Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-25T07:50:00.325Z Has data issue: false hasContentIssue false
  • English
  • Français

Group Therapy for Patients with Adjustment Disorder in Primary Care

Published online by Cambridge University Press:  16 November 2018

José Manuel Sanz Cruces ,
Isabel María García Cuenca ,
Laura Lacomba-Trejo ,
Miguel Ángel Cuquerella Adell ,
Isabel Cano Navarro ,
María Ferrandis Cortés ,
Eva Jordá Carreres  and
Eva Carbajo Álvarez
José Manuel Sanz Cruces
Affiliation:
Hospital Universitario Institut Pere Mata (Spain)
Isabel María García Cuenca*
Affiliation:
Consorci Hospital General Universitari de Valencia (Spain)
Laura Lacomba-Trejo
Affiliation:
Consorci Hospital General Universitari de Valencia (Spain)
Miguel Ángel Cuquerella Adell
Affiliation:
Consorci Hospital General Universitari de Valencia (Spain)
Isabel Cano Navarro
Affiliation:
Consorci Hospital General Universitari de Valencia (Spain)
María Ferrandis Cortés
Affiliation:
Consorci Hospital General Universitari de Valencia (Spain)
Eva Jordá Carreres
Affiliation:
Consorci Hospital General Universitari de Valencia (Spain)
Eva Carbajo Álvarez
Affiliation:
Consorci Hospital General Universitari de Valencia (Spain)
*
*Correspondence concerning this article should be addressed to Isabel María García Cuenca. Unidad de Psicología Clínica y de la Salud del Consorci Hospital General Universitari de Valencia (Spain). Avenida Tres Cruces, 2, 46014 Valencia (Spain). E-mail: isagarciacuenca@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

A high percentage of patients have a diagnosis of adjustment disorder (AD) when they arrive at primary care (PC) appointments. However, most of them do not receive adequate psychological treatment. The present study’s aim is to determine the efficacy of a group psychological treatment program in patients with AD. The sample consisted of patients with AD from two PC units in Valencia, from which two groups were randomly generated: A treatment group (n = 31) and a waiting-list group (n = 20), homogeneous in terms of socio-demographic and psychometric variables prior to treatment. Treatment consisted of eight one-hour group sessions held on a weekly basis; taking a cognitive-behavioral approach, they addressed aspects like controlling anxiety, cognitive restructuring, and coping techniques. The variables analyzed were: Psychopathology (Revised Symptom Inventory, SCL–90–R), health-related quality of life (Health Questionnaire, SF–12), and risk of suicidal behavior (Suicide Risk Scale). Means comparisons, ANCOVAs, and tests of effect size were performed. Statistically significant differences were observed in the variables, such that after intervention, the experimental group exhibited less anxious (F = 4.11, p =.048, η2 = .08) and depressive symptoms (F = 2.41, p =.029, η 2= .10) and higher quality of life related to physical (F = 7.17, p =.010, η2 = .13) and emotional health (F = 10.31, p =.002, η2 = .18). For the reasons above, we conclude that a comprehensive approach to emotional distress in PC, including group psychological interventions, is one solution for the demand for social services, and could provide savings on economic as well as human costs.

Keywords

adjustment disordergroup therapyhealthprimary care
Type
Research Article
Information
The Spanish Journal of Psychology , Volume 21 , 2018 , E50
Copyright
Copyright © Universidad Complutense de Madrid and Colegio Oficial de Psicólogos de Madrid 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alonso, J., Prieto, L., & Antó, J. M. (1995). La versión española del SF–36 Health Survey (Cuestionario de salud SF–36): Un instrumento para la medida de los resultados clínicos [The Spanish version of the SF–36 Health Survey: An instrument for measuring clinical outcomes]. Medicina Clínica, 104, 771–776.Google Scholar
American Psychological Association (2014). Manual diagnóstico y estadístico de los trastornos mentales [Diagnostic and statistical manual of mental disorders] (5th Ed.). Madrid, Spain: Panamericana.Google Scholar
Barra, E. (2003). Influencia del estado emocional en la salud física [Influence of emotional state on physical health]. Terapia Psicológica, 21, 55–60.Google Scholar
Batterham, P. J., Christensen, H., Mackinnon, A. J., Gosling, J. A., Thorndike, F. P., Ritterband, L. M., … Griffiths, K. M. (2017). Trajectories of change and long-term outcomes in a randomised controlled trial of internet-based insomnia treatment to prevent depression. BJ Psych Open, 3(5), 228–235. https://doi.org/10.1192/bjpo.bp.117.005231Google Scholar
Burgos, M. L., Ortiz, M. D., Muñoz, F., Vega, P., & Bordallo, R. (2006). Intervención grupal en los trastornos de ansiedad en atención primaria: Técnicas de relajación y cognitivo conductuales [Group intervention in anxiety disorders in primary care: Relaxation and cognitive behavioral techniques]. SEMERGEN - Medicina de Familia, 32, 205–210. https://doi.org/10.1016/S1138-3593(06)73258-0CrossRefGoogle Scholar
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26, 17–31. https://doi.org/10.1016/j.cpr.2005.07.003CrossRefGoogle ScholarPubMed
Cano, A. (2011). Bases teóricas y apoyo empírico de la intervención psicológica sobre los desórdenes emocionales en atención primaria. Una actualización [Theoretical bases and empirical support for psychological intervention in emotional disorders in primary care. An update]. Ansiedad y Estrés, 17, 157–184.Google Scholar
Carta, M. G., Balestrieri, M., Murru, A., & Hardoy, M. C. (2009). Adjustment disorder: Epidemiology, diagnosis and treatment. Clinical Practice and Epidemiology in Mental Health, 5(15). https://doi.org/10.1186/1745-0179-5-15CrossRefGoogle Scholar
Casey, P. (2009). Adjustment disorder. CNS Drugs, 23, 927–938. https://doi.org/10.2165/11311000-000000000-00000CrossRefGoogle ScholarPubMed
Casey, P., Dowrick, C., & Wilkinson, G. (2001). Adjustment disorders. Fault line in the psychiatry glossary. The British Journal of Psychiatry, 179, 479–481. https://doi.org/10.1192/bjp.179.6.479CrossRefGoogle ScholarPubMed
Cape, J., Whittington, C., Buszewicz, M., Wallace, P., & Underwood, L. (2010). Brief psychological therapies for anxiety and depression in primary care: Meta-analysis and meta-regression. BMC Medicine, 8, 38. https://doi.org/10.1186/1741-7015-8-38CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd Ed.). Hillsdale, NJ: Erlbaum.Google Scholar
Cuijpers, P., Smit, F., & van Straten, A. (2007). Psychological treatments of subthreshold depression: A meta-analytic review. Acta Psychiatrica Scandinavica, 115, 434–441. https://doi.org/10.1111/j.1600-0447.2007.00998.xCrossRefGoogle ScholarPubMed
Derogatis, L. R., & Savitz, K. L. (2000). The SCL–90–R and brief symptom inventory (BSI) in primary care. In Maruish, M. E. (Ed.), Handbook of psychological assessment in primary care settings (pp. 297–334). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
Egea, E., Trigo, A., & Bernal, M. T. (2014, February). Experiencia de grupo terapéutico para trastornos adaptativos [Experience of group therapy for adaptive disorders]. Paper presented at Interpsiquis 2014, the 15th virtual meeting of Psiquiatría.com. Retrieved from https://psiquiatria.com/atencion-primaria/experiencia-de-grupo-terapeutico-para-trastornos-adaptativos/Google Scholar
Fernández, A., Haro, J. M., Martinez-Alonso, M., Demyttenaere, K., Brugha, T. S., Autonell, J., … Alonso, J. (2007). Treatment adequacy for anxiety and depressive disorders in six European countries. The British Journal of Psychiatry, 190, 172–173. https://doi.org/10.1192/bjp.bp.106.023507CrossRefGoogle ScholarPubMed
Fernández, A., Saameño, J. A., Pinto-Meza, A., Luciano, J. V., Autonell, J., Palao, D., … Serrano, A. (2010). Burden of chronic physical conditions and mental disorders in primary care. The British Journal of Psychiatry, 196, 302–309. https://doi.org/10.1192/bjp.bp.109.074211CrossRefGoogle ScholarPubMed
González de Rivera, J. L., Derogatis, L. R., de las Cuevas, C., Gracia, R., Rodríguez, F., Henry-Benítez, M., & Monterrey, A. L. (1989). The Spanish version of the SCL– 90–R. Normative data in the general population. Towson, MD: Clinical Psychometric Research.Google Scholar
Gradus, J. L., Qin, P., Lincoln, A. K., Miller, M., Lawler, E., & Lash, T. L. (2010). The association between adjustment disorder diagnosed at psychiatric treatment facilities and completed suicide. Clinical Epidemiology, 2, 23–28. https://doi.org/10.1192/bjpo.bp.117.005231CrossRefGoogle ScholarPubMed
Høifødt, R. S., Strøm, C., Kolstrup, N., Eisemann, M., & Waterloo, K. (2011). Effectiveness of cognitive behavioral therapy in primary health care: A review. Family Practice, 28, 489–504. https://doi.org/10.1093/fampra/cmr017CrossRefGoogle ScholarPubMed
Hollinghurst, S., Kessler, D., Peters, T. J., & Gunnell, D. (2005). Opportunity cost of antidepressant prescribing in England: Analysis of routine data. British Medical Journal, 330, 999. https://doi.org/10.1136/bmj.38377.715799.F7CrossRefGoogle ScholarPubMed
Huntley, A. L., Araya, R., & Salisbury, C. (2012). Group psychological therapies for depression in the community: Systematic review and meta-analysis. The British Journal of Psychiatry, 200, 184–190. https://doi.org/10.1192/bjp.bp.111.092049CrossRefGoogle ScholarPubMed
Kaplan, H. I., & Sadock, B. J. (1998). Synopsis of psychiatry. Baltimore, MD: Williams & Wilkins.Google Scholar
Kovess-Masfety, V., Alonso, J., Brugha, T. S., Angermeyer, M. C., Haro, J. M., & Sevilla-Dedieu, C. (2007). Differences in lifetime use of services for mental health problems in six European countries. Psychiatric Services, 58, 213–220. https://doi.org/10.1176/ps.2007.58.2.213CrossRefGoogle ScholarPubMed
Linde, K., Sigterman, K., Kriston, L., Rücker, G., Jamil, S., Meissner, K., & Schneider, A. (2015). Effectiveness of psychological treatments for depressive disorders in primary care: Systematic review and meta-analysis. Annals of Family Medicine, 13, 56–68. https://doi.org/10.1370/afm.1719CrossRefGoogle ScholarPubMed
Ministerio de Sanidad y Consumo (2008). Guía de práctica clínica para el manejo de pacientes con trastornos de ansiedad en atención primaria [Clinical practice guidelines for managing patients with anxiety disorders in primary care]. Madrid, Spain: Unidad de Evaluación de Tecnologías Sanitarias.Google Scholar
Molés, M., Quero, S., Pérez, M. A., Nebot, S., & Botella, C. (2015). Eficacia diferencial de dos formas de aplicar las tareas para casa en el tratamiento de los trastornos adaptativos. Terapia emocional on line vs. formato tradicional [Differential efficacy of two ways to apply homework in the treatment of adaptive disorders. Emotional therapy online vs. traditional format]. Àgora de Salut, 1, 245–257. https://doi.org/10.6035/AgoraSalut.2015.1.19CrossRefGoogle Scholar
National Institute for Health and Care Excellence (2011). Common mental health disorders. Identification and pathways to care (NICE clinical guidelines CG123). Retrieved from NICE website https://www.nice.org.uk/guidance/cg123Google Scholar
Osma, J., Castellano, C., Crespo, E., & García-Palacios, A. (2015). El protocolo unificado para el tratamiento transdiagnóstico de los trastornos emocionales en formato grupal en el ámbito de la salud mental pública española [The unified protocol for cross-diagnostic treatment of emotional disorders in a group format in the context of public mental health in Spain]. Behavioral Psychology/Psicología Conductual, 23, 447–466.Google Scholar
Pastor, J. (2008). El psicólogo en atención primaria: Un debate necesario en el sistema nacional de salud [The psychologist in primary care: A necessary debate in the national health system]. Papeles del Psicólogo, 29, 271–290.Google Scholar
Pelkonen, M., & Marttunen, M. (2005). Adolescent outpatients with depressive disorders: Clinical characteristics and treatment received. Nordic Journal of Psychiatry, 59, 127–133. https://doi.org/10.1080/08039480510022981CrossRefGoogle ScholarPubMed
Rubio, G., Montero, I., Jáuregui, J., Villanueva, R., Casado, M. A., Marín, J. J., & Santo-Domingo, J. (1998). Validación de la escala de riesgo suicida de Plutchik en población española [Validation of the Plutchik Suicide Risk Scale in a Spanish population]. Archivos de Neurobiología, 61, 143–152.Google Scholar
Sánchez-García, M. (2014). Análisis de la eficacia de un tratamiento grupal cognitivo-conductual en sujetos con somatizaciones [Analysis of the efficacy of a cognitive-behavioral group treatment in subjects with somatizations]. Anales de Psicología, 30, 412–421. https://doi.org/10.6018/analesps.30.2.170271CrossRefGoogle Scholar
Sanz-Cruces, J. M., García-Cuenca, I. M., Cuquerella-Adell, M. A., Cano-Navarro, I., Jordá-Carreres, E., Blasco-Gallego, J., & Carbajo-Álvarez, E. (2016). Intervención grupal en trastorno adaptativo [Group intervention in adaptive disorder]. Behavioral Psychology, 24, 389–403.Google Scholar
Segarra, G., Farriols, N., & Palma, C. (2011). Prevalencia, impacto y tratamiento psicológico grupal de los trastornos de ansiedad: Una revisión en el ámbito de la atención primaria [Prevalence, impact and group psychological treatment of anxiety disorders: A review in the primary care context]. Aloma Revista de Psicologia, Ciències de l’Educació i de l’Esport, 28, 209–224.Google Scholar
Simón, N., Molés, M., & Quero, S. (2017). Tratamientos psicológicos para los trastornos adaptativos: Una revisión [Psychological treatments for adjustment disorders: A review]. Àgora de Salut VI, 4(39), 377–386.CrossRefGoogle Scholar
Sundquist, J., Lilja, Å., Palmér, K., Memon, A. A., Wang, X., Johansson, L. M., & Sundquist, K. (2015). Mindfulness group therapy in primary care patients with depression, anxiety and stress and adjustment disorders: Randomized controlled trial. The British Journal of Psychiatry, 206, 128–135. https://doi.org/10.1192/bjp.bp.114.150243CrossRefGoogle Scholar
van der Heiden, C., & Melchior, K. (2012). Cognitive-behavioral therapy for adjustment disorder: A preliminary study. The Behavior Therapist, 35, 57–60.Google Scholar