-based care with little therapist involvement. This study aims to explore the feasibility of an app-based system called My EMI, Emotional Well-being for people with emotional disorders. According to daily EMAs, the app will provide personalized EMIs while participants receive a self-applied online transdiagnostic treatment. The app will be used as an add-tool to the online intervention to address emotion dysregulation, foster adherence, and reinforce contents. The current study describes the study protocol for this trial. Method and analysis A single-group, open trial design will be used. Participants will be 30 adults suffering from emotional disorders. Primary outcomes will be app usability, acceptability, and response rates. Secondary outcomes will be either evaluated in Qualtrics at pre-treatment, post-treatment, and 3-month follow-up (depression and anxiety severity, and transdiagnostic dimensions of emotional disorders) or daily throughout the study with the app (EMAs of mood and five transdiagnostic mechanisms of therapeutic change). EMIs will consist of brief, evidence-based transdiagnostic CBT digital content (images, infographics, or videos) delivered just-in-time. Only if problems persist, short phone calls or episodic videocalls will be conducted. The Ethics Committee of the Jaume I University approved the study and all its procedures (CD/111/2021) in December 2021. Discussion Identifying personalized and scalable interventions is paramount to improve mental health care, especially its accessibility, and to reduce the psychological distress of people with mental health problems. Feasibility data of the app (EMA and EMI system) supported by a self-applied online transdiagnostic intervention will be important to explore whether this modern approach is a real option to move forward personalized psychological interventions for persons with emotional disorders. Trial registration ClinicalTrials.gov Identifier: NCT05109780. Registered 05 November 2021, https://clinicaltrials.gov/ct2/show/NCT05109780.
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Affiliation(s)
- Patricia Gual-Montolio
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Diana Castilla
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Irene Zaragoza
- Department of Personality, Assessment, and Psychological Treatments, Universidad de Valencia, 46010 Valencia, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Juana Bretón-López
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, 12071 Castellon de la Plana, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Osma J, Martínez-García L, Prado-Abril J, Peris-Baquero Ó, González-Pérez A. Developing a smartphone App based on the Unified Protocol for the transdiagnostic treatment of emotional disorders: A qualitative analysis of users and professionals' perspectives. Internet Interv 2022; 30:100577. [PMID: 36213084 PMCID: PMC9535424 DOI: 10.1016/j.invent.2022.100577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 12/01/2022] Open
Abstract
Emotional Disorders have become the most prevalent mental disorders in the world. In relation to their high prevalence, mental health care from public health services faces major challenges. Consequently, finding solutions to deliver cost-effective evidence-based treatments has become a main goal of today's clinical psychology. Smartphone apps for mental health have emerged as a potential tool to deal with it. However, despite their effectiveness and advantages, several studies suggest the need to involve patients and professionals in the design of these apps from the first stage of the development process. Thus, this study aimed to identify, from both a group of users and professionals, the needs, opinions, expectations and design aspects of a future smartphone app based in the Unified Protocol (UP), that will allow to develop the subsequent technical work of the app engineers. Two focus groups were conducted, one with 7 professionals and the other with 9 users, both groups familiar with the UP. A thematic content analysis based in grounded theory was performed in order to define emergent categories of analysis derived from the interview data. The results revealed 8 common topics in both focus groups and 5 specific key topics were identified in the professionals' focus group. Of the total proposals, 93 % of the professionals' and 78 % of the users' are implemented in the preliminary version of the app.
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Affiliation(s)
- Jorge Osma
- University of Zaragoza, Department of Psicology and Sociology, Faculty of Social and Human Sciences, C/Atarazanas, 4, 44003 Teruel, Spain
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
- Corresponding author at: Universidad de Zaragoza, Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, C/Atarazanas, 4, 44003 Teruel, Spain.
| | - Laura Martínez-García
- University of Zaragoza, Department of Psicology and Sociology, Faculty of Social and Human Sciences, C/Atarazanas, 4, 44003 Teruel, Spain
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Javier Prado-Abril
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, Zaragoza, Spain
| | - Óscar Peris-Baquero
- University of Zaragoza, Department of Psicology and Sociology, Faculty of Social and Human Sciences, C/Atarazanas, 4, 44003 Teruel, Spain
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Alberto González-Pérez
- Institute of New Imaging Technologies, Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12071 Castellón, Spain
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Yan K, Yusufi MH, Nazari N. Application of unified protocol as a transdiagnostic treatment for emotional disorders during COVID-19: An internet-delivered randomized controlled trial. World J Clin Cases 2022; 10:8599-8614. [PMID: 36157826 PMCID: PMC9453349 DOI: 10.12998/wjcc.v10.i24.8599] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/02/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has been an emotionally challenging time, especially for young adults. It is associated with a substantial increase in the prevalence of mental health problems, negative symptoms, and stressful experiences that compromise well-being. In low-income countries, internet-delivered psychological services could have a remarkable impact on the population's mental health, given the lack of mental health professionals. AIM To investigate the efficacy of internet-delivered cognitive-behavior therapy (CBT)-transdiagnostic intervention for adults with emotional disorders. METHODS In this internet-delivered randomized controlled trial, 102 students with an emotional disorder (mean age = 28.20 years, standard deviation = 5.07) were randomly allocated to receive unified protocol (UP) (n = 51) or treatment as the usual intervention. Following a semi-structured clinical interview, participants completed an online survey including the Overall Anxiety Severity and Impairment Scale, Overall Depression Severity and Impairment Scale, Difficulties in Emotion Regulation Scale, Positive and Negative Affect Schedule, and Emotional Style Questionnaire. RESULTS The participants showed a high degree of adherence. In total, 78% (n = 40) of the experimental group participants completed the UP treatment. Considering the intention to treat procedure, the results of the analysis of covariance indicated that participants who received UP showed statistically significant changes in depression symptoms [Cohen's d = -1.50 with 95% confidence interval (CI): -1.90 to -1.10], anxiety (Cohen's d = -1.06 with 95%CI: -1.48 to -0.65), difficulties with emotion regulation (Cohen's d = -0.33 with 95%CI: -0.7 to -0.06), positive affect (Cohen's d = 1.27 with 95%CI: 0.85 to 1.68), negative affect (Cohen's d= -1.04 with 95%CI: -1.46 to -0.63), and healthy emotionality (Cohen's d = 0.53 with 95%CI: 0.09 to 0.13) compared with the control group. CONCLUSION This study's findings highlight the potential value of transdiagnostic internet-delivered programs for young adults with an emotional disorder during the COVID-19 pandemic, and expand the research examining emotional well-being improvements resulting from CBT-transdiagnostic interventions. The findings suggest that UP, which generally concentrates on reducing negative effects, can increase positive effects.
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Affiliation(s)
- Kou Yan
- School of Humanities and Education, Xi'an Eurasia University, Xi'an 710065, Shaanxi Province, China
| | | | - Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Lorestan, Iran
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Long-term cost-effectiveness of group unified protocol in the Spanish public mental health system. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
The limited material and human resources available in the Spanish public mental health system, combined with the high prevalence of emotional disorders nowadays, makes it necessary to search for and implement other more cost-effective formats. The versatility of the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders allows its application in group format, which could be a cost-effective solution for the system. The aim of the present study is to investigate the cost-effectiveness of the UP applied in group format in specialized care units compared to the Treatment as usual (TAU) in the Spanish public mental health system over a 15-month time period. The sample of this study consisted of 188 patients, diagnosed with an emotional disorder, randomized to the UP condition in group format or to the TAU condition in individual format. The findings of this study have shown the same beneficial results for the participants with symptoms of anxiety and depression in both conditions and greater improvements in quality of life in the UP condition. Regarding cost-effectiveness results, at the 15-month follow-up, participants in the UP condition received a greater number of sessions, with a lower total economic cost compared to the TAU condition. Finally, reductions in the number of participants using antidepressants and a reduction in medication burden were found in the UP condition over time. The results of this study show that UP applied in a group format can be a cost-effectiveness solution for the Spanish public mental health system. Trial registration number: NCT03064477 (March 10, 2017).
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Osma J, Martínez-García L, Peris-Baquero Ó, Navarro-Haro MV, González-Pérez A, Suso-Ribera C. Implementation, efficacy and cost effectiveness of the unified protocol in a blended format for the transdiagnostic treatment of emotional disorders: a study protocol for a multicentre, randomised, superiority controlled trial in the Spanish National Health System. BMJ Open 2021; 11:e054286. [PMID: 34972770 PMCID: PMC8720993 DOI: 10.1136/bmjopen-2021-054286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Emotional disorders (EDs) have become the most prevalent psychological disorders in the general population, which has boosted the economic burden associated with their management. Approximately half of the individuals do not receive adequate treatment. Consequently, finding solutions to deliver cost-effective treatments for EDs has become a key goal of today's clinical psychology. Blended treatments, a combination of face-to-face and online interventions, have emerged as a potential solution to the previous. The Unified Protocol for the Transdiagnostic Treatment of EDs (UP) might serve this purpose, as it can be applied to a variety of disorders simultaneously and its manualised format makes it suitable for blended interventions. METHODS AND ANALYSIS The study is a multicentre, randomised, superiority, clinical trial. Participants will be 310 individuals with a diagnosis of an ED. They will be randomised to a treatment as usual (individual cognitive behavioural therapy) or a UP condition in a blended format (face-to-face individual UP +online, app-based UP). Primary outcomes will be ED diagnostic criteria and depression and anxiety symptoms. Cost efficiency of the intervention, app usability, as well as opinion and confidence in the treatment will also be evaluated. Assessment points will include baseline and 3 months, 6 months and 12 months after UP treatment. ETHICS AND DISSEMINATION The study has received approvals by the Ethics Research Committee of Navarra, Castellón, Euskadi, Castilla y León, Extremadura, Lleida and Aragón. The study is currently under an approval process by the Ethics Research Committees of all the remaining collaborating centres. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings. TRIAL REGISTRATION NUMBER NCT04304911.
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Affiliation(s)
- J Osma
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Laura Martínez-García
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Óscar Peris-Baquero
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - María Vicenta Navarro-Haro
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
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Peris-Baquero Ó, Osma J, Gil-LaCruz M, Martínez-García L. Acceptability of and intention to use the Unified Protocol delivered in group format in the Spanish Public Health System. J Eval Clin Pract 2021; 27:1299-1309. [PMID: 33565231 DOI: 10.1111/jep.13546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/14/2021] [Accepted: 01/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The high prevalence of emotional disorders leads to a high demand for mental care which results in high costs and long waiting lists in public mental health settings. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is a recent emotion-regulation-based intervention that can be a cost-effective solution in public mental health settings due its transdiagnostic approach and the possibility to apply it in group format. However, the acceptability by mental healthcare professionals (MHCPs) delivering the UP in group format has not been explored. METHODS Thirty-three MHCPs, grouped into MHCPs without previous experience and MHCPs with experience in delivering the UP, were asked about aspects of acceptability and intention to use. Quantitative analysis was carried out to explore MHCPs acceptability. Furthermore, qualitative opinion about UP were collected through a SWOT (strengths, weaknesses, opportunities, threats) analysis to explore MHCPs opinion of delivering the UP intervention in a group format, within the Spanish Public Mental Health System. RESULTS The results showed high scores in all acceptability dimensions and intention to use in the future. SWOT analysis showed strengths and opportunities focusing on its transdiagnostic nature and the cost-effective benefits of group treatment, and weaknesses and threats related to the limited material and human resources. CONCLUSIONS Findings indicate high acceptability of the UP by MHCPs working within the Spanish Public Mental Health System and also identified areas for improvements. In order to enhance the dissemination and implementation of the UP, it is essential to consider MHCPs' perceptions and to be open to their suggestions.
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Affiliation(s)
- Óscar Peris-Baquero
- Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, Teruel, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Jorge Osma
- Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, Teruel, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Marta Gil-LaCruz
- Departamento de Psicología y Sociología, Facultad de Ciencias de la Salud, Zaragoza, Spain
| | - Laura Martínez-García
- Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, Universidad de Zaragoza, Teruel, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
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Carlucci L, Saggino A, Balsamo M. On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis. Clin Psychol Rev 2021; 87:101999. [PMID: 34098412 DOI: 10.1016/j.cpr.2021.101999] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 01/19/2023]
Abstract
In recent years a large array of treatment protocols conceptualized as transdiagnostic have been developed with clinical and practical advantages compared to traditional single-disorder protocols. Within this panorama, the Transdiagnostic Unified Protocol (UP) of Emotional Disorders was developed aimed at treating the negative affective processes underlying several diagnostic categories, and accounting for the covariance of different emotional disorders. The UP has been found to efficiently target the roots of these disorders leading to a reduction in symptoms of co-occurring disorders. However, several questions have marginally addressed in the previous studies, and some UP features still remain unexplored. The present meta-analysis aims at evaluating whether the UP results to significant changes in anxiety and depression symptoms severity in children, adolescents, and adults. 19 RCTs and 13 uncontrolled pre-post trials comprising 2183 patients/clients met inclusion criteria for meta-analysis. Large to moderate combined overall effect size for both depression plus anxiety were detected in the uncontrolled pre-post studies (g = 0.756) and in RTCs studies (g = 0.452), respectively. Large effect size at pre-treatment to 3-6-month follow-up was observed for combined depression plus anxiety (g = 1.113). Subgroup analysis suggested that UP treatment does not differ across the anxiety and depression self-report measures. Moreover, UP intervention outperformed both passive and active control conditions to treat negative affective syndromes. Meta-regression confirmed the moderate effects of therapist level of experience, the sample characteristics, and the UP-protocol adaptations. The findings indicate that the manualized UP treatment has potential to contribute to improving mental health outcomes, particularly of anxiety and depression.
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Affiliation(s)
- Leonardo Carlucci
- School of Medicine and Health Sciences, G. d'Annunzio University of Chieti-Pescara, Italy.
| | - Aristide Saggino
- School of Medicine and Health Sciences, G. d'Annunzio University of Chieti-Pescara, Italy
| | - Michela Balsamo
- School of Medicine and Health Sciences, G. d'Annunzio University of Chieti-Pescara, Italy
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Suso-Ribera C, Ros AMJ, Osma J. Psychometric properties and validation of the Portuguese version of the Anxiety Control Questionnaire Revised (ACQ-R). CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00269-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Osma J, Peris-Baquero O, Suso-Ribera C, Farchione TJ, Barlow DH. 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. Psychother Res 2021; 32:329-342. [PMID: 34132170 DOI: 10.1080/10503307.2021.1939190] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The present study aims to investigate the effectiveness of the Unified Protocol (UP), a transdiagnostic treatment of emotional disorders (EDs), when applied in a group format in the public mental health system in Spain. METHODS 488 participants with a primary diagnosis of ED were randomized to the UP group or to the treatment as usual (TAU; individual, disorder-specific cognitive behavioral therapy). Personality, depression and anxiety symptoms, affect, and quality of life were assessed at pre-treatment, 3 months after treatment onset (coinciding with the end of the UP treatment), and 6 and 9 months after treatment onset (follow-ups). The moderating effect of the treatment condition and the number of sessions received in the evolution of study outcomes was investigated with a linear mixed model analysis. RESULTS A significant improvement in outcomes occurred in both conditions, except for extraversion in the TAU. Improvements in depression, anxiety and quality of life were larger in the UP condition. After the treatment, improvements were maintained at follow-ups in all study outcomes. An interaction between Time*Condition*Sessions was found for depression. CONCLUSION The results add to the existing evidence on the effectiveness of the UP and may be important for implementation purposes in the Spanish or other similar public mental health systems. Trial registration number NCT03064477 (March 10, 2017).
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Affiliation(s)
- J Osma
- Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - O Peris-Baquero
- Universidad de Zaragoza, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | | | - T J Farchione
- Center for Anxiety and Related Disorders, Boston University (EEUU), Boston, MA, USA
| | - D H Barlow
- Center for Anxiety and Related Disorders, Boston University (EEUU), Boston, MA, USA
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Díaz-García A, González-Robles A, García-Palacios A, Fernández-Felipe I, Tur C, Castilla D, Botella C. Blended transdiagnostic group CBT for emotional disorders: A feasibility trial protocol. Internet Interv 2021; 23:100363. [PMID: 33520670 PMCID: PMC7820549 DOI: 10.1016/j.invent.2021.100363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Emotional disorders (anxiety and depressive disorders) are a relevant public health concern associated with high prevalence, high costs, and important disability. Therefore, research priorities include designing and testing cost-effective interventions to reach everyone in need. Internet-delivered interventions for emotional disorders are effective and can help to disseminate and implement evidence-based treatments. However, although these treatments are generally effective, not all patients benefit from this treatment format equally. Blended treatments are a new form of intervention that combines the strengths of face-to-face and Internet approaches. Nevertheless, research on blended interventions has focused primarily on individual therapy, and less attention has been paid to the potential of using this format in group psychotherapy. This study aims to analyze the feasibility of blended transdiagnostic group CBT for emotional disorders. The current article describes the study protocol for this trial. METHOD AND ANALYSIS A one-armed pilot trial will be conducted. Participants will be 30 adults suffering from DSM-5 anxiety and/or depressive disorders. The treatment consists of a blended transdiagnostic group intervention delivered during a period of 24 weeks. Groups of 6 to 10 patients will attend a total of eight 2-hour, face-to-face sessions, alternated with the use of an online platform where they will find the contents of the treatment protocol. The intervention has four core components: present-focused awareness, cognitive flexibility, identification and modification of behavioral and cognitive patterns of emotional avoidance, and interoceptive and situational exposure. These components are delivered in 16 modules. Assessments will be performed at baseline, during the treatment, at post-treatment, and at 3-month follow-up. Clinical and treatment acceptability outcomes will be included. Quantitative and qualitative data (participants' views about blended group psychotherapy) will be analyzed. ETHICS AND DISSEMINATION The trial has received ethical approval from the Ethics Committee of Universitat Jaume I (September 2019) and will be conducted in accordance with the study protocol, the Declaration of Helsinki, and good clinical practice. The results of this study will be disseminated by presentation at conferences and will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04008576. Registered 05 July 2019, https://clinicaltrials.gov/ct2/show/NCT04008576.
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Affiliation(s)
- Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza (Campus de Teruel), Teruel, Spain
| | - Alberto González-Robles
- Department of Psychology and Sociology, Universidad de Zaragoza (Campus de Teruel), Teruel, Spain
| | - Azucena García-Palacios
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
| | - Isabel Fernández-Felipe
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Cintia Tur
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
| | - Diana Castilla
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
- Department of Personality, Evaluation and Psychological Treatments, Universidad de Valencia, Valencia, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, Spain
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Osma J, Peris-Baquero O, Suso-Ribera C, Sauer-Zavala S, Barlow DH. Predicting and Moderating the Response to the Unified Protocol: Do Baseline Personality and Affective Profiles Matter? COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10208-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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17
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Corpas J, Moriana JA, Venceslá JF, Gálvez-Lara M. Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial. Int J Clin Health Psychol 2021; 21:100203. [PMID: 33363586 PMCID: PMC7753034 DOI: 10.1016/j.ijchp.2020.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background/Objective Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. Method: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. Results: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. Conclusions: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems.
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Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), and Reina Sofia University Hospital, Cordoba, Spain
| | - Juan A. Moriana
- Department of Psychology, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), and Reina Sofia University Hospital, Cordoba, Spain
| | - Jose F. Venceslá
- Department of Psychology, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), and Reina Sofia University Hospital, Cordoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), and Reina Sofia University Hospital, Cordoba, Spain
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18
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Rodriguez-Moreno S, Farchione TJ, Roca P, Marín C, Guillén AI, Panadero S. Initial Effectiveness Evaluation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders for Homeless Women. Behav Modif 2020; 46:506-528. [PMID: 33345583 DOI: 10.1177/0145445520982562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study is to evaluate the effectiveness of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders adapted for homeless women (UPHW). Eighty-one homeless women participated in this single-blinded quasi-experimental clinical trial, involving up to 12 sessions of group treatment, and 3-and 6-month follow-ups. The participants received either immediate treatment with the UPHW (n = 46) or delayed treatment, following a 12-week wait-list control period (WLC; n = 35). Primary outcomes included depression and anxiety. Secondary measures comprised positive and negative affect, psychological well-being, health perception, and social support. The UPHW resulted in significant improvement on measures of anxiety, depression and negative affect. Improvements in anxiety and depression were maintained over a 3-month follow-up period, but not at 6-month. The reliability of the clinical changes showed significant differences between UPHW and WLC for depression. Moreover, the inter-session assessment in the UPHW group showed a linear trend reduction for depression and anxiety scores along the 12 sessions. The clinical implications on the UPHW in social settings are also discussed.
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19
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A Single-Session Workshop to Enhance Emotional Awareness and Emotion Regulation for Graduate Students: A Pilot Study. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Nazari N, Sadeghi M, Ghadampour E, Mirzaeefar D. Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial. BMC Psychol 2020; 8:114. [PMID: 33129356 PMCID: PMC7603744 DOI: 10.1186/s40359-020-00480-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder. METHODS Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity. RESULTS The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen's d = 1.9), anxiety symptoms (Cohen's d = 2.16), worry symptoms (Cohen's d = 1.27), emotion dysregulation (Cohen's d = 0.44), positive affect (Cohen's d = 1.51), and negative affect (Cohen's d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001). CONCLUSION The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS. Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view .
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Affiliation(s)
- Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran.
| | - Masood Sadeghi
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Ezatolah Ghadampour
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
| | - Davod Mirzaeefar
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
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21
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Nazari N, Aligholipour A, Sadeghi M. Transdiagnostic treatment of emotional disorders for women with multiple sclerosis: a randomized controlled trial. BMC Womens Health 2020; 20:245. [PMID: 33129298 PMCID: PMC7603725 DOI: 10.1186/s12905-020-01109-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 10/25/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, unpredictable, neurodegenerative disease, significantly associated with psychological, behavioral, cognitive, and emotional consequences. MS is more common in females than males and frequently affects women during their reproductive years. Despite the frequent mental disorders, comorbidities, and emotional problems in People with MS (PwMS), these conditions are too often underdiagnosed and undertreated. OBJECTIVE This study aimed to examine the efficacy of a group format of the Unified Protocol (UP) for the Transdiagnostic treatment of depression and anxiety disorders in females with MS. METHODS In the present study, Sixty-four adult females diagnosed with MS were randomized to either the UP (n = 32) or treatment-as-usual conditions. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional regulation, and affectivity. RESULTS Repeated measure analysis of variance (ANOVA) revealed that the UP significantly improved depression scores [Cohen's d = - 2.11, 95% CI (- 2.72, - 1.50)], anxiety scores [Cohen's d = - 3.34, 95% CI (- 4.01, - 2.58)], positive and negative affect scale (PANAS)-positive affect scores [Cohen's d = 1.46, 95% CI (1.46, 2.01)], PANAS-negative affect scores [Coen's d = - 2.21, 95% CI (- 2.84, - 1.60)], difficulties emotion regulation scale scores [Cohen's d = 1.40, 95% CI (- 0.87, - 0.03)], and Worry scale scores [Cohen's d = - 0.45, 95% CI (- 0.95, - 0.04)] at the end of treatment relative to compared to the control condition. Also, treatment gains were maintained at the three-month follow-up (p < 0.001). CONCLUSION The findings provide the support that the UP could be an additional efficient psychological treatment for females with MS. ISRCTN Number: ISRCTN95459505.
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Affiliation(s)
- Nabi Nazari
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran.
| | - Akram Aligholipour
- Department of Psychology, Islamic Azad University, Hamadan Branch, Hamadan, Iran
| | - Masoud Sadeghi
- Department of Psychology, Faculty of Human Sciences, Lorestan University, Khorramabad, Iran
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Nazari N, Sadeghi M, Ghadampour E, Mirzaeefar D. Transdiagnostic treatment of emotional disorders in people with multiple sclerosis: randomized controlled trial. BMC Psychol 2020. [DOI: doi.org/10.1186/s40359-020-00480-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abstract
Background
Multiple sclerosis (MS) is a neurodegenerative disease of the central nervous system. MS is significantly associated with a high rate of psychological, behavioral, and emotional consequences. Despite the frequent mental disorders, high rate of psychological comorbidities, and emotional problems in people with MS (PwMS), these conditions are often underdiagnosed and undertreated. This study aimed to examine the efficacy of a group format of the unified protocol for the transdiagnostic treatment of emotional disorders in adult PwMS associated with an emotional disorder.
Methods
Seventy adult PwMS were randomized using an internet-based computer system to either the unified protocol (n = 35) or treatment as usual condition. The assessment protocol included semi-structured clinical interviews and self-reports evaluating diagnostic criteria, depression, anxiety and worry symptoms, emotional dysregulation, and affectivity.
Results
The parametric test of analysis of covariance, followed the intent to treat analyses, revealed the unified protocol significantly changed depression symptoms (Cohen’s d = 1.9), anxiety symptoms (Cohen’s d = 2.16), worry symptoms (Cohen’s d = 1.27), emotion dysregulation (Cohen’s d = 0.44), positive affect (Cohen’s d = 1.51), and negative affect (Cohen’s d = 1.89) compared with the control group. The unified protocol also significantly improved outcome scores at the end of treatment relative to baseline (p < .001).
Conclusion
The findings support that the unified protocol could be an additional efficient psychological treatment for PwMS.
Trial registration IRCT, number: IRCT20190711044173N1. Registered 31october 2019, https://en.irct.ir/user/trial/40779/view.
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Brief Acceptance and Commitment Therapy for Fibromyalgia: Feasibility and Effectiveness of a Replicated Single-Case Design. Pain Res Manag 2020; 2020:7897268. [PMID: 33123304 PMCID: PMC7586182 DOI: 10.1155/2020/7897268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
Objective Overall, the literature on the effectiveness of psychological treatments in general and those for fibromyalgia in particular has been dominated by research designs that focus on large groups and explore changes on average, so the treatment impact at the individual level remains unclear. In this quasi-experimental, replicated single-case design, we will test the feasibility and effectiveness of a brief acceptance and committed therapy intervention using ecological momentary assessment supported by technology. Methods The sample comprised 7 patients (3 in the individual condition and 4 in the group condition) who received a brief, 5-week psychological treatment. Patient evolution was assessed one week prior to treatment onset and during the whole study with a smartphone app. Because ecological momentary assessment and the use of an app are not frequent practices in routine care, we also evaluated the feasibility of this assessment methodology (i.e., compliance with the app). Change was investigated with a nonoverlap of all pairs index. Outcomes were pain interference with sleep and social activities, fatigue, sadness, and pain intensity. Results Patient change was not uniform across outcomes. Four patients (two in each condition) showed relatively moderate levels of change (approximately 60% nonoverlap in several outcomes). The remaining patients showed more modest improvements which affected a reduced number of outcomes. Based on nonoverlapping indices, there was no clear evidence in favor of any treatment format. Conclusions An alternative design to large-scale trials, one that focuses on the individual change, exists and it can be implemented in pain research. The use of technology (e.g., smartphones) simplifies such designs by facilitating ecological momentary assessment. Based on our findings showing that changes were not homogeneous across patients or outcomes, more single-case designs and patient-centered analyses (e.g., responder and moderation analyses) are required.
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Suso-Ribera C, Martínez-Borba V, Martín-Brufau R, Suso-Vergara S, García-Palacios A. Individual differences and health in chronic pain: are sex-differences relevant? Health Qual Life Outcomes 2019; 17:128. [PMID: 31331336 PMCID: PMC6647055 DOI: 10.1186/s12955-019-1182-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Because psychological variables are known to intercorrelate, the goal of this investigation was to compare the unique association between several well-established psychological constructs in pain research and pain-related outcomes. Sex differences are considered because pain is experienced differently across sex groups. METHODS Participants were 456 consecutive chronic pain patients attending a tertiary pain clinic (mean age = 58.4 years, SD = 14.8, 63.6% women). The study design was cross-sectional. Psychological constructs included personality (NEO-Five Factor Inventory), irrational thinking (General Attitudes and Beliefs Scale), and coping (Social Problem Solving Inventory). Outcomes were pain severity and interference (Brief Pain Inventory) and physical, general, and mental health status (Short Form-36). To decide whether the bivariate analyses and the two-block, multivariate linear regressions for each study outcome (block 1 = age, sex, and pain severity; block 2 = psychological variables) should be conducted with the whole sample or split by sex, we first explored whether sex moderated the relationship between psychological variables and outcomes. An alpha level of 0.001 was set to reduce the risk of type I errors due to multiple comparisons. RESULTS The moderation analyses indicated no sex differences in the association between psychological variables and study outcomes (all interaction terms p > .05). Thus, further analyses were calculated with the whole sample. Specifically, the bivariate analyses revealed that psychological constructs were intercorrelated in the expected direction and mostly correlated with mental health and overall perceived health status. In the regressions, when controlling for age, sex, and pain severity, psychological factors as a block significantly increased the explained variance of physical functioning (ΔR2 = .037, p < .001), general health (ΔR2 = .138, p < .001), and mental health (ΔR2 = .362, p < .001). However, unique associations were only obtained for mental health and neuroticism (β = - 0.30, p < .001) and a negative problem orientation (β = - 0.26, p < .001). CONCLUSIONS There is redundancy in the relationship between psychological variables and pain-related outcomes and the strength of this association is highest for mental health status. The association between psychological characteristics and health outcomes was comparable for men and women, which suggests that the same therapeutic targets could be selected in psychological interventions of pain patients irrespective of sex.
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Affiliation(s)
- C Suso-Ribera
- Universitat Jaume I, Avda. Vicent Sos Baynat s/n. 12071, Castellón de la Plana, Spain.
| | - V Martínez-Borba
- Universitat Jaume I, Avda. Vicent Sos Baynat s/n. 12071, Castellón de la Plana, Spain
| | | | | | - A García-Palacios
- Universitat Jaume I, Avda. Vicent Sos Baynat s/n. 12071, Castellón de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, CB06/03, Instituto de Salud Carlos III, Barcelona, Spain
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Osma J, Suso-Ribera C, Peris-Baquero Ó, Gil-Lacruz M, Pérez-Ayerra L, Ferreres-Galan V, Torres-Alfosea MÁ, López-Escriche M, Domínguez O. What format of treatment do patients with emotional disorders prefer and why? Implications for public mental health settings and policies. PLoS One 2019; 14:e0218117. [PMID: 31181100 PMCID: PMC6557569 DOI: 10.1371/journal.pone.0218117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/25/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We analyzed the preference of three psychological intervention formats-individual, group, and online-in a sample of 267 patients with a primary diagnosis of emotional disorder in Spanish public mental health settings. METHOD We studied patients' preferences considering sociodemographic characteristics, diagnoses, history of psychological treatments, number of sessions, and satisfaction with past interventions. RESULTS Most participants (85.4%) preferred psychological treatment in an individual format, 14.2% in group, and 0.4% online. When comparing the people who chose individual and group treatment, no demographic or clinical differences were found. The arguments against group format were the lack of privacy and expression difficulties. Regarding online format, these included being considered impersonal and ineffective. CONCLUSION The rejection of group and online psychotherapy formats allows us to define the actions we should carry out in public mental health settings to improve the acceptance of more cost-effective therapy formats.
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Affiliation(s)
- Jorge Osma
- Departamento de psicología y sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, Spain
| | - Carlos Suso-Ribera
- Departamento de psicología básica, clínica y psicobiología, Universitat Jaume I, Castellón, Spain
| | | | - Marta Gil-Lacruz
- Departamento de psicología y sociología, Universidad de Zaragoza, Teruel, Spain
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Gálvez-Lara M, Corpas J, Venceslá JF, Moriana JA. Evidence-Based Brief Psychological Treatment for Emotional Disorders in Primary and Specialized Care: Study Protocol of a Randomized Controlled Trial. Front Psychol 2019; 9:2674. [PMID: 30671005 PMCID: PMC6331401 DOI: 10.3389/fpsyg.2018.02674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/12/2018] [Indexed: 01/23/2023] Open
Abstract
Emotional Disorders (EDs) are very prevalent in Primary Care (PC). However, general practitioners (GPs) have difficulties to make the diagnosis and the treatment of this disorders that are usually treated with drugs. Brief psychological therapies may be a new option to treat EDs in a PC context. This article aims to present a study protocol to evaluate the effectiveness and the efficiency of an adaptation to brief format of the "Unified Protocol (UP) for the transdiagnostic treatment of EDs." This is a single-blinded RCT among 165 patients with EDs. Patients will be randomly assigned to receive brief psychological treatment based on UP, conventional psychological treatment, conventional psychological treatment plus pharmacological treatment, minimum intervention based on basic psychoeducational information, or pharmacological treatment only. Outcome measure will be the following: GAD-7, STAI, PHQ-9, BDI-II, PHQ-15, PHQ-PD, and BSI-18. Assessments will be carried out by blinded raters at baseline, after the treatment and 6-month follow-up. The findings of this RCT may encourage the implementation of brief therapies in the PC context, what would lead to the decongestion of the public health system, the treatment of a greater number of people with EDs in a shorter time, the reduction of the side effects of pharmacological treatment and a possible economic savings for public purse. Clinical Trial Registration: ClinicalTrial.gov, identifier NCT03286881. Registered September 19, 2017.
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Affiliation(s)
- Mario Gálvez-Lara
- Department of Psychology, University of Córdoba, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
| | - Jorge Corpas
- Department of Psychology, University of Córdoba, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
| | - José Fernando Venceslá
- Department of Psychology, University of Córdoba, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
| | - Juan A. Moriana
- Department of Psychology, University of Córdoba, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
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Antón-Menárguez V, Jareño B, Lara-Espejo I, Redondo-Jiménez M, García-Marín P. [Effectiveness of psychological intervention by groups in Primary Care]. Semergen 2018; 45:86-92. [PMID: 30527512 DOI: 10.1016/j.semerg.2018.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 04/15/2018] [Accepted: 05/08/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The aim of this study is to analyse the efficacy of a trans-diagnostic psychological therapy group aimed at reducing anxiety symptomatology. This was delivered within a Primary Care setting by clinical psychology. MATERIAL AND METHODS The assessment was completed through the outcome measure Clinical Outcomes in Routine Evaluation-Short Form A (CORE-SFA). The intervention consisted of a Cognitive Behavioural Therapy group that delivered one session a week for 4 weeks. Components of this therapy included: psycho-education, cognitive restructuring, assertiveness training, sleep hygiene, problem solving, relaxation techniques, and time management. The data for this study was collected between January 2015 and October 2016, with a sample of 48 patients. RESULTS Results from the data collected demonstrated a statistically significant reduction of the anxiety symptomatology. Moreover, 79.2% of the sample was discharged from services following this group intervention. CONCLUSIONS The clinical implications of this study are discussed, supporting the efficacy of a trans-diagnostic Cognitive Behavioural Therapy group in a Primary Care setting for the treatment of symptoms of sub-clinical anxiety and depression.
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Affiliation(s)
- V Antón-Menárguez
- Unidad de Salud Mental, Hospital General Universitario de Elche, Elche, España; Elche
| | - B Jareño
- Unidad de Salud Mental, Hospital General Universitario de Elche, Elche, España; Elche
| | - I Lara-Espejo
- Unidad de Salud Mental, Hospital General Universitario de Elche, Elche, España; Elche
| | | | - P García-Marín
- Hospital General Universitario de Elche, Elche, España; Elche
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