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Jurado-González F, García-Torres F, Contreras A, Muñoz-Navarro R, González-Blanch C, Adrián Medrano L, Ruiz-Rodríguez P, Moreno EM, Pérez-Dueñas C, Cano-Vindel A, Moriana JA. Comparing psychological versus pharmacological treatment in emotional disorders: A network analysis. PLoS One 2024; 19:e0301675. [PMID: 38568925 PMCID: PMC10990220 DOI: 10.1371/journal.pone.0301675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
Transdiagnostic group cognitive behavioural therapy (TD-GCBT) is more effective in improving symptoms and severity of emotional disorders (EDs) than treatment as usual (TAU; usually pharmacological treatment). However, there is little research that has examined the effects of these treatments on specific symptoms. This study used Network Intervention Analysis (NIA) to investigate the direct and differential effects of TD-GCBT + TAU and TAU on specific symptoms of anxiety and depression. Data are from a multicentre randomised clinical trial (N = 1061) comparing TD-GCBT + TAU versus TAU alone for EDs. The networks included items from the PHQ-9 (depression) and GAD-7 (anxiety) questionnaire and mixed graphical models were estimated at pre-treatment, post-treatment and 3-, 6- and 12-month follow-up. Results revealed that TD-GCBT + TAU was associated with direct effects, mainly on several anxiety symptoms and depressed mood after treatment. New direct effects on other depressive symptoms emerged during the follow-up period promoted by TD-GCBT compared to TAU. Our results suggest that the improvement of anxiety symptoms after treatment might precipitate a wave of changes that favour a decrease in depressive symptomatology. NIA is a methodology that can provide fine-grained insight into the likely pathways through which treatments exert their effects.
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Affiliation(s)
- Francisco Jurado-González
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - Alba Contreras
- University Catholique San Antonio of Murcia, Murcia, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Social and Human Sciences, University of Zaragoza, Teruel, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital—IDIVAL, Santander, Cantabria, Spain
| | | | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - Eliana M. Moreno
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | - Carolina Pérez-Dueñas
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
| | | | - Juan A. Moriana
- Department of Psychology, University of Cordoba/Maimonides Institute for Biomedical Research of Cordoba (IMIBIC)/Reina Sofia University Hospital, Cordoba, Spain
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Prieto-Vila M, González-Blanch C, Estupiñá Puig FJ, Buckman JEJ, Saunders R, Muñoz-Navarro R, Moriana JA, Rodríguez-Ruiz P, Barrio-Martínez S, Carpallo-González M, Cano-Vindel A. Long-term depressive symptom trajectories and related baseline characteristics in primary care patients: Analysis of the PsicAP clinical trial. Eur Psychiatry 2024; 67:e32. [PMID: 38532731 DOI: 10.1192/j.eurpsy.2024.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND There is heterogeneity in the long-term trajectories of depressive symptoms among patients. To date, there has been little effort to inform the long-term trajectory of symptom change and the factors associated with different trajectories. Such knowledge is key to treatment decision-making in primary care, where depression is a common reason for consultation. We aimed to identify distinct long-term trajectories of depressive symptoms and explore pre-treatment characteristics associated with them. METHODS A total of 483 patients from the PsicAP clinical trial were included. Growth mixture modeling was used to identify long-term distinct trajectories of depressive symptoms, and multinomial logistic regression models to explore associations between pre-treatment characteristics and trajectories. RESULTS Four trajectories were identified that best explained the observed response patterns: "recovery" (64.18%), "late recovery" (10.15%), "relapse" (13.67%), and "chronicity" (12%). There was a higher likelihood of following the recovery trajectory for patients who had received psychological treatment in addition to the treatment as usual. Chronicity was associated with higher depressive severity, comorbidity (generalized anxiety, panic, and somatic symptoms), taking antidepressants, higher emotional suppression, lower levels on life quality, and being older. Relapse was associated with higher depressive severity, somatic symptoms, and having basic education, and late recovery was associated with higher depressive severity, generalized anxiety symptoms, greater disability, and rumination. CONCLUSIONS There were different trajectories of depressive course and related prognostic factors among the patients. However, further research is needed before these findings can significantly influence care decisions.
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Affiliation(s)
- Maider Prieto-Vila
- Department of Experimental Psychology, Cognitive Processes and Logopedics, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - César González-Blanch
- Mental Health Centre, University Hospital "Marqués de Valdecilla" - IDIVAL, Santander, Spain
| | - Francisco J Estupiñá Puig
- Department of Personality, Assessment and Clinical Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Joshua E J Buckman
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
- iCope - Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - Rob Saunders
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
| | - Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Juan A Moriana
- Department of Psychology, University of Cordoba, Cordoba, Spain
| | | | - Sara Barrio-Martínez
- Department of Experimental Psychology, Cognitive Processes and Logopedics, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
- Mental Health Centre, University Hospital "Marqués de Valdecilla" - IDIVAL, Santander, Spain
| | - María Carpallo-González
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Antonio Cano-Vindel
- Department of Experimental Psychology, Cognitive Processes and Logopedics, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
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Carpallo-González M, Muñoz-Navarro R, González-Blanch C, Cano-Vindel A. Symptoms of emotional disorders and sociodemographic factors as moderators of dropout in psychological treatment: A meta-review. Int J Clin Health Psychol 2023; 23:100379. [PMID: 36922928 PMCID: PMC10009192 DOI: 10.1016/j.ijchp.2023.100379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 02/08/2023] [Indexed: 03/07/2023] Open
Abstract
Objective Dropout from psychological treatment is an important problem that substantially limits treatment effectiveness. A better understanding of this phenomenon, could help to minimize it. Therefore, we performed a systematic review of meta-analyses (MA) on dropout from psychological treatments to (1) determine the estimated overall dropout rate (DR) and (2) to examine potential predictors of dropout, including clinical symptoms (anxiety and depression) and sociodemographic factors. Method A literature search of the PubMed PsycINFO, Embase, Scopus and Google Scholar databases was conducted. We identified 196 MAs on dropout from psychological treatment carried out primarily in adult patients or mixed samples (adults and children) between 1990 and 2022. Of these, 12 met all inclusion criteria. Two forest plots were created to visualize the DR and the relationship between DR and the disorder. Results The DR ranged from 15.9% to 46.8% and was significantly moderated by symptoms of emotional disorders. The highest DR were observed in younger, unmarried patients, and those with lower educational and income levels. Conclusions DR in patients undergoing psychological treatment is highly heterogeneous, but higher in individuals presenting symptoms of anxiety and/or depression, especially the latter. Given that high DR undermine the effectiveness of psychological interventions, it is clear that greater efforts are needed to reduce dropout, particularly among individuals with symptoms of emotional disorders.
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Affiliation(s)
| | | | - César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
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4
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Barrio-Martínez S, Cano-Vindel A, Priede A, Medrano LA, Muñoz-Navarro R, Moriana JA, Carpallo-González M, Prieto-Vila M, Ruiz-Rodríguez P, González-Blanch C. Worry, rumination and negative metacognitive beliefs as moderators of outcomes of Transdiagnostic group cognitive-behavioural therapy in emotional disorders. J Affect Disord 2023; 338:349-357. [PMID: 37336250 DOI: 10.1016/j.jad.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Despite the relevance of cognitive processes such as rumination, worry, negative metacognitive beliefs in emotional disorders, the existing literature about how these cognitive processes moderate the effect of treatment in treatment outcomes is limited. The aim of the present study was to explore the potential moderator effect of baseline cognitive processes-worry, rumination and negative metacognitive beliefs-on the relationship between treatment allocation (transdiagnostic cognitive-behavioural therapy -TD-CBT plus treatment as usual-TAU vs. TAU alone) and treatment outcomes (anxiety and depressive symptoms, quality of life [QoL], and functioning) in primary care patients with emotional disorders. METHODS A total of 631 participants completed scales to evaluate worry, rumination, negative metacognitive beliefs, QoL, functioning, and anxiety and depressive symptoms. RESULTS Worry and rumination acted as moderators on the effect of treatment for anxiety (b = -1.25, p = .003; b = -0.98, p = .048 respectively) and depressive symptoms (b = -1.21, p = .017; b = -1.34, p = .024 respectively). Individuals with higher baseline levels of worry and rumination obtained a greater reduction in emotional symptoms from the addition TD-CBT to TAU. Negative metacognitive beliefs were not a significant moderator of any treatment outcome. LIMITATIONS The study assesses cognitive processes over a relatively short period of time and uses self-reported instruments. In addition, it only includes individuals with mild or moderate anxiety or depressive disorders, which limits generalization to other populations. CONCLUSIONS These results underscore the generalization of the TD-CBT to individuals with emotional disorders in primary care with different cognitive profiles, especially those with high levels of worry and rumination.
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Affiliation(s)
- Sara Barrio-Martínez
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain.
| | | | - Amador Priede
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain; Mental Health Centre, Hospital de Laredo, Laredo, Spain
| | | | - Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Spain
| | - Juan Antonio Moriana
- Department of Psychology, Universidad de Córdoba, Córdoba, Spain; Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
| | - María Carpallo-González
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Spain
| | | | - Paloma Ruiz-Rodríguez
- Embarcaciones Primary Care Centre, Health Service of Madrid, Tres Cantos, Madrid, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital - IDIVAL, Santander, Spain; Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
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García-Batista ZE, Cantisano-Guzmán LM, Guerra-Peña K, Alvarez A, Moretti L, Cano-Vindel A, Muñoz-Navarro R, Medrano LA, Baltra RA. PsicAP transdiagnostic protocol of group cognitive-behavioral training for emotional disorders in Dominican Republic: a randomized controlled trial protocol. BMC Psychiatry 2023; 23:363. [PMID: 37226144 DOI: 10.1186/s12888-023-04771-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/11/2023] [Indexed: 05/26/2023] Open
Abstract
Emotional disorders (ED) such as anxiety, depression and somatization are extremely prevalent disorders that can affect an individual's quality of life and functionality. Primary Health Care (PHC) is the first place to identify most patients with these conditions. Mental health services in the Dominican Republic, as well as in Latin America and the Caribbean in general, are unable to provide appropriate care for most people with mental disorders. Using evidence-based treatment protocols is also crucial to make progress in helping people with ED. The PsicAP project is a group intervention that uses a transdiagnostic approach and is grounded in cognitive-behavioral techniques. The program is implemented in 7 group sessions, each lasting for one and a half hours. The program has been shown to be effective in reducing clinical symptoms, dysfunction, and in improving quality of life. It is also a non-time-intensive, low-cost treatment that is helpful for addressing EDs in a PHC context. The objective is to bring psychological treatments into PHC facilities of Dominican Republic, making them more accessible for a larger amount of the population.
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Affiliation(s)
- Zoilo Emilio García-Batista
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Av. Autopista Duarte Km. 1 1/2, Santiago, 51000, Dominican Republic.
| | | | - Kiero Guerra-Peña
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Adriana Alvarez
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Luciana Moretti
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
- Universidad Siglo 21, Córdoba, Argentina
| | | | | | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
- Universidad Siglo 21, Córdoba, Argentina
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González-Blanch C, Barrio-Martínez S, Priede A, Martínez-Gómez S, Pérez-García-Abad S, Miras-Aguilar M, Ruiz-Gutiérrez J, Muñoz-Navarro R, Ruiz-Rodríguez P, Medrano LA, Prieto-Vila M, Carpallo-González M, Aguilera-Martín Á, Gálvez-Lara M, Cuadrado F, Moreno E, García-Torres F, Venceslá JF, Corpas J, Jurado-González FJ, Moriana JA, Cano-Vindel A. Cost-effectiveness of transdiagnostic group cognitive behavioural therapy versus group relaxation therapy for emotional disorders in primary care (PsicAP-Costs2): Protocol for a multicentre randomised controlled trial. PLoS One 2023; 18:e0283104. [PMID: 36928238 PMCID: PMC10019745 DOI: 10.1371/journal.pone.0283104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Several randomised controlled trials (RCT) have demonstrated the superiority of transdiagnostic group cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) for emotional disorders in primary care. To date, however, no RCTs have been conducted to compare TD-CBT to another active intervention in this setting. Our aim is to conduct a single-blind RCT to compare group TD-CBT plus TAU to progressive muscle relaxation (PMR) plus TAU in adults (age 18 to 65 years) with a suspected emotional disorder. We expect that TD-CBT + TAU will be more cost-effective than TAU + PMR, and that these gains will be maintained at the 12-month follow-up. Seven therapy sessions (1.5 hours each) will be offered over a 24-week period. The study will be carried out at four primary care centres in Cantabria, Spain. The study will take a societal perspective. Psychological assessments will be made at three time points: baseline, post-treatment, and at 12-months. The following variables will be evaluated: clinical symptoms (anxiety, depression, and/or somatic); functioning; quality of life (QoL); cognitive-emotional factors (rumination, worry, attentional and interpretative biases, emotion regulation and meta-cognitive beliefs); and satisfaction with treatment. Data on health service use, medications, and sick days will be obtained from electronic medical records. Primary outcome measures will include: incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICURs). Secondary outcome measures will include: clinical symptoms, QoL, functioning, and treatment satisfaction. Bootstrap sampling will be used to assess uncertainty of the results. Secondary moderation and mediation analyses will be conducted. Two questionnaires will be administered at sessions 1, 4, and 7 to assess therapeutic alliance and group satisfaction. If this trial is successful, widespread application of this cost-effective treatment could greatly improve access to psychological treatment for emotional disorders in the context of increasing demand for mental healthcare in primary care. Trial registration: ClinicalTrials.gov: Cost-effectiveness of a Transdiagnostic Psychological Treatment for Emotional Disorders in Primary Care (PsicAP). NCT05314920.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital—IDIVAL, Santander, Spain
- Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
- * E-mail:
| | - Sara Barrio-Martínez
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Amador Priede
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
- Mental Health Centre, Hospital de Laredo, Laredo, Spain
| | - Sandra Martínez-Gómez
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Saioa Pérez-García-Abad
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - María Miras-Aguilar
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - José Ruiz-Gutiérrez
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - Leonardo A. Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, Dominican Republic
| | | | | | - Ángel Aguilera-Martín
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Fátima Cuadrado
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Eliana Moreno
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - José F. Venceslá
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Jorge Corpas
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Francisco J. Jurado-González
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Juan A. Moriana
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
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García-Batista ZE, Guerra-Peña K, Alsina-Jurnet I, Cano-Vindel A, Álvarez-Hernández A, Cantisano-Guzmán LM, Bordas-Puras M, Moretti L, Medrano LA. Design and validation of virtual environments for the treatment of cleaning obsessive-compulsive disorder. Heliyon 2022; 8:e12487. [PMID: 36575692 PMCID: PMC9780645 DOI: 10.1016/j.heliyon.2022.e12487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/22/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
During the coronavirus outbreak, it was noted that pre-existing psychological illnesses worsened, and numerous research indicate that those with contamination-related obsessions and cleaning compulsions (C-OCD) may be more affected. Virtual Reality (VR) and other immersive technologies have shown to be effective for the treatment of disorders related to anxiety, thus showing their potential to transform OCD treatment by means of integrating virtual elements. VR exposure has shown benefits compared to live or imagined exposure, however, to be effective it must be able to elicit high emotional arousal in users. Based on this, the present work aimed to develop different virtual environments scenarios and evaluate their efficacy in generating an emotional response in people with C-OCD symptoms. Based on the literature review, two virtual scenarios were created (dirty public bathroom and unhygienic kitchen). Subsequently, two groups were then constituted: C-OCD group (n = 20, aged between 18 and 48 years) characterized by an obtained score of more than 13 points (cut-point) in the Yale-Brown Scale for Obsessive-Compulsive Disorder (Y-BOCS) and by showing C-OCD symptoms when doing the structured interview (SCID-I), and a control group (n = 20, aged between 18 and 56 years), all participants were residents of the Dominican Republic. Exposure to the virtual environments generated high levels of state and subjective anxiety in both groups, although significantly higher in the C-OCD group. The results obtained indicate that the VR scenarios developed are suitable for eliciting emotional responses and, consequently, that they can be used to complement the treatment of C-OCD.
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Affiliation(s)
- Zoilo Emilio García-Batista
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
- Corresponding author.
| | - Kiero Guerra-Peña
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
| | - Ivan Alsina-Jurnet
- Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Sagrada Família, 7. Vic, 08500 Catalunya, Spain
| | | | - Adriana Álvarez-Hernández
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
| | - Luisa Marilia Cantisano-Guzmán
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
| | - Marlia Bordas-Puras
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
| | - Luciana Moretti
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
- Universidad Siglo 21, Calle de los Latinos, 8555 Córdoba, Argentina
| | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
- Universidad Siglo 21, Calle de los Latinos, 8555 Córdoba, Argentina
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8
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Barrio-Martínez S, González-Blanch C, Priede A, Muñoz-Navarro R, Medrano LA, Moriana JA, Carpallo-González M, Ventura L, Ruiz-Rodríguez P, Cano-Vindel A. Emotion Regulation as a Moderator of Outcomes of Transdiagnostic Group Cognitive-Behavioral Therapy for Emotional Disorders. Behav Ther 2022; 53:628-641. [PMID: 35697427 DOI: 10.1016/j.beth.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 11/02/2022]
Abstract
The aim of this study was to examine the potential moderating effect of baseline emotion regulation skills-cognitive reappraisal and expressive suppression-on the relationship between treatment allocation and treatment outcomes in primary care patients with emotional symptoms. A total of 631 participants completed scales to evaluate emotion regulation, anxiety, depression, functioning, and quality of life (QOL). The moderation analysis was carried out using the SPSS PROCESS macro, version 3.5. Expressive suppression was a significant moderator in the relationship between treatment allocation and treatment outcomes in terms of symptoms of anxiety (b = -0.530, p = .026), depression (b = -0.812, p = .004), and QOL (b = 0.156, p = .048). Cognitive reappraisal acted as a moderator only in terms of QOL (b = 0.217, p = .028). The findings of this study show that participants with higher scores of expressive suppression benefited more from the addition of transdiagnostic cognitive-behavioral therapy to treatment as usual (TAU) in terms of anxiety and depressive symptoms, and QOL. Individuals with higher levels of cognitive reappraisal obtained a greater benefit in terms of QOL from the addition of psychological treatment to TAU. These results underscore the relevant role that emotion regulation skills play in the outcomes of psychological therapy for emotional symptoms.
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Affiliation(s)
| | | | - Amador Priede
- Valdecilla Biomedical Research Institute, Hospital de Laredo
| | | | | | - Juan Antonio Moriana
- Universidad de Córdoba and Maimónides Institute for Research in Biomedicine of Cordoba
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9
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Muñoz-Navarro R, Medrano LA, Limonero JT, González-Blanch C, Moriana JA, Ruiz-Rodríguez P, Cano-Vindel A. The mediating role of emotion regulation in transdiagnostic cognitive behavioural therapy for emotional disorders in primary care: Secondary analyses of the PsicAP randomized controlled trial. J Affect Disord 2022; 303:206-215. [PMID: 34998804 DOI: 10.1016/j.jad.2022.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Emotional disorders are highly prevalent in primary care. Transdiagnostic cognitive behavior therapy (TD-CBT) is a promising treatment of emotional disorders. In this study, we evaluated several emotion regulation strategies as potential mediators of treatment outcomes in a clinical sample of primary care. METHODS A total of 1061 primary care patients were included in a randomized clinical trial comparing treatment-as-usual (TAU) to TD-CBT+TAU. Of these, 631 (TAU=316; TD-CBT+TAU=315) completed the full treatment and all pre- and post-treatment scales to assess symptoms (anxiety, depression, somatization), emotion regulation strategies (worry, rumination, negative metacognition, suppression, cognitive reappraisal), overall functioning, and quality of life (QoL). RESULTS Treatment and direct effects showed that TD-CBT+TAU was superior to TAU alone. On the multivariate mediation analysis of indirect effects, three maladaptive strategies (worry, rumination and negative metacognition) had significant effects on all emotional symptoms. Suppression was also significant for depression. Rumination and negative metacognition were significant mediators of functioning, while only negative metacognition was significant for QoL. Reappraisal had no effect on any outcome. LIMITATIONS We focused mainly on maladaptive cognitive emotion regulation strategies and only studied one behavioural strategy (suppression) and one adaptive strategy (reappraisal). CONCLUSIONS Targeting certain maladaptive emotion regulation strategies (worry, rumination, suppression, negative metacognition) as mediators for treatment with TD-CBT could reduce emotional symptoms and improve well-being. Negative metacognition was the most transdiagnostic strategy, whereas an adaptive strategy such as reappraisal was not a mediator. Thus, maladaptive emotion regulation strategies are key mediators in transdiagnostic therapy for emotional disorders in primary care.
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Affiliation(s)
- Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments Faculty of Psychology. University of Valencia, Av. Blasco Ibáñez, 10. 46010. Valencia, Spain.
| | - Leonardo Adrián Medrano
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Autopista Duarte Km 1 1/2, Santiago De Los Caballeros 51000, Dominican Republic.
| | - Joaquín T Limonero
- Department of Basic Psychology, University Autonoma of Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - César González-Blanch
- Mental Health Centre, University Hospital "Marqués de Valdecilla"- IDIVAL. Av. Valdecilla, 25, 39008 Santander, Cantabria, 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.
| | - Antonio Cano-Vindel
- Department of Experimental Psychology. Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain.
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Cano-Vindel A, Ruiz-Rodríguez P, Moriana JA, Medrano LA, González-Blanch C, Aguirre E, Muñoz-Navarro R. Improving Access to Psychological Therapies in Spain: From IAPT to PsicAP. Psicothema 2022; 34:18-24. [PMID: 35048891 DOI: 10.7334/psicothema2021.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Anxiety and depression are very prevalent in primary care, with high rates of chronic cases, comorbidity and lost quality of life, along with huge economic costs. The Improving Access to Psychological Therapies (IAPT) project, launched in the United Kingdom in 2007, has become an international benchmark for the treatment of common mental disorders. In Spain, Psicofundación developed the PsicAP clinical trial, following the precedent set by the IAPT. METHOD This study reviews and compares and contrasts the methods, results, and contributions of the IAPT and PsicAP. RESULTS The IAPT is a project for the pragmatic implementation of evidence-based psychological therapies in primary care. PsicAP is a randomized clinical trial whose results demonstrated that adding a psychological treatment (seven group sessions of transdiagnostic cognitive-behavioural therapy) to treatment-as-usual (TAU) for anxiety and depression in the primary care setting was more effective and cost-effective than TAU alone. The therapeutic gains and the cost-effectiveness were maintained at a 12 months follow-up. Moreover, the percentage of reliably recovered patients was comparable to the numbers from the IAPT. CONCLUSIONS This brief psychological treatment should be implemented in the Spanish public health system, similar to the precedent set by the IAPT initiative.
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11
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García-Batista ZE, Guerra-Peña K, Garrido LE, Cantisano-Guzmán LM, Moretti L, Cano-Vindel A, Arias VB, Medrano LA. Using Constrained Factor Mixture Analysis to Validate Mixed-Worded Psychological Scales: The Case of the Rosenberg Self-Esteem Scale in the Dominican Republic. Front Psychol 2021; 12:636693. [PMID: 34489774 PMCID: PMC8417066 DOI: 10.3389/fpsyg.2021.636693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
Abstract
A common method to collect information in the behavioral and health sciences is the self-report. However, the validity of self-reports is frequently threatened by response biases, particularly those associated with inconsistent responses to positively and negatively worded items of the same dimension, known as wording effects. Modeling strategies based on confirmatory factor analysis have traditionally been used to account for this response bias, but they have recently become under scrutiny due to their incorrect assumption of population homogeneity, inability to recover uncontaminated person scores or preserve structural validities, and their inherent ambiguity. Recently, two constrained factor mixture analysis (FMA) models have been proposed by Arias et al. (2020) and Steinmann et al. (2021) that can be used to identify and screen inconsistent response profiles. While these methods have shown promise, tests of their performance have been limited and they have not been directly compared. Thus the objective of the current study was to assess and compare their performance with data from the Dominican Republic of the Rosenberg Self-Esteem Scale (N = 632). Additionally, as this scale had not yet been studied for this population, another objective was to show how using constrained FMAs could help in the validation of mixed-worded scales. The results indicated that removing the inconsistent respondents identified by both FMAs (≈8%) reduced the amount of wording effects in the database. However, whereas the Steinmann et al. method only cleaned the data partially, the Arias et al. (2020) method was able to remove the great majority of the wording effects variance. Based on the screened data with the Arias et al. method, we evaluated the psychometric properties of the RSES for the Dominican population, and the results indicated that the scores had good validity and reliability properties. Given these findings, we recommend that researchers incorporate constrained FMAs into their toolbox and consider using them to screen out inconsistent respondents to mixed-worded scales.
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Affiliation(s)
- Zoilo Emilio García-Batista
- School of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Kiero Guerra-Peña
- School of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Luis Eduardo Garrido
- School of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | | | - Luciana Moretti
- School of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.,Faculty of Psychology, Universidad Siglo 21, Córdoba, Argentina
| | | | - Víctor B Arias
- Faculty of Psychology, Universidad de Salamanca, Salamanca, Spain
| | - Leonardo Adrián Medrano
- School of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.,Faculty of Psychology, Universidad Siglo 21, Córdoba, Argentina
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12
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Ventura L, Cano-Vindel A, Muñoz-Navarro R, Barrio-Martínez S, Medrano LA, Moriana JA, Ruíz-Rodríguez P, Carpallo-González M, González-Blanch C. The role of cognitive factors in differentiating individuals with somatoform disorders with and without depression. J Psychosom Res 2021; 148:110573. [PMID: 34298468 DOI: 10.1016/j.jpsychores.2021.110573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
The present study, based on a cross-sectional design, was conducted in the primary care setting with patients presenting somatic symptoms suggestive of somatoform disorders (SFD). The main aim of the study was to determine whether cognitive variables could differentiate between patients with SFD alone and those who also present depressive symptoms suggestive of depression (SFD + depression). All participants (N = 796) completed validated self-report measures to assess somatic, depressive, and/or anxiety symptoms, as well as functional impairment, quality of life (QoL), and cognitive variables (worry, rumination, metacognition, cognitive distortions, and emotion regulation). Univariate and multivariate analyses (controlled for potential sociodemographic and clinical confounders) were performed. On the univariate analysis, significant differences between the SFD and SFD + depression groups were found in sociodemographic and clinical variables, functional impairment, QoL, and cognitive variables. On the multivariate analysis, the only significative variables associated with comorbid SFD + depression were anxiety (β = 0.27; p < 0.001), physical and psychological QoL (β = -0.10; p = 0.01; and β = -0.21; p < 0.001, respectively), and marital status (β = -65; p < 0.05). Cognitive variables were not significantly related to depressive symptoms in patients with SFD. These findings suggest that patients with SFD - with or without comorbid depression - share common cognitive processes and thus both groups could benefit from transdiagnostic cognitive therapy.
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Affiliation(s)
- Ludovica Ventura
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | | | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Human and Social Sciences, University of Zaragoza, Spain
| | | | | | - Juan Antonio Moriana
- Department of Psychology, Universidad de Córdoba, Spain; Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
| | - Paloma Ruíz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - María Carpallo-González
- Spanish Foundation for the Promotion and Development of Scientific and Professional Psychology, Madrid, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital - IDIVAL, Santander, Spain; Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain.
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13
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Barrio-Martínez S, Cano-Vindel A, Muñoz-Navarro R, Moriana JA, Ruíz-Rodríguez P, Medrano LA, Ventura L, González-Blanch C. Factors differentiating panic disorder with and without comorbid symptoms of depression. Psychol Psychother 2021; 94:523-540. [PMID: 33993636 DOI: 10.1111/papt.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/17/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to examine the sociodemographic and clinical differences between people with a probable diagnosis of panic disorder (PD) and those with PD and a probable comorbid diagnosis major depressive disorder (PD + MDD). We also sought to explore the potential contribution of cognitive variables to help differentiate between PD and PD + MDD. This was a subgroup analysis of 331 patients with PD symptoms who were included in the PsicAP clinical trial. All participants completed scales to evaluate panic, depression, somatization, cognitive and performance variables. A univariate analysis showed significant differences (p < .01) between the groups (PD vs PD + MDD) in clinical variables. Somatization was the best predictor of comorbid PD + MDD (β = .346; p < .01). Cognitive variables do not appear to play an essential role in predicting the presence of depressive symptoms in people with a screen positive for PD. These findings appear to support a transdiagnostic treatment approach for PD, which may be useful regardless of whether comorbid depression is present or not. PRACTITIONER POINTS: Somatic symptoms were associated with a higher probability of be in the PD + MDD group. Cognitive variables do not play a relevant role in the differentiation of both groups. A transdiagnostic approach can be useful for the treatment of PD or PD + MDD group.
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Affiliation(s)
| | | | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Human and Social Sciences, University of Zaragoza, Spain
| | - Juan Antonio Moriana
- Department of Psychology, Universidad de Córdoba/Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain
| | | | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, Dominican Republic
| | - Ludovica Ventura
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital - IDIVAL, Santander, Spain.,Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
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14
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Moriana JA, Jurado-González FJ, García-Torres F, Contreras A, Muñoz-Navarro R, González-Blanch C, Medrano LA, Ruiz-Rodríguez P, Cano-Vindel A. Exploring the structure of the GAD-7 scale in primary care patients with emotional disorders: A network analysis approach. J Clin Psychol 2021; 78:283-297. [PMID: 34287885 DOI: 10.1002/jclp.23217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Anxiety symptoms are one of the most frequent manifestations in people attending primary care, although how the symptoms are associated is unclear. This study aimed to establish the symptom structure of the Generalized Anxiety Disorder scale (GAD-7) using a novel network approach in combination with traditional analytical tools. METHODS A sample of 1704 primary care patients with emotional disorders (i.e., anxiety, depression, and/or somatization) completed the GAD-7 to report their anxiety symptoms. We examined the GAD-7 structure using exploratory graph analysis (EGA) compared to exploratory factor analysis (EFA) and confirmatory factor analysis. RESULTS The EFA results showed a one-factor solution, but EGA revealed a two-factor solution (cognitive-emotional and somatic). "Worrying too much" and "difficulty relaxing" were the most relevant symptoms. CONCLUSIONS The results support the possible distinction between the somatic and cognitive-emotional components of the GAD-7, thus permitting more specific screening in primary care settings.
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Affiliation(s)
- Juan A Moriana
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Francisco J Jurado-González
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Alba Contreras
- Department of Personality, Complutense University, Madrid, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, University of Zaragoza, Teruel, Spain
| | - César González-Blanch
- Mental Health Centre, University Hospital Marques de Valdecilla-IDIVAL, Santander, Cantabria, Spain
| | | | - Paloma Ruiz-Rodríguez
- Castilla la Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - Antonio Cano-Vindel
- Department of Experimental Psychology, Complutense University, Madrid, Spain
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15
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García-Batista ZE, Guerra-Peña K, Alsina-Jurnet I, Cano-Vindel A, Cantisano-Guzmán LM, Nazir-Ferreiras A, Moretti LS, Medrano LA, Garrido LE. Design and Validation of Augmented Reality Stimuli for the Treatment of Cleaning Obsessive-Compulsive Disorder. Front Psychol 2021; 12:618874. [PMID: 34135802 PMCID: PMC8201081 DOI: 10.3389/fpsyg.2021.618874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Fear to contamination is an easy-to-provoke, intense, hard-to-control, and extraordinarily persistent fear. A worsening of preexisting psychiatric disorders was observed during the COVID-19 (coronavirus disease 2019) outbreak, and several studies suggest that those with obsessive-compulsive disorder (OCD) may be more affected than any other group of people. In the face of worsening OCD symptoms, there is a need for mental health professionals to provide the support needed not only to treat patients who still report symptoms, but also to improve relapse prevention. In this line, it is recommended to improve alternative strategies such as online consultations and digital psychiatry. The aim of this study is to develop augmented reality (AR) stimuli that are clinically relevant for patients with cleaning OCD and assess their efficiency to obtain emotionally significant responses. Four AR stimuli were developed: a plastic bag full of garbage, a piece of bread with mold, a dirty sports shoe, and a piece of rotten meat. All stimuli were shown to a clinical group (17 patients with cleaning OCD) and a control group (11 patients without OCD). Relevant results were the design of the AR stimuli. These stimuli were validated with the statistical difference in perceived anxiety in the meat stimuli between the clinical and control groups. Nevertheless, when looking at effect sizes, all stimuli present effect sizes from small (plastic bag) to large (meat), with both shoe and bread between small and medium effect sizes. These results are a valuable support for the clinical use of these AR stimuli in the treatment of cleaning OCD.
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Affiliation(s)
- Zoilo Emilio García-Batista
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Kiero Guerra-Peña
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Ivan Alsina-Jurnet
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - Antonio Cano-Vindel
- Departamento de Psicología Básica, Facultad de Psicología, Universidad Complutense de Madrid, Spain
| | | | - Asha Nazir-Ferreiras
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Luciana Sofía Moretti
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.,Facultad de Psicología, Universidad Siglo 21, Argentina
| | - Leonardo Adrián Medrano
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.,Facultad de Psicología, Universidad Siglo 21, Argentina
| | - Luis Eduardo Garrido
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
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16
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González-Blanch C, Muñoz-Navarro R, Medrano LA, Moriana JA, Ruiz-Rodríguez P, Cano-Vindel A. Moderators and predictors of treatment outcome in transdiagnostic group cognitive-behavioral therapy for primary care patients with emotional disorders. Depress Anxiety 2021; 38:757-767. [PMID: 34043853 DOI: 10.1002/da.23164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/06/2021] [Accepted: 04/17/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Transdiagnostic group cognitive behavior therapy (TD-GCBT) has shown to be efficacious in the treatment of emotional disorders in primary care. However, little is known about possible moderators or predictors of treatment outcome. We aimed to explore the potential predictors and moderators of outcome in a large multicentre randomized controlled trial comparing TD-GCBT plus treatment as usual (TAU) to TAU alone. METHOD Putative demographic and baseline clinical variables were examined using the PROCESS macro as potential predictors/moderators of depressive and anxiety symptoms at posttreatment and 1-year follow-up. RESULTS Analyses were based on a study completer sample of 1061 participants randomized to TD-CBT + TAU (n = 527) or TAU alone (n = 534), with 631 participants assessed at the posttreatment evaluation and 388 at the 1-year follow-up. Individuals working or with a partner among sociodemographic variables, and higher baseline comorbidities and more severity of symptoms among clinical variables obtained more benefits from adding TDCBT to TAU. Those taking medication before treatment obtained less benefits from the TD-GCBT than those without prescribed antidepressant medications, after controlling for baseline severity of symptoms. Overall, the moderating effect of clinical (but not sociodemographic) variables remained at 1-year follow-up. CONCLUSION Findings support largely the generalization of the TD-GCBT for emotional disorders in primary care to a variety of sociodemographic and clinical groups. However, TD-GCBT seems to work to a greater extent for those individuals with a more severe clinical profile. Providing TD-GCBT before prescribing antidepressant medication and while people are still working may enhance the effects of adding this psychological treatment to TAU in primary care.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | - Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Social and Human Sciences University of Zaragoza, Zaragoza, Spain
| | - Leonardo Adrián Medrano
- Research Secretariat, Faculty of Psychology, Universidad Empresarial Siglo 21, Córdoba, Argentina
| | - Juan Antonio Moriana
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC, Reina Sofía University Hospital, University of Córdoba, Córdoba, Spain
| | | | - Antonio Cano-Vindel
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
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Muñoz-Navarro R, Malonda E, Llorca-Mestre A, Cano-Vindel A, Fernández-Berrocal P. Worry about COVID-19 contagion and general anxiety: Moderation and mediation effects of cognitive emotion regulation. J Psychiatr Res 2021; 137:311-318. [PMID: 33744510 PMCID: PMC8548031 DOI: 10.1016/j.jpsychires.2021.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 12/16/2022]
Abstract
The global pandemic caused by coronavirus disease 2019 (COVID-19) occasioned that most of the population in Spain was confined to home to reduce the risk of contagion. This affected mental health, increasing anxiety and worry about COVID-19 contagion. The aim of this study was assessing the moderation and mediation effect of cognitive emotion regulation strategies (CERS) on general anxiety and whether the mediation effect was moderated by gender and/or age. A total of 1753 Spanish adults (78,6% female; M = 40.4 years, SD = 12.9) participated in an online survey that was available from March 26 to April 25 (2020) during the time period in which the population in Spain was confined. Participants completed measures of worry about COVID-19 contagion, the Cognitive Emotion Regulation Questionnaire-Short (CERQ-Short) and the Generalized Anxiety Disorder-7 (GAD-7). Several models were tested through structural equation modelling. Moderation analyses reported that maladaptive strategies moderated positively anxiety, whereas adaptive strategies moderated negatively anxiety. Also, the best fitted mediation model found that worry about COVID-19 contagion and general anxiety was mediated by CERS in different directions. Maladaptive CERS increased anxiety, whereas adaptive CERS reduced anxiety. Age (not gender) also moderated this mediation, were younger adults presented an indirect effect only through maladaptive CERS, but older adults through both adaptive and maladaptive. Limitations are related to the study design which was a convenience sample. CERS moderated and mediated between worry about COVID-19 contagion and general anxiety. Prevention programs for mental health problems during the pandemic must be provided, especially for younger adults.
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Affiliation(s)
- 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.
| | - Elisabeth Malonda
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Avd. Blasco Ibañez, 10, 46010, Valencia, Spain.
| | - Anna Llorca-Mestre
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Avd. Blasco Ibañez, 10, 46010, Valencia, Spain.
| | - Antonio Cano-Vindel
- Department of Experimental Psychology, Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223, Madrid, Spain.
| | - Pablo Fernández-Berrocal
- Department of Basic Psychology, Faculty of Psychology, University of Málaga, Campus de Teatinos, 29071, Málaga, Spain.
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18
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Muñoz-Navarro R, Adrián Medrano L, González-Blanch C, Carpallo-González M, Olave L, Iruarrizaga I, Ruiz-Rodríguez P, Moriana JA, Cano-Vindel A. Validity of Brief Scales for Assessing Transdiagnostic Cognitive Emotion Regulation Strategies in Primary Care Patients With Emotional Disorders. European Journal of Psychological Assessment 2021. [DOI: 10.1027/1015-5759/a000584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Abstract. Cognitive emotion regulation strategies have been proposed as an explanation for transdiagnostic vulnerability to emotional disorders, which are highly prevalent in the primary care setting. The use of brief psychological instruments to detect cognitive-emotional factors – such as worry, rumination, interpretative and attentional distortions, and metacognitions – could provide valuable clinical data to better guide treatment in primary care. The aim of the present study was to evaluate the psychometric properties of four brief scales derived from the full versions of four assessment instruments (PSWQ, RRS, IACTA, and MCQ-30). The brief scales were completed by 1,250 primary care patients with an emotional disorder diagnosed by a general practitioner. The following characteristics of the scales were assessed: (a) internal structure (assessed by confirmatory factor analysis), (b) internal consistency, (c) convergent validity, (d) metric invariance across gender and age, and (e) predictive validity. The results showed a unifactorial structure for all of the tested scales, with an acceptable internal consistency and convergent validity, and invariance across gender and age. The brief scales presented predictive validity using the PHQ-4, a 4-item scale used to detect depression and generalized anxiety disorders, suggesting that these brief scales are optimal for use in the primary care setting.
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Affiliation(s)
- Roger Muñoz-Navarro
- Department of Psychology and Sociology, Faculty of Work and Social Sciences, University of Zaragoza, Spain
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Spain
| | - Leonardo Adrián Medrano
- Faculty of Psychology, University Siglo 21, Córdoba, Argentina
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - César González-Blanch
- Mental Health Centre, University Hospital “Marqués de Valdecilla” – IDIVAL, Santander, Cantabria, Spain
| | | | - Leticia Olave
- Faculty of Psychology, Complutense University of Madrid, Spain
| | | | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - Juan A. Moriana
- Department of Psychology, University of Córdoba/Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC/Reina Sofía University Hospital, Córdoba, Spain
| | - Antonio Cano-Vindel
- Faculty of Psychology, University Siglo 21, Córdoba, Argentina
- Faculty of Psychology, Complutense University of Madrid, Spain
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Santolaya Prego de Oliver J, Muñoz-Navarro R, González-Blanch C, Llorca-Mestre A, Malonga E, Medrano L, Ruiz-Rodríguez P, Moriana JA, Cano-Vindel A. Disability and perceived stress in primary care patients with major depression. Psicothema 2020; 32:167-175. [PMID: 32249741 DOI: 10.7334/psicothema2019.319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent in the Spanish primary care (PC) setting and the leading cause of disability in Spain. The aim of this study was to evaluate several key psychometric properties of the Sheehan Disability Scale (SDS) in patients with or without MDD and varying degrees of symptom severity using the Patient Health Questionnaire-9 (PHQ-9). METHOD A total of 1,704 PC patients participating in the PsicAP clinical trial completed the SDS and PHQ-9. We evaluated the factor structure, measurement invariance across gender, internal consistency, and the discriminative and predictive validity. RESULTS Confirmatory factor analyses revealed a unifactorial model of the SDS containing 4 items (SDS-4) with the best model fit (CFI: .99; GFI: .99; TLI: 96; RMSEA: .10). This model contained the three life domain items (work, family, and social life) plus perceived stress (PS) with significant loadings. The internal consistency of the SDS-4 was acceptable in patients with or without MDD, regardless of symptom severity. The SDS-4 also showed good discriminative capacity and acceptable predictive validity in all subsamples. CONCLUSIONS These findings support the use of the SDS-4 to assess depression-related disability in patients at Spanish primary care centres.
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Cano-García FJ, Muñoz-Navarro R, Sesé Abad A, Moretti LS, Medrano LA, Ruiz-Rodríguez P, González-Blanch C, Moriana JA, Cano-Vindel A. Latent structure and factor invariance of somatic symptoms in the patient health questionnaire (PHQ-15). J Affect Disord 2020; 261:21-29. [PMID: 31600584 DOI: 10.1016/j.jad.2019.09.077] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/03/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Somatic symptoms are highly prevalent in primary care although insufficiently understood. The Patient Health Questionnaire (PHQ-15) is a valuable screening test but it has not yet been possible to unequivocally demonstrate its latent structure and measurement invariance. METHODS A total of 1,255 patients from 28 primary care centres suffering symptoms of anxiety, depression or somatisation participated in a clinical trial. They completed the PHQ-15 at baseline and 374 retook it at three months. Exploratory structural equation modelling (ESEM) was used to compare three models: 1) a single global factor for somatisation, 2) four specific correlated factors, and 3) a bifactor model integrating the first two models. RESULTS A multi-group invariance analysis of the best-fit model was performed: the bifactor model (χ2=25.17, df=23, p = 0.34, RMSEA=0.009, CFI=1.00, TLI=0.999). Strict invariance was good for both gender (RMSEA = 0.046, CFI = 0.973, TLI = 0.963) and age (RMSEA = 0.048, CFI = 0.964, TLI = 0.962). Configural and metric invariance were confirmed for moment of assessment, but scalar invariance was not. LIMITATIONS The two main limitations were the sample (primary care patients with emotional disorders), which was not representative of the general population, and the utilisation of ESEM (vs. confirmatory factor analysis), which did not allow a second-order factor model to be tested. CONCLUSIONS PHQ-15 showed a bifactor structure, providing both a single global measure of somatisation and specific measures of pain, gastrointestinal, cardiopulmonary and fatigue factors. Its factor invariance with regard to both gender and age was confirmed.
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Affiliation(s)
- Francisco Javier Cano-García
- Department of Personality, Assessment and Psychological Treatments, School of Psychology, Universidad de Sevilla, Spain.
| | - Roger Muñoz-Navarro
- Department of Basic Psychology, School of Psychology, Universidad de Valencia, Spain
| | - Albert Sesé Abad
- Department of Psychology, School of Psychology, Universitat de les Illes Balears, Palma, Spain
| | | | | | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital - IDIVAL, Santander, Cantabria, Spain
| | - Juan A Moriana
- Department of Psychology, Universidad de Córdoba/Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC)/Reina Sofía University Hospital, Córdoba, Spain
| | - Antonio Cano-Vindel
- Department of Experimental Psychology, School of Psychology, Universidad Complutense de Madrid, Madrid, Spain
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Moreno E, Muñoz-Navarro R, Medrano LA, González-Blanch C, Ruiz-Rodríguez P, Limonero JT, Moretti LS, Cano-Vindel A, Moriana JA. Factorial invariance of a computerized version of the GAD-7 across various demographic groups and over time in primary care patients. J Affect Disord 2019; 252:114-121. [PMID: 30981054 DOI: 10.1016/j.jad.2019.04.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/07/2019] [Accepted: 04/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The Generalized Anxiety Disorder 7-item scale (GAD-7) is commonly used by clinicians and researchers to screen for anxiety disorders and to monitor anxiety symptoms in primary care. However, findings regarding its factor structure are mixed, with most studies reporting a best-fitting for a one-factor structure, whereas others indicate a two-factor model. To be valid for comparisons, the GAD-7 should measure the same latent construct with the same structure across groups and over time. We aimed to examine the best-fit factor structure model of the GAD-7 among primary care patients and to evaluate its measurement invariance. METHODS A total of 1255 patients completed the computerized version of GAD-7 and a subsample of 238 cases was assessed at the 3-month follow-up. A confirmatory factor analysis (CFA) was performed and analyses of multiple-group invariance were also conducted to determine the extent to which the factor structure was comparable across various sociodemographic groups and over time. RESULTS The results showed that both a one- and two-factor structure (representing somatic and cognitive-affective components) were invariant across sociodemographic groups and over time. The two-factor structure provided the best model fit. LIMITATIONS Results cannot be generalized to all primary care patients, as only patients whose general practitioners consider them to suffer emotional disorders were included. CONCLUSIONS Our study supports the reliability and validity of the one- and two-factor model of the GAD-7, both for screening purposes and for monitoring response to treatment.
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Affiliation(s)
- Eliana Moreno
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC, Reina Sofía University Hospital, University of Córdoba, Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain.
| | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Avd. Blasco Ibañez, 21, 46010, Valencia, Spain.
| | | | - César González-Blanch
- Mental Health Centre, University Hospital "Marqués de Valdecilla"- IDIVAL, Av. Valdecilla 25, 39008 Santander, Cantabria, Spain.
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Calle Teruel, 4, 28941 Fuenlabrada, Madrid, Spain.
| | - Joaquín T Limonero
- Department of Basic Psychology, Autonomous University of Barcelona, Campus de la UAB, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain.
| | - Luciana Sofía Moretti
- Faculty of Psychology, University Siglo 21, De los Latinos 8555, 5008 Córdoba, Argentina.
| | - Antonio Cano-Vindel
- Department of Basic Psychology, Faculty of Psychology, Complutense University of Madrid, Campus de Somosaguas, s/n, 28223 Madrid, Spain.
| | - Juan A Moriana
- Department of Psychology, Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC, Reina Sofía University Hospital, University of Córdoba, Av. Menéndez Pidal, s/n, 14004 Córdoba, Spain.
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González-Blanch C, Fernando Hernández-de-Hita, Muñoz-Navarro R, Ruíz-Rodríguez P, Medrano LA, Moriana JA, Cano-Vindel A. Domain-specific associations between disability and depression, anxiety, and somatization in primary care patients. Psychiatry Res 2018; 269:596-601. [PMID: 30205353 DOI: 10.1016/j.psychres.2018.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/26/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
This study explores the associations between different disability domains and the most prevalent symptoms of mental disorders in primary care patients (i.e. depression, anxiety, and somatization). A total of 1241 participants from 28 primary care centres completed self-report measures of depression, anxiety, and somatization. This same sample also completed the Sheehan Disability Scale (SDS) to assess functional impairment in work, social life, and family life domains. Associations between the symptoms and each disability domain were examined using hierarchical regression analyses. Depression emerged as the strongest predictor of all three disability domains. Somatization was associated only with the work domain, and anxiety was associated only with the family life domain. Clinical symptoms explained a greater proportion of the variance than sociodemographic variables. In primary care patients, depression, anxiety and somatizations were associated with distinct domains of disability. Early provision of effective treatments in the primary care setting may be crucial to reduce the societal burden of common mental disorders.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla- IDIVAL. Santander, Spain.; Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain.
| | | | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | | | - Juan Antonio Moriana
- Department of Psychology, University of Córdoba/Maimónides Institute for Research in Biomedicine of Córdoba-IMIBIC/Reina Sofía University Hospital, Spain
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García-Batista ZE, Guerra-Peña K, Cano-Vindel A, Herrera-Martínez SX, Medrano LA. Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic. PLoS One 2018; 13:e0199750. [PMID: 29958268 PMCID: PMC6025862 DOI: 10.1371/journal.pone.0199750] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/13/2018] [Indexed: 11/30/2022] Open
Abstract
The Beck Depression Inventory-II (BDI-II) is currently one of the most widely used measures in both research and clinical practice for assessing depression. Although the psychometric properties of the scale have been well established through many studies worldwide, so far there is no study examining the validity and reliability of BDI-II in Republic Dominican. The purpose of the present study was twofold: (a) to examine the latent structure of BDI-II by testing several competing models proposed in the literature; and (b) to provide evidence of validity and reliability of the BDI-II in Republic Dominican. Confirmatory factor analysis indicated that a bifactor model with a general depression factor and three specific factors consisting of cognitive, affective and somatic showed the best fit to the data. Internal reliability was moderate to high for all subscales and for the total scale. Scores on BDI-II discriminated between clinical and general population, supporting for external validity. Practical implications are discussed and suggestions for further research are also made.
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Affiliation(s)
| | - Kiero Guerra-Peña
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
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Ruiz-Rodríguez P, Cano-Vindel A, Muñoz-Navarro R, Wood CM, Medrano LA, Moretti LS. Cost-Effectiveness and Cost-Utility Analysis of the Treatment of Emotional Disorders in Primary Care: PsicAP Clinical Trial. Description of the Sub-study Design. Front Psychol 2018; 9:281. [PMID: 29559944 PMCID: PMC5845711 DOI: 10.3389/fpsyg.2018.00281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 02/19/2018] [Indexed: 01/06/2023] Open
Abstract
Introduction: In the primary care (PC) setting in Spain, the prevalence of emotional disorders (EDs) such as anxiety, depression and somatoform disorder is high. In PC patients, these disorders are not always managed in accordance with the recommendations provided by clinical practice guidelines, resulting in major direct and indirect economic costs and suboptimal treatment outcomes. The aim is to analyze and compare the cost-effectiveness and cost-utility of group-based psychological therapy versus treatment as usual (TAU). Methods: Multicenter, randomized controlled trial involving 300 patients recruited from PC centers in Madrid, Spain, with symptoms or possible diagnosis of anxiety, mood (mild or moderate), or somatoform disorders. Patients will be randomized to one of two groups: an experimental group, which will receive group-based transdiagnostic cognitive-behavioral therapy (TD-CBT); and a control group, which will receive TAU (mainly pharmacological interventions) prescribed by their general practitioner (GP). Clinical assessment will be performed with the Patient Health Questionnaire (PHQ). Direct and indirect costs will be calculated and relevant socio-demographic variables will be registered. The Spanish version of the EuroQol 5D-5L will be administered. Patients will be assessed at baseline, immediately after treatment finalization, and at 6 and 12 months post-treatment. Discussion: To our knowledge, this is the first study to compare TD-CBT to TAU in the PC setting in Spain. This is the first comparative economic evaluation of these two treatment approaches in PC. The strength of the study is that it is a multicenter, randomized, controlled trial of psychotherapy and TAU for EDs in PC. Trial registration: Protocol code: ISCRCTN58437086; 20/05/2013. EUDRACT: 2013-001955-11. Protocol Version: 6, 11/01/2014.
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Affiliation(s)
| | - Antonio Cano-Vindel
- Department of Basic Psychology II (Cognitive Processes), Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Cristina M Wood
- Department of Basic Psychology II (Cognitive Processes), Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Leonardo A Medrano
- Department of Psychological Assessment, Universidad Siglo 21, Córdoba, Argentina
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González-Blanch C, Medrano LA, Muñoz-Navarro R, Ruíz-Rodríguez P, Moriana JA, Limonero JT, Schmitz F, Cano-Vindel A. Factor structure and measurement invariance across various demographic groups and over time for the PHQ-9 in primary care patients in Spain. PLoS One 2018; 13:e0193356. [PMID: 29474410 PMCID: PMC5825085 DOI: 10.1371/journal.pone.0193356] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 02/02/2018] [Indexed: 11/18/2022] Open
Abstract
The Patient Health Questionnaire (PHQ-9) is a widely-used screening tool for depression in primary care settings. The purpose of the present study is to identify the factor structure of the PHQ-9 and to examine the measurement invariance of this instrument across different sociodemographic groups and over time in a sample of primary care patients in Spain. Data came from 836 primary care patients enrolled in a randomized controlled trial (PsicAP study) and a subsample of 218 patients who participated in a follow-up assessment at 3 months. Confirmatory factor analysis (CFA) was used to test one- and two-factor structures identified in previous studies. Analyses of multiple-group invariance were conducted to determine the extent to which the factor structure is comparable across various demographic groups (i.e., gender, age, marital status, level of education, and employment situation) and over time. Both one-factor and two-factor re-specified models met all the pre-established fit criteria. However, because the factors identified in the two-factor model were highly correlated (r = .86), the one-factor model was preferred for its parsimony. Multi-group CFA indicated measurement invariance across different demographic groups and across time. The present findings suggest that physicians in Spain can use the PHQ-9 to obtain a global score for depression severity in different demographic groups and to reliably monitor changes over time in the primary care setting.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital “Marqués de Valdecilla”- IDIVAL, Santander, Spain
| | | | - Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Juan Antonio Moriana
- Department of Psychology, University of Córdoba/ Maimónides Institute for Research in Biomedicine of Cordoba-IMIBIC/Reina Sofía University Hospital, Córdoba, Spain
| | - Joaquín T. Limonero
- Department of Basic Psychology, Autonomous University of Barcelona, Bellaterra, Barcelona, Spain
| | | | - Antonio Cano-Vindel
- Department of Basic Psychology, University Complutense of Madrid, Madrid, Spain
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González-Blanch C, Umaran-Alfageme O, Cordero-Andrés P, Muñoz-Navarro R, Ruiz-Rodríguez P, Medrano LA, Ruiz-Torres M, Dongil Collado E, Cano-Vindel A. Tratamiento psicológico de los trastornos emocionales en Atención Primaria: el manual de tratamiento transdiagnóstico del estudio PsicAP. Ansiedad y Estrés 2018. [DOI: 10.1016/j.anyes.2017.10.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Muñoz-Navarro R, Cano-Vindel A, Moriana JA, Medrano LA, Ruiz-Rodríguez P, Agüero-Gento L, Rodríguez-Enríquez M, Pizà MR, Ramírez-Manent JI. Screening for generalized anxiety disorder in Spanish primary care centers with the GAD-7. Psychiatry Res 2017; 256:312-317. [PMID: 28666201 DOI: 10.1016/j.psychres.2017.06.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/30/2017] [Accepted: 06/10/2017] [Indexed: 10/19/2022]
Abstract
The aim of the study was to determine the criterion validity of a computerized version of the General Anxiety Disorder-7 (GAD-7) questionnaire to detect general anxiety disorder in Spanish primary care centers. A total of 178 patients completed the GAD-7 and were administered the Composite International Diagnostic Interview (CIDI) for DSM-IV Axis I Disorders, which was used as a reference standard. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. A cut-off of 10 yielded a sensitivity of .87, a specificity of .78, a positive predictive value of .93, a negative predictive value of .64, a positive likelihood ratio of 3.96 a negative likelihood ratio of .17 and Younden's Index of .65. The GAD-7 performed very well with a cut-off value of 10, the most frequently used cut-off point. Thus, a computerized version of the GAD-7 is an excellent screening tool for detecting general anxiety disorder in Spanish primary care settings.
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Affiliation(s)
- Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Valencia, Spain.
| | - Antonio Cano-Vindel
- Department of Basic Psychology, Faculty of Psychology, University Complutense of Madrid, Madrid, Spain.
| | - Juan Antonio Moriana
- Department of Psychology, University of Córdoba (Spain), Maimonides Institute of Research in Biomedicine of Córdoba (IMIBIC), Córdoba, Spain.
| | | | | | - Laura Agüero-Gento
- Son Espases University Hospital, Health Service of Balear Islands, Balear Islands, Spain.
| | | | - María Rosa Pizà
- Palmanova-Calvià Mental Health Service, Health Service of Balear Islands, Balear Islands, Spain.
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Muñoz-Navarro R, Cano-Vindel A, Medrano LA, Schmitz F, Ruiz-Rodríguez P, Abellán-Maeso C, Font-Payeras MA, Hermosilla-Pasamar AM. Utility of the PHQ-9 to identify major depressive disorder in adult patients in Spanish primary care centres. BMC Psychiatry 2017; 17:291. [PMID: 28793892 PMCID: PMC5550940 DOI: 10.1186/s12888-017-1450-8] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/28/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The prevalence of major depressive disorder (MDD) in Spanish primary care (PC) centres is high. However, MDD is frequently underdiagnosed and consequently only some patients receive the appropriate treatment. The present study aims to determine the utility of the Patient Health Questionnaire-9 (PHQ-9) to identify MDD in a subset of PC patients participating in the large PsicAP study. METHODS A total of 178 patients completed the full PHQ test, including the depression module (PHQ-9). Also, a Spanish version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was implemented by clinical psychologists that were blinded to the PHQ-9 results. We evaluated the psychometric properties of the PHQ-9 as a screening tool as compared to the SCID-I as a reference standard. RESULTS The psychometric properties of the PHQ-9 for a cut-off value of 10 points were as follows: sensitivity, 0.95; specificity, 0.67. Using a cut-off of 12 points, the values were: sensitivity, 0.84; specificity, 0.78. Finally, using the diagnostic algorithm for depression (DSM-IV criteria), the sensitivity was 0.88 and the specificity 0.80. CONCLUSIONS As a screening instrument, the PHQ-9 performed better with a cut-off value of 12 versus the standard cut-off of 10. However, the best psychometric properties were obtained with the DSM-IV diagnostic algorithm for depression. These findings indicate that the PHQ-9 is a highly satisfactory tool that can be used for screening MDD in the PC setting. TRIAL REGISTRATION Current Controlled Trials ISRCTN58437086 . Registered 20 May 2013.
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Affiliation(s)
- Roger Muñoz-Navarro
- Department of Basic Psychology, Faculty of Psychology, University of Valencia, Av. Blasco Ibáñez, 21, 46010, Valencia, Spain.
| | - Antonio Cano-Vindel
- 0000 0001 2157 7667grid.4795.fDepartment of Basic Psychology, University Complutense of Madrid, Madrid, Spain
| | | | - Florian Schmitz
- 0000 0004 1936 9748grid.6582.9Department of Psychology, Ulm University, Ulm, Germany
| | | | - Carmen Abellán-Maeso
- Hospital Ntra. Sra. Perpetuo Socorro, Mental Health Service of Albacete, Albacete, Spain
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Cordero-Andrés P, González-Blanch C, Umaran-Alfageme O, Muñoz-Navarro R, Ruíz-Rodríguez P, Medrano LA, Hernández-de Hita F, Pérez-Poo T, Cano-Vindel A. Tratamiento psicológico de los trastornos emocionales en atención primaria: fundamentos teóricos y empíricos del estudio PsicAP. Ansiedad y Estrés 2017. [DOI: 10.1016/j.anyes.2017.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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García-Batista ZE, Guerra-Peña K, Cano-Vindel A, Herrera-Martínez SX, Flores-Kanter PE, Medrano LA. Propiedades psicométricas del Inventario de ansiedad estado-rasgo en población general y hospitalaria de República Dominicana. Ansiedad y Estrés 2017. [DOI: 10.1016/j.anyes.2017.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Muñoz-Navarro R, Cano-Vindel A, Ruiz-Rodríguez P, Adrián Medrano L, González-Blanch C, Moriana JA, Capafons Bonet A, Dongil-Collado E. Modelo jerárquico de diagnóstico y derivación de los trastornos mentales comunes en centros de atención primaria. Una propuesta a partir del ensayo clínico PsicAP. Ansiedad y Estrés 2017. [DOI: 10.1016/j.anyes.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cano-Vindel A, Muñoz-Navarro R, Wood CM, Limonero JT, Medrano LA, Ruiz-Rodríguez P, Gracia-Gracia I, Dongil-Collado E, Iruarrizaga I, Chacón F, Santolaya F. Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual in Adult Patients With Emotional Disorders in the Primary Care Setting (PsicAP Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e246. [PMID: 28011446 PMCID: PMC5219590 DOI: 10.2196/resprot.6351] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/30/2016] [Accepted: 10/22/2016] [Indexed: 12/18/2022] Open
Abstract
Background Demand for primary care (PC) services in Spain exceeds available resources. Part of this strong demand is due to the high prevalence of emotional disorders (EDs)—anxiety, depression, and somatic symptom disorders—and related comorbidities such as pain or chronic illnesses. EDs are often under- or misdiagnosed by general practitioners (GPs) and, consequently, treatment is frequently inadequate. Objective We aim to compare the short- and long-term effectiveness of group-delivered transdiagnostic cognitive behavioral therapy (TD-CBT) versus treatment as usual (TAU) in the treatment of EDs in the PC setting in Spain. We also aim to compare the effect of these treatments on disability, quality of life, cognitive-emotional factors, and treatment satisfaction. Methods Here we present the study design of a two-arm, single-blind, randomized controlled trial (N=1126) to compare TAU to TD-CBT for EDs. TAU will consist primarily of pharmacological treatment and practical advice from the GP while TD-CBT will be administered in seven 90-minute group sessions held over a period ranging from 12 to 14 weeks. Psychological assessments are carried out at baseline (ie, pretreatment); posttreatment; and at 3-, 6-, and 12-month follow-up. The study is conducted in approximately 26 PC centers from the National Health System in Spain. Results This study was initiated in December 2013 and will remain open to new participants until recruitment and follow-up has been completed. We expect all posttreatment evaluations to be completed by December 2017, and follow-up will end in December 2018. Conclusions We expect the TD-CBT group to have better results compared to TAU on all posttreatment measures and that this improvement will be maintained during follow-up. This project could serve as a model for use in other areas or services of the National Health System in Spain and even in other countries. ClinicalTrial International Standard Randomized Controlled Trial Number (ISRCTN): 58437086; http://www.isrctn.com/ISRCTN58437086 (Archived by WebCite at http://www.webcitation.org/6mbYjQSn3)
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Affiliation(s)
- Antonio Cano-Vindel
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Roger Muñoz-Navarro
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Cristina Mae Wood
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Joaquín T Limonero
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Leonardo Adrián Medrano
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Universidad Siglo 21, Córdoba, Argentina
| | - Paloma Ruiz-Rodríguez
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Fuenlabrada Primary Care Center, Health Service of Madrid, Madrid, Spain
| | | | - Esperanza Dongil-Collado
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Catholic University of Valencia, Valencia, Spain
| | - Iciar Iruarrizaga
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Social Work, Complutense University of Madrid, Madrid, Spain
| | - Fernando Chacón
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Complutense University of Madrid, Madrid, Spain.,Spanish Association of Psychologists, Madrid, Spain
| | - Francisco Santolaya
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Spanish Association of Psychologists, Madrid, Spain.,Malva-Rosa Mental Health Service, Valencia, Spain
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Muñoz-Navarro R, Cano-Vindel A, Wood CM, Ruíz-Rodríguez P, Medrano LA, Limonero JT, Tomás-Tomás P, Gracia-Gracia I, Dongil-Collado E, Iruarrizaga MI. The PHQ-PD as a Screening Tool for Panic Disorder in the Primary Care Setting in Spain. PLoS One 2016; 11:e0161145. [PMID: 27525977 PMCID: PMC4985125 DOI: 10.1371/journal.pone.0161145] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/01/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Panic disorder is a common anxiety disorder and is highly prevalent in Spanish primary care centres. The use of validated tools can improve the detection of panic disorder in primary care populations, thus enabling referral for specialized treatment. The aim of this study is to determine the accuracy of the Patient Health Questionnaire-Panic Disorder (PHQ-PD) as a screening and diagnostic tool for panic disorder in Spanish primary care centres. METHOD We compared the psychometric properties of the PHQ-PD to the reference standard, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) interview. General practitioners referred 178 patients who completed the entire PHQ test, including the PHQ-PD, to undergo the SCID-I. The sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios of the PHQ-PD were assessed. RESULTS The operating characteristics of the PHQ-PD are moderate. The best cut-off score was 5 (sensitivity .77, specificity .72). Modifications to the questionnaire's algorithms improved test characteristics (sensitivity .77, specificity .72) compared to the original algorithm. The screening question alone yielded the highest sensitivity score (.83). CONCLUSION Although the modified algorithm of the PHQ-PD only yielded moderate results as a diagnostic test for panic disorder, it was better than the original. Using only the first question of the PHQ-PD showed the best psychometric properties (sensitivity). Based on these findings, we suggest the use of the screening questions for screening purposes and the modified algorithm for diagnostic purposes.
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Affiliation(s)
- Roger Muñoz-Navarro
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, University of Valencia, Valencia, Spain
- * E-mail:
| | - Antonio Cano-Vindel
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Cristina Mae Wood
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Paloma Ruíz-Rodríguez
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Castilla La Nueva Primary Care Center, Health Service of Madrid, Madrid, Spain
| | - Leonardo Adrián Medrano
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, University Siglo 21, Córdoba, Argentina, Spain
| | - Joaquín T Limonero
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Stress and Health Research Group, Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Bellaterra, Spain
| | - Patricia Tomás-Tomás
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Malva-Rosa Primary Care Center, Health Service of Valencia, Valencia, Spain
| | - Irene Gracia-Gracia
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Esperanza Dongil-Collado
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain
- Faculty of Psychology, Catholic University of Valencia, Valencia, Spain
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Medrano LA, Muñoz-Navarro R, Cano-Vindel A. Procesos cognitivos y regulación emocional: aportes desde una aproximación psicoevolucionista. Ansiedad y Estrés 2016. [DOI: 10.1016/j.anyes.2016.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Panic attacks frequently lead to psychopathological disorders, including panic disorder. Even though panic disorder is a highly comorbid and disabling mental health problem associated with stressful life or traumatic events, perievent panic attacks and their association with panic disorder have hardly been investigated as a central topic after mass trauma. Using data from a longitudinal population-based assessment of Madrid residents after the March 11, 2004 train bombings (N = 1,589), with assessments conducted 1, 6, and 12 months after the attacks, the rate of perievent panic attacks was 10.9%. Level of exposure, previous life stressors, and negative emotionality were associated with perievent panic attacks (β = .12, .15, and .10, respectively), which in turn mediated the relationship between exposure to the terrorist event and panic disorder in the following year. Previous life stressors (β = .15) and low social support (β = -.14) were directly associated with panic disorder during the subsequent year. The most vulnerable individuals who experienced perievent panic attacks were 3.7 times, 95% confidence interval [CI] = [2.1, 6.4], more likely to suffer from panic disorder in the following year. Results suggest that early identification of perievent panic attacks following mass trauma may be helpful for reducing panic disorder.
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Affiliation(s)
- Cristina M Wood
- Faculty of Psychology, Somosaguas Campus, Complutense University of Madrid, Madrid, Spain.
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Salguero JM, Cano-Vindel A, Iruarrizaga I, Fernández-Berrocal P, Galea S. Trajectory and predictors of depression in a 12-month prospective study after the Madrid March 11 terrorist attacks. J Psychiatr Res 2011; 45:1395-403. [PMID: 21683961 DOI: 10.1016/j.jpsychires.2011.05.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 05/12/2011] [Accepted: 05/30/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND Few longitudinal studies have examined the trajectory of and the risk factors for depression in a representative sample of the population exposed to terrorism. A 12 month prospective study was conducted among a sample of Madrid city residents after the March 11, 2004 terrorist attacks. We aimed to document the trajectories of depressive symptoms and determine the risk factors associated with these trajectories. METHODS We conducted telephone surveys among a representative sample of Madrid citizens (N = 1589) to recruit baseline respondents approximately 1 month after the March 11 terrorist attacks. Participants were re-contacted at 6 and 12 months after baseline for further telephone interviews. RESULTS Findings reveal heterogeneity in the longitudinal trajectories of depression ranging from the absence of depressive symptoms over time, to transient or chronic depression. Life and recent stressors, experiencing direct exposure to the attacks, personality traits, poor physical health and other psychological disorders were principally associated with a worse trajectory of depression after this event. CONCLUSIONS Consistent with a stress diathesis model, ongoing stressors and intense event exposure are key drivers of a chronic depression trajectory after a mass traumatic event.
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Affiliation(s)
- J M Salguero
- University of Malaga, Campus de Teatinos S/N, Malaga, Spain.
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Salguero JM, Fernández-Berrocal P, Iruarrizaga I, Cano-Vindel A, Galea S. Major depressive disorder following terrorist attacks: a systematic review of prevalence, course and correlates. BMC Psychiatry 2011; 11:96. [PMID: 21627850 PMCID: PMC3120744 DOI: 10.1186/1471-244x-11-96] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 06/01/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Terrorist attacks are traumatic events that may result in a wide range of psychological disorders for people exposed. This review aimed to systematically assess the current evidence on major depressive disorder (MDD) after terrorist attacks. METHODS A systematic review was performed. Studies included assessed the impact of human-made, intentional, terrorist attacks in direct victims and/or persons in general population and evaluated MDD based on diagnostic criteria. RESULTS A total of 567 reports were identified, 11 of which were eligible for this review: 6 carried out with direct victims, 4 with persons in general population, and 1 with victims and general population. The reviewed literature suggests that the risk of MDD ranges between 20 and 30% in direct victims and between 4 and 10% in the general population in the first few months after terrorist attacks. Characteristics that tend to increase risk of MDD after a terrorist attack are female gender, having experienced more stressful situations before or after the attack, peritraumatic reactions during the attack, loss of psychosocial resources, and low social support. The course of MDD after terrorist attacks is less clear due to the scarcity of longitudinal studies. CONCLUSIONS Methodological limitations in the literature of this field are considered and potentially important areas for future research such as the assessment of the course of MDD, the study of correlates of MDD or the comorbidity between MDD and other mental health problems are discussed.
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Affiliation(s)
- José M Salguero
- Department of Personality, Evaluation and Psychological Treatment, Psychology Faculty, University of Malaga, Campus de Teatinos s/n. Malaga, 29071 Malaga, Spain
| | | | - Itziar Iruarrizaga
- Department of Basic Psychology, Complutense University of Madrid, Madrid, Spain
| | - Antonio Cano-Vindel
- Department of Basic Psychology, Complutense University of Madrid, Madrid, Spain
| | - Sandro Galea
- Department of Epidemiology, Columbia University, New York City, New York, USA
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Cano-Vindel A, Miguel-Tobal JJ, González-Ordi H, Iruarrizaga I. [Arousal versus threat when inducing an anxiety reaction]. Psicothema 2009; 21:177-182. [PMID: 19403068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Over the past years, several authors have used voluntary hyperventilation as a method for inducing physiological arousal and the experience of anxiety. The purpose of this investigation is to analyze the relationship between the process of arousal and the experience of anxiety. In order to induce anxiety, two tasks were assigned: hyperventilating and preparing a speech. General hypothesis tested: hyperventilation will induce a high level of physiological arousal (heart rate and skin conductance) with a limited experience of anxiety (subjective appraisal of valence, intensity, and control), whereas preparing a speech will generate a high level of arousal and a significant increase in the experience of anxiety. A sample of 89 women was divided into two groups (n=45 and n=44). After matching the two groups in various anxiety parameters, both tasks were carried out in a different order by each group in the laboratory. Results obtained confirm the main hypothesis and provide evidence against the use of hyperventilation as a technique for generating anxious experience.
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Miguel-Tobal JJ, Cano-Vindel A, Gonzalez-Ordi H, Iruarrizaga I, Rudenstine S, Vlahov D, Galea S. PTSD and depression after the Madrid March 11 train bombings. J Trauma Stress 2006; 19:69-80. [PMID: 16568454 DOI: 10.1002/jts.20091] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The March 11, 2004, train bombings in Madrid, Spain, caused the largest loss of life from a single terrorist attack in modern European history. We used a cross-sectional random digit dial survey of Madrid residents to assess the prevalence of posttraumatic stress disorder (PTSD) and major depression in the general population of Madrid 1 to 3 months after the March 11 train bombings. Of respondents 2.3% reported symptoms consistent with PTSD related to the March 11 bombings and 8.0% of respondents reported symptoms consistent with major depression. The prevalence of PTSD was substantially lower, but the prevalence of depression was comparable to estimates reported after the September 11 attacks in Manhattan. The findings suggest that across cities, the magnitude of a terrorist attack may be the primary determinant of the prevalence of PTSD in the general population, but other factors may be responsible for determining the population prevalence of depression.
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Abstract
This paper examines the nature of trait anxiety using self-report and objective measures of biological, behavioral, and cognitive characteristics as predictors in multiple regression analyses. Trait anxiety was associated with self-reported psychological maladjustment and psychosomatic disorders, but not with actual physical capacity and skills, cardiovascular fitness, or biochemical parameters. Under social-evaluative stress, trait anxiety was associated with self-reported cognitive and somatic state anxiety, but only slightly with actual behavioral anxiety (only gaze avoidance) and physiological arousal (only heart rate recovery). There was high stability in relationships over a 3-month period. These results favor a cognitive, rather than a biological, conceptualization of trait anxiety. It is suggested that a cognitive bias to focus on internal threat-related stimuli is a vulnerability factor in trait anxiety that predisposes to anxiety disorders.
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