Aplicación del protocolo unificado para el tratamiento transdiagnóstico de los trastornos emocionales en pacientes post-cirugía bariátrica: estudio de efectividad y viabilidad en formato grupal
Resumen
La obesidad es un grave problema de salud con implicaciones globales. La cirugía bariátrica (CB) es el tratamiento más utilizado y eficaz, pero hay pacientes que no pierden una cantidad sustancial de peso, hecho que se ha relacionado con la presencia de síntomas de alimentación emocional, ansiedad y depresión. El objetivo de este estudio es analizar la viabilidad y efectividad de una intervención basada en la regulación de las emociones denominada Protocolo Unificado (PU), aplicada en formato grupal a 6 pacientes post-CB que presentan trastornos/síntomas emocionales. Los resultados tras el tratamiento mostraron altas tasas de asistencia y satisfacción con el PU, y mejorías estadísticamente significativas para el neuroticismo, los síntomas de los trastornos alimentarios y la alimentación emocional. En el seguimiento a los 6 meses, se muestran reducciones significativas en los síntomas de ansiedad, neuroticismo, inadaptación y disregulación (d = 0.83-1.46) y el índice de masa corporal se mantuvo estable a lo largo del tiempo. Estos resultados preliminares son esperanzadores sobre la viabilidad y efectividad del PU para tratar la disregulación emocional en pacientes después de la CB.
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American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington: Author.
Arnow, B., Kenardy, J., & Agras, W. (1995). The Emotional Eating Scale: The development of a measure to assess coping with negative affect by eating. International Journal of Eating Disorders, 18(1), 79-90. http://dx.doi.org/10.1002/1098-108X(199507)18:1%3C79::AID-EAT2260180109%3E3.0.CO;2-V
Barlow, D. H., Farchione, T. J., Bullis, J. R., Gallagher, M. W., Murray-Latin, H., Sauer-Zavala, S., … 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
Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. (2015). Protocolo unificado para el tratamiento transdiagnóstico de los trastornos emocionales: Manual del terapeuta y Manual del paciente [Unified protocol for transdiagnostic treatment of emotional disorders: Therapist and patient guide]. Madrid: Alianza Editorial. (Orig., 2011).
Barlow, D. H., Farchione, T. J., Sauer-Zavala, S., Murray-Latin, H., Ellard, K. K., Bullis, J. R., … Cassiello-Robbins, C. (2019). Protocolo Unificado para el tratamiento transdiagnóstico de los trastornos emocionales. Manual del paciente [Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Patient's Guide]. Madrid: Alianza Editorial.
Barlow, D.H., Farchione, T. J., Sauer-Zavala, S., Murray-Latin, H., Ellard, K. K., Bullis, J. R., … Cassiello-Robbins, C. (2018). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide (2nd ed.). New York, NY: Oxford University Press.
Bean, M. K., Stewart, K., & Olbrisch, M. E. (2008). Obesity in America: Implications for Clinical and Health Psychologists. Journal of Clinical Psychology in Medical Settings, 15(3), 214-224. http://dx.doi.org/10.1007/s10880-008-9124-9
Beck, A. T., & Steer, R. (1993). Beck Anxiety Inventory manual. San Antonio, TX: Psychological Corporation.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.
Bentley, K. H., Gallagher, M. W., Carl, J. R., & Barlow, D. H. (2014). Development and validation of the Overall Depression Severity and Impairment Scale. Psychological Assessment, 26(3), 815-830. https://doi.org/10.1037/a0036216
Brown, T. A., & Barlow, D. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV Anxiety and Mood Disorders: Implications for assessment and treatment. Psychological Assessment, 21(3), 256-271. http://dx.doi.org/10.1037/a0016608
Carl, J. R., Gallagher, M. W., Sauer-Zavala, S. E., Bentley, K. H., & Barlow, D. H. (2014). A preliminary investigation of the effects of the unified protocol on temperament. Comprehensive Psychiatry, 55(6), 1426-1434. https://doi.org/10.1016/j.comppsych.2014.04.015
Cassiello-Robbins, C., Southward, M. W., Tirpak, J. W., & Sauer-Zavala, S. (2020). A systematic review of unified protocol applications with adult populations: Facilitating widespread dissemination via adaptability. Clinical Psychology Review, 13(61), 98-99. https://doi.org/10.1016/j.cpr.2020.101852
Cassin, S. E., Sockalingam, S., Du, C., Wnuk, S., Hawa, R., & Parikh, S. V. (2016). A pilot randomized controlled trial of telephone-based cognitive behavioural therapy for pre-operative bariatric surgery patients. Behaviour Research and Therapy, 80,17–22. https://doi.org/http://dx.doi. org/10.1016/j.brat.2016.03.001.
Cassin, S. E., Sockalingam, S., Wnuk, S., Strimas, R., Royal, S., Hawa, R., & Parikh, S. V. (2013). Cognitive-behavioral therapy for bariatric surgery patients: Preliminary evidence for feasibility, acceptability, and effectiveness. Cognitive and Behavioral Practice, 20(4), 529–543. https://doi.org/10.1016/j.cbpra.2012.10.002
Castaneda, D., Popov, V. B., Wander, P., & Thompson, C. C. (2019). Risk of suicide and self-harm is increased after bariatric surgery—a systematic review and meta-analysis. Obesity Surgery, 29(1), 322–333. http://dx.doi.org/10.1007/s11695-018-3493-4
Cohen, J. (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 20, 37-46. http://dx.doi.org/10.1177/001316446002000104
Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairburn, C. G. (1987). The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders, 6, 485-494. http://dx.doi.org/10.1002/1098-108X(198707)6:4%3C485::AID-EAT2260060405%3E3.0.CO;2-O
Costa, P. T., & McCrae, R. R. (1999). Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI). Madrid: TEA Ediciones.
De Andrés Pizarro, J. (2000). El análisis de estudios cualitativo [Qualitative study analysis]. Atención Primaria [Primary Care], 25(1), 42-46.
Echeburúa, E., Corral, P., & Fernández-Montalvo, J. (2000). Maladjustment Inventory (MI): Psychometric properties in clinical contexts. Análisis y Modificación de Conducta [Analysis and Behavioral Modification], 26(107), 325-340.
Ellard, K. K., Fairholme, C. P., Boisseau, C. L., Farchione, T. J., & Barlow, D. H. (2010). Unified protocol for the transdiagnostic treatment of emotional disorders: Protocol development and initial outcome data. Cognitive and Behavioral Practice, 17, 88-101. http://dx.doi.org/10.1016/j.cbpra.2009.06.002
Ferrando, L., Bobes, J., Gibert, J., Soto, M., & Soto, O. (2000). MINI entrevista neuropsiquiátrica internacional [MINI international neuropsychiatric interview]. Madrid: Instituto IAP.
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. http://dx.doi.org/10.1007/s10862-008-9102-4
Henderson, M., & Freeman, C. P. L. (1987). A self-rating scale for bulimia: The ‘BITE’. The British Journal of Psychiatry, 150 (1), 18-24. http://dx.doi.org/10.1192/bjp.150.1.18
Hernáez, A., Zomeño, M. D., Dégano, I. R., Pérez-Fernández, S., Goday, A., Vila, J., … Marrugat, J. (2019). Exceso de peso en España: situacioón actual, proyecciones para 2030 y sobrecoste directo estimado para el Sistema Nacional de Salud [Excess weight in Spain: Current situation, projections for 2030, and estimated direct extra cost for the Spanish Health System. Revista Española de Cardiología [Spanish Journal of Cardiology], 72(11), 916-924. https://doi.org/10.1016/j.recesp.2018.07.009
Hervás, G., & Jódar, R. (2008). The Spanish version of the Difficulties in Emotion Regulation Scale. Clinica y Salud [Clinical and Health], 19(2), 139-156.
Hjelmesæth, J., Rosenvinge, J. H., Gade, H., & Friborg, O. (2019). Effects of cognitive-behavioral therapy on eating behaviors, affective symptoms, and weight loss after bariatric surgery: A randomized clinical trial. Obesity Surgery, 29(1), 61-69. https://doi.org/10.1007/s11695-018-3471-x
IBM Corp. (2013). IBM SPSS Statistics for Windows, Version 22.0. New York: IBM.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19.
Jumbe, S., Hamlet, C., & Meyrick, J. (2017). Psychological aspects of bariatric surgery as a treatment for obesity. Current Obesity Reports, 6(1), 71-78. https://doi.org/10.1007/s13679-017-0242-2
Kalarchian, M. A., & Marcus, M. D. (2003). Management of the bariatric surgery patient: Is there a role for the cognitive-behavior therapist? Cognitive and Behavioral Practice, 10(2), 112-119. https://doi.org/10.1016/S1077-7229(03)80019-6
Lahey, B. B. (2009). Public health significance of neuroticism. American Psychologist, 64(4), 241-256. https://doi.org/10.1038/jid.2014.371
Larsen, D., Attkisson, C., Hargreaves, W., & Nguyen, T. (1979). Assessment of client/patient satisfaction: Development of a general scale. Evaluation and Program Planning, 2, 197–207.
Lauren, A. D., Sijercic, I., & Cassin, S. E. (2020). Preoperative and post-operative psychosocial interventions for bariatric surgery patients: A systematic review. Obesity Reviews, 1-23. https://doi.org/10.1111/obr.12926
Magán, I., Sanz, J., & García-Vera, M. P. (2008). Psychometric properties of a Spanish version of the Beck Anxiety Inventory (BAI) in general population. The Spanish Journal of Psychology, 11(2), 626–640. https://doi.org/10.1017/S1138741600004637
Martín, E., Ruiz-Tovar, J., & Sánchez, R. (2017). Vía clínica de cirugía bariátrica 2017 [Clinical pathway of bariatric surgery 2017]. Albacete: Inm3diA comunicación.
Martínez-Borba, V., Osma, J., Crespo-Delgado, E., Andreu-Pejo, L., & Monferrer-Serrano, A. (2022). Prevention of Emotional Disorders and Symptoms Under Health Conditions: A Pilot Study using the Unified Protocol in a Fertility Unit. Anales de Psicología / Annals of Psychology, 38(1), 25–35. https://doi.org/10.6018/analesps.462331
Mezzich, J. E., Ruipérez, M. A., Pérez, C., Yoon, G., Liu, J., & Mahmud, S. (2000). The Spanish version of the Quality of Life Index. The Journal of Nervous and Mental Disease, 188(5), 301-305. http://dx.doi.org/10.1097/00005053-200005000-00008
Moya, T. R., Bersabé, R., & Jiménez, M. (2004). Fiabilidad y validez del test de investigación bulímica de Edimburgo (BITE) en una muestra de adolescentes españoles [Reliability and validity of the Bulimic Investigatory Test Edinburgh (BITE) in a sample of Spanish adolescents]. Psicología Conductual [Conductual Psychology], 12, 447-461.
National Health and Medical Research Council. (2013). Clinical practice guidelines for the management of overweight and obesity in children and adolescents. Canberra: National Health and Medical Research Council.
Norman, S. B., Allard, C. B., Trim, R. S., Thorp, S. R., Behrooznia, M., Masino, T. T., & Stein, M. B. (2013). Psychometrics of the Overall Anxiety Severity and Impairment Scale (OASIS) in a sample of women with and without trauma histories. Archives of Women’s Mental Health, 16(2), 123–129. https://doi.org/10.1007/s00737-012-0325-8
OECD (2019). The heavy burden of obesity: The economics of prevention, OECD Health Policy Studies. Paris: OECD Publishing. https://doi.org/10.1787/b53ed5f9-fr
Oltmanns, J. R., Rivera, J., Cole, J., Merchant, A., & Steiner, J. P. (2020). Personality psychopathology: Longitudinal prediction of change in body mass index and weight post-bariatric surgery. Health Psychology, 39(3), 245–254. https://doi.org/10.1037/hea0000842
Osma, J., Castellano, C., Crespo, E., & García-Palacios, A. (2015). The unified protocol for transdiagnostic treatment of emotional disorders in group format in a Spanish public mental health setting. Behavioral Psychology, 23(3), 447-466.
Osma, J., Martínez-García, L.; Quilez-Orden, A.; Peris-Baquero, Ó. (2021). Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Medical Conditions: A Systematic Review. International Journal of Environmental Research and Public Health, 18, 5077. https://doi.org/10.3390/ ijerph18105077
Osma, J., Quilez-Orden, A., Suso-Ribera, C., Peris-Baquero, O., Norman, S. B., Bentley, K. H., & 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. https://doi.org/10.1016/j.jad.2019.03.063
Osma, J., Sánchez-Gómez, A., & Peris-Baquero, Ó. (2018). Applying the unified protocol to a single case of major depression with schizoid and depressive personality traits. Psicothema, 30(4), 364-369. https://doi.org/10.7334/psicothema2018.41
Perpiñá, C., Cebolla, A., Botella, C., Lurbe, E., & Torró, M. (2011). Emotional Eating Scale for Children and Adolescents: Psychometric characteristics in a Spanish sample. Journal of Clinical Child & Adolescent Psychology, 40(3), 424-433. http://dx.doi.org/10.1080/15374416.2011.563468
Qualtrics. (2017). Qualtrics (version 2.16) [computer program]. Provo, UT: Qualtrics.
Raich, R. M., Mora, M., Soler, A., Avila, C., Clos, I., & Zapater, L. (1996). Adaptación de un instrumento de evaluación de la insatisfacción corporal [Adaptation of a body dissatisfaction assessment instrument]. Clínica y Salud [Clinical and Health], 7, 51-66.
Sanz, J., García-Vera, M. P., & Fortún, M. (2012). El Inventario de ansiedad de Beck“ (BAI): propiedades psicométricas de la versión española en pacientes con trastornos psicológicos [The Beck Anxiety Inventory (BAI): psychometric properties of the Spanish version in patients with psychological disorders]. Psicología Conductual [Behavioral Psychology], 20(3), 563.
Sanz, J., García-Vera, M., Espinosa, R., Fortún, M., & Vázquez, C. (2005). Adaptación española del Inventario para la depresión de Beck-II (BDI-II): Propiedades psicométricas en pacientes con trastornos psicológicos [Spanish adaptation of the Beck Depression Inventory-II (BDI-II): Psychometric properties in patients with psychological disorders]. Clínica y Salud [Clinical and Health], 16, 121-142.
Sanz, J., Perdigón, A. L., & Vázquez, C. (2003). The Spanish adaptation of Beck’s Depression Inventory-II (BDI-II): Psychometric properties in the general population [The Spanish adaptation of Beck's Depression Inventory-II (BDI-II): Psychometric properties in the general population]. Clínica y Salud [Clinical and Health], 14, 249–280.
Sarwer, D. B., & Heinberg, L. J. (2020). A Review of the psychosocial aspects of clinically severe obesity and bariatric surgery. American Psychological Association, 75(2), 252-264. http://dx.doi.org/10.1037/amp0000550
Sauer-Zavala, S., Cassiello-Robbins, C., Ametaj, A. A., Wilner, J. G., & Pagan, D. (2019). Transdiagnostic treatment personalization: The feasibility of ordering unified protocol modules according to patient strengths and weaknesses. Behavior Modification, 43(4), 518-543. https://doi.org/10.1177/0145445518774914
Sauer-Zavala, S., Fournier, J., Jarvi Steele, S., Woods, B., Wang, M., Farchione, T., & Barlow, D. (2020). Does the unified protocol really change neuroticism? Results from a randomized trial. Psychological Medicine, 1-10. doi:10.1017/S0033291720000975
Sauer-Zavala, S., Gutner, C. A., Farchione, T. J., Boettcher, H. T., Bullis, J. R., & Barlow, D. H. (2017). Current Definitions of “transdiagnostic” in treatment development: A search for consensus. Behavior Therapy, 48, 128-138. https://doi.org/10.1016/j.beth.2016.09.004
Sheehan, D. V. (2015). Mini International Neuropsychiatric Interview 7.0. (MINI 7.0). Jacksonville, FL: Medical Outcomes Systems.
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (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).
Simon, G. E., Von Korff, M., Saunders, K., Miglioretti, D. L., Crane, P. K., van Belle, G., & Kessler, R. C. (2006). Association between obesity and psychiatric disorders in the US adult population. Archives of General Psychiatry, 63, 824-830. http://dx.doi.org/10.1001/archpsyc.63.7.824
Sockalingam, S., Cassin, S. E., Wnuk, S., Du, C., Jackson, T., Hawa, R., & Parikh, S. V. (2017). A pilot study on telephone cognitive behavioral therapy for patients’ six-months post-bariatric surgery. Obesity Surgery, 27(3), 670–675. https://doi.org/10.1007/s11695-016-2322-x
Sockalingam, S., Leung, S. E., Hawa, R., Wnuk, S., Parikh, S. V., Jackson, T., & Cassin, S. E. (2019). Telephone-based cognitive behavioural therapy for female patients’ 1-year post-bariatric surgery: A pilot study. Obesity Research and Clinical Practice, 13(5), 499-504. https://doi.org/10.1016/j.orcp.2019.07.003
Spirou, D., Raman, J., & Smith, E. (2020). Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review. Obesity Reviews, 1–24. https://doi.org/10.1111/obr.12998
Tirpak, J. W., Cassiello-Robbins, C., Ametaj, A., Olesnycky, O. S., Sauer-Zavala, S., Farchione, T. J., & Barlow, D. H. (2019). Changes in positive affect in cognitive-behavioral treatment of anxiety disorders. General Hospital Psychiatry, 61, 111-115. https://doi.org/10.1016/j.genhosppsych.2019.06.008
Wilfley, D. E., Vannucci, A., & White, E. K. (2010). Early Intervention of Eating- and Weight-Related Problems. Journal of Clinical Psychology in Medical Settings, 17(4), 285–300. http://dx.doi.org/10.1007/s10880-010-9209-0
World Health Organization. (1992). The ICD-10 Classification of mental and behavioural disorders. Clinical descriptions and diagnostic guidelines (10th revision). Geneva: Author.
Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group therapy (5th ed.). New York: IUP
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