Cost‐effectiveness and cost‐utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP‐Costs): a multicentre randomized controlled trial protocol

Background: Emotional disorders are common, and they have become more prevalent since the COVID‐19 pan‐ demic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetu‐ ate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive‐behavioural therapy (tCBT) as a cost‐effective alternative. However, it is not suitable for everyone; in some cases, one‐on‐one sessions may be more effective. The objective of the present study is to compare, in cost‐benefit terms, group and individual tCBT with the treatment usu‐ ally administered in Spanish primary care (TAU). Methods: A randomized, controlled, multicentre, and single‐blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calcu‐ late incremental cost‐effectiveness and cost‐utility ratios. Discussion: This trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped‐care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems. Trial registration: ClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021

Protocolo transdiagnóstico PsicAP de entrenamiento cognitivo-conductual en grupo para trastornos emocionales

Anxiety disorders and depression are highly prevalent today. The PsicAP clinical trial showed that adding 7 sessions of group cognitive-behavioural training with a transdiagnostic approach to the usual treatment of emotional disorders in adult primary care patients increased efficacy and cost-effectiveness in reducing symptom levels, reduced disability and improved quality of life. In this work, these 7 sessions of the PsicAP protocol of transdiagnostic treatment are described, aimed at intervening on the factors common to the different disorders: cognitive distortions and emotional regulation strategies. It is an intervention based on learning through psychoeducation, cognitive restructuring, relaxation, behavioural techniques and relapse prevention. It concludes by arguing about the usefulness of this protocol to reduce the gap between research and clinical practice, something necessary in today's societyLos trastornos de ansiedad y la depresión son altamente prevalentes en la sociedad actual. El ensayo clínico PsicAP demostró que añadir 7 sesiones de entrenamiento cognitivo-conductual en grupo con enfoque transdiagnóstico al tratamiento habitual de trastornos emocionales en pacientes adultos de atención primaria aumentó la eficacia y coste-efectividad para reducir los niveles de síntomas, redujo la discapacidad y mejoró la calidad de vida. En este trabajo se describen esas 7 sesiones del protocolo PsicAP de tratamiento transdiagnóstico, dirigido a la intervención sobre los factores comunes a los distintos trastornos: las distorsiones cognitivas y las estrategias de regulación emocional. Se trata de una intervención basada en el aprendizaje mediante psicoeducación, reestructuración cognitiva, relajación, técnicas conductuales y prevención de recaídas. Se concluye argumentando sobre la utilidad de este protocolo para reducir la brecha entre investigación y práctica clínica, algo necesario en la sociedad actua

Adaptación y aplicación de escalas de adquisición de competencias en el aprendizaje práctico de la psicoterapia

El aprendizaje de la Psicoterapia requiere la adquisición de conocimientos teórico-prácticos que se ven recogidos en los planes de postgrado (fundamentalmente en el Master en Psicología General Sanitaria). Sin embargo, la adquisición de competencias y habilidades ha pasado a un segundo plano, delegando su adquisición a aprendizajes informales. En este proyecto se pretende aplicar una escala de competencias en psicoterapia (CTTS) a una muestra de psicólogos en formación, analizar sus resultados en función de la dificultad del caso y adoptar las medidas pedagógicas (fundamentalmente de supervisión) que sean necesarias para la potenciación de estas competencias

Predictors of the course of depressive symptomatology in primary care patients : a cohort study of the PsicAP trial

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Psicología, leída el 19-09-2023La depresión es altamente prevalente, genera una elevada discapacidad y altos costes económicos y sociales. Sin embargo, es destacable que el conocimiento existente sobre la presencia de sintomatología depresiva o depresión leve-moderada sea escasa a pesar de que la evidencia indique que genera un alto impacto en la salud y calidad de vida de las personas, además de ser un factor de riesgo para desarrollar una depresión más grave en el futuro. Asimismo, investigaciones previas indican que curso de la sintomatología depresiva es altamente heterogénea entre los pacientes, pero la laguna de conocimiento existente sobre las trayectorias de la depresión es notoria, especialmente en los servicios de Atención Primaria, a pesar de ser el contexto más común de tratamiento de los pacientes con depresión leve-moderada. Además, la investigación en el trazado de las trayectorias permite conocer la asociación de las mismas con diferentes características pretratamiento, lo cual puede resultar de gran utilidad para predecir la posible trayectoria que los pacientes pueden seguir a lo largo del tiempo...Depression is highly prevalent, it is associated with high disability and substantial economic and social costs. However, it is remarkable that the knowledge about the presence of depressive symptomatology or mild-moderate depression is scarce, despite the evidence suggests that it has a high impact on the health and quality of life of individuals, in addition it is a risk factor to develop a more severe depression in the future.Furthermore, previous research indicates that the course of depressive symptomatology is highly heterogeneous among patients, but the state of knowledge about the trajectories of depression is quite limited, especially in primary care services, even it is the most common context for the treatment of patients with mild-moderate depression. In addition, research on the identification of the trajectories can be used to investigate the association of trajectories with a variety of pre-treatment characteristics, which can be particularly useful to predict the likely trajectory that patients may develop over time...Fac. de PsicologíaTRUEunpu

Psicothema

Resumen tomado de la publicaciónFactores de riesgo asociados con recaída en el Trastorno Depresivo Mayor en atención primaria: una revisión sistemática. Antecedentes: el Trastorno Depresivo Mayor (TDM) es altamente recurrente. La mayoría de los pacientes con TDM son tratados en atención primaria (AP). Por ello, el objetivo de esta revisión sistemática fue identificar factores de riesgo relacionados con la recaída del TDM en AP. Método: se realizó una revisión sistemática de PsycINFO, PubMed, Web of Science y ScienceDirect, desde 1978 a 2019, siguiendo las pautas PRISMA. Resultados: ocho estudios cumplieron criterios de elegibilidad identificando 12 factores de riesgo asociados con recaída del TDM. Los pacientes que mostraron mayor frecuencia de recaída fueron: 1) aquellos que mostraron mayor puntuación en neuroticismo, discapacidad, severidad previa del TDM, abusos en la infancia; 2) menor puntuación en extraversión, autoestima, rol emocional, funcionamiento físico; 3) antecedentes de recaída del TDM; 4) comorbilidad; y 5) peor adherencia a la medicación antidepresiva (MAD). En cuanto al tipo de tratamiento, MAD con terapia cognitivo conductual y psicoeducación reportaron menos recaídas y el tratamiento cognitivo basado en mindfulness para pacientes con mayor puntuación en abusos en la infancia. Conclusiones: pese a la alta heterogeneidad de los estudios, se identificaron diferentes factores de riesgo asociados con recaída; sin embargo, se necesita más investigación con ensayos controlados aleatorios centrados en este problema.ES

Worry, rumination and negative metacognitive beliefs as moderators of outcomes of Transdiagnostic group cognitive-behavioural therapy in emotional disorders

2023 Acuerdos transformativos CRUEBackground: Despite the relevance of cognitive processes such as rumination, worry, negative metacognitive beliefs in emotional disorders, the existing literature about how these cognitive processes moderate the effect of treatment in treatment outcomes is limited. The aim of the present study was to explore the potential moderator effect of baseline cognitive processes—worry, rumination and negative metacognitive beliefs—on the relationship between treatment allocation (transdiagnostic cognitive-behavioural therapy —TD-CBT plus treatment as usual—TAU vs. TAU alone) and treatment outcomes (anxiety and depressive symptoms, quality of life [QoL], and functioning) in primary care patients with emotional disorders. Methods: A total of 631 participants completed scales to evaluate worry, rumination, negative metacognitive beliefs, QoL, functioning, and anxiety and depressive symptoms. Results: Worry and rumination acted as moderators on the effect of treatment for anxiety (b = 1.25, p =.003; b = 0.98, p =.048 respectively) and depressive symptoms (b = 1.21, p =.017; b = 1.34, p =.024 respectively). Individuals with higher baseline levels of worry and rumination obtained a greater reduction in emotional symptoms from the addition TD-CBT to TAU. Negative metacognitive beliefs were not a significant moderator of any treatment outcome. Limitations: The study assesses cognitive processes over a relatively short period of time and uses self-reported instruments. In addition, it only includes individuals with mild or moderate anxiety or depressive disorders, which limits generalization to other populations. Conclusions: These results underscore the generalization of the TD-CBT to individuals with emotional disorders in primary care with different cognitive profiles, especially those with high levels of worry and rumination.Instituto de Investigación ValdecillaAgencia Estatal de Investigación (España)Depto. de Psicología Experimental, Procesos Cognitivos y LogopediaFac. de PsicologíaTRUEpubAPC financiada por la UC

Long-term depressive symptom trajectories and related baseline characteristics in primary care patients: Analysis of the PsicAP clinical trial

Abstract Background There is heterogeneity in the long-term trajectories of depressive symptoms among patients. To date, there has been little effort to inform the long-term trajectory of symptom change and the factors associated with different trajectories. Such knowledge is key to treatment decision-making in primary care, where depression is a common reason for consultation. We aimed to identify distinct long-term trajectories of depressive symptoms and explore pre-treatment characteristics associated with them. Methods A total of 483 patients from the PsicAP clinical trial were included. Growth mixture modeling was used to identify long-term distinct trajectories of depressive symptoms, and multinomial logistic regression models to explore associations between pre-treatment characteristics and trajectories. Results Four trajectories were identified that best explained the observed response patterns: “recovery” (64.18%), “late recovery” (10.15%), “relapse” (13.67%), and “chronicity” (12%). There was a higher likelihood of following the recovery trajectory for patients who had received psychological treatment in addition to the treatment as usual. Chronicity was associated with higher depressive severity, comorbidity (generalized anxiety, panic, and somatic symptoms), taking antidepressants, higher emotional suppression, lower levels on life quality, and being older. Relapse was associated with higher depressive severity, somatic symptoms, and having basic education, and late recovery was associated with higher depressive severity, generalized anxiety symptoms, greater disability, and rumination. Conclusions There were different trajectories of depressive course and related prognostic factors among the patients. However, further research is needed before these findings can significantly influence care decisions

La salud mental en nuestras manos: Una acción para los estudiantes de doctorado desde la Facultad de Psicología

DecanatoFac. de PsicologíaFALSEsubmitte