Informes de Pacientes y Terapeutas Sobre el Resultado de la PsicoterapiaSimilitudes y Diferencias

  1. Concepción Fernández-Rodríguez 1
  2. Víctor Loredo-Martínez 2
  3. Rocío Coto-Lesmes 1
  1. 1 Universidad de Oviedo
    info

    Universidad de Oviedo

    Oviedo, España

    ROR https://ror.org/006gksa02

  2. 2 Universidad de Zaragoza
    info

    Universidad de Zaragoza

    Zaragoza, España

    ROR https://ror.org/012a91z28

Revista:
Psicothema

ISSN: 0214-9915 1886-144X

Año de publicación: 2023

Volumen: 35

Número: 4

Páginas: 374-383

Tipo: Artículo

Otras publicaciones en: Psicothema

Resumen

Las discrepancias entre terapeutas y pacientes sobre los resultados terapéuticos indican la necesidad de analizar qué síntomas y procesos se tienen en cuenta al evaluar el cambio clínico. Se analizó la correspondencia entre paciente y terapeuta, en pre y post tratamiento, al informar sobre ansiedad, depresión, Evitación Experiencial (EA), Fusión Cognitiva (FC) y Activación (A). Método: Se examinó la convergencia entre la información obtenida mediante cuestionarios estandarizados y escalas analógicas visuales (EVA) en 94 pacientes con ansiedad y/o depresión que participaron en un estudio clínico controlado (estudio TRANSACTIVA). Resultados: Se encontró correlación significativa (p < .05) entre todas las medidas de ansiedad y depresión, independientemente de la fuente, momento y procedimiento de medida al 95% de confianza. En la EVA, paciente y terapeuta coincidieron (p < .05) al valorar síntomas específicos. Respecto a EA, CF y A, las medidas del terapeuta mostraron correlaciones más altas y significativas que las del paciente, aunque, en cada condición, todas las medidas del paciente se correlacionaron entre sí (p < .05). Conclusiones: Se observó adecuada correspondencia entre terapeuta y paciente al informar sobre el cambio clínico. La EVA de un ítem parece adecuada para identificar ansiedad, depresión y patrones transdiagnósticos de EA, CF y A.

Referencias bibliográficas

  • Armento, M. E., & Hopko, D. R. (2007). The Environmental Reward Observation Scale (EROS): Development, validity, and reliability. Behavior Therapy, 38(2), 107–119. https://doi.org/10.1016/j.beth.2006.05.003
  • Bandelow, B., Sagebiel, A., Belz, M., Görlich, Y., Michaelis, S., & Wedekind, D. (2018). Enduring effects of psychological treatments for anxiety disorders: meta-analysis of follow-up studies. The British Journal of Psychiatry, 212(6), 333-338. https://doi.org/10.1192/bjp.2018.49
  • Bardeen, J. R., & Fergus, T. A. (2011). The interactive effect of cognitive fusion and experiential avoidance on anxiety, depression, stress and posttraumatic stress symptoms. Journal of Contextual Behavioral Science, 5(1), 1-6. https://doi.org/10.1016/j.jcbs.2016.02.002
  • Barney, J. L., Lillis, J., Haynos, A. F., Forman, E., & Juarascio, A. S. (2019). Assessing the valuing process in Acceptance and Commitment Therapy: Experts’ review of the current status and recommendations for future measure development. Journal of Contextual Behavioral Science, 12, 225-233. https://doi.org/10.1016/j.jcbs.2018.08.002
  • Barraca, J., & Pérez-Álvarez, M. (2010). Adaptación española del Environmental Reward Observation Scale (EROS) [Spanish adaptation of the Environmental Reward Observation Scale (EROS)]. Ansiedad y Estrés, 16(1), 95–107.
  • Bauer-Staeb, C., Kounali, D. Z., Welton, N. J., Griffith, E., Wiles, N. J., Lewis, G., Faraway, J. J., & Button, K. S. (2021). Effective dose 50 method as the minimal clinically important difference: Evidence from depression trials. Journal of Clinical Epidemiology, 137, 200-208. https://doi.org/10.1016/j.jclinepi.2021.04.002
  • Beck, A. T., & Steer, R. A. (1993). Beck Depression Inventory manual. The Psychological Corporation.
  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676-688. https://doi.org/10.1016/j.beth.2011.03.007
  • Bowling, A., Rowe, G., Lambert, N., Waddington, M., Mahtani, K. R., Kenten, C., Howe, A., & Francis, S. A. (2012). The measurement of patients’ expectations for health care: A review and psychometric testing of a measure of patients’ expectations. Health Technology Assessment, 16(30). https://doi.org/10.3310/hta16300
  • Chawla, N., & Ostafin, B. (2007). Experiential avoidance as a functional dimensional approach to psychopathology: An empirical review. Journal of Clinical Psychology, 63(9), 871-890. https://doi.org/10.1002/jclp.20400
  • Cheng, Q., Shi, C., Yan, C., Ren, Z., Chan, S. H. W., Xiong, S., Zhang, T., & Zheng, H. (2022). Sequential multiple mediation of cognitive fusion and experiential avoidance in the relationship between rumination and social anxiety among Chinese adolescents. Anxiety, Stress, & Coping, 35(3), 354-364. https://doi.org/10.1080/10615806.2021.1955864
  • Cherry, K. M., Vander Hoeven, E., Patterson, T. S., & Lumley, M. N. (2021). Defining and measuring “psychological flexibility”: A narrative scoping review of diverse flexibility and rigidity constructs and perspectives. Clinical Psychology Review, 84, Article 101973. https://doi.org/10.1016/j.cpr.2021.101973
  • Cookson, C., Luzon, O., Newland, J., & Kingston, J. (2020). Examining the role of cognitive fusion and experiential avoidance in predicting anxiety and depression. Psychology and Psychotherapy: Theory, Research and Practice, 93(3), 456-473. https://doi.org/10.1111/papt.12233
  • Corruble, E., Legrand, J. M., Zvenigorowski, H., Duret, C., & Guelfi, J. D. (1999). Concordance between self-report and clinician’s assessment of depression. Journal of Psychiatric Research, 33(5), 457-465. https://doi. org/10.1016/s0022-3956(99)00011-4
  • Coto-Lesmes, R., Fernández-Rodríguez, C., & González-Fernández, S. (2020a). Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. Journal of Affective Disorders, 263, 107-120. https://doi.org/10.1016/j.jad.2019.11.154
  • Coto-Lesmes, R., Fernández-Rodríguez, C., & González-Fernández, S. (2020b). Activación Conductual en formato grupal para ansiedad y depresión. Una revisión sistemática [Behavioral Activation in group format for anxiety and depression. A systematic review]. Terapia Psicológica, 38(1), 63-84. https://doi.org/10.4067/S0718-48082020000100063
  • Cuijpers, P., Li, J., Hofmann, S. G., & Andersson, G. (2010). Selfreported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: A meta-analysis. Clinical Psychology Review, 30(6), 768-778. https://doi.org/10.1016/j.cpr.2010.06.001
  • Fergus, T. A. (2015). I really believe I suffer from a health problem: Examining an association between cognitive fusion and healthy anxiety. Journal of Clinical Psychology, 71(9), 920-934. https://doi.org/10.1002/jclp.22194
  • Fernández-Rodríguez, C., Paz-Caballero, D., González-Fernández, S., & Pérez-Álvarez, M. (2018). Activation vs. experiential avoidance as a transdiagnostic condition of emotional distress: An empirical study. Frontiers in Psychology, 9, Article 1618. https://doi.org/10.3389/fpsyg.2018.01618
  • Fernández Rodríguez, C., Coto Lesmes, R., Martínez Loredo, V., & Cuesta Izquierdo, M. (2022b). Psychological inflexibility, anxiety and depression: The moderating role of cognitive fusion, experiential avoidance and activation. Psicothema. 34(2), 240-248. https://doi.org/10.7334/psicothema2021.344
  • Fernández-Rodríguez, C., Coto-Lesmes, R., Martínez-Loredo, V., González-Fernández, S., & Cuesta, M. (2022a). Is activation the active ingredient of transdiagnostic therapies? A randomized clinical trial of behavioral activation, acceptance and commitment therapy, and transdiagnostic cognitive-behavioral therapy for emotional disorders. Behavior Modification, 47(1), 3-45. https://doi. org/10.1177/01454455221083309.
  • Flückiger, C., Del Re, A. C., Wampold, B. E., & Horvath, A. O. (2018). The alliance in adult psychotherapy: A meta-analytic synthesis. Psychotherapy, 55(4), 316–340. https://doi.org/10.1037/pst0000172
  • Franklin, C. L., & Raines, A. M. (2019). The overlap between OCD and PTSD: Examining self-reported symptom differentiation. Psychiatry Research, 280, Article 112508. https://doi.org/10.1016/j.psychres.2019.112508
  • García-Campayo, J., Zamorano, E., Ruiz, M. A., Pardo, A., Pérez-Páramo, M., López-Gómez, V., Freire, O., & Rejas, J. (2010). Cultural adaptation into Spanish of the Generalized Anxiety Disorder-7 (GAD-7) Scale as a screening tool. Health and Quality of Life Outcomes, 8(1), 1-11. https://doi.org/10.1186/1477-7525-8-8
  • Gelso, C. J., Kivlighan Jr, D. M., & Markin, R. D. (2018). The real relationship and its role in psychotherapy outcome: A meta-analysis. Psychotherapy, 55(4), 434-444 https://doi.org/10.1037/pst0000183
  • Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., Kerr, S., Tansey, L., Noel, P., Ferenbach, C.,
  • Masley, S., Roach, L., Lloyd, J., May, L., Clarke, S., & Remington, B. (2014). The development and initial validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45(1), 83-101. https://doi.org/10.1016/j.beth.2013.09.001
  • Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181-192. https://doi.org/10.1016/j.jcbs.2020.09.009
  • González-Fernández, S., & Fernández-Rodríguez, C. (2019). Acceptance and commitment therapy in cancer: Review of applications and findings. Behavioral Medicine, 45(3), 255-269. https://doi.org/10.1080/08964289.2018.1452713
  • González Fernández, S., Fernández Rodríguez, C., Padierna Sánchez, C., Besteiro González, J. L., & Pérez Álvarez, M. (2019). Behavioral activation in cancer: Review of treatments and evidences. Revista Argentina de Clínica Psicológica, 28(2), 140-153. https://doi.org/10.24205/03276716.2018.1087
  • Guo, T., Xiang, Y. T., Xiao, L. E., Hu, C. Q., Chiu, H. F., Ungvari, G. S., Correll, C. U., Lai, K. Y. C., Feng, L., geng, Y., Feng, Y., & Wang, G. (2015). Measurement-based care versus standard care for major depression: A randomized controlled trial with blind raters. American Journal of Psychiatry, 172(10), 1004-1013. https://doi.org/10.1176/appi.ajp.2015.14050652
  • Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and Commitment Therapy: The process and practice of mindful change. Guilford Press.
  • Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168. https://doi.org/10.1037/0022-006X.64.6.1152
  • Hershenberg, R., McDonald, W. M., Crowell, A., Riva-Posse, P., Craighead, W. E., Mayberg, H. S., & Dunlop, B. W. (2020). Concordance between clinician-rated and patient reported outcome measures of depressive symptoms in treatment resistant depression. Journal of Affective Disorders, 266, 22-29. https://doi.org/10.1016/j.jad.2020.01.108
  • Hobbs, C., Lewis, G., Dowrick, C., Kounali, D., Peters, T. J., & Lewis, G. (2021). Comparison between self-administered depression questionnaires and patients’ own views of changes in their mood: A prospective cohort study in primary care. Psychological Medicine, 51(5), 853-860. https://doi.org/10.1017/S0033291719003878
  • Hopko, D. R., Bourland, S. L., Stanley, M. A., Beck, J. G., Novy, D. M., Averill, P. M., & Swann, A. C. (2000). Generalized anxiety disorder in older adults: Examining the relation between clinician severity ratings and patient self‐report measures. Depression and Anxiety, 12(4), 217-225.
  • Jacobson, N. S., Martell, C. R., & Dimidjian, S. (2001). Behavioral activation treatment for depression: Returning to contextual roots. Clinical Psychology: Science and Practice, 8(3), 255-270. https://doi.org/10.1093/clipsy.8.3.255
  • Kanter, J. W., Baruch, D. E., & Gaynor, S. T. (2006). Acceptance and commitment therapy and behavioral activation for the treatment of depression: Description and comparison. The Behavior Analyst, 29(2), 161-185. https://doi.org/10.1007/BF03392129
  • Kendrick, T., El‐Gohary, M., Stuart, B., Gilbody, S., Churchill, R., Aiken, L., Bhattacharya, A., Gimson, A., Brütt, A. L., de Jong, K., & Moore, M. (2016). Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults. Cochrane Database of Systematic Reviews, (7), Article CD011119. https://doi.org/10.1002/14651858.CD011119.pub2.
  • Malpass, A., Dowrick, C., Gilbody, S., Robinson, J., Wiles, N., Duffy, L., & Lewis, G. (2016). Usefulness of PHQ-9 in primary care to determine meaningful symptoms of low mood: A qualitative study. British Journal of General Practice, 66(643), e78-e84. https://doi.org/10.3399/bjgp16X683473
  • Manos, R. C., Kanter, J. W., & Busch, A. M. (2010). A critical review of assessment strategies to measure the behavioral activation model of depression. Clinical Psychology Review, 30(5), 547-561. https://doi.org/10.1016/j.cpr.2010.03.008
  • Martell, C. R., Dimidjian, S., & Herman-Dunn, R. (2013). Behavioral activation for depression: A clinician’s guide. Guilford Press Martin, F., & Oliver, T. (2019). Behavioral activation for children and adolescents: A systematic review of progress and promise. European Child & Adolescent Psychiatry, 28(4), 427-441. https://doi.org/10.1007/s00787-018-1126-z
  • Meidlinger, P. C., & Hope, D. A. (2017). The new transdiagnostic cognitive behavioral treatments: Commentary for clinicians and clinical researchers. Journal of Anxiety Disorders, 46, 101-109. https://doi.org/10.1016/j.janxdis.2016.11.002
  • Norcross, J. C., & Lambert, M. J. (2018). Psychotherapy relationships that work III. Psychotherapy, 55(4), 303-315. https://doi.org/10.1037/pst0000193
  • O’Mahen, H. A., Wilkinson, E., Bagnall, K., Richards, D. A., & Swales, A. (2017). Shape of change in internet based behavioral activation treatment for depression. Behaviour Research and Therapy, 95, 107-116. https://doi.org/10.1016/j.brat.2017.05.011
  • Ong, C. W., Pierce, B. G., Petersen, J. M., Barney, J. L., Fruge, J. E., Levin, M. E., & Twohig, M. P. (2020). A psychometric comparison of psychological inflexibility measures: Discriminant validity and ítem performance. Journal of Contextual Behavioral Science, 18, 34-47. https://doi.org/10.1016/j.jcbs.2020.08.007
  • Price, D., Edwards, M., Davies, F., Cooper, A., McFadzean, J., Carson-Stevens, A., Cooke, M., Dale, J., Evans, B. A., Harrington, B., Hepburn, J., Siriwardena, A. N., Snooks, H., & Edwards, A. (2022). Patients’ experiences of attending emergency departments where primary care services are located: Qualitative findings from patient and clinician interviews from a realist evaluation. BMC Emergency Medicine, 22(1), 1-12. https://doi.org/10.1186/s12873-021-00562-9
  • Quintana, J. M., Padierna, A., Esteban, C., Arostegui, I., Bilbao, A., & Ruiz, I. (2003). Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 107(3), 216–221. https://doi.org/10.1034/j.1600-0447.2003.00062.x
  • Robinson, J., Khan, N., Fusco, L., Malpass, A., Lewis, G., & Dowrick, C. (2017). Why are there discrepancies between depressed patients’ Global Rating of Change and scores on the Patient Health Questionnaire depression module? A qualitative study of primary care in England. BMJ open, 7(4), Article e014519. https://doi.org/10.1136/bmjopen-2016-014519
  • Rogge, R. D., Daks, J. S., Dubler, B. A., & Saint, K. J. (2019). It’s all about the process: Examining the convergent validity, conceptual coverage, unique predictive validity, and clinical utility of ACT process measures. Journal of Contextual Behavioral Science, 14, 90–102. https://doi.org/10.1016/j.jcbs.2019.10.001.
  • Romero-Moreno, R., Márquez-González, M., Losada, A., Gillanders, D., & Fernández-Fernández, V. (2014). Cognitive fusion in dementia caregiving: Psychometric properties of the Spanish version of the “Cognitive Fusion Questionnaire”. Behavioral Psychology/Psicología Conductual, 22(1), 117-132.
  • Ruiz, F. J., Langer, A. I., Luciano, C., Cangas, A. J., & Beltrán, I. (2013). Measuring experiential avoidance and psychological inflexibility: The Spanish version of the Acceptance and Action Questionnaire - II. Psicothema, 25(1), 123–129. https://doi.org/10.7334/psicothema2011.239
  • Santos, M. M., Rae, J. R., Nagy, G. A., Manbeck, K. E., Hurtado, G. D., West, P., Santiago-Rivera, A., & Kanter, J. W. (2017). A client-level session-by-session evaluation of behavioral activation’s mechanism of action. Journal of Behavior Therapy and Experimental Psychiatry, 54, 93-100. https://doi.org/10.1016/j.jbtep.2016.07.003
  • Santos, M. M., Ullman, J., Leonard, R. C., Puspitasari, A. J., Cook, J., & Riemann, B. C. (2019). Behavioral activation as a mechanism of change in residential treatment for mood problems: A growth curve model analysis. Behavior Therapy, 50(6), 1087-1097. https://doi.org/10.1016/j.beth.2019.05.004
  • Sanz, J., & García-Vera, M. P. (2007). Análisis psicométrico de las versiones breves del Inventario para la Depresión de Beck de 1978 (BDI-IA) [A psychometric analysis of the short forms of the 1978 version of the Beck Depression Inventory (BDI-IA)]. Psicología Conductual, 15(4), 191–214.
  • Spinhoven, P., van Hemert, A. M., & Penninx, B. W. (2017). Experiential avoidance and bordering psychological constructs as predictors of the onset, relapse and maintenance of anxiety disorders: One or many? Cognitive Therapy and Research, 41(6), 867-880. https://doi.org/10.1007/s10608-017-9856-7
  • Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https://doi.org/10.1001/ archinte.166.10.1092
  • Stockton, D., Kellett, S., Berrios, R., Sirois, F., Wilkinson, N., & Miles, G. (2019). Identifying the underlying mechanisms of change during acceptance and commitment therapy (ACT): A systematic review of contemporary mediation studies. Behavioural and Cognitive Psychotherapy, 47(3), 332-362. https://doi.org/10.1017/S1352465818000553
  • Zimmerman, M., Walsh, E., Friedman, M., Boerescu, D. A., & Attiullah, N. (2018). Are self-report scales as effective as clinician rating scales in measuring treatment response in routine clinical practice? Journal of Affective Disorders, 225, 449-452. https://doi.org/10.1016/j.jad.2017.08.024
  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x