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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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García-Torres F, Jacek Jabłoński M, Gómez-Solís Á, Jaén-Moreno MJ, Moriana JA, Moreno-Díaz MJ, Aranda E. Psychological distress predicts quality of life in the first months of cancer diagnosis in cancer caregivers. PSYCHOL HEALTH MED 2023; 28:2872-2882. [PMID: 37142554 DOI: 10.1080/13548506.2023.2208367] [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: 06/14/2022] [Accepted: 04/21/2023] [Indexed: 05/06/2023]
Abstract
In cancer caregivers, anxiety and depression may negatively impact quality of life. Information regarding correlations and the predictive capacity of anxiety and depression with regard to the domains of quality of life of caregivers 6 months after a patient's cancer diagnosis is sparse. Sixty-seven caregivers of cancer patients were recruited and completed the Hospital Anxiety and Depression Scale (HADS) and the Short-Form Health Survey (SF-36) 30-45 days (T1) and 180-200 days (T2) after diagnosis. Depression and anxiety (T1) correlated with quality of life in terms of general health, vitality, social functioning, as well as role limitations due to emotional problems, and mental health (T2). Depression scores at T1 predicted general health, vitality, social functioning, role limitations due to emotional problems and mental health. Although these results are interesting, it must be noted that the sample size was somewhat limited and that the patients' cancer types may have influenced the results obtained. Psychological distress, particularly depression, correlated with and acted as a predictor for changes in the different domains of quality of life, highlighting the relevance of the evaluation of psychological distress in cancer caregivers shortly after cancer diagnosis. These results underscore the importance of differentiating between the different domains in the evaluation of impairments of quality of life in cancer caregivers.
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Affiliation(s)
- Francisco García-Torres
- Department of Psychology, University of Cordoba, Cordoba, Spain/IMIBIC Health Research Institute/Reina Sofía University Hospital of Cordoba, Cordoba, Spain
| | | | | | - María José Jaén-Moreno
- IMIBIC Health Research Institute/Department of Social Health Sciences, Radiology and Physical Medicine/University of Córdoba, Spain
| | - Juan A Moriana
- Department of Psychology, University of Cordoba, Cordoba, Spain/IMIBIC Health Research Institute/Reina Sofía University Hospital of Cordoba, Cordoba, Spain
| | - María José Moreno-Díaz
- Department of Social Health Sciences, Radiology and Physical Medicine/University of Córdoba, Córdoba, Spain
| | - Enrique Aranda
- Medical Oncology Department, Reina Sofía University Hospital, Spain
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Sanmartín FJ, Velasco J, Gálvez-Lara M, Cuadrado F, Moriana JA. Risk Factors Associated with Gambling on Loot Boxes. Psicothema 2023; 35:397-405. [PMID: 37882424 DOI: 10.7334/psicothema2022.484] [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: 10/27/2023]
Abstract
BACKGROUND Loot boxes (LBs) are virtual objects that players open without knowing the value of the item they will obtain. Because of their features, studies have explored their association with gambling, finding commonalities. However, risk factors have been overlooked. This study examined risk factors associated with gambling as applied to LBs (gambling in the past year, having family/friends who use LBs/gamble, trait impulsivity, and sensation-seeking). METHOD 253 participants (82.2% men) with a mean age of 28 years ( SD = 12.11)—in three groups: gamblers ( n = 89), LB purchasers ( n = 63), and free-LB openers ( n = 101)—completed a self-report. RESULTS Having family/friends who used LBs was related to increased engagement in opening LBs at no cost. However, having gambled in the past year or having family/friends who used LBs or who gambled was not associated with increased purchasing. Gamblers, LB purchasers, and LB openers scored equally highly on impulsivity and sensation-seeking. Because some gamblers used LBs, and LB purchasers also opened free-LBs, further analyses were performed to control for the effects of overlapping groups. Loot boxers had higher scores in sensation-seeking than gamblers. CONCLUSIONS The results can contribute to the development of prevention and intervention strategies for LB users.
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Affiliation(s)
- Francisco J Sanmartín
- University of Córdoba (Spain), Maimonides Institute for Biomedical Research of Córdoba (Spain), Reina Sofia University Hospital (Spain)
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Velasco J, Sanmartín FJ, Gálvez-Lara M, Cuadrado F, Moriana JA. Psychological Effects of Professional Exposure to Trauma and Human Suffering: Systematic Review and Meta-Analysis. Trauma Violence Abuse 2023; 24:1656-1676. [PMID: 35202557 DOI: 10.1177/15248380221074314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Over the past decades, a growing interest has emerged toward understanding the impact that the exposure to human suffering produces in mental health professionals, leading to the identification of three constructs: vicarious traumatization (VT), compassion fatigue (CF), and secondary trauma (ST). However, little is known about how these conditions affect psychologists. A systematic review and a meta-analysis were conducted to examine the evidence about the effects of occupational exposure to trauma and suffering in studies that included psychologists among their samples. Fifty-two studies were included comprising 10,233 participants. Overall, the results showed that most professionals did not experience relevant distress due to their work, yet some of them developed clinically significant symptoms (i.e., PTSD). However, solid conclusions could not be drawn due to the numerous methodological difficulties found in this research field (i.e., group heterogeneity, lack of comparison groups, and conceptual overlap). Thus, it is necessary to further investigate this topic with scientific rigor to understand these stressors and develop evidence-based interventions.
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Affiliation(s)
- Judith Velasco
- Department of Psychology, University of Cordoba, Spain
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Spain
- Reina Sofia University Hospital, Spain
| | | | - Mario Gálvez-Lara
- Department of Psychology, University of Cordoba, Spain
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Spain
- Reina Sofia University Hospital, Spain
| | - Fátima Cuadrado
- Department of Psychology, University of Cordoba, Spain
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Spain
- Reina Sofia University Hospital, Spain
| | - Juan A Moriana
- Department of Psychology, University of Cordoba, Spain
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Spain
- Reina Sofia University Hospital, Spain
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Corpas J, Moriana JA, Venceslá JF, Gálvez-Lara M. Cognitive processes associated with emotional disorders: implications for efficient psychological treatments. J Ment Health 2023; 32:54-62. [PMID: 33989506 DOI: 10.1080/09638237.2021.1922651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments. AIMS To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments. METHODS We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses. RESULTS Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied. CONCLUSIONS For "pure" disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.
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Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Juan A Moriana
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Jose F Venceslá
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, University of Córdoba, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain.,Reina Sofia University Hospital, Córdoba, Spain
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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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Ruano A, García-Torres F, Gálvez-Lara M, Moriana JA. Psychological and Non-Pharmacologic Treatments for Pain in Cancer Patients: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2022; 63:e505-e520. [PMID: 34952171 DOI: 10.1016/j.jpainsymman.2021.12.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 10/23/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 12/21/2022]
Abstract
CONTEXT Pain is the most fearful symptom in cancer. Although there is a relationship between psychosocial variables and oncologic pain, psychological and non-pharmacological treatments for pain management in cancer patients are not very widespread. OBJECTIVES To analyze the efficacy of psychological and non-pharmacological treatments for reducing pain in cancer patients. METHODS We performed a systematic review following the PRISMA protocol. In January 2021, data were extracted from PubMed, Web of Science and Scopus, including randomised controlled trials (RCT) published in the last five years (from 28 January, 2015 to December 15, 2020), in the English language and whose sample was patients with cancer pain. The database search used the following keywords: cancer, cancer-related pain, psychological intervention, non-pharmacologic intervention. The Cochrane risk of bias assess ment for randomised trials (RoB 2) was used for quality appraisal. RESULTS After the inclusion and exclusion criteria were applied, ten papers were fully screened. The evidence suggested that the most effective interventions to reduce cancer pain were mindfulness-based cognitive therapy, guided imagery and progressive muscle relaxation and emotional and symptom focused engagement (EASE). Music therapy and brief cognitive behavioral strategies (CBS) require more research, while coping skills training and yoga did not show positive effects. Overall, we obtained a moderate size effect (d = 0.642, 95% CI: 0.125-1.158) favourable to psychological and non-pharmacologic treatments at post-treatment, which increased at follow-up (k = 5, d = 0.826, 95% CI: 0.141-1.511). CONCLUSION This study provides insight into psychological interventions which might be applied and contribute to cancer-related pain reduction in adults. Although the results are not completely consistent, they may shed light on psychology applications in the oncology environment.
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Affiliation(s)
- Alejandra Ruano
- Department of Psychology, University of Cordoba (A.R., F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, University of Cordoba (A.R., F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC) (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Reina Sofia University Hospital (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain.
| | - Mario Gálvez-Lara
- Department of Psychology, University of Cordoba (A.R., F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC) (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Reina Sofia University Hospital (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain
| | - Juan A Moriana
- Department of Psychology, University of Cordoba (A.R., F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC) (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain; Reina Sofia University Hospital (F.G.-T., M.G.-L., J.A.M.), Cordoba, Spain
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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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Corpas J, Moriana JA, Venceslá JF, Gálvez-Lara M. Brief psychological therapies for emotional disorders in primary care: A systematic review and meta-analysis. Clinical Psychology: Science and Practice 2021. [DOI: 10.1037/cps0000009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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12
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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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13
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Corpas J, Moriana JA, Venceslá JF, Gálvez-Lara M. Effectiveness of brief group transdiagnostic therapy for emotional disorders in primary care: A randomized controlled trial identifying predictors of outcome. Psychother Res 2021; 32:456-469. [PMID: 34269640 DOI: 10.1080/10503307.2021.1952331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Indexed: 10/20/2022] Open
Abstract
AbstractBrief transdiagnostic psychotherapy is a possible approach for emotional disorders in primary care. The objective of the present randomized controlled trial was to determine its effectiveness compared with the treatment as usual based on pharmacological interventions in patients with mild/moderate symptoms. In addition, emotional regulation strategies and cognitive factors were studied as potential predictors. Participants (N = 105) were assigned to brief group therapy based on the Unified Protocol (n = 53) or treatment as usual (n = 52). They were assessed before and after the interventions. Mean differences and stepwise regression analyses were performed. Brief group transdiagnostic psychotherapy was more effective than medication in reducing all clinical symptoms (p = .007 for generalized anxiety; p = .000 for somatization; p = .000 for panic disorder; and p = .041 for depression) and in modifying emotional regulation strategies and cognitive processes (p = .000 for cognitive reappraisal, expressive suppression, worry, rumination, and metacognition) with moderate/high effect sizes. Besides, it was found that these variables acted as predictors of the therapeutic change. It is concluded that brief therapies could be an accurate treatment for mild/moderate emotional disorders in primary care due to their cost-effective characteristics.
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Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Cordoba, Córdoba, Spain.,Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain
| | - Juan A Moriana
- Department of Psychology, University of Cordoba, Córdoba, Spain.,Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain
| | - Jose F Venceslá
- Department of Psychology, University of Cordoba, Córdoba, Spain.,Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain
| | - Mario Gálvez-Lara
- Department of Psychology, University of Cordoba, Córdoba, Spain.,Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Spain
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García-Carmona M, García-Torres F, Jacek Jabłoński M, Gómez Solís Á, Jaén-Moreno MJ, Moriana JA, Moreno-Díaz MJ, Aranda E. The influence of family social support on quality of life of informal caregivers of cancer patients. Nurs Open 2021; 8:3411-3419. [PMID: 33949797 PMCID: PMC8510708 DOI: 10.1002/nop2.887] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/20/2021] [Accepted: 03/15/2021] [Indexed: 12/24/2022] Open
Abstract
AIM Caregivers of cancer patients are at high risk of experiencing impairments in terms of anxiety, depression and quality of life. This study examines the mediation capacity that perceived emotional support can have after diagnosis and six months later between depression and anxiety after diagnosis and quality of life in informal caregivers of cancer patients. DESIGN A sample of 67 informal caregivers of cancer patients was used. This study is longitudinal, ex post facto prospective, with convenience sampling. METHODS Participants completed the Medical Outcomes Study 36-Item Short Form (SF-36), the Hospital Anxiety and Depression Scale (HADS) and the Berlin Social Support Scale (BSSS) and a sociodemographic questionnaire. Data were collected between March 2017 and November 2018. RESULTS Spearman's correlation analysis showed that anxiety, depression and perceived emotional support were related to quality of life. The mediation analysis showed that the relationship between depression after diagnosis and quality of life six months later was mediated by perceived emotional support.
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Affiliation(s)
- Margarita García-Carmona
- Department of Psychology, University of Cordoba, Cordoba, Spain.,IMIBIC Health Research Institute/Reina Sofía University Hospital of Cordoba, Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, University of Cordoba, Cordoba, Spain.,IMIBIC Health Research Institute/Reina Sofía University Hospital of Cordoba, Cordoba, Spain
| | - Marcin Jacek Jabłoński
- Institute of Psychology, Faculty of Philosophy, Jesuit University Ignatianum in Krakow, Krakow, Poland
| | | | - María José Jaén-Moreno
- IMIBIC Health Research Institute/Department of Social Health Sciences, Radiology and Physical Medicine, University of Córdoba, Córdoba, Spain
| | - Juan A Moriana
- Department of Psychology, University of Cordoba, Cordoba, Spain.,IMIBIC Health Research Institute/Reina Sofía University Hospital of Cordoba, Cordoba, Spain
| | - María José Moreno-Díaz
- Department of Social Health Sciences, Radiology and Physical Medicine, University of Córdoba, Córdoba, Spain
| | - Enrique Aranda
- Medical Oncology Department, Reina Sofía University Hospital, Córdoba, Spain
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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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16
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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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Corpas J, Moriana JA, Venceslá JF, Gálvez-Lara M. Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial. Int J Clin Health Psychol 2021; 21:100203. [PMID: 33363586 PMCID: PMC7753034 DOI: 10.1016/j.ijchp.2020.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [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: 07/24/2020] [Accepted: 11/06/2020] [Indexed: 12/14/2022] Open
Abstract
Background/Objective Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. Method: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. Results: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. Conclusions: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems.
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Affiliation(s)
- Jorge Corpas
- Department of Psychology, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), and Reina Sofia University Hospital, Cordoba, Spain
| | - Juan A. Moriana
- Department of Psychology, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), and Reina Sofia University Hospital, Cordoba, Spain
| | - Jose F. Venceslá
- Department of Psychology, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), and Reina Sofia University Hospital, Cordoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), and Reina Sofia University Hospital, Cordoba, Spain
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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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Cuadrado F, Antolí A, Rosal-Nadales M, Moriana JA. Giving Meaning to Alzheimer's Disease: An Experimental Study Using a Framing Approach. Health Commun 2020; 35:447-455. [PMID: 30676089 DOI: 10.1080/10410236.2019.1567441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The prejudices and stereotypes associated with Alzheimer's disease (AD) are based on contents that highlight the most negative and dramatic aspects of the symptoms of this disease. This is reinforced by the preponderance of negative representations related to AD. In this paper, these representations have been analyzed as frames. The most dominant frame used to represent dementia is "body-mind dualism," and its alternative is the "body-mind unity" counter-frame. This study aims to define the impact of different messages inspired by the Dualism frame and the Unity counter-frame in the collective representation and meaning given to AD. Posters of simulated health campaigns about AD were designed, combining contents related to the Dualism frame and the Unity counter-frame, and were shown to 85 participants. To analyze the impact of both types of frameworks, a pre-post record of the attitudes of the participants toward AD was conducted using the Attitudes toward Dementia Scale. The assessment of the campaign and the self-report emotions were also registered. Participants' eye movements were measured during exposure to the posters. Attitudes toward dementia were found to be significantly more positive following exposure to discourses characteristic of the Unity counter-frame. Likewise, the dualism discourse evoked more sadness and anger. Moreover, the posters that used the discourse of the Unity counter-frame were considered more useful. We concluded that attitudes toward dementia are influenced by framing. Designing suitable health campaigns using these frames could help mitigate the attitudes and stigma associated with AD.
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Affiliation(s)
- Fátima Cuadrado
- Department of Psychology, University of Cordoba
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)
- Reina Sofia University Hospital
| | - Adoración Antolí
- Department of Psychology, University of Cordoba
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)
- Reina Sofia University Hospital
| | | | - Juan A Moriana
- Department of Psychology, University of Cordoba
- Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC)
- Reina Sofia University Hospital
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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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Gálvez-Lara M, Corpas J, Velasco J, Moriana JA. El Conocimiento y el Uso en la Práctica Clínica de los Tratamientos Psicológicos Basados en la Evidencia. Clínica y Salud 2019. [DOI: 10.5093/clysa2019a12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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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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Gálvez-Lara M, Corpas J, Venceslá JF, Moriana JA. Evidence-Based Brief Psychological Treatment for Emotional Disorders in Primary and Specialized Care: Study Protocol of a Randomized Controlled Trial. Front Psychol 2019; 9:2674. [PMID: 30671005 PMCID: PMC6331401 DOI: 10.3389/fpsyg.2018.02674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [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: 06/28/2018] [Accepted: 12/12/2018] [Indexed: 01/23/2023] Open
Abstract
Emotional Disorders (EDs) are very prevalent in Primary Care (PC). However, general practitioners (GPs) have difficulties to make the diagnosis and the treatment of this disorders that are usually treated with drugs. Brief psychological therapies may be a new option to treat EDs in a PC context. This article aims to present a study protocol to evaluate the effectiveness and the efficiency of an adaptation to brief format of the "Unified Protocol (UP) for the transdiagnostic treatment of EDs." This is a single-blinded RCT among 165 patients with EDs. Patients will be randomly assigned to receive brief psychological treatment based on UP, conventional psychological treatment, conventional psychological treatment plus pharmacological treatment, minimum intervention based on basic psychoeducational information, or pharmacological treatment only. Outcome measure will be the following: GAD-7, STAI, PHQ-9, BDI-II, PHQ-15, PHQ-PD, and BSI-18. Assessments will be carried out by blinded raters at baseline, after the treatment and 6-month follow-up. The findings of this RCT may encourage the implementation of brief therapies in the PC context, what would lead to the decongestion of the public health system, the treatment of a greater number of people with EDs in a shorter time, the reduction of the side effects of pharmacological treatment and a possible economic savings for public purse. Clinical Trial Registration: ClinicalTrial.gov, identifier NCT03286881. Registered September 19, 2017.
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Affiliation(s)
- Mario Gálvez-Lara
- Department of Psychology, University of Córdoba, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
| | - Jorge Corpas
- Department of Psychology, University of Córdoba, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
| | - José Fernando Venceslá
- Department of Psychology, University of Córdoba, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
| | - Juan A. Moriana
- Department of Psychology, University of Córdoba, Córdoba, Spain
- Maimónides Biomedical Research Institute of Córdoba, Córdoba, Spain
- Reina Sofia University Hospital, Córdoba, Spain
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Langer ÁI, Stanghellini G, Cangas AJ, Lysaker PH, Nieto-Muñoz L, Moriana JA, Barrigón ML, Ambrosini A. Interpretation, emotional reactions and daily life implications of hallucination-like experiences in clinical and nonclinical populations. Psicothema 2016; 27:19-25. [PMID: 25633765 DOI: 10.7334/psicothema2014.97] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Research on Hallucination-Like Experiences (HLEs) has not yet explored whether people without psychosis who have HLEs attribute the same level of significance to them. This significance includes whether or not the HLEs elicit similar emotional reactions in people with and without psychosis, or if the HLEs occur in same context between the two groups. The objective of this study was to compare the characteristics of these experiences in a non-clinical group and a clinical group of patients with schizophrenia and schizophrenia spectrum disorders. METHOD Both groups were evaluated to determine the prevalence of HLEs. After the evaluation, they were interviewed about the characteristics of these experiences. RESULTS Both groups sought to actively eliminate the HLEs, could identify the presence of a trigger factor, and experienced little perceived control. However, HLEs elicited more anxiety, discomfort and interference in daily life in the clinical group than in the non-clinical group. Furthermore, the clinical group members defined their hallucinations more negatively and were reported to have experienced them under stressful events. CONCLUSIONS These findings suggest that the two experiences are not entirely equivalent, especially when taking into account the emotional reaction produced by these experiences and the meaning people attach to them.
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Affiliation(s)
- Álvaro I Langer
- Pontifical Catholic University of Chile and University of Tarapacá
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Abstract
The present study examined the relationship between the Type A Behavior Pattern and certain psychopathological disorders, namely, anxiety and depression, within an occupational setting. A sample group of 100 high school teachers (37 men and 63 women) who had taken one or more psychiatric leaves of absence were studied. An additional 100 teachers (47 men and 53 women), with no history of psychiatric sick-leaves, were randomly assigned to a control group. The groups shared the same organizational setting. The Jenkins Activity Survey, Form H, was administered to assess the Type A Behavior Pattern of both groups. Binomial logistic regression analysis indicated this pattern was related to psychiatric sick-leaves.
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Valencia M, Moriana JA, Kopelowicz A, Lopez SR, Liberman RP. Social-Skills Training for Spanish-Speaking Persons with Schizophrenia: Experiences From Latin America, Spain, and the United States. American Journal of Psychiatric Rehabilitation 2015. [DOI: 10.1080/15487768.2014.954161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
BACKGROUND Several studies have suggested the continuity of psychotic symptoms between the general population and clinical samples, and have shown that, in fact, the predisposition to hallucinations is a multi-dimensional construct. However, there is no agreement concerning the number of factors comprising it or the significance of psychotic-like experiences. An examination of the beliefs associated with these experiences could increase knowledge of the continuity of hallucinations. AIMS The purpose of this work was to analyze the structure of the Revized Hallucination Scale (RHS), applied to a sample of Spanish university students to find out the meaning for the participants and their associated beliefs on each item. METHODS The RHS was administered to a total of 265 participants. Along with the frequency of each experience, participants were asked to provide an example of each situation described and to what they attributed it. RESULTS The results emphasized the presence of four factors that are variously made up of six types of beliefs: personal difficulties; psychological explanations; dreamlike experiences; vivid thoughts; perceptive distortions; and personal desires. CONCLUSIONS The relevance of these results with regard to the differences that might exist in hallucinations in clinical and normal populations is discussed.
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Affiliation(s)
- Adolfo J Cangas
- Department of Clinical Psychology, University of Almería, Almería, Spain.
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Abstract
OBJECTIVE The purpose of this study was to test an intervention that adapted the University of California, Los Angeles (UCLA) social and independent living skills program for application in the patient's home and in an outpatient setting in Spain. METHODS An intervention group of 32 patients with schizophrenia was selected for comparison with a matched control group of patients who were undergoing conventional outpatient treatment for schizophrenia during six-month treatment periods. The Positive and Negative Syndrome Scale (PANSS) scoring system was used to compare the two groups, with a pretest-posttest design. RESULTS Analysis of variance indicated a significant phase-by-treatment interaction effect of the intervention on PANSS scores. CONCLUSIONS The results of this study suggest that a combination of outpatient follow-up care and in-home care centered on psychosocial skills training is more effective than conventional treatment in improving general symptoms among individuals with schizophrenia.
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