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Emotional disorders (ED) such as anxiety, depression and somatization are extremely prevalent disorders that can affect an individual's quality of life and functionality. Primary Health Care (PHC) is the first place to identify most patients with these conditions. Mental health services in the Dominican Republic, as well as in Latin America and the Caribbean in general, are unable to provide appropriate care for most people with mental disorders. Using evidence-based treatment protocols is also crucial to make progress in helping people with ED. The PsicAP project is a group intervention that uses a transdiagnostic approach and is grounded in cognitive-behavioral techniques. The program is implemented in 7 group sessions, each lasting for one and a half hours. The program has been shown to be effective in reducing clinical symptoms, dysfunction, and in improving quality of life. It is also a non-time-intensive, low-cost treatment that is helpful for addressing EDs in a PHC context. The objective is to bring psychological treatments into PHC facilities of Dominican Republic, making them more accessible for a larger amount of the population.
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Trastornos del Humor , Calidad de Vida , Humanos , República Dominicana , Instituciones de Atención Ambulatoria , Cognición , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Emotional disorders are common, and they have become more prevalent since the COVID-19 pandemic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetuate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive-behavioural therapy (tCBT) as a cost-effective alternative. However, it is not suitable for everyone; in some cases, one-on-one sessions may be more effective. The objective of the present study is to compare, in cost-benefit terms, group and individual tCBT with the treatment usually administered in Spanish primary care (TAU). METHODS: A randomized, controlled, multicentre, and single-blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calculate incremental cost-effectiveness and cost-utility ratios. DISCUSSION: This trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped-care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021).
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COVID-19 , Calidad de Vida , Adulto , Análisis Costo-Beneficio , Humanos , Estudios Multicéntricos como Asunto , Pandemias , Atención Primaria de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , SARS-CoV-2 , Resultado del TratamientoRESUMEN
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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Trastornos de Ansiedad , Cuestionario de Salud del Paciente , Ansiedad/psicología , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Análisis Factorial , Humanos , Atención Primaria de SaludRESUMEN
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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OBJECTIVE: Transdiagnostic group cognitive behavior therapy (TD-GCBT) has shown to be efficacious in the treatment of emotional disorders in primary care. However, little is known about possible moderators or predictors of treatment outcome. We aimed to explore the potential predictors and moderators of outcome in a large multicentre randomized controlled trial comparing TD-GCBT plus treatment as usual (TAU) to TAU alone. METHOD: Putative demographic and baseline clinical variables were examined using the PROCESS macro as potential predictors/moderators of depressive and anxiety symptoms at posttreatment and 1-year follow-up. RESULTS: Analyses were based on a study completer sample of 1061 participants randomized to TD-CBT + TAU (n = 527) or TAU alone (n = 534), with 631 participants assessed at the posttreatment evaluation and 388 at the 1-year follow-up. Individuals working or with a partner among sociodemographic variables, and higher baseline comorbidities and more severity of symptoms among clinical variables obtained more benefits from adding TDCBT to TAU. Those taking medication before treatment obtained less benefits from the TD-GCBT than those without prescribed antidepressant medications, after controlling for baseline severity of symptoms. Overall, the moderating effect of clinical (but not sociodemographic) variables remained at 1-year follow-up. CONCLUSION: Findings support largely the generalization of the TD-GCBT for emotional disorders in primary care to a variety of sociodemographic and clinical groups. However, TD-GCBT seems to work to a greater extent for those individuals with a more severe clinical profile. Providing TD-GCBT before prescribing antidepressant medication and while people are still working may enhance the effects of adding this psychological treatment to TAU in primary care.
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BACKGROUND: The prevalence of major depressive disorder (MDD) in Spanish primary care (PC) centres is high. However, MDD is frequently underdiagnosed and consequently only some patients receive the appropriate treatment. The present study aims to determine the utility of the Patient Health Questionnaire-9 (PHQ-9) to identify MDD in a subset of PC patients participating in the large PsicAP study. METHODS: A total of 178 patients completed the full PHQ test, including the depression module (PHQ-9). Also, a Spanish version of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was implemented by clinical psychologists that were blinded to the PHQ-9 results. We evaluated the psychometric properties of the PHQ-9 as a screening tool as compared to the SCID-I as a reference standard. RESULTS: The psychometric properties of the PHQ-9 for a cut-off value of 10 points were as follows: sensitivity, 0.95; specificity, 0.67. Using a cut-off of 12 points, the values were: sensitivity, 0.84; specificity, 0.78. Finally, using the diagnostic algorithm for depression (DSM-IV criteria), the sensitivity was 0.88 and the specificity 0.80. CONCLUSIONS: As a screening instrument, the PHQ-9 performed better with a cut-off value of 12 versus the standard cut-off of 10. However, the best psychometric properties were obtained with the DSM-IV diagnostic algorithm for depression. These findings indicate that the PHQ-9 is a highly satisfactory tool that can be used for screening MDD in the PC setting. TRIAL REGISTRATION: Current Controlled Trials ISRCTN58437086 . Registered 20 May 2013.
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Trastorno Depresivo Mayor/diagnóstico , Cuestionario de Salud del Paciente , Valor Predictivo de las Pruebas , Atención Primaria de Salud/métodos , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Psicometría , Sensibilidad y Especificidad , EspañaRESUMEN
BACKGROUND: Epidemiological studies reveal a high prevalence of alcohol use and comorbidity rates with emotional disorders. This study aims to explore the possible mediational effect of stress-coping strategies on the relationship between symptoms of emotional disorders and problematic alcohol use. METHODS: The sample included 1014 participants (33.82% male, 66.17% female) aged 18 to 75 years (M = 33.0, SD = 15.15). Three mediation analyzes were carried out, for depressive, anxious and somatization symptomatology measured with the LSB-50 in which they acted as an independent variable, the coping strategies of the CSQ as a mediating variable and the problematic alcohol use, measured with AUDIT, as a dependent variable. Additionally, sex, age, educational level, and socioeconomic status were entered as covariates. RESULTS: In all the models, problematic alcohol use was mediated by Problem-Solving Focus and Open Emotional Expression. However, while in depressive symptoms was a fully mediation, in anxious and somatization symptomatology was partially mediated. CONCLUSIONS: The similarities found may be due to shared variance between emotional disorders. Interventions focused on Problem-Solving Focus could improve the emotional symptoms and the problematic alcohol use.
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BACKGROUND: During the COVID-19 lockdown in 2020, the General Council of Psychology in Spain, together with the regional Official Colleges of Psychology, launched the Psychological Care Telephone Program (PCTP) to provide mental health services to the population. METHOD: The aim of the present study was to perform a descriptive analysis of the PCTP by analysing the data collected during the lockdown and at the 12-month follow-up, and to develop a brief protocol designed to standardise data collection procedures. RESULTS: A total of 10,119 inbound telephone calls were made to the PCTP from March to May 2020, and 337 follow-up calls at 12 months. The most common reasons for contacting the PCTP were to consult for symptoms of anxiety (66.8%), depression (30.5%), and/or family problems (13.9%). At the 12-month follow-up, many users experienced anxiety (38%), depressive (35%), and panic (34%) symptoms. More than half of users reported using psychopharmacological medicines. CONCLUSIONS: This study demonstrates the need to offer the population telephone-based mental health consultations during times of crisis. It also shows the importance of systematising intervention and data collection procedures for future crises. We propose a data collection protocol for use with emergency telephone psychological assistance programmes.
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COVID-19 , Servicios de Salud Mental , Teléfono , Humanos , España , COVID-19/epidemiología , Femenino , Masculino , Adulto , Persona de Mediana Edad , Cuarentena/psicología , Recolección de Datos/métodos , Trastornos Mentales/terapia , Trastornos Mentales/epidemiología , Adulto Joven , Adolescente , Anciano , Depresión/epidemiología , Telemedicina , Ansiedad/epidemiología , PandemiasRESUMEN
Despite the high economic costs associated with emotional disorders, relatively few studies have examined the variation in costs according to whether the patient has achieved a reliable recovery. The aim of this study was to explore differences in health care costs and productivity losses between primary care patients from a previous randomized controlled trial (RCT)-PsicAP-with emotional symptoms who achieved a reliable recovery and those who did not after transdiagnostic cognitive-behavioral therapy (TD-CBT) plus treatment as usual (TAU) or TAU alone. Sociodemographic and cost data were obtained for 134 participants treated at five primary care centers in Madrid for the 12-month posttreatment period. Reliable recovery rates were higher in the patients who received TD-CBTâ¯+â¯TAU versus TAU alone (66% vs. 34%, respectively; chi-squareâ¯=â¯13.78, dfâ¯=â¯1, pâ¯<â¯.001). Patients who did not achieve reliable recovery incurred more costs, especially associated with general practitioner consultations (tâ¯=â¯3.01, dfâ¯=â¯132, pâ¯=â¯.003), use of emergency departments (tâ¯=â¯2.20, dfâ¯=â¯132, pâ¯=â¯.030), total health care costs (tâ¯=â¯2.01, dfâ¯=â¯132, pâ¯=â¯.040), and sick leaves (tâ¯=â¯1.97, dfâ¯=â¯132, pâ¯=â¯.048). These findings underscore the societal importance of achieving a reliable recovery in patients with emotional disorders, and further support the value of adding TD-CBT to TAU in the primary care setting.
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Terapia Cognitivo-Conductual , Costos de la Atención en Salud , Humanos , Masculino , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Terapia Cognitivo-Conductual/economía , Terapia Cognitivo-Conductual/métodos , Atención Primaria de Salud/economía , Atención Primaria de Salud/métodos , Eficiencia , Resultado del Tratamiento , Ausencia por Enfermedad/economía , Ausencia por Enfermedad/estadística & datos numéricos , Síntomas Afectivos/terapia , Síntomas Afectivos/economía , Síntomas Afectivos/psicologíaRESUMEN
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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Depresión , Síntomas sin Explicación Médica , Humanos , Ansiedad , Trastornos de Ansiedad/psicología , Depresión/psicología , Estudios Longitudinales , Atención Primaria de SaludRESUMEN
INTRODUCTION: The aim of this study was to use cluster analysis based on the trajectory of five cognitive-emotional processes (worry, rumination, metacognition, cognitive reappraisal and expressive suppression) over time to explore differences in clinical and performance variables in primary care patients with emotional symptoms. METHODS: We compared the effect of adding transdiagnostic cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) according to cluster membership and sought to determine the variables that predicted cluster membership. 732 participants completed scales about cognitive-emotional processes, anxiety and depressive symptoms, functioning, and quality of life (QoL) at baseline, posttreatment, and at 12 months. Longitudinal cluster analysis and logistic regression analyses were carried out. RESULTS: A two-cluster solution was chosen as the best fit, named as "less" or "more" improvement in cognitive-emotional processes. Individuals who achieved more improvement in cognitive-emotional processes showed lower emotional symptoms and better QoL and functioning at all three time points. TAU+TD-CBT, income level, QoL and anxiety symptoms were significant predictors of cluster membership. CONCLUSIONS: These results underscore the value of adding TD-CBT to reduce maladaptive cognitive-emotional regulation strategies. These findings highlight the importance of the processes of change in therapy and demonstrate the relevance of the patient's cognitive-emotional profile in improving treatment outcomes.
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Cognición , Terapia Cognitivo-Conductual , Emociones , Calidad de Vida , Humanos , Masculino , Femenino , Terapia Cognitivo-Conductual/métodos , Análisis por Conglomerados , Adulto , Estudios Longitudinales , Persona de Mediana Edad , Cognición/fisiología , Ansiedad/terapia , Ansiedad/psicología , Depresión/terapia , Depresión/psicología , Resultado del TratamientoRESUMEN
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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Terapia Cognitivo-Conductual , Humanos , Ansiedad/terapia , Trastornos de Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Trastornos del Humor , Resultado del Tratamiento , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Objective: Dropout from psychological treatment is an important problem that substantially limits treatment effectiveness. A better understanding of this phenomenon, could help to minimize it. Therefore, we performed a systematic review of meta-analyses (MA) on dropout from psychological treatments to (1) determine the estimated overall dropout rate (DR) and (2) to examine potential predictors of dropout, including clinical symptoms (anxiety and depression) and sociodemographic factors. Method: A literature search of the PubMed PsycINFO, Embase, Scopus and Google Scholar databases was conducted. We identified 196 MAs on dropout from psychological treatment carried out primarily in adult patients or mixed samples (adults and children) between 1990 and 2022. Of these, 12 met all inclusion criteria. Two forest plots were created to visualize the DR and the relationship between DR and the disorder. Results: The DR ranged from 15.9% to 46.8% and was significantly moderated by symptoms of emotional disorders. The highest DR were observed in younger, unmarried patients, and those with lower educational and income levels. Conclusions: DR in patients undergoing psychological treatment is highly heterogeneous, but higher in individuals presenting symptoms of anxiety and/or depression, especially the latter. Given that high DR undermine the effectiveness of psychological interventions, it is clear that greater efforts are needed to reduce dropout, particularly among individuals with symptoms of emotional disorders.
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Background: Emotion Regulation (ER) involves any explicit or implicit process that may alter the emotion felt, its duration and expression, and is a transdiagnostic factor of vulnerability involved in the etiology and maintenance of different emotional disorders. The Cognitive Emotion Regulation Questionnaire (CERQ) assesses nine cognitive strategies involved in ER and is a valuable tool. Its popularity and wide use led to the development of two abbreviated versions: a version with 18 items (two items per factor) and a 27-item version (three items per factor). Objective: To analyze the psychometric properties of both versions in the Argentinean population. Design: The research design was instrumental. The factor structure of the CERQ-18 and CERQ-27 as well as the reliability of the scores and the construct of each dimension were evaluated. In addition, we gathered validity evidence for its relationship with other variables by associating the CERQ scores with Difficulties in Emotion Regulation Scale (DERS) scores. Results: The CERQ-18 presented more consistent evidence regarding its internal structure (adequate fit indices and factor loadings of moderate magnitude) and reliability. Given that the association of the two versions with the DERS is similar, we recommend that the 18-item version be used. Conclusion: The CERQ-18 has quite similar psychometric properties to the CERQ-27 in the general population of Argentina and the findings contribute to an understanding of its internal structure.
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The aim of this study is to contribute to the evidence regarding variables related to emotional symptom severity and to use them to exemplify the potential usefulness of logistic regression for clinical assessment at primary care, where most of these disorders are treated. Cross-sectional data related to depression and anxiety symptoms, sociodemographic characteristics, quality of life (QoL), and emotion-regulation processes were collected from 1,704 primary care patients. Correlation and analysis of variance (ANOVA) tests were conducted to identify those variables associated with both depression and anxiety. Participants were then divided into severe and nonsevere emotional symptoms, and binomial logistic regression was used to identify the variables that contributed the most to classify the severity. The final adjusted model included psychological QoL (p < .001, odds ratio [OR] = .426, 95% CI [.318, .569]), negative metacognitions (p < .001, OR = 1.083, 95% CI [1.045, 1.122]), physical QoL (p < .001, OR = .870, 95% CI [.841, .900]), brooding rumination (p < .001, OR = 1.087, 95% CI [1.042, 1.133]), worry (p < .001, OR = 1.047, 95% CI [1.025, 1.070]), and employment status (p = .022, OR [.397, 2.039]) as independent variables, ρ2 = .326, area under the curve (AUC) = .857. Moreover, rumination and psychological QoL emerged as the best predictors to form a simplified equation to determine the emotional symptom severity (ρ2 = .259, AUC = .822). The use of statistical models like this could accelerate the assessment and treatment-decision process, depending less on the subjective point of view of clinicians and optimizing health care resources.
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BACKGROUND: Despite the relevance of cognitive processes such as rumination, worry, negative metacognitive beliefs in emotional disorders, the existing literature about how these cognitive processes moderate the effect of treatment in treatment outcomes is limited. The aim of the present study was to explore the potential moderator effect of baseline cognitive processes-worry, rumination and negative metacognitive beliefs-on the relationship between treatment allocation (transdiagnostic cognitive-behavioural therapy -TD-CBT plus treatment as usual-TAU vs. TAU alone) and treatment outcomes (anxiety and depressive symptoms, quality of life [QoL], and functioning) in primary care patients with emotional disorders. METHODS: A total of 631 participants completed scales to evaluate worry, rumination, negative metacognitive beliefs, QoL, functioning, and anxiety and depressive symptoms. RESULTS: Worry and rumination acted as moderators on the effect of treatment for anxiety (b = -1.25, p = .003; b = -0.98, p = .048 respectively) and depressive symptoms (b = -1.21, p = .017; b = -1.34, p = .024 respectively). Individuals with higher baseline levels of worry and rumination obtained a greater reduction in emotional symptoms from the addition TD-CBT to TAU. Negative metacognitive beliefs were not a significant moderator of any treatment outcome. LIMITATIONS: The study assesses cognitive processes over a relatively short period of time and uses self-reported instruments. In addition, it only includes individuals with mild or moderate anxiety or depressive disorders, which limits generalization to other populations. CONCLUSIONS: These results underscore the generalization of the TD-CBT to individuals with emotional disorders in primary care with different cognitive profiles, especially those with high levels of worry and rumination.
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Terapia Cognitivo-Conductual , Calidad de Vida , Humanos , Ansiedad/psicología , Trastornos de Ansiedad/terapia , Trastornos de Ansiedad/psicología , Trastornos del Humor , Terapia Cognitivo-Conductual/métodosRESUMEN
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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Terapia Cognitivo-Conductual , Terapia por Relajación , Análisis Costo-Beneficio , Terapia Cognitivo-Conductual/métodos , Resultado del Tratamiento , Atención Primaria de Salud , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Estudios Multicéntricos como AsuntoRESUMEN
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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Terapia Cognitivo-Conductual , Calidad de Vida , Trastornos de Ansiedad/terapia , Accesibilidad a los Servicios de Salud , Humanos , EspañaRESUMEN
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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Terapia Cognitivo-Conductual , Regulación Emocional , Trastornos de Ansiedad/psicología , Emociones , Humanos , Atención Primaria de Salud , Calidad de VidaRESUMEN
The aim of this study was to examine the potential moderating effect of baseline emotion regulation skills-cognitive reappraisal and expressive suppression-on the relationship between treatment allocation and treatment outcomes in primary care patients with emotional symptoms. A total of 631 participants completed scales to evaluate emotion regulation, anxiety, depression, functioning, and quality of life (QOL). The moderation analysis was carried out using the SPSS PROCESS macro, version 3.5. Expressive suppression was a significant moderator in the relationship between treatment allocation and treatment outcomes in terms of symptoms of anxiety (bâ¯=â¯-0.530, pâ¯=â¯.026), depression (bâ¯=â¯-0.812, pâ¯=â¯.004), and QOL (bâ¯=â¯0.156, pâ¯=â¯.048). Cognitive reappraisal acted as a moderator only in terms of QOL (bâ¯=â¯0.217, pâ¯=â¯.028). The findings of this study show that participants with higher scores of expressive suppression benefited more from the addition of transdiagnostic cognitive-behavioral therapy to treatment as usual (TAU) in terms of anxiety and depressive symptoms, and QOL. Individuals with higher levels of cognitive reappraisal obtained a greater benefit in terms of QOL from the addition of psychological treatment to TAU. These results underscore the relevant role that emotion regulation skills play in the outcomes of psychological therapy for emotional symptoms.