Abstract
Emotional disorders are the most prevalent and with the greatest comorbidity. The present study shows the findings of a single case that used an A-B design to address the comorbidity of emotional disorders through the transdiagnostic perspective of telepsychology. The participant, a 41-year-old woman with symptoms of anxiety and depression derived from being a victim of physical and emotional violence, experienced significant improvements throughout a web/mobile-based intervention program with weekly accompaniment from a therapist synchronously for 60 minutes videoconference for 8 weeks. A considerable reduction resulted in the general and specific symptoms of anxiety, depression, and emotional dysregulation, with changes of between 50% and 60% compared to the baseline. The most notable reduction in symptoms occurred in post-traumatic stress symptoms. The participant evaluated the treatment received as highly acceptable, suitable, and adequate and highlighted the high usability of the system. The results indicated that the transdiagnostic intervention program via the Internet proved to be a promising tool to address emotional and traumatic disorders, even in situations of limited access to clinical care. However, future research is required to support its long-term effectiveness.
References
American Psychological Association (2013). Guidelines for the Practice of Telepsychology. American Psychologist. Recuperado de https://www.apa.org/practice/guidelines/telepsychology
Antuña C., C. y Rodríguez, F.J. (2022). Los trastornos emocionales desde el modelo transdiagnóstico: un estudio de caso. Análisis y Modificación de Conducta, 48(177), 3-14. Doi: 10.33776/amc.v48i177.6920
Barlow, D.H., Allen, L.B. y Choate, M.L. (2016). Toward a unified treatment for emotional disorders. Behavior Therapy, 47(6), 838-853. Doi: 10.1016/j.beth.2016.11.005
Barlow, D.H., Farchione, T.J., Fairholme, C., Ellard, K.K., Boisseau, C., Allen, L. y Ehrenreich-May, J. (2011). Unified protocol for the transdiagnostic treatment of emotional disorders: Therapist guide. Oxford University Press.
Beck, A.T., Epstein, N., Brown, G. y Steer, R. (1998). Beck Anxiety Inventory. APA PsycTests. Doi: 10.1037/t02025-000
Beck, A.T., Steer, R.A. y Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. San Antonio: Psychological Corporation.
Bentley, K.H., Gallagher, M.W., Carl, J.R. y Barlow, D.H. (2014). Development and validation of the Overall Depression Severity and Impairment Scale. Psychological Assessment, 26(3), 815-830. Doi: 10.1037/a0036216
Botella, C., Gallego, M.J., García P., A., Guillén, V., Baños, R.M., Quero, S. y Alcañiz, M. (2010). An internet-based self-help treatment for fear of public speaking: A controlled trial. Cyberpsychology, Behavior and Social Networking, 13(4), 407-421. Doi: 10.1089/cyber.2009.0224
Brenes, G.A. (2007). Anxiety, depression and quality of life in primary care patients. The Primary Care Companion to the Journal of Clinical Psychiatry, 9(6), 437-443. Doi: 10.4088/PCC.v09n0606
Cruz F., C., López, L., Blas, C., González, L. y Chávez, R. (2005). Datos sobre la validez y confiabilidad de la Symptom Check List 90 (SCL 90) en una muestra de sujetos mexicanos. Salud Mental, 28(1), 72-81.
De la Rosa G., A., Flores P., L.A., Esquivel S., E., Santillán, C., García, R., Domínguez, A., Arenas, P., Castellanos, R., Berra, E., Silvestre, R., Miranda, G., Díaz, D., Hernández, A., Flores, A., Valencia, P. y Vázquez, M. (2022). Efficacy of a transdiagnostic guided internet-delivered intervention for emotional, trauma and stress-related disorders in Mexican population: study protocol for a randomized controlled trial. BMC Psychiatry, 22(1). Doi: 10.1186/s12888-022-04132-6
De la Rosa G., A., Hernández P., A., Valencia, P., Flores P., A., Serrano, B., Flores, A., Dominguez R., A., Vázquez, M. y González, E. (2023). Online transdiagnostic intervention for emotional, trauma- and stressor-related disorders in the Mexican population: A randomized pilot and feasibility trial. Contemporary Clinical Trials Communications, 35. Doi: 10.1016/j.conctc.2023.101204
De la Rosa G., A., Hernández P., A., Valencia, P. y Guajardo G., D. (2021). Análisis dimensional de la Escala de Dificultades en la Regulación Emocional (DERS-15) en universitarios mexicanos. Evaluar, 21(2), 80-97. Doi: 10.35670/1667-4545.v21.n2.34401
Derogatis, L. (1994). SCL-90-R. Symptom Checklist-90-R. Administration, Scoring and Procedures Manual. Minneapolis: National Computer System.
Durón F., R., Cárdenas L., G., Castro C., J. y De la Rosa G., A. (2019). Adaptación de la Lista Checable de Trastorno por Estrés Postraumático para DSM-5 en población mexicana. Acta de Investigación Psicológica, 9(1), 26-36. Doi: 10.22201/fpsi.20074719e.2019.1.03
Ellard, K., Fairholme, C., Boisseau, C., Farchione, T. y Barlow, D. (2010). Unified protocol for the transdiagnostic treatment of emotional disorders: protocol development and initial outcome data. Cognitive Behavior Practice, 17(1), 88-101. Doi: 10.1016/j.cbpra.2009.06.002
González, D., Reséndiz, A. y Reyes L., I. (2015). Adaptation of the BDI-II in Mexico. Salud Mental, 38(4), 237-244. Doi: 10.17711/sm.0185-3325.2015.033
Gratz, K.L. y Roemer, L. (2008). 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, 30, 315. Doi: 10.1007/s10862-008-9102-4
Harvey, A., Watkins, E., Mansell, W. y Shafran, R. (2004). Cognitive behavioral processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford University Press.
Heinze, M., Sheehan, D. y Cortés, J. (2000). Mini International Neuropsychiatric Interview (MINI): Spanish version (South and Central America) 500 DSM-IV. México: Instituto Nacional de Psiquiatría.
Jurado, S., Villegas, M., Méndez, L., Rodríguez, F., Loperena, V. y Varela, R. (1998). La estandarización del Inventario de Beck para los residentes de la Ciudad de México. Salud Mental, 21(3), 237-244. Recuperado de https://www.revistasaludmental.mx/index.php/salud_mental/article/view/706
Kato, N., Ito, M., Matsuoka, Y.J., Horikoshi, M. y Ono, Y. (2021). Application of the unified protocol for a japanese patient with post-traumatic stress disorder and multiple comorbidities: a single-case study. International Journal of Environmental Research and Public Health, 18(21). Doi: 10.3390/ijerph182111644
McCord, C.E., Saenz, J., Armstrong, T.W. y Elliott, T.R. (2015). Training the next generation of counseling psychologists in the practice of telepsychology. Counseling Psychology Quarterly, 28(3), 324-344. Doi: 10.1080/09515070.2015.1053433
Mineka, S., Watson, D. y Clark, L.A. (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology, 49, 377-412. Doi: 10.1146/annurev.psych.49.1.377
Norman, S.B., Campbell S., L., Hitchcock, C.A., Sullivan, S., Rochlin, A., Wilkins, K.C. y Stein, M.B. (2011). Psychometrics of a brief measure of anxiety to detect severity and impairment: the Overall Anxiety Severity and Impairment Scale (OASIS). Journal of Psychiatric Research, 45(2), 262-268. Doi: 10.1016/j.jpsychires.2010.06.011
Organización Mundial de la Salud (2022a). Trastornos mentales. Ginebra: OMS. Recuperado de https://www.who.int/es/news-room/fact-sheets/detail/mental-disorders
Organización Mundial de la Salud (2022b). Salud mental y COVID-19: datos iniciales sobre las repercusiones de la pandemia. Ginebra: OMS. Recuperado de https://www.who.int/es/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1
Osma, J., Quiles O., A., Suso R., C., Peris B., O., Norman, S.B., Bentley, K.H. y 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(1), 9-18. Doi: 10.1016/j.jad.2019.03.063
Pote, H., Rees, A., Holloway-Biddle, C. y Griffith, E. (2021). Workforce challenges in digital health implementation: How are clinical psychology training programmes developing digital competences? Digit Health, 7, 1-11. Doi: 10.1177/2055207620985396
Robles, R., Varela, R., Jurado, S. y Páez, F. (2001). Versión mexicana del Inventario de Ansiedad de Beck: Propiedades psicométricas. Revista Mexicana de Psicología, 18(2), 211-218.
Rojas J., C., Polanco C., R., Caycho R., T., Muñoz V., C., Muño M., M., Luna G., T. y Muñoz T., T. (2022). Telepsicología para psicoterapeutas: lecciones aprendidas en tiempos del Covid-19. Revista Interamericana de Psicología, 56(2), 1733. Doi: 10.30849/ripijp.v56i2.1733
Rosique, M.T., Sandín, B., Valiente, R.M., García E., J. y Chorot, P. (2019). Tratamiento transdiagnóstico de un caso clínico con elevada comorbilidad de trastornos emocionales: aplicación del Protocolo Unificado. Revista Argentina de Clínica Psicológica, 28(1), 79. Doi: 10.24205/03276716.2019.1092
Sandín, B., Chorot, P. y Valiente, R.M. (2012). Transdiagnóstico: Nueva frontera en psicología clínica. Revista de Psicopatología y Psicología Clínica, 17(3), 185-203. Doi: 10.5944/rppc.vol.17.num.3.2012.11839
Sheehan, D.V., Lecrubier, Y., Harnett-Sheehan, K., Janavs, J., Weiller, E., Keskiner, A., Schinka, J., Knapp, E., Sheehan, M.F. y Dunbar, G.C. (1997). The validity of the MINI International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12(59), 232-241. Doi: 10.1016/S0924-9338(97)83297-X
Sociedad Mexicana de Psicología (2010). Código ético del psicólogo (5a ed.). Trillas.
Taylor, C., Graham, A., Flatt, R., Waldherr, K. y Fitzsimmons-Craft, E. (2021). Current state of scientific evidence on Internet-based interventions for the treatment of depression, anxiety, eating disorders and substance abuse: an overview of systematic reviews and meta-analyses. European Journal of Public Health, 31(1), i3-i10. Doi: 10.1093/eurpub/ckz208
Weathers, F.W., Litz, B., Keane, T.M., Palmieri, P.A., Marx, B.P., Schnurr, P.P. (2013). The PTSD Checklist for DSM-5 (PCL-5). www.ptsd.va.gov
Weisel, K., Zarski, A., Berger, T., Schaub, M., Krieger, T., Moser, C., Berking, M. y Ebert, D. (2018). Transdiagnostic tailored internet-and mobile-based guided treatment for major depressive disorder and comorbid anxiety: study protocol of a randomized controlled trial. Frontiers in Psychiatry, 9. Doi: 10.3389/fpsyt.2018.00274