Publication: Estrés postraumático y violencia de pareja: análisis de la eficacia de tratamientos psicológicos
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2015-02-11
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Universidad Complutense de Madrid
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Abstract
El objetivo principal de este estudio es el desarrollo, replicación y evaluación de un programa de terapia psicológica dirigido a la disminución de la sintomatología del Trastorno de Estrés Postraumático (según criterios DSM-IV-TR) y otras variables psicopatológicas (depresión, autoestima, inadaptación y cogniciones postraumáticas) para mujeres expuestas a violencia de pareja. Es un programa protocolarizado y multicomponente. Se plantean tres hipótesis. Con diseño cuasi-experimental para: (1) mayor eficacia del programa de tratamiento (postratamiento y seguimientos al mes, tres, seis y doce meses) en comparación con un grupo no tratado, (2) iguales resultados en el contraste diferencial del tratamiento según formato de intervención: individual vs. grupal, y experimental para: (3) mayor beneficio por aplicación de los componentes de la intervención en el orden de terapia cognitiva seguida de exposición frente al orden inverso, aplicado a la muestra total tratada y al formato individual. Los resultados indican una magnitud del efecto del tratamiento intra-grupo elevada en todos los contrastes realizados para la muestra de tratamiento (N=95). El tamaño del efecto inter-grupo es alto en todos los contrastes para la comparación del tratamiento con el grupo control (N=21), moderado en la variable dependiente TEPT en la comparación entre formatos de aplicación individual (N=45) vs. grupal (N=50) en los seguimientos a los 6 y 12 meses y nulo o bajo en la comparación entre grupos según el orden de aplicación de las técnicas (terapia cognitiva seguida de exposición, N=47 y orden inverso, N=48). Las ganancias son más rápidas en las variables clínicas respecto al reajuste social o cogniciones postraumáticas. Así, el programa de intervención psicológica que se ha desarrollado y replicado en este estudio ha resultado eficaz, eficiente y efectivo. El diseño es útil, con calidad metodológica, aplicado en un tiempo limitado, breve y a bajo costo y los beneficios se mantienen a largo plazo.
The primary objective of this study is the development, implementation and evaluation of a psychological program therapy directed at decreasing symptoms of PTSD (according to DSM-IV-TR) and other psychopathological variables (depression, self-esteem, inadequacy and posttraumatic cognitions) for women exposed to intimate partner violence. It is a formalized protocol and multi design components program. Three hypotheses were raised. With quasi-experimental design: (1) increased efficiency of the treatment program (post-treatment and follow-up at one, three, six and twelve months) compared with an untreated group, (2) the same results in the differential contrast of treatment as intervention format: individual vs. group, and experimental design for: (3) greater benefit by applying the intervention components in order of cognitive therapy followed by exposure to the reverse order, applied to the complete treated sample and individual format. The results indicate statistical and clinical significance for the treatment sample (N=95), with a pronounced decrease of the psychopathological evaluated symptoms. Large effect size is found in any groups who have been treated for all of dependent variables in all tests performed. Treatment group is superior to wait-list-control group (N=21). Individual format (N=45) shows a moderate effect size for PTSD, depression, self-esteem and general maladjustment in the follow-ups at 6 and 12 months, so, is superior to medium and long term for the group treatment application (N=50). No systematic difference in comparison of groups dependent upon the techniques application order is obtained; however, cognitive therapy followed by exposure (N=47) obtained better clinical results for PTSD at 12-months follow-up. Thus, this psychological intervention program that has been developed and replicated in this study has demonstrated its efficacy, effectiveness and efficiency. The design is useful and methodological quality. It is applied for a limited period, is brief and economical, and the benefits are maintained long term.
The primary objective of this study is the development, implementation and evaluation of a psychological program therapy directed at decreasing symptoms of PTSD (according to DSM-IV-TR) and other psychopathological variables (depression, self-esteem, inadequacy and posttraumatic cognitions) for women exposed to intimate partner violence. It is a formalized protocol and multi design components program. Three hypotheses were raised. With quasi-experimental design: (1) increased efficiency of the treatment program (post-treatment and follow-up at one, three, six and twelve months) compared with an untreated group, (2) the same results in the differential contrast of treatment as intervention format: individual vs. group, and experimental design for: (3) greater benefit by applying the intervention components in order of cognitive therapy followed by exposure to the reverse order, applied to the complete treated sample and individual format. The results indicate statistical and clinical significance for the treatment sample (N=95), with a pronounced decrease of the psychopathological evaluated symptoms. Large effect size is found in any groups who have been treated for all of dependent variables in all tests performed. Treatment group is superior to wait-list-control group (N=21). Individual format (N=45) shows a moderate effect size for PTSD, depression, self-esteem and general maladjustment in the follow-ups at 6 and 12 months, so, is superior to medium and long term for the group treatment application (N=50). No systematic difference in comparison of groups dependent upon the techniques application order is obtained; however, cognitive therapy followed by exposure (N=47) obtained better clinical results for PTSD at 12-months follow-up. Thus, this psychological intervention program that has been developed and replicated in this study has demonstrated its efficacy, effectiveness and efficiency. The design is useful and methodological quality. It is applied for a limited period, is brief and economical, and the benefits are maintained long term.
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamientos Psicológicos I, leída el 07-05-2014