Terapia de Aceptación y Compromiso en conducta suicida: una revisión sistemática
Resumen
El suicidio se ha convertido en un problema social y de salud pública a nivel mundial. En este sentido, la Terapia de Aceptación y Compromiso (ACT) podría ser eficaz en su abordaje, existiendo evidencia sobre la relación entre algunos de sus componentes y la conducta suicida. Así, el presente estudio tuvo por objetivo realizar una revisión sistemática sobre la eficacia de ACT en conducta suicida. Para ello se siguió el protocolo PRISMA, empleando las siguientes bases de datos: PsycInfo, PubMed, Scopus y PsicoDoc. Inicialmente se obtuvieron 108 publicaciones potencialmente relevantes, de las cuales, finalmente, 13 fueron incluidas en la revisión. La calidad de los estudios se analizó a través de un instrumento de evaluación de riesgo de sesgos. Como resultados, a nivel general se observaron disminuciones estadísticamente significativas en ideación suicida (IS) y factores de riesgo de suicidio. Además, algunos estudios señalaron relaciones estadísticamente significativas entre un aumento de flexibilidad psicológica y la disminución de IS. Si bien los datos apuntaron a una posible eficacia de ACT en la reducción de IS, es necesario llevar a cabo mayor número de estudios experimentales que contemplen la complejidad de la conducta suicida y exploren los procesos de cambio implicados.
Descargas
Citas
Academy of Nutrition and Dietetics. (2016). Evidence Analysis Manual. https://www.andeal.org/evidence-analysis-manual
Al-Halabí, S. & Fonseca-Pedrero, E. (2021). Suicidal behavior prevention: The time to act is now. Clínica y Salud, 32(2), 89-92. https://doi.org/10.5093/clysa2021a17
Al-Halabí, S. & García Haro, J. M. (2021). Tratamientos psicológicos para la conducta suicida [Psychological treatments for suicidal behavior]. En E. Fonseca Pedrero (Coord.), Manual de tratamientos psicológicos. Adultos (pp. 639-675). Pirámide.
* As’hab, P. P., Keliat, B. A., & Wardani, I. Y. (2022). The effects of acceptance and commitment therapy on psychosocial impact and adherence of multidrug-resistant tuberculosis patients. Journal of Public Health Research, 11(2): 2337. https://doi.org/10.4081/jphr.2021.2737
* Barnes, S. M., Borges, L. M., Smith, G. P., Walser, R. D., Forster, J. E., & Bahraini, N. H. (2021). Acceptance and Commitment Therapy to Promote Recovery from suicidal crises: A Randomized Controlled Acceptability and Feasibility Trial of ACT for life. Journal of Contextual Behavioral Science, 20, 35-45. https://doi.org/10.1016/j.jcbs.2021.02.003
Batterham, P. J., Ftanou, M., Pirkis, J., Brewer, J. L., Mackinnon, A. J., Beautrais, A., Fairweather-Schmidt, A. K., & Christensen, H. (2015). A systematic review and evaluation of measures for suicidal ideation and behaviors in population-based research. Psychological Assessment, 27(2), 501–512. https://doi.org/10.1037/pas0000053
Beck, A. T., Brown, G., Berchick, R. J., Stewart, B. L., & Steer, R. A. (1990). Relationship between hopelessness and ultimate suicide: A replication with psychiatric outpatients. American Journal of Psychiatry, 147, 190-195. https://doi.org/10.1176/ajp.147.2.190
Beck, A. T., Kovacs, M., & Weissman, A. (1979). Assessment of suicidal intention: the Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47(2) 343-352. https://doi.org/10.1037/0022-006X.47.2.343
Beck, A. T. & Steer, R. A. (1988). Manual for the Beck Hopelessness Scale. Psychological Corporation.
Beck, A.T & Steer, R. A. (1991). Manual for the Beck scale for suicide ideation. Psychological Corporation.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory- II. Psychological Corporation.
Bennett, C. M. & Taylor, D. D. (2019). ACTing as yourself: Implementing acceptance and commitment therapy for transgender adolescents through a developmental lens. Journal of child and adolescent counseling, 5(2), 146-160. https://doi.org/10.1080/23727810.2019.1586414
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the acceptance and action Questionnaire-II: a revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4): 676e688. http://dx.doi.org/10.1016/j.beth.2011.03.007.
Brem, M. J., Coop Gordon, K., & Stuart, G. L. (2020). Integrating acceptance and commitment therapy with functional analytic psychotherapy: a case study of an adult male with mixed depression and anxiety. Clinical Case Studies, 19(1), 34-50. https://doi.org/10.1177/1534650119883351
Brodsky, B. S., Spruch-Feiner, A., & Stanley, B. (2018). The zero suicide model: applying evidence-based suicide prevention practices to clinical care. Frontiers in Psychiatry, 9: 33. https://doi.org/10.3389/fpsyt.2018.00033
Chang, N. A., Jager-Hyman, S., Brown, G. K., Cunningham A., & Stanley, B. (2016). Treating the suicidal patient: Cognitive therapy and dialectical behavior therapy. In R. C. O’Connor & J. Pirkis (eds.), The International handbook of suicide prevention (pp. 36- 60). Wiley Blackwell.
Chou, W., Yen, C., & Liu, T. (2018). Predicting effects of psychological inflexibility/ experiential avoidance and stress coping strategies for internet addiction, significant depression, and suicidality in college students: A prospective study. International Journal of Environmental Research and Public Health, 15(788), 1–11. https://doi.org/10.3390/ijerph15040788
Crasta, D., Daks, J. S., & Rogge, R. D. (2020). Modeling suicide risk among parents during the COVID-19 pandemic: psychological inflexibility exacerbates the impact of COVID-19 stressors on interpersonal risk factors for suicide. Journal of Contextual Behavioral Science, 18, 117-127. https://doi.org/10.1016/j.jcbs.2020.09.003.
D’Anci, K. E., Uhl, S., Giradi, G., & Martín, C. (2019). Treatments for the prevention and management of suicide: A systematic review. Annals of Internal Medicine, 171, 334- 342. https://doi.org/10.7326/M19-0869
* Ducasse, D., Jaussent, I., Arpon-Brand, V., Vienot, M., Laglaoui, C., Béziat, S., Calati, R., Carrière, I., Guillaume, S., Courtet, P., & Olié, E. (2018). Acceptance and Commitment Therapy for the Management of Suicidal Patients: A Randomized Controlled Trial. Psychotherapy and psychosomatics, 87(4), 211-222. https://doi.org/10.1159/000488715
* Ducasse, D., René, E., Béziat, S., Guillaume, S., Courtet, P., & Olié, E. (2014). Acceptance and Commitment Therapy for Management of Suicidal Patients: A Pilot Study. Psychotherapy and Psychosomatics, 83(6), 374-376. https://doi.org/10.1159/000365974
Feixas, G., Evans, C., Trujillo, A., Saúl, L. A., Botella, L., Corbella, S., González, E., Bados, A., García-Grau, E., & López-González M. A., (2012). La Versión Española del CORE- OM: Clinical Outcomes in Routine Evaluation-Outcome Measure. Revista de Psicoterapia, 23(89), 109-135. https://doi.org/10.33898/rdp.v23i89.641
Fonseca-Pedrero, E. & Pérez de Albéniz, A. (2020). Evaluación de la conducta suicida en adolescentes: A propósito de la escala Paykel de suicidio [Evaluation of suicidal behavior in adolescents: About the Paykel suicide scale]. Papeles del psicólogo, 41(2), 106-115. https://doi.org/10.23923/pap.psicol2020.2928
Fonseca Pedrero, E., Pérez-Álvarez, M., Al-Halabí, S., Inchausti, F., Muñiz, J., López-Navarro, E., Pérez de Albéniz, A., Lucas Molina, B., Debbané, M., Bobes-Bascarán, M. T., Gimeno-Peón, A., Prado-Abril, J., Fernández-Álvarez, J., Rodríguez-Testal, J. F., González Pando, D., Díez-Gómez, A., García Montes, J. M., García-Cerdán, L., Osma, J., ... Marrero, R. J. (2021). Tratamientos psicológicos para adultos basados en la evidencia: una revisión selectiva [Evidence-based psychological treatments for adults: a selective review]. Psicothema, 33(2), 188-197.https://doi.org/10.7334/psicothema2020.426
Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., Kerr, S., Tansey, L., Noel, P., Ferenbach, C., Masley, S., Roach, L., Lloyd, J., May, L., Clarke, S., & Remington, B. (2014). The development and initial validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45, 83-101. https://doi.org/10.1016/j.beth.2013.09.001
Hapenny, J. E. & Fergus, T. A. (2017). Cognitive fusion, experiential avoidance, and their interactive effect: Examining associations with thwarted belongingness and perceived burdensomeness. Journal of Contextual Behavioral Science, 6(1), 35-41. https://doi.org/10.1016/j.jcbs.2016.10.004
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013). Acceptance and commitment therapy and contextual behavioral science: Examining the progress of a distinctive model of behavioral and cognitive therapy. Behavior Therapy, 44(2), 180-198. https://doi.org/10.1016/j.beth.2009.08.002
Hayes, S. C., Merwin, R. M., McHugh, L., Sandoz, E. K., A-Tjak, J. G., Ruiz, F. J., Barnes-Holmes, D., Bricker, J. B., Ciarrochi, J., Dixon, M. R., Fung, K. P., Gloster, A. T., Gobin, R. L., Gould, E. R., Hofmann, S. G., Kasujja, R., Karekla, M., Luciano, C., & McCracken, L. M. (2021). Report of the ACBS task force on the strategies and tactics of contextual behavioral science research. Journal of Contextual Behavioral Science, 20, 172-183. https://doi.org/10.1016/j.jcbs.2021.03.007
Hayes, S. C., Pistorello, J., & Biglan, A. (2008). Acceptance and commitment therapy: Model, data, and extension to the prevention of suicide. Brazilian Journal of Behavioral and Cognitive Therapy, 1, 81-102. https://doi.org/10.31505/rbtcc.v10i1.329
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2014). Terapia de Aceptación y Compromiso: Proceso y práctica del cambio consciente [Acceptance and Commitment Therapy: Process and practice of conscious change]. Desclee de Brouwer.
Hawton, K., Witt, K. G., Salisbury, T. L. T., Arensman, E., Gunnell, D., Hazell, P., Townsend, E., & van Heeringen, K. (2016). Psychosocial interventions following selfharm in adults: A systematic review and meta-analysis. Lancet Psychiatry, 3, 740-750. https://doi.org/10.1016/S2215-0366(16)30070-0
Hennings, J. M. (2020). Function and Psychotherapy of Chronic Suicidality in Borderline Personality Disorder: Using the Reinforcement Model of Suicidality. Frontiers in Psychiatry, 11: 199. https://doi.org/10.3389/fpsyt.2020.00199
* Hinrichs, K. L., Steadman-Wood, P., & Meyerson, J. L. (2020). ACT now: The intersection of Acceptance and Commitment Therapy with palliative care in a veteran with chronic suicidal ideation. Clinical gerontologist, 43(1), 126-131. https://doi.org/10.1080/07317115.2019.1642974
Hiraoka, R., Cook, A. J., Bivona, J. M., Meyer, E. C., & Morissette, S. B. (2015). Acceptance and commitment therapy in the treatment of depression related to military sexual trauma in a woman veteran: A case study. Clinical Case Studies, 15(1), 84-97. https://doi.org/10.1177/1534650115594004
Instituto Nacional de Estadística. (2020). Informe Anual. https://www.ine.es/ss/Satellite?L=es_ES&c=Page&cid=1254735905219&p=1254735905219&pagename=INE%2FINELayout
Krafft, J., Hicks, T., Mack, S., & Levin, M. (2018). Psychological inflexibility predicts suicidality over time in college students. The American Association of Suicidology, 1- 9. https://doi.org/10.1111/sltb.12533
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine, 16, 606-613. https://doi/.org/10.1046/j.1525-1497.2001.016009606.xç
* Kumpula, M. J., Wagner, H. R., Dedert, E. A., Crowe, C. M., Day, K. T., Powell, K., Batdorf, W. H., Shaban, H., Kim, E., & Kimbrel, N. A. (2019). An evaluation of the effectiveness of evidence-based psychotherapies for depression to reduce suicidal ideation among male and female veterans. Women's Health Issues, 29, 103-111. https://doi.org/10.1016/j.whi.2019.04.013
Leavey, K. & Hawkins, R. (2017). Is cognitive behavioural therapy effective in reducing suicidal ideation and behaviour when delivered face-to-face or via e-health? A systematic review and meta-analysis. Cognitive Behaviour Therapy, 46, 353-374. https://doi.org/10.1080/16506073.2017.1332095
* Luoma, J. B. & Villatte, J. L. (2012). Mindfulness in the treatment of suicidal individuals. Cognitive and Behavioral Practice, 19(2), 265-276. https://doi.org/10.1016/j.cbpra.2010.12.003
* Meyer, E. C., Walser, R., Hermann, B., La Bash, H., DeBeer, B. B., Morissette, S. B., Kimbrel, N. A., Know, O., Batten, S. V., & Schnurr, P. P. (2018). Acceptance and commitment therapy for co‐occurring posttraumatic stress disorder and alcohol use disorders in veterans: Pilot treatment outcomes. Journal of Traumatic Stress, 31(5), 781-789. https://doi.org/10.1002/jts.22322
Metalsky, G. I. & Joiner, T. E. (1997). The hopelessness depression symptom questionnaire. Cognitive Therapy and Research, 21(3), 359-384. https://doi.org/10.1023/A:1021882717784
* Morton, J., Snowdon, S., Gopold, M., & Guymer, E. (2012). Acceptance and commitment therapy group treatment for symptoms of borderline personality disorder: A public sector pilot study. Cognitive and Behavioral Practice, 19(4), 527-544. https://doi.org/10.1016/j.cbpra.2012.03.005
O’Connor, R. C. & Nock, M. K. (2014): The psychology of suicidal behaviour. Lancet Psychiatry, 1(1), 73-85. https://doi.org/10.1016/S2215-0366(14)70222-6
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseef, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., & Moher, D. (2021). Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas [PRISMA 2020 Statement: An Updated Guide to the Publication of Systematic Reviews]. Revista Española de Cardiología, 74(9), 790-799. https://doi.org/10.1016/j.recesp.2021.06.016
Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia– Suicide Severity Rating Scale: Initial validity and internal consistency findings from three multisite studies with adolescents and adults. American Journal of Psychiatry, 168(12), 1266-1277. https://doi.org/10.1176/appi.ajp.2011.10111704
Riblet, N., Shiner, B., Young-Xu, Y., & Watts, B. (2017). Strategies to prevent death by suicide: Meta-analysis of randomised controlled trials. British Journal of Psychiatry, 210, 396- 402. https://doi.org/10.1192/bjp.bp.116.187799
Runeson, B., Odeberg, J., Pettersson, A., Edbom, T., Jildevik Adamsson, I., & Waern, M. (2017). Instruments for the assessment of suicide risk: a systematic review evaluating the certainty of the evidence. PLoS ONE, 12(7): e0180292. https://doi.org/10.1371/journal.pone.0180292
* Sokol, Y., Ridley, J., Goodman, M., Landa, Y., Hernandez, S., & Dixon, L. (2021). Continuous Identity Cognitive Therapy: Feasibility and Acceptability of a Novel Intervention for Suicidal Symptoms. Journal of Cognitive Psychotherapy, 35(1), 64-80. https://doi.org/10.1891/JCPSY-D-20-00023
Tighe, J., Nicholas, J., Shand, F., & Christensen, H. (2018). Efficacy of acceptance and commitment therapy in reducing suicidal ideation and deliberate self-harm: systematic review. JMIR mental health, 5(2), e10732. https://doi.org/10.2196/10732
* Tighe, J., Shand, F., Ridani, R., Mackinnon, A., De La Mata, N., & Christensen, H. (2017). Ibobbly mobile health intervention for suicide prevention in Australian Indigenous youth: a pilot andomized controlled trial. BMJ open, 7(1): e013518. https://doi.org/10.1136/bmjopen-2016-013518
* Vaca-Ferrer, R., García, R. F., & Valero-Aguayo, L. (2020). Eficacia de un programa de intervención grupal con mujeres víctimas de violencia de género en el marco de las terapias contextuales [Efficacy of a group intervention program with women victims of gender violence within the framework of contextual therapies]. Anales de Psicología, 36(2), 188-199. https://doi.org/10.6018/analesps.396901
* Walser, R. D., Garvert, D. W., Karlin, B. E., Trockel, M., Ryu, D. M., & Taylor, C. B. (2015). Effectiveness of Acceptance and Commitment Therapy in treating depression and suicidal ideation in Veterans. Behaviour research and therapy, 74, 25-31. https://doi.org/10.1016/j.brat.2015.08.012
Weeks, S. N., Renshaw, T. L., Galliher, R. V., & Tehee, M. (2020). The moderating role of psychological inflexibility in the relationship between minority stress, substance misuse, and suicidality in LGB+ adolescents. Journal of Contextual Behavioral Science, 18, 276-286. https://doi.org/10.1016/j.jcbs.2020.10.007
World Health Organization (WHO) (2018). World health statistics data visualizations dashboard (target 3.4 suicide). Recuperado de https://apps.who.int/gho/data/node.sdg.3-4-viz-2?lang=en.
Zalsman, G., Hawton, K., Wasserman, D., van Heeringen, K., Arensman, E., Sarchiapone, M., Carli, V., Höschl, C., Barzilay, R., Balazs, J., Purebl, G., Kahn, J. P., Sáiz, P. A., Lipsicas, C. B., Bobes, J., Cozman, D., Ulrich Hegerl, U., & Zohar, J. (2016). Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry, 3, 646- 659. https://doi.org/10.1016/S2215-0366(16)30030-X
Zettle, R. (2007). ACT for depression: A clinician's guide to using acceptance & commitment therapy in treating depression. New Harbinger Publications.
Zortea, T. C., Cleare, S., Melson, A. J., Wetherall, K., & O’Connor, R. C. (2020). Understanding and managing suicide risk. British Medical Bulletin, 134(1), 73-84. https://doi.org/10.1093/bmb/ldaa013
Derechos de autor 2024 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.
