Palabras clave
Moderators
Cognitive Behavioral Therapy
Acceptance and Commitment Therapy
Panic disorder Predictores
Moderadores
Terapia Cognitivo Conductual
Terapia de Aceptación y Compromiso
Trastorno de pánico
Cómo citar
Resumen
Antecedentes: Conocer las variables que influyen en el resultado de las terapias puede mejorar los resultados y reducir
el coste sociosanitario. Se examinaron posibles predictores y moderadores de resultado (edad, género, duración del
trastorno de pánico, motivación al cambio, responsabilidad y evitación experiencial) en Terapia Cognitivo Conductual
(TCC) y Terapia de Aceptación y Compromiso (ACT). Método: Ochenta participantes con trastorno de pánico, 56
mujeres y 24 hombres, con una edad media de 38 años, recibieron 12 sesiones grupales de TCC o ACT. Fueron
evaluados con varias medidas antes, después del tratamiento y en un seguimiento a los tres meses. Resultados: TCC
superó a ACT entre las personas mayores, hombres y con menor duración del trastorno de pánico. ACT superó a
TCC entre los más jóvenes, mujeres y con mayor duración del trastorno. En general, las mujeres de mayor edad, con
trastorno de pánico de larga duración, en etapa de contemplación y con una alta evitación experiencial mejoraron más,
tanto en TCC como en ACT. Conclusiones: Aunque son necesarios futuros estudios, parecen existir predictores y
moderadores de la efectividad de TCC y ACT. Tener en cuenta estas variables puede ayudar a mejorar el tratamiento
de las personas con trastorno de pánico.
Citas
American Psychiatric Association. (2009). Practice guideline for the treatment of patients with panic disorder (2nd ed.).
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Arch, J. J., & Ayers, C. R. (2013). Which treatment worked better for whom? Moderators of group cognitive behavioral therapy versus adapted mindfulness based stress reduction for anxiety disorders. Behaviour Research and Therapy, 51(8), 434–442. https://doi.org/10.1016/j.brat.2013.04.004
Arch, J. J., & Craske, M. G. (2008). Acceptance and commitment therapy and cognitive behavioral therapy for anxiety disorders: Different treatments, similar mechanisms? Clinical Psychology: Science and Practice, 15(4), 263–279. https://doi.org/10.1111/j.1468-2850.2008.00137.x
Arch, J. J., Eifert, G. H., Davies, C. D., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology, 80(5), 750–765. https://doi.org/10.1037/a0028310
Bados, A. (2000). Agorafobia y ataques de pánico [Agoraphobia and panic attacks]. Pirámide.
Bandelow, B., & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21st century. Dialogues in Clinical Neuroscience, 17(3), 327–335.
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). The Guilford Press.
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich May, J. T. (2010). Unified protocol for transdiagnostic treatment of emotional disorders. Oxford University Press. https://doi.org/10.1093/med:psych/9780199772667.001.0001
Başaran, S. K., & Sütcü, S. T. (2016). Effectiveness of cognitive behavioral group therapy for treatment of panic disorder: A systematic review. Current Approaches in Psychiatry, 8(1), 79–94.
Bilet, T., Olsen, T., Andersen, J. R., & Martinsen, E. W. (2020). Cognitive behavioral group therapy for panic disorder in a general clinical setting: A prospective cohort study with 12 to 31-years follow-up. BMC Psychiatry, 20(1), Article 259. https://doi.org/10.1186/s12888-020- 02679-w
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
Bulbena, A., Berrios, G. E., & Fernández de Larrinoa, P. (2000). Medición clínica en psiquiatría y psicología [Clinical measurement in psychiatry and psychology]. Masson.
Cassiello-Robbins, C., Southward, M. W., Tirpak, J. W., & Sauer-Zavala,S. (2020). A systematic review of unified protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review, 78, Article 101852. https://doi.org/10.1016/j.cpr.2020.101852
Chambless, D. L., Caputo, G. C., Bright, P., & Gallagher, R. (1984). Assessment of fear of fear in agoraphobics: The Body Sensations Questionnaire and the Agoraphobic Cognitions Questionnaire. Journal of Consulting and Clinical Psychology, 52(6), 1090–1097. https://doi.org/10.1037/0022006X.52.6.1090
Costa, P. T., & McCrae, R. (2002). Revised NEO personality inventory (NEO PI-R). NEO Five-Factor inventory (NEO-FFI) (2a ed.). TEA Ediciones.
Craske, M. G., & Barlow, D. H. (2007). Mastery of your anxiety and panic: Therapist guide (4th ed.). Oxford University Press.
Craske, M. G., Niles, A. N., Burklund, L. J., Wolitzky-Taylor, K. B., Vilardaga, J. C. P., Arch, J. J., Saxbe, D. E., & Lieberman, M. D. (2014). Randomized controlled trial of cognitive behavioral therapy and acceptance and commitment therapy for social phobia: Outcomes and moderators. Journal of Consulting and Clinical Psychology, 82(6), 1034–1048. https://doi.org/10.1037/a0037212
Davies, C. D., Niles, A. N., Pittig, A., Arch, J. J., & Craske, M. G. (2015). Physiological and behavioral indices of emotion dysregulation as predictors of outcome from cognitive behavioral therapy and acceptance and commitment therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 46, 35–43. https://doi.org/10.1016/j. jbtep.2014.08.002
De’ath, G. (2007). Boosted trees for ecological modeling and prediction. Ecology, 88(1), 243–251. http://www.ncbi.nlm.nih.gov/pubmed/17489472
Dozois, D. J. A., Westra, H. A., Collins, K. A., Fung, T. S., & Garry, J. K. F. (2004). Stages of change in anxiety: Psychometric properties of the University of Rhode Island Change Assessment (URICA) scale. Behaviour Research and Therapy, 42(6), 711–729. https://doi.org/10.1016/S0005-7967(03)00193-1
Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and values-based behavior change strategies. New Harbinger.
Erickson, D. H., Janeck, A. S., & Tallman, K. (2007). A cognitive-behavioral group for patients with various anxiety disorders. Psychiatric Services, 58(9), 1205–1211. https://doi.org/10.1176/ps.2007.58.9.1205
Ferrando, L., Bobes, J., Gibert, J., Soto, M., & Soto, O. (2000). MINI. Entrevista Neuropsiquiátrica Internacional. Versión en español 5.0.0 [MINI. International Neuropsychiatric Interview. Spanish version 5.0.0]. Instituto IAP.
Fonseca-Pedrero, E., Pérez-Álvarez, M., Al-Halabí, S., Inchausti, F., Muñiz, J., López-Navarro, E., Pérez de Albéniz, A., Lucas-Molina, B., Debbané, M., Bobes-Bascarán, M. T., Gimeno-Peón, A., Prado- Abril, J., Fernández-Álvarez, J., Rodríguez-Testal, J. F., González- Pando, D., Díez-Gómez, A., García-Montes, J. M., García-Cerdán, L., Osma, J., … Marrero, R. J. (2021). Tratamientos psicológicos empíricamente apoyados para adultos: una revisión selectiva [Evidence- based psychological treatments for adults: A selective review]. Psicothema, 33(2), 188–197. https://doi.org/https://doi.org/10.7334/psicothema2020.426
Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31(6), 772–799. https://doi.org/10.1177/0145445507302202
Frisch, M. B., Clark, M. P., Rouse, S. V., Rudd, M. D., Paweleck, J. K., Greenstone, A., & Kopplin, D. A. (2005). Predictive and treatment validity of life satisfaction and the Quality of Life Inventory. Assessment, 12(1), 66–78. https://doi.org/10.1177/1073191104268006
Gloster, A. T., Sonntag, R., Hoyer, J., Meyer, A. H., Heinze, S., Ströhle, A., Eifert, G. H., & Wittchen, H. U. (2015). Treating treatment-resistant patients with panic disorder and agoraphobia using psychotherapy: A randomized controlled switching trial. Psychotherapy and Psychosomatics, 84(2), 100–109. https://doi.org/10.1159/000370162
González-Blanch, C., Umaran-Alfageme, O., Cordero-Andrés, P., Muñoz- Navarro, R., Ruiz-Rodríguez, P., Medrano, L. A., Ruiz-Torres, M., Dongil-Collado, E., & Cano-Vindel, A. (2018). Tratamiento psicológico de los trastornos emocionales en Atención Primaria: el manual de tratamiento transdiagnóstico del estudio PsicAP [Psychological treatment of emotional disorders in Primary Care: The transdiagnostic treatment manual of the PsicAP study]. Ansiedad y Estrés, 24(1), 1–11. https://doi.org/10.1016/j.anyes.2017.10.005
Hayes, S. C. (2004). Acceptance and commitment therapy and the new behavior therapies. In S. C. Hayes, V. M. Follette, & M. M. Linehan (Eds.), Mindfulness and acceptance: Expanding the cognitive behavioral tradition (pp. 1–29). The Guilford Press.
Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. The Guilford Press.
Hendriks, G. J., Keijsers, G. P. J., Kampman, M., Hoogduin, C. A. L., & Oude Voshaar, R. C. (2012). Predictors of outcome of pharmacological and psychological treatment of late-life panic disorder with agoraphobia. International Journal of Geriatric Psychiatry, 27(2), 146–150. https://doi.org/10.1002/gps.2700
Hofmann, S. G. (2004). Cognitive mediation of treatment change in social phobia. Journal of Consulting and Clinical Psychology, 72(3), 392– 399. https://doi.org/10.1037/0022-006X.72.3.393
Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta- analyses. Cognitive Therapy and Research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1
Hothorn, T., Bretz, F., & Westfall, P. (2008). Simultaneous inference in general parametric models. Biometrical Journal, 50(3), 346–363. https://doi.org/10.1002/bimj.200810425
Kampman, M., Keijsers, G. P. J., Hoogduin, C. A. L., & Hendriks, G.-J. (2008). Outcome prediction of cognitive behaviour therapy for panic disorder: Initial symptom severity is predictive for treatment outcome, comorbid anxiety or depressive disorder, cluster C personality disorders and initial motivation are not. Behavioural and Cognitive Psychotherapy, 36(1), 99–112. https://doi.org/10.1017/S1352465807004018
Kraemer, H. C., Frank, E., & Kupfer, D. J. (2006). Moderators of treatment outcomes: Clinical, research, and policy importance. Journal of the American Medical Association, 296(10), 1286–1289. https://doi. org/10.1001/jama.296.10.1286
Liddon, L., Kingerlee, R., Seager, M., & Barry, J. A. (2019). What are the factors that make a male-friendly therapy? In J. Barry, R. Kingerlee,
M. Seager, & L. Sullivan (Eds.), The palgrave handbook of male psychology and mental health (pp. 671–694). Palgrave Macmillan.
Lincoln, T. M., Rief, W., Hahlweg, K., Frank, M., Von Witzleben, I., Schroeder, B., & Fiegenbaum, W. (2005). Who comes, who stays, who profits? Predicting refusal, dropout, success, and relapse in a short intervention for social phobia. Psychotherapy Research, 15(3), 210– 225. https://doi.org/10.1080/10503300512331387834
Manfro, G. G., Heldt, E., Cordioli, A. V., & Otto, M. W. (2008). Cognitive- behavioral therapy in panic disorder. Revista Brasileira de Psiquiatria, 30(2), 81–87. https://doi.org/10.1590/S1516-44462008000600005
McCabe, R. E., & Gifford, S. M. (2009). Psychological treatment of panic disorder and agoraphobia. In M. M. Antony, & M. B. Stein (Eds.), Handbook of anxiety and related disorders (pp. 308–320). Oxford University Press.
McConnaughy, E. A., DiClemente, C. C., Prochaska, J. O., & Velicer, W. F. (1989). Stages of change in psychotherapy: A follow-up report.
Psychotherapy, 26(4), 494–503. https://doi.org/10.1037/h0085468
Mesri, B., Niles, A. N., Pittig, A., LeBeau, R. T., Haik, E., & Craske, M.G. (2017). Public speaking avoidance as a treatment moderator for social anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 55, 66–72. https://doi.org/10.1016/j.jbtep.2016.11.010
Meuret, A. E., Hofmann, S. G., & Rosenfield, D. (2010). Catastrophic appraisal and perceived control as moderators of treatment response in panic disorder. International Journal of Cognitive Therapy, 3(3), 262– 277. https://doi.org/10.1521/ijct.2010.3.3.262
Nakano, Y., Lee, K., Noda, Y., Ogawa, S., Kinoshita, Y., Funayama, T., Watanabe, N., Chen, J., Noguchi, Y., & Furukawa, T. A. (2008). Cognitive-behavior therapy for Japanese patients with panic disorder: Acute phase and one-year follow-up results. Psychiatry and Clinical Neurosciences, 62(3), 313–321. https://doi.org/10.1111/j.1440- 1819.2008.01799.x
Niles, A. N., Mesri, B., Burklund, L. J., Lieberman, M. D., & Craske, M. G. (2013). Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia. Behaviour Research and Therapy, 51(10), 669–679. https://doi.org/10.1016/j.brat.2013.06.005
Niles, A. N., Wolitzky-Taylor, K. B., Arch, J. J., & Craske, M. G. (2017). Applying a novel statistical method to advance the personalized treatment of anxiety disorders: A composite moderator of comparative drop-out from CBT and ACT. Behaviour Research and Therapy, 91, 13–23. https://doi.org/10.1016/j.brat.2017.01.001
Norton, P. J., & Roberge, P. (2017). Transdiagnostic therapy. Psychiatric Clinics of North America, 40(4), 675–687. https://doi.org/10.1016/j.psc.2017.08.003
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, Article 46. https://doi.org/10.1186/ s12955-018-0866-2
Otto, M. W., & Deveney, C. (2005). Cognitive-behavioral therapy and the treatment of panic disorder: Efficacy and strategies. The Journal of Clinical Psychiatry, 66(4), 28–32.
Plana-Ripoll, O., Pedersen, C. B., Holtz, Y., Benros, M. E., Dalsgaard, S., de Jonge, P., Fan, C. C., Degenhardt, L., Ganna, A., Greve, A. N.,
Gunn, J., Iburg, K. M., Kessing, L. V., Lee, B. K., Lim, C. C. W., Mors, O., Nordentoft, M., Prior, A., Roest, A. M., … McGrath, J. J. (2019). Exploring comorbidity within mental disorders among a Danish national population. JAMA Psychiatry, 76(3), 259–270. https://doi.org/10.1001/ jamapsychiatry.2018.3658
Prochaska, J. O., & Di Clemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy, 19(3), 276–288. https://doi.org/10.1037/h0088437
R Development Core Team. (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing. http://www.rproject.org/
Ramnerö, J., & Öst, L. G. (2004). Prediction of outcome in the behavioural treatment of panic disorder with agoraphobia. Cognitive Behaviour Therapy, 33(4), 176–180. https://doi.org/10.1080/16506070410031691 Rosser, S., Issakidis, C., & Peters, L. (2003). Perfectionism and social phobia: Relationship between the constructs and impact on cognitive behavior therapy. Cognitive Therapy and Research, 27(2), 143–151.
https://doi.org/https://doi.org/10.1023/A:1023505108426
Ruiz, F. J. (2010). A review of acceptance and commitment therapy (ACT) empirical evidence: Correlation, experimental, sychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10(1), 125–162. https://www.redalyc.org/articulo.oa?id=56017066008
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
Schneider, R. L., Arch, J. J., & Wolitzky-Taylor, K. B. (2015). The state of personalized treatment for anxiety disorders: A systematic review of treatment moderators. Clinical Psychology Review, 38, 39–54. https:// doi.org/10.1016/j.cpr.2015.02.004
Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., Gorman, J. M., & Papp, L. A. (1997). Multicenter collaborative Panic Disorder Severity Scale. American Journal of Psychiatry, 154(11), 1571–1575. https://doi.org/10.1176/ ajp.154.11.1571
Skapinakis, P., Lewis, G., Davies, S., Brugha, T., Prince, M., & Singleton,
N. (2011). Panic disorder and subthreshold panic in the UK general population: Epidemiology, comorbidity and functional limitation. European Psychiatry, 26(6), 354–362. https://doi.org/10.1016/j. eurpsy.2010.06.004
Tolin, D. F. (2010). Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clinical Psychology Review, 30(6), 710–720. https://doi.org/10.1016/j.cpr.2010.05.003
Vallejos, M., Orbegoso, C., & Capa, W. (2007). Escala de evaluación del cambio de la Universidad de Rhode Island (URICA): validez y confiabilidad en drogadependientes [University of Rhode Island Change Assessment scale (URICA): Validity and reliability in drug dependents]. Revista de Psicología, 9, 52–59. https://revistas.ucv.edu. pe/index.php/revpsi/article/view/513
White, K. S., Allen, L. B., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2010). Attrition in a multicenter clinical trial for panic disorder. Journal of Nervous and Mental Disease, 198(9), 665–671. https://doi.org/10.1097/NMD.0b013e3181ef3627
Wolitzky-Taylor, K. B., Arch, J. J., Rosenfield, D., & Craske, M. G. (2012). Moderators and non-specific predictors of treatment outcome for anxiety disorders: A comparison of cognitive behavioral therapy to acceptance and commitment therapy. Journal of Consulting and Clinical Psychology, 80(5), 786–799. https://doi.org/10.1037/a0029418