Developing a smartphone app based on the unified protocol for the transdiagnostic treatment of emotional disorders: a qualitative analysis of users and professionals' perspectives

Emotional Disorders have become the most prevalent mental disorders in the world. In relation to their high prevalence, mental health care from public health services faces major challenges. Consequently, finding solutions to deliver cost-effective evidence-based treatments has become a main goal of today's clinical psychology. Smartphone apps for mental health have emerged as a potential tool to deal with it. However, despite their effectiveness and advantages, several studies suggest the need to involve patients and professionals in the design of these apps from the first stage of the development process. Thus, this study aimed to identify, from both a group of users and professionals, the needs, opinions, expectations and design aspects of a future smartphone app based in the Unified Protocol (UP), that will allow to develop the subsequent technical work of the app engineers. Two focus groups were conducted, one with 7 professionals and the other with 9 users, both groups familiar with the UP. A thematic content analysis based in grounded theory was performed in order to define emergent categories of analysis derived from the interview data. The results revealed 8 common topics in both focus groups and 5 specific key topics were identified in the professionals' focus group. Of the total proposals, 93 % of the professionals' and 78 % of the users' are implemented in the preliminary version of the app

Protocolo Unificado en formato grupal para la mejora de los síntomas de los trastornos emocionales en el sistema de salud público español.

Background: The Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders (EDs) has demonstrated its efficacy in improving dimensions shared by EDs, but there is insufficient evidence regarding the specific symptoms of each ED. The main objective of the study was to evaluate the efficacy of the UP applied in a group format compared with individual Treatment as Usual (TAU), in improving specific ED symptoms. Methods: The study sample (n=243) was a subset of participants of a randomized controlled trial conducted in the Spanish public health system. Specific symptoms assessed from pre-treatment to the six-month follow-up were: depressive, agoraphobic, generalized anxiety, panic, and obsessive-compulsive symptoms. Personality dimensions and quality of life were also measured. Results: There were statistically significant changes after the UP in all the study variables (0.44 = d = 1.35). Changes in depressive symptoms, obsessive-compulsive disorder, and perceived quality of life were superior in the UP. Conclusions: The results support the efficacy of group UP for improving both transdiagnostic dimensions and specific ED symptoms, as well as quality of life, through the public health-care system.Antecedentes: el Protocolo Unificado (PU) para el tratamiento transdiagnóstico de los trastornos emocionales (TEs) ha demostrado eficacia en la mejora de las dimensiones compartidas por los TEs, pero no hay suficiente evidencia respecto a los síntomas específicos de cada uno de los TEs. El objetivo principal de este estudio fue evaluar la eficacia del PU aplicado en formato grupal, en comparación con un Tratamiento Habitual (TH) individual, para mejorar los síntomas específicos de los TEs. Método: la muestra del estudio (n=243) fueron un subgrupo de participantes de un ensayo controlado aleatorizado en el sistema de salud público español. Los síntomas evaluados antes y hasta los 6 meses de seguimiento fueron: depresión, agorafobia, ansiedad generalizada, pánico y obsesivo-compulsivo. También se midieron dimensiones de la personalidad y la calidad de vida. Resultados: se produjeron cambios estadísticamente significativos tras el PU en todas las variables (0.44 = d = 1.35). Los cambios en síntomas de depresión, trastorno obsesivo-compulsivo y calidad de vida fueron superiores en el PU. Conclusiones: los resultados apoyan la eficacia del PU en grupo para mejorar tanto las dimensiones transdiagnósticas, como los síntomas específicos de los TEs, así como la calidad de vida en nuestro sistema público de salud

Assessment of Acceptability and Initial Effectiveness of a Unified Protocol Prevention Program to Train Emotional Regulation Skills in Female Nursing Professionals during the COVID-19 Pandemic

Healthcare professionals, especially women, have shown increases in anxious-depressive symptoms as a consequence of the COVID-19 pandemic. The aim of this pilot study was to evaluate the acceptability and preliminary effectiveness of a Unified Protocol (UP) prevention program to provide emotional regulation skills to cope with stressful situations. The sample consisted of 27 nursing professionals (100% women; mean age: 45.67; SD = 7.71) working in a Spanish public hospital during COVID-19, who were randomized to an immediate treatment group (ITG, n = 13) or to a delayed treatment group (DTG, n = 14, which served as the waiting list control group and received the program 5 weeks after the ITG had received it). The program consisted of five-weekly, two-hour, UP-based group sessions. Variables related to emotional symptomatology, emotional regulation, personality, burnout, and perceived quality of life were evaluated at the following time points: pre-and post-intervention and at 1-, 3-, and 6-month follow-ups. Statistically significant between-group differences showed lower emotional exhaustion and personal accomplishment in favor of the ITG after the intervention. Regarding the effect over time for all participants who received the UP (n = 27), statistically significant reductions were observed in neuroticism, personal accomplishment, and subjective distress caused by traumatic events (-0.23 = d = -0.73). A statistically significant interaction “Time*Condition” was found in anxiety, with increases in the DTG. Participants showed high satisfaction with the UP. These findings show good acceptability and preliminary effectiveness of the UP to reduce the emotional impact of the pandemic in female nursing workers. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

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

INTRODUCTION Emotional disorders (EDs) have become the most prevalent psychological disorders in the general population, which has boosted the economic burden associated with their management. Approximately half of the individuals do not receive adequate treatment. Consequently, finding solutions to deliver cost-effective treatments for EDs has become a key goal of today’s clinical psychology. Blended treatments, a combination of face-to-face and online interventions, have emerged as a potential solution to the previous. The Unified Protocol for the Transdiagnostic Treatment of EDs (UP) might serve this purpose, as it can be applied to a variety of disorders simultaneously and its manualised format makes it suitable for blended interventions. METHODS AND ANALYSIS The study is a multicentre, randomised, superiority, clinical trial. Participants will be 310 individuals with a diagnosis of an ED. They will be randomised to a treatment as usual (individual cognitive behavioural therapy) or a UP condition in a blended format (face-to-face individual UP +online, app-based UP). Primary outcomes will be ED diagnostic criteria and depression and anxiety symptoms. Cost efficiency of the intervention, app usability, as well as opinion and confidence in the treatment will also be evaluated. Assessment points will include baseline and 3 months, 6 months and 12 months after UP treatment. ETHICS AND DISSEMINATION The study has received approvals by the Ethics Research Committee of Navarra, Castellón, Euskadi, Castilla y León, Extremadura, Lleida and Aragón. The study is currently under an approval process by the Ethics Research Committees of all the remaining collaborating centres. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings.Funding for the study was provided by the PI20/00697 project integrated in Plan Estatal de I+D+I 2017–2020 and co-funded by the 'ISCIII-Subdirección General de Evaluación y Fomento de la investigación del Fondo Europeo de Desarrollo Regional (FEDER), Otra manera de hacer Europa'. Co-funding for this study was also provided by Gobierno de Aragón and FEDER 2014–2020 'Construyendo Europa desde Aragón' (research team: S31_20D). These funding sources had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data or decision to submit results

Psychometric properties and validation of the Spanish versions of the overall anxiety and depression severity and impairment scales

Background Anxiety and depressive disorders are the most frequent disorders for which patients seek care in public health settings in Spain. This study aimed at validating the Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS), which are brief screening scales for anxiety and depression consisting of only five items each. Methods The study was conducted in a Spanish clinical sample receiving outpatient mental health treatment (N = 339). A subsample of participants (n = 219) was assessed before and after receiving a course of cognitive-behavioral treatment. Results The results revealed excellent internal consistency estimates (Cronbach's alpha for the OASIS and the ODSIS was 0.87 and 0.94, respectively), along with promising convergent and discriminant validity and test-criterion relationships (i.e., moderate correlation with other measures of depression and anxiety, as well as with neuroticism, quality of life, adjustment, and negative affect). A one-dimensional structure was obtained for the OASIS and the ODSIS. The ROC analyses indicated an area under the curve of 0.83 for the OASIS and the ODSIS when predicting moderate-to-severe anxiety and depression, respectively. Good sensitivity to therapeutic change was also evidence and the analysis of the sensitivity as a function of 1-specificity area suggested a cutoff value of 10 for both scales. Limitations Inter-rater reliability of diagnoses with the ADIS-IV interview could not be investigated and the results obtained may not be generalizable to other samples and health settings. Conclusions The availability of these two short and psychometrically sound measures should make screening of anxiety and depressive symptoms in routine care more feasible

What format of treatment do patients with emotional disorders prefer and why? Implications for public mental health settings and policies

Objective We analyzed the preference of three psychological intervention formats—individual, group, and online—in a sample of 267 patients with a primary diagnosis of emotional disorder in Spanish public mental health settings. Method We studied patients’ preferences considering sociodemographic characteristics, diagnoses, history of psychological treatments, number of sessions, and satisfaction with past interventions. Results Most participants (85.4%) preferred psychological treatment in an individual format, 14.2% in group, and 0.4% online. When comparing the people who chose individual and group treatment, no demographic or clinical differences were found. The arguments against group format were the lack of privacy and expression difficulties. Regarding online format, these included being considered impersonal and ineffective. Conclusion The rejection of group and online psychotherapy formats allows us to define the actions we should carry out in public mental health settings to improve the acceptance of more costeffective therapy formats

Descripción del inventario multidimensional para los trastornos emocionales (MEDI) para la evaluación y diagnóstico dimensional

El modelo híbrido dimensional-categorial para el diagnóstico de los trastornos emocionales propone la existencia de un conjunto de dimensiones compartidas asociadas a la etiología y mantenimiento de los diferentes trastornos emocionales (trastornos de ansiedad, del estado de ánimo y otros trastornos relacionados). El Inventario Multidimensional para los Trastornos Emocionales (MEDI) se desarrolló para evaluar de manera eficiente las dimensiones propuestas por este modelo híbrido (neuroticismo, afecto positivo, estado de ánimo deprimido, activación autónoma, ansiedad somática, ansiedad social, intrusiones cognitivas, reexperimentación traumática y evitación) y cuenta con pruebas de validez en España. El objetivo del presente artículo es describir esta herramienta de evaluación dimensional y comparar sus resultados con los obtenidos siguiendo los criterios del DSM-5 en una serie de casos clínicos. Se discuten las virtudes del MEDI y las ventajas de una perspectiva dimensional transdiagnóstica en la personalización del tratamiento psicológico

Tratamientos psicológicos empíricamente apoyados para adultos: Una revisión selectiva

Antecedentes: los tratamientos psicológicos han mostrado su eficacia, efectividad y eficiencia para el abordaje de los trastornos mentales; no obstante, considerando el conocimiento científico generado en los últimos años, no se dispone de trabajos de actualización en español sobre cuáles son los tratamientos psicológicos con respaldo empírico. El objetivo fue realizar una revisión selectiva de los principales tratamientos psicológicos empíricamente apoyados para el abordaje de trastornos mentales en personas adultas. Método: se recogen niveles de evidencia y grados de recomendación en función de los criterios propuestos por el Sistema Nacional de Salud de España (en las Guías de Práctica Clínica) para diferentes trastornos psicológicos. Resultados: los resultados sugieren que los tratamientos psicológicos disponen de apoyo empírico para el abordaje de un amplio elenco de trastornos psicológicos. El grado de apoyo empírico oscila de bajo a alto en función del trastorno psicológico analizado. La revisión sugiere que ciertos campos de intervención necesitan una mayor investigación. Conclusiones: a partir de esta revisión selectiva, los profesionales de la psicología podrán disponer de información rigurosa y actualizada que les permita tomar decisiones informadas a la hora de implementar aquellos procedimientos psicoterapéuticos empíricamente fundamentados en función de las características de las personas que demandan ayuda. Background: Psychological treatments have shown their efficacy, effectiveness, and efficiency in dealing with mental disorders. However, considering the scientific knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically supported psychological treatments. The main goal was to carry out a selective review of the main empirically supported psychological treatments for mental disorders in adults. Method: Levels of evidence and degrees of recommendation were collected based on the criteria proposed by the Spanish National Health System (Clinical Practice Guidelines) for different psychological disorders. Results: The results indicate that psychological treatments have empirical support for the approach to a wide range of psychological disorders. These levels of empirical evidence gathered range from low to high depending on the psychological disorder analysed. The review indicates the existence of certain fields of intervention that need further investigation. Conclusions: Based on this selective review, psychology professionals will be able to have rigorous, up-to-date information that allows them to make informed decisions when implementing empirically based psychotherapeutic procedures based on the characteristics of the people who require help

Estudio sobre el uso, aceptabilidad e implementación del Protocolo Unificado en psicólogos generales sanitarios en España

The dissemination of evidence-based psychological treatments (EBPT) is a pending task for Clinical Psychology. Through an online sur-vey and following the Theoretical Framework of Acceptability, we ana-lyzed the opinions about use, acceptability and intention to use in the fu-ture of the Unified Protocol for the transdiagnostic treatment of emotional disorders (UP) in a sample of 153 professionals of General Health Psy-chology (GHPs). All participants took a training course in the UP and were grouped depending on their previous experience in the UP application. The results showed high scores in acceptability and intention to use in the future in GHPs regardless of the group. Finally, statistically significant cor-relations were found between intention to use in the future and affective attitude, consistency of the intervention and perceived efficacy (in both groups) and self-efficacy (in the group of GHPs without experience in the use of UP). The UP is an EBPT that presents high levels of acceptance and intention to use by the GHPs who received training in this interven-tion, this will facilitate its dissemination and implementation and will allow a greater number of people to benefit from this treatment.La diseminación de tratamientos psicológicos basados en la evidencia (TPBE) es una tarea pendiente para la Psicología Clínica. A tra-vés de una encuesta online y siguiendo el Modelo Teórico sobre Aceptabi-lidad, analizamos las opiniones sobre el uso, aceptabilidad e intención de uso en el futuro del Protocolo Unificado para el tratamiento transdiagnós-tico de los trastornos emocionales (PU) en una muestra de 153 profesiona-les de la Psicología General Sanitaria (PGS). Todos los participantes habían realizado un curso de formación sobre el PU y se agruparon según su expe-riencia previa con la aplicación del PU. Los resultados mostraron altas pun-tuaciones en aceptabilidad e intención de uso en los PGS con independen-cia del grupo. Se encontraron correlaciones estadísticamente significativas entre la intención de uso en el futuro y la actitud afectiva, coherencia de la intervención y eficacia percibida (en ambos grupos) y autoeficacia (en el grupo de PGS sin experiencia en el uso del PU). El PU es un TPBE que presenta altos niveles de aceptación e intención de uso por parte de los PGS que recibieron formación en esta intervención, esto facilitará su dise-minación e implementación y permitirá que un mayor número de personas puedan beneficiarse de este tratamiento

Psicothema

Resumen tomado de la publicaciónAplicando el protocolo unificado en un caso de depresión mayor y rasgos de personalidad depresivos y esquizoides. Antecedentes: presentamos la utilización del Protocolo Unificado (PU) en un caso de un hombre diagnosticado con Trastorno Depresivo Mayor y rasgos de personalidad Esquizoides y Depresivos. El PU se centra en identificar las conductas de regulación emocional desadaptativas y entrenar en nuevas estrategias de regulación como la re-evaluación cognitiva o la exposición emocional. Método: estudio de investigación de caso único. La intervención se desarrolló en 20 sesiones de 1 hora de duración durante 6 meses. Se realizaron seguimientos a los 3, 6 y 12 meses. Resultados: a los 12 meses de seguimiento se produjo un cambio clínico significativo en la sintomatología depresiva (RCIBDI-II = -5.51), afecto negativo (RCINEGATIVE PANAS = -3.61), calidad de vida (RCIICV-Sp = 4.61) y rasgos de personalidad esquizoides (RCIMCMI-III-Esquizoide = -4.36) y Depresivos (RCIMCMI-III-Depresivos = -5.24). Los rasgos de personalidad no interfirieron en la implementación, curso y adherencia al tratamiento. Los resultados se discuten con respecto a estudios similares basados en la utilización del PU para el entrenamiento en regulación emocional en casos con comorbilidad clínica. Conclusiones: el entrenamiento en estrategias de regulación emocional a través del PU puede ser una propuesta efectiva para el tratamiento de trastornos emocionales con rasgos de personalidad patológicos comórbidos.Universidad de Oviedo. Biblioteca de Psicología; Plaza Feijoo, s/n.; 33003 Oviedo; Tel. +34985104146; Fax +34985104126; [email protected]