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Barrio-Martínez S, Rodriguez-Perez N, Priede A, Medrano LA, Muñoz-Navarro R, Moriana JA, Carpallo-González M, Prieto-Vila M, Ruiz-Rodríguez P, Cano-Vindel A, González-Blanch C. Patterns of cognitive-emotional change after cognitive-behavioural treatment in emotional disorders: A 12-month longitudinal cluster analysis. PLoS One 2024; 19:e0301746. [PMID: 38713680 DOI: 10.1371/journal.pone.0301746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/16/2024] [Indexed: 05/09/2024] Open
Abstract
INTRODUCTION The aim of this study was to use cluster analysis based on the trajectory of five cognitive-emotional processes (worry, rumination, metacognition, cognitive reappraisal and expressive suppression) over time to explore differences in clinical and performance variables in primary care patients with emotional symptoms. METHODS We compared the effect of adding transdiagnostic cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) according to cluster membership and sought to determine the variables that predicted cluster membership. 732 participants completed scales about cognitive-emotional processes, anxiety and depressive symptoms, functioning, and quality of life (QoL) at baseline, posttreatment, and at 12 months. Longitudinal cluster analysis and logistic regression analyses were carried out. RESULTS A two-cluster solution was chosen as the best fit, named as "less" or "more" improvement in cognitive-emotional processes. Individuals who achieved more improvement in cognitive-emotional processes showed lower emotional symptoms and better QoL and functioning at all three time points. TAU+TD-CBT, income level, QoL and anxiety symptoms were significant predictors of cluster membership. CONCLUSIONS These results underscore the value of adding TD-CBT to reduce maladaptive cognitive-emotional regulation strategies. These findings highlight the importance of the processes of change in therapy and demonstrate the relevance of the patient's cognitive-emotional profile in improving treatment outcomes.
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Affiliation(s)
- Sara Barrio-Martínez
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | | | - Amador Priede
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
- Mental Health Centre, Hospital de Laredo, Laredo, Spain
| | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Juan Antonio Moriana
- Department of Psychology, Universidad de Córdoba, Córdoba, Spain
- Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
| | - María Carpallo-González
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | | | - Paloma Ruiz-Rodríguez
- Embarcaciones Primary Care Centre, Health Service of Madrid, Tres Cantos, Madrid, Spain
| | | | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital-IDIVAL, Santander, Spain
- Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
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Barrio-Martínez S, Ruiz-Rodríguez P, Medrano LA, Priede A, Muñoz-Navarro R, Moriana JA, Carpallo-González M, Prieto-Vila M, Cano-Vindel A, González-Blanch C. Effect of Reliable Recovery on Health Care Costs and Productivity Losses in Emotional Disorders. Behav Ther 2024; 55:585-594. [PMID: 38670670 DOI: 10.1016/j.beth.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 04/28/2024]
Abstract
Despite the high economic costs associated with emotional disorders, relatively few studies have examined the variation in costs according to whether the patient has achieved a reliable recovery. The aim of this study was to explore differences in health care costs and productivity losses between primary care patients from a previous randomized controlled trial (RCT)-PsicAP-with emotional symptoms who achieved a reliable recovery and those who did not after transdiagnostic cognitive-behavioral therapy (TD-CBT) plus treatment as usual (TAU) or TAU alone. Sociodemographic and cost data were obtained for 134 participants treated at five primary care centers in Madrid for the 12-month posttreatment period. Reliable recovery rates were higher in the patients who received TD-CBT + TAU versus TAU alone (66% vs. 34%, respectively; chi-square = 13.78, df = 1, p < .001). Patients who did not achieve reliable recovery incurred more costs, especially associated with general practitioner consultations (t = 3.01, df = 132, p = .003), use of emergency departments (t = 2.20, df = 132, p = .030), total health care costs (t = 2.01, df = 132, p = .040), and sick leaves (t = 1.97, df = 132, p = .048). These findings underscore the societal importance of achieving a reliable recovery in patients with emotional disorders, and further support the value of adding TD-CBT to TAU in the primary care setting.
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Affiliation(s)
| | | | | | - Amador Priede
- Valdecilla Biomedical Research Institute and Mental Health Centre, Hospital de Laredo
| | | | - Juan Antonio Moriana
- Universidad de Córdoba and Maimónides Institute for Research in Biomedicine of Cordoba
| | | | | | | | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital and Universidad Europea del Atlántico
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Estupiñá FJ, Santalla Á, Prieto-Vila M, Sanz A, Larroy C. Mental Health in Doctoral Students: Individual, Academic, and Organizational Predictors. Psicothema 2024; 36:123-132. [PMID: 38661159 DOI: 10.7334/psicothema2023.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND The mental health of doctoral students is a matter of concern, and several variables appear to be associated with the state of their mental health. However, there have been no studies on the population of doctoral students in Spain to date using validated instruments. METHOD A cross-sectional observational study was conducted to assess mental health in 1,018 doctoral students. The impact of personal, academic, psychological, and social/organisational variables on their mental health was assessed. RESULTS Between 50% and 60% of the sample might be experiencing a common psychological disorder, while 18.8% of the sample might be experiencing passive suicidal ideation. In addition, using binary logistic regression, significant predictors of negative mental health were identified, including: sociodemographic variables (being female); academic variables (longer time spent in a doctoral programme); psychological variables (lower life satisfaction; greater interference and less clarity about negative emotions); and social and organisational variables (greater fear of losing tuition rights, lower social support, and greater interference of academic work with personal life). CONCLUSIONS Doctoral students need measures to remedy and prevent mental health issues based on improving self-care and emotion regulation, promoting social support at university, and reducing the pressure of losing tuition rights among final-year students.
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Prieto-Vila M, González-Blanch C, Estupiñá Puig FJ, Buckman JE, Saunders R, Muñoz-Navarro R, Moriana JA, Rodríguez-Ruiz P, Barrio-Martínez S, Carpallo-González M, Cano-Vindel A. Long-term depressive symptom trajectories and related baseline characteristics in primary care patients: Analysis of the PsicAP clinical trial. Eur Psychiatry 2024; 67:e32. [PMID: 38532731 PMCID: PMC11059253 DOI: 10.1192/j.eurpsy.2024.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/13/2024] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
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.
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Affiliation(s)
- Maider Prieto-Vila
- Department of Experimental Psychology, Cognitive Processes and Logopedics, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - César González-Blanch
- Mental Health Centre, University Hospital “Marqués de Valdecilla” – IDIVAL, Santander, Spain
| | - Francisco J. Estupiñá Puig
- Department of Personality, Assessment and Clinical Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Joshua E.J. Buckman
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
- iCope – Camden and Islington Psychological Therapies Services, Camden & Islington NHS Foundation Trust, London, UK
| | - Rob Saunders
- Research Department of Clinical, Centre for Outcomes and Research Effectiveness, Educational and Health Psychology, UCL, London, UK
| | - Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Juan A. Moriana
- Department of Psychology, University of Cordoba, Cordoba, Spain
| | | | - Sara Barrio-Martínez
- Department of Experimental Psychology, Cognitive Processes and Logopedics, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
- Mental Health Centre, University Hospital “Marqués de Valdecilla” – IDIVAL, Santander, Spain
| | - María Carpallo-González
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Antonio Cano-Vindel
- Department of Experimental Psychology, Cognitive Processes and Logopedics, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
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Barrio-Martínez S, Cano-Vindel A, Priede A, Medrano LA, Muñoz-Navarro R, Moriana JA, Carpallo-González M, Prieto-Vila M, Ruiz-Rodríguez P, González-Blanch C. Worry, rumination and negative metacognitive beliefs as moderators of outcomes of Transdiagnostic group cognitive-behavioural therapy in emotional disorders. J Affect Disord 2023; 338:349-357. [PMID: 37336250 DOI: 10.1016/j.jad.2023.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND 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.
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Affiliation(s)
- Sara Barrio-Martínez
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain.
| | | | - Amador Priede
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain; Mental Health Centre, Hospital de Laredo, Laredo, Spain
| | | | - Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Spain
| | - Juan Antonio Moriana
- Department of Psychology, Universidad de Córdoba, Córdoba, Spain; Maimónides Institute for Research in Biomedicine of Cordoba (IMIBIC), Córdoba, Spain
| | - María Carpallo-González
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Spain
| | | | - Paloma Ruiz-Rodríguez
- Embarcaciones Primary Care Centre, Health Service of Madrid, Tres Cantos, Madrid, Spain
| | - César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital - IDIVAL, Santander, Spain; Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
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González-Blanch C, Barrio-Martínez S, Priede A, Martínez-Gómez S, Pérez-García-Abad S, Miras-Aguilar M, Ruiz-Gutiérrez J, Muñoz-Navarro R, Ruiz-Rodríguez P, Medrano LA, Prieto-Vila M, Carpallo-González M, Aguilera-Martín Á, Gálvez-Lara M, Cuadrado F, Moreno E, García-Torres F, Venceslá JF, Corpas J, Jurado-González FJ, Moriana JA, Cano-Vindel A. Cost-effectiveness of transdiagnostic group cognitive behavioural therapy versus group relaxation therapy for emotional disorders in primary care (PsicAP-Costs2): Protocol for a multicentre randomised controlled trial. PLoS One 2023; 18:e0283104. [PMID: 36928238 PMCID: PMC10019745 DOI: 10.1371/journal.pone.0283104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Several randomised controlled trials (RCT) have demonstrated the superiority of transdiagnostic group cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) for emotional disorders in primary care. To date, however, no RCTs have been conducted to compare TD-CBT to another active intervention in this setting. Our aim is to conduct a single-blind RCT to compare group TD-CBT plus TAU to progressive muscle relaxation (PMR) plus TAU in adults (age 18 to 65 years) with a suspected emotional disorder. We expect that TD-CBT + TAU will be more cost-effective than TAU + PMR, and that these gains will be maintained at the 12-month follow-up. Seven therapy sessions (1.5 hours each) will be offered over a 24-week period. The study will be carried out at four primary care centres in Cantabria, Spain. The study will take a societal perspective. Psychological assessments will be made at three time points: baseline, post-treatment, and at 12-months. The following variables will be evaluated: clinical symptoms (anxiety, depression, and/or somatic); functioning; quality of life (QoL); cognitive-emotional factors (rumination, worry, attentional and interpretative biases, emotion regulation and meta-cognitive beliefs); and satisfaction with treatment. Data on health service use, medications, and sick days will be obtained from electronic medical records. Primary outcome measures will include: incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICURs). Secondary outcome measures will include: clinical symptoms, QoL, functioning, and treatment satisfaction. Bootstrap sampling will be used to assess uncertainty of the results. Secondary moderation and mediation analyses will be conducted. Two questionnaires will be administered at sessions 1, 4, and 7 to assess therapeutic alliance and group satisfaction. If this trial is successful, widespread application of this cost-effective treatment could greatly improve access to psychological treatment for emotional disorders in the context of increasing demand for mental healthcare in primary care. Trial registration: ClinicalTrials.gov: Cost-effectiveness of a Transdiagnostic Psychological Treatment for Emotional Disorders in Primary Care (PsicAP). NCT05314920.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, Marqués de Valdecilla University Hospital—IDIVAL, Santander, Spain
- Faculty of Health Sciences, Universidad Europea del Atlántico, Santander, Spain
- * E-mail:
| | - Sara Barrio-Martínez
- Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Amador Priede
- Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
- Mental Health Centre, Hospital de Laredo, Laredo, Spain
| | - Sandra Martínez-Gómez
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Saioa Pérez-García-Abad
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - María Miras-Aguilar
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - José Ruiz-Gutiérrez
- Resident of Clinical Psychology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Roger Muñoz-Navarro
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Paloma Ruiz-Rodríguez
- Castilla La Nueva Primary Care Centre, Health Service of Madrid, Fuenlabrada, Madrid, Spain
| | - Leonardo A. Medrano
- Pontificia Universidad Católica Madre y Maestra, Santiago De Los Caballeros, Dominican Republic
| | | | | | - Ángel Aguilera-Martín
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Mario Gálvez-Lara
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Fátima Cuadrado
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Eliana Moreno
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Francisco García-Torres
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - José F. Venceslá
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Jorge Corpas
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Francisco J. Jurado-González
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
| | - Juan A. Moriana
- Department of Psychology, Faculty of Education Sciences, University of Cordoba, Cordoba, Spain
- Maimónides Biomedical Research Institute of Cordoba, Reina Sofía University Hospital, Cordoba, Spain
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