Patients´ and Therapists´ Reports of Psychotherapy Outcomes: Similarities and Differences.

BACKGROUND: Discrepancies between therapists' and patients' measures regarding therapeutic results indicate the need to analyze which symptoms and processes are being taken into consideration when reporting clinical change. This study analyzes the concordance between patient and therapist, at pre- and post-treatment, when reporting about anxiety, depression, Experiential Avoidance (EA), Cognitive Fusion (CF) and Activation (A). METHOD: Convergence was examined between information obtained by means of standardized measures and visual analogical scales (VAS) in 94 patients with anxiety and/or depression who participated in a controlled clinical study (TRANSACTIVA study). RESULTS: Statistically significant correlation ( p < .05) was found between all the measures of anxiety and depression, regardless of the source, timepoint, and measures procedure at 95% confidence. In the VAS, patient and therapist agreed ( p < .05) in their evaluation of specific symptoms. For EA, CF and A, the therapists' measures demonstrated stronger correlations than those of the patients, although, in each condition, all the patients' measures correlated with each other ( p < .05). CONCLUSIONS: Suitable agreement was found between therapist and patient when reporting clinical change. One-item VAS appeared to b suitable for identifying anxiety, depression and the transdiagnostic patterns of EA, CF and A.

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.

Studying the usefulness of contextual and cognitive transdiagnostic therapies calls for an analysis of both their differential efficacy and their specificity when acting on the transdiagnostic conditions on which they focus. This controlled trial compares the post-treatment and 3- and 6-month follow-up effects of Behavioral Activation (BA), Acceptance and Commitment Therapy (ACT) and Cognitive-Behavioral Transdiagnostic Therapy (TD-CBT) on emotional symptomatology, and analyses the role played by Experiential Avoidance, Cognitive Fusion, Activation and Emotion Regulation in the clinical change. One hundred twenty-eight patients who fulfilled diagnostic criteria for anxiety and/or depression (intention-to-treat sample) were randomly assigned to three experimental group-treatment conditions (BA, n = 34; ACT, n = 27; TD-CBT n = 33) and one control group (WL, n = 34). Ninety-nine (77.34%) completed the treatment (per-protocol sample). In the post-treatment, all therapies reduced anxiety and depression symptomatology. In the follow-ups, the reduction in emotional symptomatology was greater in the condition which produced greater and more prolonged effects on Activation. Activation appears to be the principal condition in modifying all the transdiagnostic patterns and BA was the most efficacious and specific treatment. The trial was registered at ClinicalTrials.gov NCT04117464. Raw data are available online http://dx.doi.org/10.17632/krj3w2hfsj.1.

Psychological Inflexibility, Anxiety and Depression: The Moderating Role of Cognitive Fusion, Experiential Avoidance and Activation.

BACKGROUND: Evidence about how cognitive fusion (CF) and experiential avoidance (EA) interact with emotional distress underlines the importance of analyzing the interrelationships between the different processes of psychological inflexibility in order to improve ways of addressing emotional problems. This study analyzes the moderating effect of CF, EA and activation (A) in relation to four criteria of anxiety and depression. METHOD: A cross-sectional study of a clinical sample of adults was carried out by means of a questionnaire administered before (N = 172) and 6 months after (N = 114) participation in a clinical study. RESULTS: Regression analyses gave results which were consistent in the two evaluations. The EAxCF interaction modulated anxiety symptomatology, whereas A was not a significant predictor. Nevertheless, a reduction in A was the principal modulating condition in the symptomatology of depression; and although CF and EA did act as independent predictors, the EAxCF interaction was not significant. CONCLUSIONS: The presence and intensity of manifestations of emotional distress are explained and modulated by the progressive concurrence of CF, EA and reduction in A. The use of therapeutic approaches which increase activation could be a beneficial strategy with regard to decreasing cognitive fusion and experiential avoidance.

Behavioral Activation and Acceptance and Commitment Therapy in the Treatment of Anxiety and Depression in Cancer Survivors: A Randomized Clinical Trial.

Behavioural Activation (BA) and Acceptance and Commitment Therapy (ACT) aim to reduce the inflexible avoidance of painful thoughts, feelings and memories and to encourage involvement in relevant activities, objectives which are clearly relevant to the situation of cancer survivors with emotional problems. With a view to evaluating and comparing the efficacy of both therapies, applied on a group basis, a randomized controlled trial was developed. Cancer survivors (age 18-65 years) with anxiety and/or depression were assigned at random to two experimental groups (BA; ACT) and a waiting list control group (WL). Of the 66 cancer survivors randomized to trial (intention-to-treat sample), 46 participants (M = 51.49; SD = 6.88) completed the intervention (BA, n = 17; ACT, n = 12; WL, n = 17) (per-protocol sample). The emotional state, experiential avoidance and behavioural activation of the participants was evaluated in the pre- and post-treatment and in a 3-month follow-up using standardized instruments. Both treatment groups showed statistically significant changes, indicating an improvement in all the result variables in the post-treatment and follow-up as compared to the pre-treatment. BA showed better results than ACT regarding impact on anxiety and activation. This greater efficacy may have been due to factors such as the emphasis placed in BA on behavioural activation and the central role played in it by functional analysis. The key role played by experiential avoidance and behavioral activation in the maintenance and treatment of emotional problems in cancer survivors is discussed. Raw data are available online (http://dx.doi.org/10.17632/m7w688khs8.1).

Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review.

BACKGROUND: Emotional disorders, such as anxiety and depression, are one of the main causes of disability worldwide. Recent reviews suggest that Acceptance and Commitment Therapy is effective in treating emotional disorders. However, they appraise mainly individual approaches. This review aimed to analyze published studies regarding the usefulness of Acceptance and Commitment Therapy, applied on a group basis, in the treatment of anxiety and depression. METHODS: A systematic review of the literature was conducted using the Web of Science, from 2008 to 2019. Fifteen articles fulfilled the inclusion criteria. RESULTS: Those patients who received interventions based on Acceptance and Commitment Therapy showed a better emotional state and greater psychological flexibility than patients in control groups without treatment. No differences are found with Cognitive Therapy and Cognitive-Behavioral Therapy. LIMITATIONS: the studies reviewed show limitations, principally regarding sample characteristics, study design and manner in which mechanisms responsible for changes are evaluated. CONCLUSION: Group-based Acceptance and Commitment Therapy proved to be useful in the psychological treatment of emotional disorders. However, the heterogeneity and limitations of the studies, make it impossible to determine the exact therapeutic elements, and if they are specific to the approach and procedure of this therapy. More research would be necessary to ascertain what patient and/or intervention characteristics might improve results and what the active and specific ingredients of the therapy are. This has clinical relevance because group-based interventions could be more cost-efficient, and it would help facilitate health-care decisions aimed at giving the public access to useful treatments.

Activación Conductual en formato grupal para ansiedad y depresión: una revisión sistemática / Behavioral Activation in group format for anxiety and depression: a systematic review

Resumen Dada la alta prevalencia de los Trastornos Mentales Comunes (TMC), la aplicación grupal de la Activación Conductual (AC) puede ser un abordaje eficaz, efectivo y más eficiente. El objetivo del presente trabajo es revisar los estudios publicados sobre la utilidad de la AC grupal para el tratamiento de la ansiedad y/o depresión. Método: Revisión sistemática. Resultados: Se incluyeron 17 estudios. Los pacientes que recibieron AC experimentaron mejoras en ansiedad y/o depresión y se informa de una mayor eficacia de AC frente a grupos control sin intervención. Conclusiones: La AC es útil para la prevención y el tratamiento de trastornos emocionales. No obstante, la heterogeneidad y limitaciones de los estudios impiden determinar los ingredientes terapéuticos exactos, y si éstos son específicos del enfoque y procedimiento de esta terapia. Sería necesario más investigación, de mayor calidad metodológica, y que evalúe los cambios en los patrones de activación/evitación objeto de intervención.

Abstract Given the high prevalence of Common Mental Disorders (CMD), group-based Behavioral Activation (BA) could be an efficacious, effective and more efficient approach. The objective of this work is to review the published studies about the usefulness of group-based BA for the treatment of anxiety and/or depression. Method: Systematic review. Results: 17 studies were included in the review. Patients who received BA experienced improvements in anxiety and/or depression and studies reported a greater efficacy of BA compared with no-intervention control groups. Conclusions: BA is useful for the prevention and treatment of emotional disorders. However, heterogeneity and limitations of the studies make it impossible to determine the exact therapeutic elements, and if they are specific to the approach and procedure of this therapy. More research would be necessary of a higher methodological quality to evaluate changes in the activation/avoidance patterns, which are the object of the intervention.