Publication: Papel de las actitudes y creencias disfuncionales en el tratamiento psicológico de las víctimas de terrorismo que sufren depresión
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Publication Date
2021-05-25
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García Vera, María Paz
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Universidad Complutense de Madrid
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Abstract
El trastorno por estrés postraumático (TEPT) es el trastorno mental más frecuente entre las víctimas del terrorismo y al que más atención ha prestado la comunidad científica. Sin embargo, tras un atentado terrorista pueden aparecer una gran variedad de síntomas psicopatológicos y trastornos mentales diagnosticables, entre los cuales el más frecuente, después del TEPT, es el trastorno depresivo mayor (TDM). Por ejemplo, en una revisión realizada por Salguero et al. (2011) se estimó que el riesgo de sufrir un trastorno depresivo mayor entre las víctimas directas e indirectas del terrorismo era de 20-30% y 4-10%, respectivamente. Es más, los estudios indican una alta comorbilidad entre el TEPT y el TDM, de manera que entre las víctimas con TEPT que buscan o reciben ayuda psicológica, entre un 47% y un 64% sufren además un TDM (p. ej., Gillespie, Duffy, Hackmann y Clark, 2002; Duffy, Gillespie y Clark, 2007). Por otro lado, la mayoría de los modelos cognitivos de la depresión y, en especial, la teoría cognitiva de Beck (Beck et al., 1979/1983), han propuesto que las actitudes o creencias disfuncionales son un factor de vulnerabilidad clave para el desarrollo, mantenimiento y exacerbación del TDM, en particular las actitudes o creencias que supuestamente son características de los pacientes deprimidos como, por ejemplo, aquellas que son evaluada por la Escala de Actitudes Disfuncionales (Dysfunctional Attitude Scale) o DAS de Weissman y Beck (1978), sin duda el instrumento más investigado y utilizada para evaluar dichas actitudes (Sanz y Vázquez, 1993). A pesar de la alta prevalencia del TDM en las víctimas del terrorismo y del papel que teóricamente desempeñaría las actitudes disfuncionales depresivas en su desarrollo, no se ha encontrado ninguna investigación previa específica sobre dicho papel en víctimas del terrorismo. En este sentido, por ejemplo, se desconoce si la terapia cognitivo-conductual que tan eficaz se ha mostrado en el tratamiento del TDM en víctimas de muy diverso tipo, incluidas víctimas de atentados terroristas (García-Vera et al., 2015), modifica dichas actitudes y dicha modificación está relacionada con los beneficios encontrados tras la terapia sobre los síntomas emocionales, incluidos los síntomas depresivos. Precisamente este fue el objetivo de esta tesis doctoral...
Post-traumatic stress disorder (PTSD) is the most common mental disorder among victims of terrorism and the one to which the scientific community has paid the most attention. However, after a terrorist attack, a wide variety of psychopathological symptoms and diagnosable mental disorders can appear, among which the most frequent, after PTSD, is major depressive disorder (MDD). For example, in a review by Salguero et al. (2011) it was estimated that the risk of suffering a major depressive disorder among direct and indirect victims of terrorism was 20-30% and 4-10%, respectively. Furthermore, studies indicate a high comorbidity between PTSD and MDD, so that among victims with PTSD who seek or receive psychological help, between 47% and 64% also suffer from MDD (e. g., Gillespie, Duffy, Hackmann, & Clark, 2002; Duffy, Gillespie, & Clark, 2007). On the other hand, most cognitive models of depression and especially Beck’s cognitive theory (Beck et al., 1979/1983) have proposed that dysfunctional attitudes or beliefs are a key vulnerability factor for the development, maintenance, and exacerbation of MDD, in particular the attitudes or beliefs that are supposed to be characteristic of depressed patients, such as those assessed by Weissman & Beck’s (1978) Dysfunctional Attitude Scale or DAS, undoubtedly the most researched and used instrument to assess those attitudes (Sanz & Vázquez, 1993). Despite the high prevalence of MDD among victims of terrorism and the role that depressive dysfunctional attitudes would theoretically play in its development, no previous research specifically on that role in victims of terrorism has been found. In this sense, for example, it is unknown whether cognitive-behavioral therapy, which has been shown to be so effective in treating MDD in victims of many different types of traumatic events, including victims of terrorist attacks (García-Vera et al., 2015), modifies these attitudes and this modification is related to the benefits found after therapy on emotional symptoms, including depressive symptoms. This was precisely the objective of this doctoral thesis...
Post-traumatic stress disorder (PTSD) is the most common mental disorder among victims of terrorism and the one to which the scientific community has paid the most attention. However, after a terrorist attack, a wide variety of psychopathological symptoms and diagnosable mental disorders can appear, among which the most frequent, after PTSD, is major depressive disorder (MDD). For example, in a review by Salguero et al. (2011) it was estimated that the risk of suffering a major depressive disorder among direct and indirect victims of terrorism was 20-30% and 4-10%, respectively. Furthermore, studies indicate a high comorbidity between PTSD and MDD, so that among victims with PTSD who seek or receive psychological help, between 47% and 64% also suffer from MDD (e. g., Gillespie, Duffy, Hackmann, & Clark, 2002; Duffy, Gillespie, & Clark, 2007). On the other hand, most cognitive models of depression and especially Beck’s cognitive theory (Beck et al., 1979/1983) have proposed that dysfunctional attitudes or beliefs are a key vulnerability factor for the development, maintenance, and exacerbation of MDD, in particular the attitudes or beliefs that are supposed to be characteristic of depressed patients, such as those assessed by Weissman & Beck’s (1978) Dysfunctional Attitude Scale or DAS, undoubtedly the most researched and used instrument to assess those attitudes (Sanz & Vázquez, 1993). Despite the high prevalence of MDD among victims of terrorism and the role that depressive dysfunctional attitudes would theoretically play in its development, no previous research specifically on that role in victims of terrorism has been found. In this sense, for example, it is unknown whether cognitive-behavioral therapy, which has been shown to be so effective in treating MDD in victims of many different types of traumatic events, including victims of terrorist attacks (García-Vera et al., 2015), modifies these attitudes and this modification is related to the benefits found after therapy on emotional symptoms, including depressive symptoms. This was precisely the objective of this doctoral thesis...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Psicología, leída el 20/01/2021