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Pedro LMR, de Oliveira MF, Pereira MD, da Fonseca AD, Canavarro MC. Factors Associated with Prospective Acceptability and Preferences for Unified Transdiagnostic Cognitive-Behavioral Treatments and Group Therapy in the Portuguese General Population. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01391-1. [PMID: 38839662 DOI: 10.1007/s10488-024-01391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
Group transdiagnostic cognitive-behavioral therapy (CBT) offers a promising solution for limited mental health access in Portugal. Understanding barriers to patient adherence is crucial for successful implementation. This study aimed to characterize the prospective acceptability and preferences for unified transdiagnostic CBT and group therapy in the Portuguese general population and explore their correlates. A sample of 243 participants (18-88 years old), recruited online, completed an online survey collecting information on sociodemographic and clinical characteristics, acceptability of transdiagnostic CBT treatments, specifically of Unified Protocol (UP), acceptability of group therapy, therapeutic format preferences, beliefs about group therapy and help-seeking attitudes. Most participants were receptive to and perceived as useful both unified transdiagnostic CBT and group therapy. Overall, participants presented significantly more favorable attitudes than unfavorable attitudes toward unified transdiagnostic CBT and group therapy (p < .001). Multivariate analyses revealed that (1) favorable attitudes toward transdiagnostic treatments were negatively associated with being employed and positively associated with living in an urban area, and higher efficacy scores; (2) unfavorable attitudes toward transdiagnostic treatments were positively associated with being married/cohabitating and negatively associated with vulnerability scores; (3) being female, living in an urban area, and higher efficacy and myth scores emerged as positive predictors of favorable attitudes toward group therapy; and (4) efficacy and vulnerability scores and help-seeking propensity emerged as negative predictors of unfavorable attitudes toward group therapy. These findings highlight the importance of delineating strategies to increase knowledge and acceptance of unified transdiagnostic CBT and group therapy in the Portuguese population, addressing specific individual characteristics.
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Affiliation(s)
- Liliana Maria Rodrigues Pedro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal.
| | | | - Marco Daniel Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Ana Dias da Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
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Osma J, Martínez-García L, Prado-Abril J, Peris-Baquero Ó, González-Pérez A. Developing a smartphone App based on the Unified Protocol for the transdiagnostic treatment of emotional disorders: A qualitative analysis of users and professionals' perspectives. Internet Interv 2022; 30:100577. [PMID: 36213084 PMCID: PMC9535424 DOI: 10.1016/j.invent.2022.100577] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 09/05/2022] [Accepted: 09/27/2022] [Indexed: 12/01/2022] Open
Abstract
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.
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Affiliation(s)
- Jorge Osma
- University of Zaragoza, Department of Psicology and Sociology, Faculty of Social and Human Sciences, C/Atarazanas, 4, 44003 Teruel, Spain
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
- Corresponding author at: Universidad de Zaragoza, Departamento de Psicología y Sociología, Facultad de Ciencias Sociales y Humanas, C/Atarazanas, 4, 44003 Teruel, Spain.
| | - Laura Martínez-García
- University of Zaragoza, Department of Psicology and Sociology, Faculty of Social and Human Sciences, C/Atarazanas, 4, 44003 Teruel, Spain
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Javier Prado-Abril
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
- Miguel Servet University Hospital, Zaragoza, Spain
| | - Óscar Peris-Baquero
- University of Zaragoza, Department of Psicology and Sociology, Faculty of Social and Human Sciences, C/Atarazanas, 4, 44003 Teruel, Spain
- Health Research Institute of Aragon, Biomedic Research Center of Aragon (CIBA), Av. San Juan Bosco, 13, 50009 Zaragoza, Spain
| | - Alberto González-Pérez
- Institute of New Imaging Technologies, Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12071 Castellón, Spain
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Long-term cost-effectiveness of group unified protocol in the Spanish public mental health system. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03365-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
The limited material and human resources available in the Spanish public mental health system, combined with the high prevalence of emotional disorders nowadays, makes it necessary to search for and implement other more cost-effective formats. The versatility of the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders allows its application in group format, which could be a cost-effective solution for the system. The aim of the present study is to investigate the cost-effectiveness of the UP applied in group format in specialized care units compared to the Treatment as usual (TAU) in the Spanish public mental health system over a 15-month time period. The sample of this study consisted of 188 patients, diagnosed with an emotional disorder, randomized to the UP condition in group format or to the TAU condition in individual format. The findings of this study have shown the same beneficial results for the participants with symptoms of anxiety and depression in both conditions and greater improvements in quality of life in the UP condition. Regarding cost-effectiveness results, at the 15-month follow-up, participants in the UP condition received a greater number of sessions, with a lower total economic cost compared to the TAU condition. Finally, reductions in the number of participants using antidepressants and a reduction in medication burden were found in the UP condition over time. The results of this study show that UP applied in a group format can be a cost-effectiveness solution for the Spanish public mental health system. Trial registration number: NCT03064477 (March 10, 2017).
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Osma J, Martínez-García L, Peris-Baquero Ó, Navarro-Haro MV, González-Pérez A, Suso-Ribera C. 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. BMJ Open 2021; 11:e054286. [PMID: 34972770 PMCID: PMC8720993 DOI: 10.1136/bmjopen-2021-054286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
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. TRIAL REGISTRATION NUMBER NCT04304911.
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Affiliation(s)
- J Osma
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Laura Martínez-García
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - Óscar Peris-Baquero
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
| | - María Vicenta Navarro-Haro
- Departamento de Psicología y Sociología, Universidad de Zaragoza, Teruel, Spain
- Instituto de Investigación Sanitaria de Aragón, Zaragoza, Spain
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Brief Acceptance and Commitment Therapy for Fibromyalgia: Feasibility and Effectiveness of a Replicated Single-Case Design. Pain Res Manag 2020; 2020:7897268. [PMID: 33123304 PMCID: PMC7586182 DOI: 10.1155/2020/7897268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
Objective Overall, the literature on the effectiveness of psychological treatments in general and those for fibromyalgia in particular has been dominated by research designs that focus on large groups and explore changes on average, so the treatment impact at the individual level remains unclear. In this quasi-experimental, replicated single-case design, we will test the feasibility and effectiveness of a brief acceptance and committed therapy intervention using ecological momentary assessment supported by technology. Methods The sample comprised 7 patients (3 in the individual condition and 4 in the group condition) who received a brief, 5-week psychological treatment. Patient evolution was assessed one week prior to treatment onset and during the whole study with a smartphone app. Because ecological momentary assessment and the use of an app are not frequent practices in routine care, we also evaluated the feasibility of this assessment methodology (i.e., compliance with the app). Change was investigated with a nonoverlap of all pairs index. Outcomes were pain interference with sleep and social activities, fatigue, sadness, and pain intensity. Results Patient change was not uniform across outcomes. Four patients (two in each condition) showed relatively moderate levels of change (approximately 60% nonoverlap in several outcomes). The remaining patients showed more modest improvements which affected a reduced number of outcomes. Based on nonoverlapping indices, there was no clear evidence in favor of any treatment format. Conclusions An alternative design to large-scale trials, one that focuses on the individual change, exists and it can be implemented in pain research. The use of technology (e.g., smartphones) simplifies such designs by facilitating ecological momentary assessment. Based on our findings showing that changes were not homogeneous across patients or outcomes, more single-case designs and patient-centered analyses (e.g., responder and moderation analyses) are required.
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Dindo L, Roddy MK, Boykin D, Woods K, Rodrigues M, Smith TL, Gonzalez RD, True G. Combination outreach and wellness intervention for distressed rural veterans: results of a multimethod pilot study. J Behav Med 2020; 44:440-453. [DOI: 10.1007/s10865-020-00177-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/30/2020] [Indexed: 11/27/2022]
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Quilez-Orden A, Ferreres-Galán V, Osma J. Feasibility and Clinical Usefulness of the Unified Protocol in Online Group Format for Bariatric Surgery Candidates: Study Protocol for a Multiple Baseline Experimental Design. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176155. [PMID: 32854200 PMCID: PMC7503837 DOI: 10.3390/ijerph17176155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023]
Abstract
Obesity is currently becoming a serious global public health problem due to its high prevalence and continuous increase. This condition is associated with different physical and mental health problems. The presence of emotional disorders (anxiety, depression and related disorders) among candidates for bariatric surgery is very high and predicts worse physical and psychological results. The present study aims to explore the feasibility and clinical usefulness of the Unified Protocol, a transdiagnostic emotion regulation-based intervention, delivered in an online group format to patients with emotional disorder diagnosis or symptoms, who are waiting for bariatric surgery. We will conduct a pilot study with a repeated single-case experimental design (multiple baseline design) in a public mental health service. The sample will consist of 60 participants, who will be randomized to three baseline conditions: 8, 12 or 15 evaluation days before the intervention. Diagnostic criteria, symptomatology and body mass index are the primary outcome measures, and we will include affectivity, personality, quality of life, body image, eating behavior and surgical complications like secondary measures. An analysis of treatment satisfaction will be also performed. Assessment points will include pre-treatment, baseline, treatment, post-treatment, and follow-ups every three months until two years after post-treatment. The results obtained in this study may have important clinical, social and economic implications for public mental health.
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Affiliation(s)
- Alba Quilez-Orden
- Department of Psychology and Sociology, University of Zaragoza, 44003 Teruel, Spain;
- Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | | | - Jorge Osma
- Department of Psychology and Sociology, University of Zaragoza, 44003 Teruel, Spain;
- Health Research Institute of Aragón, 50009 Zaragoza, Spain
- Correspondence: ; Tel.: +34-97-864-5390
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