Bases teóricas y apoyo empírico de la intervención psicológica sobre los desórdenes emocionales en atención primariauna actualización

  1. Cano Vindel, Antonio 1
  1. 1 Universidad Complutense de Madrid
    info

    Universidad Complutense de Madrid

    Madrid, España

    ROR 02p0gd045

Revista:
Ansiedad y estrés

ISSN: 1134-7937

Año de publicación: 2011

Volumen: 17

Número: 2-3

Páginas: 157-184

Tipo: Artículo

DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Ansiedad y estrés

Resumen

Los desórdenes emocionales (DE), que incluyen trastornos de ansiedad, del estado de ánimo y adaptativos, comparten con las somatizaciones una fuerte asociación con factores psicosociales, como el estrés, altos niveles de ansiedad o emocionalidad negativa, y son muy frecuentes en Atención Primaria (AP). La hiperfrecuentación de estos pacientes, el bajo grado de adecuación del tratamiento convencional a la evidencia científica y su baja eficacia han llevado a la puesta en marcha de programas de intervención psicológica de tipo cognitivo-conductual en AP, que mejoran la eficacia, la eficiencia, y están recomendados por guías clínicas de alta calidad. En el presente artículo se propone un enfoque de los DE y somatizaciones basado en problemas de regulación emocional (elevados sesgos cognitivos y aprendizaje emocional desadaptado), que defiende la posibilidad de hacer reversibles estos procesos cognitivo-emocionales que han llevado al desorden, usando técnicas cognitivo-conductuales, especialmente reestructuración cognitiva y exposición. Además, se analizan y discuten las bases teóricas de estas técnicas (que pueden ser el soporte psicológico de programas colaborativos), de acuerdo con los principios de una correcta regulación emocional (disminución de los sesgos cognitivos y aprendizaje emocional readaptado). Finalmente, se recomienda la diseminación de estos tratamientos psicológicos eficaces, con enfoque transdiagnóstico y tareas para casa apoyadas en Internet, a través de la aplicación de programas colaborativos escalonados en AP.

Referencias bibliográficas

  • Aldao, A., & Nolen-Hoeksema, S. (2010). Specificity of cognitive emotion regulation strategies: a transdiagnostic examination. Behaviour Research and Therapy, 48, 974-983.
  • Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotionregulation strategies across psychopathology: A metaanalytic review. Clinical Psychology Review, 30, 217-237.
  • Allen, L. B., & Barlow, D. H. (2009). Relationship of exposure to clinically irrelevant emotion cues and obsessivecompulsive symptoms. Behavior Modification, 33, 743-762.
  • Allen, L. B., White, K. S., Barlow, D. H., Shear, M. K., Gorman, J. M., & Woods, S. W. (2010). Cognitive-Behavior Therapy (CBT) for Panic Disorder: Relationship of Anxiety and Depression Comorbidity with Treatment Outcome. Journal of Psychopathology and Behavioral Assessment, 32, 185-192.
  • Amstadter, A. (2008). Emotion regulation and anxiety disorders. Journal of Anxiety Disorders, 22, 211-221.
  • Amstadter, A. B., & Vernon, L. L. (2008). A Preliminary Examination of Thought Suppression, Emotion Regulation, and Coping in a Trauma Exposed Sample. Journal of Aggression, Maltreatment & Trauma, 17, 279-295.
  • Arch, J. J., & Craske, M. G. (2006). Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behaviour Research and Therapy, 44, 1849-1858.
  • Bados López, A. (2009, 27-01-2009). Agorafobia y pánico: naturaleza, evaluación y tratamiento (2009). Universitat de Barcelona. Departament de Personalitat, Avaluació i Tractament Psicològic: http://hdl.handle.net/2445/6261
  • Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van, I. M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: a meta-analytic study. Psychological Bulletin, 133, 1-24.
  • Barlow, D. H., Farchione, T., J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., et al. (2011). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Therapist Guide. New York: Oxford University Press.
  • Bentall, R. P., Rowse, G., Shryane, N., Kinderman, P., Howard, R., Blackwood, N., et al. (2009). The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Archives of General Psychiatry, 66, 236-247.
  • Berking, M., Wupperman, P., Reichardt, A., Pejic, T., Dippel, A., & Znoj, H. (2008). Emotion-regulation skills as a treatment target in psychotherapy. Behaviour Research and Therapy, 46, 1230-1237.
  • Brewin, C. R. (1989). Cognitive change processes in psychotherapy. Psychological Review, 96, 379-394.
  • Brewin, C. R., Dalgleish, T., & Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103, 670-686.
  • Brosan, L., Hoppitt, L., Shelfer, L., Sillence, A., & Mackintosh, B. (2010). Cognitive bias modification for attention and interpretation reduces trait and state anxiety in anxious patients referred to an out-patient service: Results from a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 42, 258-264.
  • Brown, T. A., & Barlow, D. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: implications for assessment and treatment. Psychological Assessment, 21, 256-271.
  • Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clinical Psychology Review, 26, 17-31.
  • Cabedo, E., Belloch, A., Carrio, C., Larsson, C., Fernandez-Alvarez, H., & Garcia, F. (2010). Group versus individual cognitive treatment for obsessive-compulsive disorder: Changes in severity at posttreatment and one-year followup. Behavioural and Cognitive Psychotherapy, 38, 227-232.
  • Cannon, M. F., & Weems, C. F. (2010). Cognitive biases in childhood anxiety disorders: do interpretive and judgment biases distinguish anxious youth from their non-anxious peers? Journal of Anxiety Disorders, 24, 751-758.
  • Cano Vindel, A. (2007). La naturaleza y el tratamiento del trastorno de pánico con agorafobia. Boletín de la SEAS, 27, 11-23. Recuperado de http://www.ucm.es/info/seas/ Boletine/boseas27.pdf.
  • Cano-Vindel, A. (1989). Cognición, emoción y personalidad: un estudio centrado en la ansiedad. Madrid: Universidad Complutense.
  • Cano-Vindel, A. (1995). Orientaciones en el estudio de la emoción. In E. G. Fernández-Abascal (Ed.), Manual de Motivación y Emoción (pp. 337-383). Madrid: Centro de Estudios Ramón Areces.
  • Cano-Vindel, A. (2001). Inventario de Actividad Cognitiva en los Trastornos de Ansiedad (IACTA). Unpublished manuscript, Madrid: Universidad Complutense de Madrid.
  • Cano-Vindel, A. (2002). Técnicas cognitivas en el control del estrés. In E. G. Fernández-Abascal & M. P. Jiménez Sánchez (Eds.), Control del Estrés (pp. 247-271). Madrid: UNED Ediciones.
  • Cano-Vindel, A. (2003). Desarrollos actuales en el estudio del control emocional. Ansiedad y Estrés, 9, 203-229.
  • Cano-Vindel, A. (2004). La ansiedad. Claves para vencerla. Málaga: Arguval.
  • Cano-Vindel, A. (2011). Los desórdenes emocionales en Atención Primaria. Ansiedad y Estrés, 17, 73-95.
  • Cano-Vindel, A., Dongil Collado, E., & Wood, C. (2011a). El Estrés. Barcelona: OcéanoÁmbar.
  • Cano-Vindel, A., Dongil-Collado, E., Salguero, J. M., & Wood, C. M. (en prensa). Intervención cognitivo-conductual en los trastornos de ansiedad: una actualización. Infomació Psicològica.
  • Cano-Vindel, A., & Fernández-Castro, J. (1999). Procesos Cognitivos y Emoción. Presentación del Monográfico. Ansiedad y Estrés, 5, 127-128.
  • Cano-Vindel, A., & Miguel-Tobal, J. J. (1999). Valoración, afrontamiento y ansiedad. Ansiedad y Estrés, 5, 129-143.
  • Cano-Vindel, A., & Serrano Beltrán, M. (2006). Para no enfermar de estrés. Cómo combatir la ansiedad laboral. Madrid: Recoletos Grupo de Comunicación.
  • Cano-Vindel, A., Wood, C. M., Dongil, E., & Latorre, J. M. (2011b). El trastorno de pánico en Atención Primaria. Papeles del Psicólogo, 32, 3-13.
  • Cape, J., Whittington, C., Buszewicz, M., Wallace, P., & Underwood, L. (2010). Brief psychological therapies for anxiety and depression in primary care: meta-analysis and metaregression. BMC Medicine, 8, 38.
  • Carey, T. A. (2011). Exposure and reorganization: the what and how of effective psychotherapy. Clinical Psychology Review, 31, 236-248.
  • Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion Regulation and the Anxiety Disorders: An Integrative Review. Journal of Psychopathology and Behavioral Assessment, 32, 68-82.
  • Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470.
  • Craske, M. G., & Pontillo, D. C. (2001). Cognitive biases in anxiety disorders and their effect on cognitive-behavioral treatment. Bulletin of the Menninger Clinic, 65, 58-77.
  • Craske, M. G., Stein, M. B., Sullivan, G., Sherbourne, C., Bystritsky, A., Rose, R. D., et al. (2011). Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. Archives of General Psychiatry, 68, 378-388.
  • Darves-Bornoz, J. M., Alonso, J., de Girolamo, G., de Graaf, R., Haro, J. M., Kovess-Masfety, V., et al. (2008). Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey. Journal of Traumatic Stress, 21, 455-462.
  • Delgado, M. R., Olsson, A., & Phelps, E. A. (2006). Extending animal models of fear conditioning to humans. Biological Psychology, 73, 39-48.
  • Dongil Collado, E. (2008). Reestructuración cognitiva: Un caso de estrés postraumático. Ansiedad y Estrés, 14, 265-288.
  • Dongil Collado, E., & Wood, C. (2009). El tratamiento de la fobia a volar. Boletín de la SEAS, 30, 10-24. Recuperado de http://www.ucm.es/info/seas/ Boletine/boseas30.pdf.
  • Dunsmoor, J. E., Ahs, F., & Labar, K. S. (2011). Neurocognitive mechanisms of fear conditioning and vulnerability to anxiety. Frontiers in Human Neuroscience, 5, 35.
  • Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: a clinical review. Clinical Psychology Review, 31, 203-212.
  • Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319-345.
  • Ehlers, A., Clark, D. M., Hackmann, A., McManus, F., & Fennell, M. (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy, 43, 413-431.
  • Evolution Health. (2011a). Depression Center. Retrieved, March 7, 2011, from http://www.depressioncenter.n et/
  • Evolution Health. (2011b). Panic Center. Retrieved, March 7, 2011, from http://www.paniccenter.net
  • Eysenck, M. W., & Derakshan, N. (1997). Un marco teórico cognitivo para los trastornos de ansiedad. Ansiedad y Estrés, 3, 121-134.
  • Eysenck, M. W., & Eysenck, W. (2007). Four-factor theory and the anxiety disorders. Ansiedad y Estrés, 13, 283-289.
  • Fairburn, C. G., Cooper, Z., Doll, H. A., O'Connor, M. E., Bohn, K., Hawker, D. M., et al. (2009). Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: a two-site trial with 60-week follow-up. American Journal of Psychiatry, 166, 311-319.
  • Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment. Behaviour Research and Therapy, 41, 509-528.
  • Gilliam, W., Burns, J. W., Quartana, P., Matsuura, J., Nappi, C., & Wolff, B. (2010). Interactive effects of catastrophizing and suppression on responses to acute pain: a test of an appraisal x emotion regulation model. Journal of Behavioral Medicine, 33, 191-199.
  • Gonzalez, A., Zvolensky, M. J., Hogan, J., McLeish, A. C., & Weibust, K. S. (2011). Anxiety sensitivity and pain-related anxiety in the prediction of fear responding to bodily sensations: A laboratory test. Journal of Psychosomatic Research, 70, 258-266.
  • Gross, J. J. (1998). Antecedentand response-focused emotion regulation: divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74, 224-237.
  • Hagenaars, M. A., van Minnen, A., Hoogduin, C. A., & Verbraak, M. (2009). A transdiagnostic comparison of trauma and panic memories in PTSD, panic disorder, and healthy controls. Journal of Behavior Therapy and Experimental Psychiatry, 40, 412-422.
  • Hannesdottir, D. K., & Ollendick, T. H. (2007). The role of emotion regulation in the treatment of child anxiety disorders. Clinical Child and Family Psychology Review, 10, 275-293.
  • Harvey, A. G., Murray, G., Chandler, R. A., & Soehner, A. (2011). Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clinical Psychology Review, 31, 225-235.
  • Herrero-Gómez, V., & Cano Vindel, A. (2010). Un caso de trastorno adaptativo con ansiedad: evaluación, tratamiento y seguimiento. Anuario de Psicología Clínica y de la Salud, 6, 53-59.
  • Hervás, G., & Jódar, R. (2008). Adaptación al castellano de la Escala de Dificultades en la Regulación Emocional. Clínica y Salud, 19, 139-156.
  • Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 621-632.
  • Keane, T. M., Zimering, R. T., & Caddell, R. T. (1985). A behavioral formulation of PTSD in Vietnam veterans. Behavior Therapist, 8, 9-12.
  • Kiropoulos, L. A., Klein, B., Austin, D. W., Gilson, K., Pier, C., Mitchell, J., et al. (2008). Is internet-based CBT for panic disorder and agoraphobia as effective as face-to-face CBT? Journal of Anxiety Disorders, 22, 1273-1284.
  • Lang, P. (1968). Fear reduction and fear behavior: problems in treating a construct. In J. Shlien (Ed.), Research in Psychotherapy (Vol. 3). Washington, D.C.: American Psychological Association.
  • Lazarus, R. S., & Folkman, S. (1986). Estrés y procesos cognitivos. Barcelona: Martínez Roca.
  • Leal-Carcedo, L. (2011). Actividad cognitiva en el trastorno obsesivo compulsivo. Universidad Complutense, Madrid. Tesis doctoral.
  • Leal-Carcedo, L., & Cano-Vindel, A. (2008). Tratamiento del trastorno obsesivo-compulsivo desde las nuevas perspectivas cognitivas. Estudio de un caso. Ansiedad y Estrés, 14, 321-339.
  • Marks, I., & Dar, R. (2000). Fear reduction by psychotherapies. Recent findings, future directions. British Journal of Psychiatry, 176, 507-511.
  • McHugh, R. K., Otto, M. W., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2007). Cost-efficacy of individual and combined treatments for panic disorder. Journal of Clinical Psychiatry, 68, 1038-1044.
  • McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49, 186-193.
  • McManus, F., Shafran, R., & Cooper, Z. (2010). What does a transdiagnostic approach have to offer the treatment of anxiety disorders? British Journal of Clinical Psychology, 49, 491-505.
  • Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour Research and Therapy, 43, 1281-1310.
  • NICE. (2006). Core interventions in the treatment of obsessive compulsive disorder and body dysmorphic disorder. National Clinical Practice Guideline Number 31. Retrieved, April 22, 2011, from http://guidance.nice.org.uk/CG 31
  • NICE. (2009). The treatment and management of depression in adults with chronic physical health problems (partial update of CG23). Retrieved, April 22, 2011, from http://guidance.nice.org.uk/CG 91
  • NICE. (2010). Depression: the NICE guideline on the treatment and management of depression in adults (update). Retrieved, April 22, 2011, from http://guidance.nice.org.uk/CG 90
  • NICE. (2011a). Common mental health disorders: identification and pathways to care. Retrieved, July 22, 2011, from http://guidance.nice.org.uk/CG 123
  • NICE. (2011b). Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults. Management in primary, secondary and community care. Retrieved, March 7, 2011, from http://guidance.nice.org.uk/CG 113
  • Norton, P. J., & Price, E. C. (2007). A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. Journal of Nervous and Mental Disease, 195, 521-531.
  • Olivares, J., Rosa-Alcázar, A. I., & Olivares-Olivares, P. J. (2009). Transmisión de información cualificada frente a tratamiento psicológico estructurado de adolescentes con fobia social generalizada. International Journal Of Clinical And Health Psychology, 9, 241-258.
  • Paquet, C., Kergoat, M. J., & Dube, L. (2005). The role of everyday emotion regulation on pain in hospitalized elderly: insights from a prospective within-day assessment. Pain, 115, 355-363.
  • Pincus, D. B., May, J. E., Whitton, S. W., Mattis, S. G., & Barlow, D. H. (2010). Cognitivebehavioral treatment of panic disorder in adolescence. Journal of Clinical Child and Adolescent Psychology, 39, 638-649.
  • Ramos-Cejudo, J., & Cano-Vindel, A. (2008). Tratamiento cognitivo-conductual de un caso de trastorno por ansiedad generalizada: el componente metacognitivo. Ansiedad y Estrés, 14, 305-319.
  • Rayburn, N. R., & Otto, M. W. (2003). Cognitive-behavioral therapy for panic disorder: a review of treatment elements, strategies, and outcomes. CNS Spectrums, 8, 356-362.
  • Reger, M. A., & Gahm, G. A. (2009). A meta-analysis of the effects of internet-and computer-based cognitivebehavioral treatments for anxiety. Journal of Clinical Psychology, 65, 53-75.
  • Resick, P. A., Galovski, T. E., O'Brien Uhlmansiek, M., Scher, C. D., Clum, G. A., & Young-Xu, Y. (2008). A randomized clinical trial to dismantle components of cognitive processing therapy for posttraumatic stress disorder in female victims of interpersonal violence. Journal of Consulting and Clinical Psychology, 76, 243-258.
  • Roca, M., Gili, M., Garcia-Garcia, M., Salva, J., Vives, M., Garcia Campayo, J., et al. (2009). Prevalence and comorbidity of common mental disorders in primary care. Journal of Affective Disorders, 119, 52-58.
  • Roy-Byrne, P., Craske, M. G., Sullivan, G., Rose, R. D., Edlund, M. J., Lang, A. J., et al. (2010). Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. JAMA, 303, 1921-1928.
  • Schienle, A., Schafer, A., Hermann, A., Rohrmann, S., & Vaitl, D. (2007). Symptom provocation and reduction in patients suffering from spider phobia: an fMRI study on exposure therapy. European Archives of Psychiatry and Clinical Neuroscience, 257, 486-493.
  • Schneider, R., & Schulte, D. (2008). Catastrophic associations predict level of change in anxiety sensitivity in response to cognitive-behavioural treatment for panic. Behaviour Research and Therapy, 46, 557-572.
  • Scott, K. M., Bruffaerts, R., Tsang, A., Ormel, J., Alonso, J., Angermeyer, M. C., et al. (2007). Depression-anxiety relationships with chronic physical conditions: results from the World Mental Health Surveys. Journal of Affective Disorders, 103, 113-120.
  • Sirgo, A., Díaz Ovejero, M. B., Cano-Vindel, A., & Pérez Manga, G. (2001). Ansiedad, ira y depresión en mujeres con cáncer de mama. Ansiedad y Estrés, 7, 259-271.
  • Starcevic, V., & Berle, D. (2006). Cognitive specificity of anxiety disorders: a review of selected key constructs. Depression and Anxiety, 23, 51-61.
  • Thompson, R. A. (1994). Emotion regulation: a theme in search of definition. Monographs of the Society for Research in Child Development, 59, 25-52.
  • Tull, M. T., Rodman, S. A., & Roemer, L. (2008). An examination of the fear of bodily sensations and body hypervigilance as predictors of emotion regulation difficulties among individuals with a recent history of uncued panic attacks. Journal of Anxiety Disorders, 22, 750-760.
  • van der Windt, D. A., Dunn, K. M., Spies-Dorgelo, M. N., Mallen, C. D., Blankenstein, A. H., & Stalman, W. A. (2008). Impact of physical symptoms on perceived health in the community. Journal of Psychosomatic Research, 64, 265-274.
  • van Middendorp, H., Geenen, R., Sorbi, M. J., van Doornen, L. J., & Bijlsma, J. W. (2005). Emotion regulation predicts change of perceived health in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases, 64, 1071-1074.
  • Vidal-Fernández, J., Ramos-Cejudo, J., & Cano-Vindel, A. (2008). Perspectivas cognitivas en el tratamiento de la fobia social: estudio de un caso clínico. Ansiedad y Estrés, 14, 289-303.
  • Watkins, E. R. (2009). Depressive Rumination and Co-Morbidity: Evidence for Brooding as a Transdiagnostic Process. Journal of Rational-Emotive and Cognitive Behavior Therapy, 27, 160-175.
  • Wilamowska, Z. A., Thompson-Hollands, J., Fairholme, C. P., Ellard, K. K., Farchione, T. J., & Barlow, D. H. (2010). Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depression and Anxiety, 27, 882-890.
  • Wood, C. (2006). La hiperventilación como método de exposición interoceptiva en el tratamiento del trastorno de pánico. Boletín de la SEAS, 25, 10-19. Recuperado de http://www.ucm.es/info/seas/ Boletine/boseas25.pdf.
  • Wood, C. M. (2008). Doce sesiones de tratamiento cognitivo conductual en un caso de trastorno de pánico con agorafobia. Ansiedad y Estrés, 14, 239-251.
  • Zvolensky, M. J., Schmidt, N. B., Bernstein, A., & Keough, M. E. (2006). Risk-factor research and prevention programs for anxiety disorders: a translational research framework. Behaviour Research and Therapy, 44, 1219-1239.
Fuente de los datos: Dialnet