Cómo citar
Resumen
Antecedentes: 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.
Citas
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