Prevención de trastornos y síntomas emocionales en condiciones de salud: estudio piloto aplicando el Protocolo Unificado en una unidad de reproducción humana
Resumen
Los trastornos emocionales (TE) son frecuentes durante los tratamientos de fertilidad. El Protocolo Unificado (PU) es una intervención transdiagnóstica que ha demostrado su eficacia en la prevención de TE en condiciones médicas. El objetivo de este estudio piloto es: 1) mejorar la disregulación emocional para prevenir síntomas ansiosos y depresivos en mujeres en tratamiento de inseminación artificial (IA); 2) evaluar la aceptabilidad (satisfacción y adherencia). Método: 5 mujeres en tratamiento de IA, sin diagnóstico clínico, respondieron a medidas de estado de ánimo (ansiedad y depresión), afecto, calidad de vida y regulación emocional en el pre- y post-evaluación, y en los seguimientos a los 1, 3 y 6 meses. La adaptación preventiva del PU se basó en la aplicación de 6 sesiones presenciales grupales de 2 horas de duración. La situación generada por la COVID-19 provocó el cambio al formato online para finalizar el programa. Resultados: las mujeres no desarrollaron TE, no se encontraron diferencias pre-post y pre-seguimientos estadísticamente significativas en ansiedad, depresión, calidad de vida y disregulación emocional (p > .050). Se observa una tendencia a la mejoría en la evaluación post-programa. Conclusiones: Parece que programas como el PU, centrado en factores terapéuticos compartidos, ha tenido un efecto emocional preventivo durante IA.
Descargas
Citas
Adamson, G. D., de Mouzon, J., Chambers, G. M., Zegers-Hochschild, F., Mansour, R., Ishihara, O., Banker, M., & Dyer, S. (2018). International Committee for Monitoring Assisted Reproductive Technology: world report on assisted reproductive technology, 2011. Fertility and Sterility, 110(6), 1067–1080. https://doi.org/10.1016/j.fertnstert.2018.06.039
Ávila, A., & Moreno-Rosset, C. (2008). La intervención psicológica en infertilidad: Orientaciones para un protocolo de actuación clínica. Papeles Del Psicologo, 29(2), 186–196.
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., Bentley, K. H., Thompson-Hollands, J., Conklin, L. R., Boswell, J. F., Ametaj, A., Carl, J. R., Boettcher, H. T., & Cassiello-Robbins, C. (2017). The unified protocol for transdiagnostic treatment of Emotional Disorders compared with diagnosis-specific protocols for anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 74(9), 875–884. https://doi.org/10.1001/jamapsychiatry.2017.2164
Bennett, G. G., & Glasgow, R. E. (2009). The Delivery of Public Health Interventions via the Internet: Actualizing Their Potential. Annual Review of Public Health, 30, 273–292. https://doi.org/10.1146/annurev.publhealth.031308.100235
Boivin, J. (2003). A review of psychosocial interventions in infertility. Social Science & Medicine, 57(12), 2325–2341. https://doi.org/10.1016/S0277-9536(03)00138-2
Boivin, Jacky, Takefman, J., & Braverman, A. (2011). The Fertility Quality of Life (FertiQoL) tool: development and general psychometric properties. Fertility and Sterility, 96(2), 409-415.e3. https://doi.org/10.1016/j.fertnstert.2011.02.046
Bullis, J. R., Boettcher, H., Sauer-Zavala, S., Farchione, T. J., & Barlow, D. H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. Clinical Psychology: Science and Practice, 26(2). https://doi.org/10.1111/cpsp.12278
Burger, F., Neerincx, M. A., & Brinkman, W.-P. (2020). Technological State of the Art of Electronic Mental Health Interventions for Major Depressive Disorder: Systematic Literature Review. Journal of Medical Internet Research, 22(1), e12599. https://doi.org/10.2196/12599
Calhaz-Jorge, C., De Geyter, C. h, Kupka, M. S., Wyns, C., Mocanu, E., Motrenko, T., Scaravelli, G., Smeenk, J., Vidakovic, S., & Goossens, V. (2020). Survey on ART and IUI: legislation, regulation, funding and registries in European countries. Human Reproduction Open, 2020(1). https://doi.org/10.1093/hropen/hoz044
Coughlan, C., Walters, S., Ledger, W., & Li, T. C. (2014). A comparison of psychological stress among women with and without reproductive failure. International Journal of Gynecology and Obstetrics, 124(2), 143–147. https://doi.org/10.1016/j.ijgo.2013.08.006
Cox, S. J., Glazebrook, C., Sheard, C., Ndukwe, G., & Oates, M. (2006). Maternal self-esteem after successful treatment for infertility. Fertility and Sterility, 85(1), 84–89. https://doi.org/10.1016/j.fertnstert.2005.07.1287
European IVF-Monitoring Consortium, European Society of Human Reproduction and Embryology, Kupka, M., D’Hooghe, T., Ferraretti, A., de Mouzon, J., Erb, K., Castilla, J., Calhaz-Jorge, C., De Geyter, C., & Goossens, V. (2016). Assisted reproductive technology in Europe, 2011: results generated from European registers by ESHRE. Human Reproduction, 31(2), 233–248. https://doi.org/10.1093/humrep/dev319
Ferrando, L., Bobes, J., Gibert, M., Soto, M., & Soto, O. (1998). M.I.N.I Mini International Neuropsychiatric Interview. Versión en español 5.0.0. DSM-IV. Instituto IAP.
Galhardo, A., Cunha, M., Pinto-Gouveia, J., & Matos, M. (2013). The Mediator Role of Emotion Regulation Processes on Infertility-Related Stress. Journal of Clinical Psychology in Medical Settings, 20(4), 497–507. https://doi.org/10.1007/s10880-013-9370-3
Gallagher, M., Sauer-Zavala, S., Boswell, J., Carls, J., Bullis, J., Farchione, T., & Barlow, D. (2013). The impact of the Unified Protocol for Emotional Disorders on Quality of Life. Inernational Journal of Cognitive Therapy, 6(1), 57–72. https://doi.org/10.1521/ijct.2013.6.1.57
Gratz, K. L., & Roemer, L. (2004). Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
Greil, A., McQuillan, J., Lowry, M., & Shreffler, K. (2011). Infertility Treatment and Fertility-Specific Distress: A Longitudinal Analysis of a Population-Based Sample of U.S. Women. Social Science & Medicine, 73(1), 87. https://doi.org/10.1016/J.SOCSCIMED.2011.04.023
Grunberg, P. H., Dennis, C.-L., Da Costa, D., & Zelkowitz, P. (2018). Infertility patients’ need and preferences for online peer support. Reproductive Biomedicine & Society Online, 6, 80–89. https://doi.org/10.1016/j.rbms.2018.10.016
Hämmerli, K., Znoj, H., & Barth, J. (2009). The efficacy of psychological interventions for infertile patients: a meta-analysis examining mental health and pregnancy rate. Human Reproduction Update, 15(3), 279–295. https://doi.org/10.1093/humupd/dmp002
Hantsoo, L., Podcasy, J., Sammel, M., Epperson, C. N., & Kim, D. R. (2017). Pregnancy and the Acceptability of Computer-Based Versus Traditional Mental Health Treatments. Journal of Women’s Health (2002), 26(10), 1106–1113. https://doi.org/10.1089/jwh.2016.6255
Heredia, A., Padilla, F., Castilla, J. A., & Garcia-Retamero, R. (2020). Effectiveness of a psychological intervention focused on stress management for women prior to IVF. Journal of Reproductive and Infant Psychology, 38(2), 113–126. https://doi.org/10.1080/02646838.2019.1601170
Heredia, M., Tenías, J. M., Rocio, R., Amparo, F., Calleja, M. A., & Valenzuela, J. C. (2013). Quality of life and predictive factors in patients undergoing assisted reproduction techniques. European Journal of Obstetrics and Gynecology and Reproductive Biology, 167(2), 176–180. https://doi.org/10.1016/j.ejogrb.2012.12.011
Hervás, G., & Jódar, R. (2008). The Spanish version of the Difficulties in Emotion Regulation Scale. Clinica y Salud, 19(2), 139–156.
IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 22.0. IBM Corp.
Kiesswetter, M., Marsoner, H., Luehwink, A., Fistarol, M., Mahlknecht, A., & Duschek, S. (2020). Impairments in life satisfaction in infertility: Associations with perceived stress, affectivity, partnership quality, social support and the desire to have a child. Behavioral Medicine, 46(2), 130–141. https://doi.org/10.1080/08964289.2018.1564897
Kraaij, V., Garnefski, N., & Schroevers, M. J. (2009). Coping, goal adjustment, and positive and negative affect in definitive infertility. Journal of Health Psychology, 14(1), 18–26. https://doi.org/10.1177/1359105308097939
Lakatos, E., Szigeti, J., Ujma, P., Sexty, R., & Balog, P. (2017). Anxiety and depression among infertile women: a cross-sectional survey from Hungary. BMC Women’s Health, 17(1), 48. https://doi.org/10.1186/s12905-017-0410-2
Lancaster, G. A., Dodd, S., & Williamson, P. R. (2004). Design and analysis of pilot studies: Recommendations for good practice. Journal of Evaluation in Clinical Practice, 10(2), 307–312. https://doi.org/10.1111/j..2002.384.doc.x
Li, J., Luo, H., & Long, L. (2019). Mindfulness and fertility quality of life in Chinese women with infertility: assessing the mediating roles of acceptance, autonomy and self-regulation. Journal of Reproductive and Infant Psychology, 37(5), 455–467. https://doi.org/10.1080/02646838.2019.1577958
López-Gómez, I., Hervás, G., & Vázquez, C. (2015). Adaptación de las “escalas de afecto positivo y negativo” (PANAS) en una muestra general Española. Behavioral Psychology/ Psicologia Conductual, 23(3), 529–548.
Martínez-Borba, V., Suso-ribera, C., & Osma, J. (2019). Usability, Acceptability, and Feasibility of Two Technology-Based Devices for Mental Health Screening in Perinatal Care: A Comparison of Web Versus App. In P. Cipresso, S. Serino, & D. Villani (Eds.), Pervasive Computing Paradigms for Mental Health (pp. 176–189). Springer. https://doi.org/10.1007/978-3-319-74935-8
Mascarenhas, M. N., Flaxman, S. R., Boerma, T., Vanderpoel, S., & Stevens, G. A. (2012). National, Regional, and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Medicine, 9(12), e1001356. https://doi.org/10.1371/journal.pmed.1001356
Norman, S. B., Hami Cissell, S., Means-Christensen, A. J., & Stein, M. B. (2006). Development and validation of an Overall Anxiety Severity And Impairment Scale (OASIS). Depression and Anxiety, 23(4), 245–249. https://doi.org/10.1002/da.20182
Osma, J., Quilez-Orden, A., Suso-Ribera, C., Peris-Baquero, O., Norman, S., Bentley, K., & Sauer-Zavala, S. (2019). Psychometric properties and validation of the Spanish versions of the overall anxiety and depression severity and impairment scales. Journal of Affective Disorders, 252, 9–18. https://doi.org/10.1016/j.jad.2019.03.063
Osma, J., Suso-Ribera, C., Martínez-Borba, V., & Barrera, A. Z. (2020). Content and format preferences of a depression prevention program: A study in perinatal women. Anales de Psicologia, 36(1), 56–63. https://doi.org/10.6018/analesps.356051
Pasch, L. A., Holley, S. R., Bleil, M. E., Shehab, D., Katz, P. P., & Adler, N. E. (2016). Addressing the needs of fertility treatment patients and their partners: are they informed of and do they receive mental health services? Fertility and Sterility, 106(1), 209-215.e2. https://doi.org/10.1016/j.fertnstert.2016.03.006
Payne, L. (2018). Applications of the unified protocol for transdiagnostic treatment of emotional disorders. In D. Barlow & T. Farchione (Eds.), The unified protocol for chronic pain (pp. 215–231). Oxford University Press.
Pedro, J., Sobral, M. P., Mesquita-Guimarães, J., Leal, C., Costa, M. E., & Martins, M. V. (2017). Couples’ discontinuation of fertility treatments: a longitudinal study on demographic, biomedical, and psychosocial risk factors. Journal of Assisted Reproduction and Genetics, 34(2), 217–224. https://doi.org/10.1007/s10815-016-0844-8
Reinholt, N., Aharoni, R., Winding, C., Rosenberg, N., Rosenbaum, B., & Arnfred, S. (2017). Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services. Cognitive Behaviour Therapy, 46(1), 29–43. https://doi.org/10.1080/16506073.2016.1227360
Sakiris, N., & Berle, D. (2019). A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clinical Psychology Review, 72, 101751. https://doi.org/10.1016/j.cpr.2019.101751
Sandín, B., Chorot, P., Lostao, L., Joiner, T. E., Santed, M. A., & Valiente, R. M. (1999). Escalas PANAS de afecto positivo y negativo: Validacion factorial y convergencia transcultural. Psicothema, 11(1), 37–51. https://doi.org/ISSN 0214-9915
Sauer-Zavala, S., Tirpak, J. W., Eustis, E. H., Woods, B. K., & Russell, K. (2020). Unified Protocol for the Transdiagnostic Prevention of Emotional Disorders: Evaluation of a Brief, Online Course for College Freshmen. Behavior Therapy, in press. https://doi.org/10.1016/j.beth.2020.01.010
Sheehan, D., Lecrubier, Y., Sheehan, K., Amorim, P., Janavs, J., Weiller, E., Hergueta, T., Baker, R., & Dunbar, G. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The Development and Validation of a Structured Diagnostic Psychiatric Interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59(20), 22–33.
Smith, J. F., Eisenberg, M. L., Millstein, S. G., Nachtigall, R. D., Sadetsky, N., Cedars, M. I., & Katz, P. P. (2011). Fertility treatments and outcomes among couples seeking fertility care: data from a prospective fertility cohort in the United States. Fertility and Sterility, 95(1), 79–84. https://doi.org/10.1016/j.fertnstert.2010.06.043
van Dongen, A., Nelen, W., IntHout, J., Kremer, J., & Verhaak, C. (2016). e-Therapy to reduce emotional distress in women undergoing assisted reproductive technology (ART): a feasibility randomized controlled trial. Human Reproduction, 31(5), 1046–1057. https://doi.org/10.1093/humrep/dew040
Vaughan, D. A., Shah, J. S., Penzias, A. S., Domar, A. D., & Toth, T. L. (2020). Infertility remains a top stressor despite the COVID-19 pandemic. Reproductive BioMedicine Online, 41(3), 425–427. https://doi.org/10.1016/j.rbmo.2020.05.015
Vázquez, F. L., Blanco, V., Torres, Á., Otero, P., & Hermida, E. (2014). La eficacia de la prevención indicada de la depresión: Una revisión. Anales de Psicologia, 30(1), 9–24. https://doi.org/10.6018/analesps.30.1.138931
Watson, D., Clark, L., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070.
Weihs, K. L., Mairead, |, Mcconnell, H., Wiley, J. F., Crespi, C. M., Sauer-Zavala, S., & Stanton, A. L. (2019). A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single-arm pilot study. Psycho-Oncology, 28, 880–887. https://doi.org/10.1002/pon.5037
Wischmann, T. (2008). Implications of psychosocial support in infertility – a critical appraisal. Journal of Psychosomatic Obstetrics & Gynecology, 29(2), 83–90. https://doi.org/10.1080/01674820701817870
Yalom, I., & Leszcz, M. (2005). The theory and practice of group therapy 5th ed. IUP.
Ying, L., Wu, L. H., & Loke, A. Y. (2016). The effects of psychosocial interventions on the mental health, pregnancy rates, and marital function of infertile couples undergoing in vitro fertilization: a systematic review. Journal of Assisted Reproduction and Genetics, 33(6), 689–701. https://doi.org/10.1007/s10815-016-0690-8
Zegers-Hochschild, F., Adamson, G., de Mouzon, J., Ishihara, O., Mansour, R., Nygren, K., Sullivan, E., Van der Poel, S., & WHO. (2010). Glosario de terminología en Técnicas de Reproducción Asistida (TRA). In Red Latioamericana de Reproducción Asistida.
Derechos de autor 2022 Servicio de Publicaciones, Universidad de Murcia (España)
Esta obra está bajo una licencia internacional Creative Commons Atribución-CompartirIgual 4.0.
Las obras que se publican en esta revista están sujetas a los siguientes términos:
1. El Servicio de Publicaciones de la Universidad de Murcia (la editorial) conserva los derechos patrimoniales (copyright) de las obras publicadas, y favorece y permite la reutilización de las mismas bajo la licencia de uso indicada en el punto 2.
© Servicio de Publicaciones, Universidad de Murcia, 2024
2. Las obras se publican en la edición electrónica de la revista bajo una licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (texto legal). Se pueden copiar, usar, difundir, transmitir y exponer públicamente, siempre que: i) se cite la autoría y la fuente original de su publicación (revista, editorial y URL de la obra); ii) no se usen para fines comerciales; iii) se mencione la existencia y especificaciones de esta licencia de uso.
3. Condiciones de auto-archivo. Se permite y se anima a los autores a difundir electrónicamente las versiones pre-print (versión antes de ser evaluada y enviada a la revista) y/o post-print (versión evaluada y aceptada para su publicación) de sus obras antes de su publicación, ya que favorece su circulación y difusión más temprana y con ello un posible aumento en su citación y alcance entre la comunidad académica. Color RoMEO: verde.