Efetividade do Protocolo Unificado sobre sintomas de ansiedade e depressão em adultos mexicanos
Palavras-chave:
protocolo unificado, transtornos emocionais, neuroticismoResumo
Transtornos emocionais, como ansiedade e depressão, representam um problema de saúde pública mundial devido ao impacto nos indicadores de qualidade de vida das pessoas que sofrem com isso. A psicologia clínica passou a desenvolver diversas intervenções para o tratamento específico de cada uma delas. No entanto, a pesquisa e a prática clínica têm mostrado as limitações práticas que isso acarreta, razão pela qual vários grupos de pesquisa começaram a desenvolver intervenções transdiagnósticas para superar essas limitações. Objetivo: Este artigo relata a efetividade do Protocolo Unificado (UP) na modalidade online em uma série de casos (n=3) que apresentaram sintomas de ansiedade e depressão. Metodologia: delineamento intrassujeito com medidas pré e pós-tratamento. Dentre os instrumentos, foram utilizados o PHQ-9, GAD-7, DERS-E ODIS e OASIS. Foram realizadas análises entre o pré e o pós-tratamento dos três primeiros instrumentos, por meio de mudança clínica objetiva e inspeção visual da evolução semanal dos dois últimos. Resultados: observou-se uma diminuição nos escores nos três participantes do PHQ-9, GAD-7, DERS-E, que foi comparada com a tendência de queda nos escores ODSIS e OASIS. Conclusão: a intervenção foi clinicamente significativa para os participantes e evidenciou a flexibilidade na aplicação da (UP) online, no entanto, as principais limitações foram a existência de instrumentos que medem aspectos da personalidade que foram utilizados em outras investigações e uma avaliação de seguimento.
Downloads
Referências
Barlow, D. H., Allen, L. B., & Choate, M. L. (2016). Toward a Unified Treatment for Emotional Disorders - Republished Article. Behavior therapy, 47(6), 838–853. https://doi.org/10.1016/j.beth.2016.11.005
Barlow, D.H., Ellard, K. K., Fairholme, C., Farchione, T. J., boisseau, C., Allen, L., & Ehrenreich-may, J. (2011a). Unified protocol forthe transdiagnostic treatment of emotional disorders: Work-book. Oxford University Press.
Barlow, D. H., Ellard, K. K., Sauer-Zavala, S., Bullis, J. R., & Carl, J. R. (2014). The Origins of Neuroticism. Perspectives on psychological science: a journal of the Association for Psychological Science, 9(5), 481–496. https://doi.org/10.1177/1745691614544528
Barlow, D.H., Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L, Allen, L.B., Ehrenreich-May, J. (2011). The unified protocol for transdiagnostic treatment of emotional disorders: therapist guide. Oxford University Press.
Bullis, J.R., Boettcher, H., Sauer-Zavala, S., Farchione, T.J. & Barlow, D.H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. Clinical Psychology Science and Practice, 26: e12278. https://doi.org/10.1111/cpsp.12278
Cardiel, R. (1994). La medición de la calidad de vida. En L. Moreno, F. Cano-Valle y H. García-Romero (Eds.): Epidemiología clínica (pp. 189-199). Interamericana-McGraw-Hill.
Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Depression and anxiety, 35(6), 502–514. https://doi.org/10.1002/da.22728
de la Rosa-Gómez, A., Flores-Plata, L. A., Esquivel-Santoveña, E. E., Santillán Torres Torija, C., García-Flores, R., Dominguez-Rodriguez, A., Arenas-Landgrave, P., Castellanos-Vargas, R. O., Berra-Ruiz, E., Silvestre-Ramírez, R., Miranda-Díaz, G. A., Díaz-Sosa, D. M., Hernández-Posadas, A., Flores-Elvira, A. I., Valencia, P. D., & Vázquez-Sánchez, M. F. (2022). Efficacy of a transdiagnostic guided internet-delivered intervention for emotional, trauma and stress-related disorders in Mexican population: study protocol for a randomized controlled trial. BMC psychiatry, 22(1), 537. https://doi.org/10.1186/s12888-022-04132-6
Dominguez-Rodriguez, A., Chavez-Valdez, S. M., Avitia, G. C., & Valencia-Espinoza, L. C. (2020). Unified protocol for anxiety disorders in two cities of Mexico measuring gamma activity: Study protocol for a randomized controlled trial. Contemporary clinical trials communications, 18, 100556. https://doi.org/10.1016/j.conctc.2020.100556
Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H. (2010). Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: Protocol Development and Initial Outcome Data. Cognitive and behavioral practice, 17(1), 88–101. https://doi.org/10.1016/j.cbpra.2009.06.002
Familiar, I., Ortiz-Panozo, E., Hall, B., Vieitez, I., Romieu, I., Lopez-Ridaura, R., & Lajous, M. (2015). Factor structure of the Spanish version of the Patient Health Questionnaire-9 in Mexican women. International journal of methods in psychiatric research, 24(1), 74–82. https://doi.org/10.1002/mpr.1461
García-Campayo, J., Zamorano, E., Ruiz, M., Pardo, A., Pérez-Páramo, M., López-Gómez, V., . . . 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, 8. https://doi.org/10.1186/1477-7525-8-8
GBD 2019 Mental Disorders Collaborators (2022). Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. The lancet. Psychiatry, 9(2), 137–150. https://doi.org/10.1016/S2215-0366(21)00395-3
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346. https://doi.org/10.31887/DCNS.2015.17.3/akaczkurkin
Kato, N., Ito, M., Matsuoka, Y. J., Horikoshi, M., & Ono, Y. (2021). Application of the Unified Protocol for a Japanese Patient with Post-Traumatic Stress Disorder and Multiple Comorbidities: A Single-Case Study. International journal of environmental research and public health, 18(21), 11644. https://doi.org/10.3390/ijerph182111644
Lahey B. B. (2009). Public health significance of neuroticism. The American psychologist, 64(4), 241–256. https://doi.org/10.1037/a0015309
Liu, Q., He, H., Yang, J., Feng, X., Zhao, F., & Lyu, J. (2020). Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. Journal of psychiatric research, 126, 134–140. https://doi.org/10.1016/j.jpsychires.2019.08.002
Marín Tejeda, M., Robles García, R., González-Forteza, C., Andrade Palos. & Patricia, . (2012). Propiedades psicométricas de la escala “Dificultades en la Regulación Emocional” en español (DERS-E) para adolescentes mexicanos. Salud Mental, 35(6), 521-526. Retrieved from http://revistasaludmental.mx/index.php/salud_mental/article/view/1510
McRae, K., & Gross, J. J. (2020). Emotion regulation. Emotion (Washington, D.C.), 20(1), 1–9. https://doi.org/10.1037/emo0000703
Osma, J., Martínez-García, L., Peris-Baquero, Ó., Navarro-Haro, M. V., González-Pérez, A., & Suso-Ribera, C. (2021). Implementation, efficacy and cost effectiveness of the unified protocol in a blended format for the transdiagnostic treatment of emotional disorders: a study protocol for a multicentre, randomised, superiority controlled trial in the Spanish National Health System. BMJ open, 11(12), e054286. https://doi.org/10.1136/bmjopen-2021-054286
Osma, J., Quilez-Orden, A., Suso-Ribera, C., Peris-Baquero, O., Norman, S. B., Bentley, K. H., & Sauer-Zavala, S. (2019). Psychometric properties and validation of the Spanish versions of the overall anxiety and depression severity and impairment scales. Journal of affective disorders, 252, 9–18. https://doi.org/10.1016/j.jad.2019.03.063
Osma, J., Sánchez-Gómez, A., & Peris-Baquero, Ó. (2018). Applying the unified protocol to a single case of major depression with schizoid and depressive personality traits. Psicothema, 30(4), 364–369. https://doi.org/10.7334/psicothema2018.41
Osma, J., Suso-Ribera, C., García-Palacios, A., Crespo-Delgado, E., Robert-Flor, C., Sánchez-Guerrero, A., Ferreres-Galan, V., Pérez-Ayerra, L., Malea-Fernández, A., & Torres-Alfosea, M. Á. (2018). Efficacy of the unified protocol for the treatment of emotional disorders in the Spanish public mental health system using a group format: study protocol for a multicenter, randomized, non-inferiority controlled trial. Health and quality of life outcomes, 16(1), 46. https://doi.org/10.1186/s12955-018-0866-2
Ost L. G. (2014). The efficacy of Acceptance and Commitment Therapy: an updated systematic review and meta-analysis. Behaviour research and therapy, 61, 105–121. https://doi.org/10.1016/j.brat.2014.07.018
Peláez, T., López-Carrillero, R., Ferrer-Quintero, M., Ochoa, S., & Osma, J. (2022). Application of the unified protocol for the transdiagnostic treatment of comorbid emotional disorders in patients with ultra-high risk of developing psychosis: A randomized trial study protocol. Frontiers in psychology, 13, 976661. https://doi.org/10.3389/fpsyg.2022.976661
Raines, A. M., Oglesby, M. E., Allan, N. P., Short, N. A., & Schmidt, N. B. (2016). Understanding DSM-5 Hoarding Disorder: A Triple Vulnerability Model. Psychiatry, 79(2), 120–129. https://doi.org/10.1080/00332747.2016.1167474
Ranjbari, T., Karimi, J., Mohammadi, A., & Norouzi, M. R. (2018). An evaluation of the contributions of the triple vulnerability model to the prediction of emotional disorders. Iranian Journal of Psychiatry and Clinical Psychology, 23(4), 408–423. https://doi.org/10.29252/nirp.ijpcp.23.4.408
Sauer-Zavala, S & Barlow, D. H (2021). Neuroticism. A new framework for emotional disorders and their treatment. The Guilford Press.
Sauer-Zavala, S., Gutner, C. A., Farchione, T. J., Boettcher, H. T., Bullis, J. R., & Barlow, D. H. (2017). Current Definitions of "Transdiagnostic" in Treatment Development: A Search for Consensus. Behavior therapy, 48(1), 128–138. https://doi.org/10.1016/j.beth.2016.09.004
Schaeuffele, C., Homeyer, S., Perea, L., Scharf, L., Schulz, A., Knaevelsrud, C., Renneberg, B., & Boettcher, J. (2022). The unified protocol as an-internet-based intervention for emotional disorders: Randomized controlled trial. PloS one, 17(7), e0270178. https://doi.org/10.1371/journal.pone.0270178
Yang, X., Fang, Y., Chen, H., Zhang, T., Yin, X., Man, J., Yang, L., & Lu, M. (2021). Global, regional and national burden of anxiety disorders from 1990 to 2019: results from the Global Burden of Disease Study 2019. Epidemiology and psychiatric sciences, 30, e36. https://doi.org/10.1017/S2045796021000275
Zemestani, M., Ommati, P., Rezaei, F., & Gallagher, M. W. (2022). Changes in neuroticism-related constructs over the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in patients on an optimal dose of SSRI. Personality disorders, 13(2), 171–181. https://doi.org/10.1037/per0000482
Zhang, A., Borhneimer, L. A., Weaver, A., Franklin, C., Hai, A. H., Guz, S., & Shen, L. (2019). Cognitive behavioral therapy for primary care depression and anxiety: a secondary meta-analytic review using robust variance estimation in meta-regression. Journal of behavioral medicine, 42(6), 1117–1141. https://doi.org/10.1007/s10865-019-00046-z
