Modelos cognitivo-conductuales del Trastorno de Ansiedad Generalizada
Palabras clave:
Trastorno de Ansiedad Generalizada, TAG, Terapias cognitivo-conductuales, TCC, modelos psicológicosResumen
El Trastorno de Ansiedad Generalizada (TAG) es frecuentemente crónico, de considerable prevalencia, elevada comorbilidad, importantes costos para pacientes, su familia, el sistema de salud, y de mala respuesta a los tratamientos existentes. Dada la envergadura del problema clínico, se considera necesario acercar a clínicos e investigadores las perspectivas actuales sobre el mismo. Con ese objetivo, se presentan las características principales de los siguientes modelos: modelo de la preocupación como evitación, modelo de desregulación emocional, terapia conductual basada en aceptación, modelo de la intolerancia a la incertidumbre, modelo metacognitivo, modelo de evitación del contraste emocional y terapia cognitiva estándar. Se comparan y discuten brevemente semejanzas y diferencias y se concluye en la necesidad del desarrollo colaborativo de modelos psicopatológicos de comprensión y estrategias clínicas que permitan aliviar el padecimiento de las personas afectadas.Descargas
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American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed. Revised) (DSM-III-R). Washington (DC): American Psychiatric Association.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (DSM-5®). Washington (DC): American Psychiatric Association.
Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive approach. Basic: New York.
Behar, E., Dobrow DiMarco, I. Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023.
Behar, E., Zuellig, A. R. & Borkovec, T. D. (2005). Thought and imaginal activity during worry and trauma recall. Behavior Therapy, 36(2), 157-168.
Borkovec, T. D. (1994). The nature, functions, and origins of worry. En G. Davey & F. Tallis (Eds.), Worrying: perspectives on theory assessment and treatment (pp. 5–33). Sussex: Wiley.
Borkovec, T. D. & Inz, J. (1990). The nature of worry in generalized anxiety disorder: A predominance of thought activity. Behaviour research and therapy, 28(2), 153-158.
Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance Theory of Worry and Generalized Anxiety Disorder. En R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77-108). New York: Guilford.
Borkovec, T., Robinson, E., Pruzinsky, T. & DePree, J. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21(1), 9-16.
Brown, T.A, O’Leary, T. A., & Barlow, D.H. (1993). Generalized anxiety disorder. En D. H . Barlow (Ed.), Clinical Handbook of Psychological Disorders (2da., Ed., pp-137-189). New York: Guilford.
Carter, R. M., Wittchen, H. U., Pfister, H. & Kessler, R. C. (2001). One‐year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depression and anxiety, 13(2), 78-88.
Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of anxiety disorders. New York: Guilford.
Cuijpers, P., Sijbrandij, M., Koole, S., Huibers, M., Berking, M. & Andersson, G. (2014). Psychological treatment of generalized anxiety disorder: A meta-analysis. Clinical Psychology Review, 34, 130-140.
Dugas, M. J., & Robichaud, M. (2007) Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. New York: Taylor & Francis.
Ekman, P. E. & Davidson, R. J. (1994). The nature of emotion: Fundamental questions. Oxford University Press.
Etchebarne, I. (2014). Estrategias psicoterapéuticas iniciales para el tratamiento del Trastorno de Ansiedad Generalizada. Tesis doctoral. Facultad de Psicología, Universidad de Buenos Aires.
Foa, E. B. & Kozak, M. J. (1986). Emotional processing of fear: exposure to corrective information. Psychological bulletin, 99(1), 20-35.
Foa, E. B., Huppert, J. D., & Cahill, S. P. (2006). Emotional processing theory: An update. In B. O. Rothbaum (Ed.), Pathological anxiety: Emotional processing in etiology and treatment (pp. 3–24). New York: Guilford.
Gomez, R. & Francis, L. M. (2003). Generalised Anxiety Disorder: relationships with Eysenck’s, Gray’s and Newman’s theories. Personality and Individual Differences, 34(1), 3-17.
Greenberg, L. S. (2002). Integrating an emotion-focused approach to treatment into psychotherapy integration. Journal of Psychotherapy integration, 12(2), 154-189.
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of general psychology, 2(3), 271.
Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry, 16(3), 245-246.
Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of consulting and clinical psychology, 64(6), 1152-1162.
Heimberg, R. G., Turk, C. L., & Mennin, D. S. (2004). Assesment. En R. G. Heimberg, C. L. Turk, & Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 219-247). New York: Guilford.
Henning, E. R., Turk, C. L., Mennin, D. S., Fresco, D. M. & Heimberg, R. G. (2007). Impairment and quality of life in individuals with generalized anxiety disorder. Depression and Anxiety, 24(5), 342-349.
Hettema, J. M., Neale, M. C., Kendler, K. S. (2001). A Review and Meta-Analysis of the Genetic Epidemiology of Anxiety Disorders. American Journal of Psychiatry, 158, 1568–1578.
Hirshfeld, D. R., Rosenbaum, J. F., Biederman, J., Bolduc, E. A., Faraone, S. V., Snidman, N., Reznick, J. S., Kagan, J. (1992). Stable Behavioral Inhibition and Its Association with Anxiety Disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 31, 103- 111.
Hoffman, D. L., Dukes, E. M. & Wittchen, H. U. (2008). Human and economic burden of generalized anxiety disorder. Depression and anxiety, 25(1), 72-90.
Kagan, J., Reznick, J., & Snidman, N. (1988). Biological Bases of Childhood Shyness. American Association for the Advancement of Science, 240, 167 - 171.
Katsuragi, S., Kunugi, H., Sano, A., Tsutsumi, T., Isogawa, K., Nanko, S., & Akiyoshi, J. (1999). Association between Serotonin Transporter Gene Polymorphism and Anxiety-Related Traits. Society of Biological Psychiatry, 45, 368- 370.
Kendler, K. S., Gardner, C. O., Gatz, M., & Pedersen, N. L. (2007). The sources of co-morbidity between major depression and generalized anxiety disorder in a Swedish national twin simple. Psychological Medicine, 37, 453-462.
Kessler, R. C., Chiu, W. T., Demler, O. & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of general psychiatry, 62(6), 617-627.
LeDoux, J. (1998). Fear and the brain: where have we been, and where are we going?. Biological psychiatry, 44(12), 1229-1238.
Leonardo, E. D. & Hen, R. (2008). Anxiety as a Developmental Disorder. Neuropsychopharmacology Reviews, 33, 134–140.
Lesch, K. P., Zeng, Y., Reif, A., Gutknecht, L. (2003). Anxiety-related traits in mice with modified genes of the serotonergic pathway. European Journal of Pharmacology, 480, 185– 204.
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford.
Llera, S. J., & Newman, M. G. (2014). Rethinking the role of worry in generalized anxiety disorder: Evidence supporting a model of emotional contrast avoidance. Behavior Therapy, 45(3), 283-299.
Newman, M. G., & Llera, S. J. (2011). A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry. Clinical psychology review, 31(3), 371-382.
Mennin, D. S. (2004). Emotion regulation therapy for generalized anxiety disorder. Clinical Psychology & Psychotherapy, 11(1), 17-29.
Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2005). Preliminary evidence for an emotion dysregulation model of generalized anxiety disorder. Behaviour research and therapy, 43(10), 1281-1310.
Mowrer, O. (1947). On the dual nature of learning—a re-interpretation of conditioning and problem-solving. Harvard educational review, 17, 102-148.
Newman, M. G. & Fisher, A. J. (2013). Mediated Moderation in Combined Cognitive Behavioral Therapy Versus Component Treatments for Generalized Anxiety Disorder. Journal of Consulting and Clinical Psychology, 81(3), 405–14.
National Institute for Health and Care Excellence (NICE) (2011). Generalised anxiety disorder and panic disorder in adults: management. Clinical guideline [CG113]. Disponible en www.nice.org.uk
National Institute for Health and Care Excellence (NICE) (2012). Generalised anxiety disorder in adults: Evidence Update September 2012. Disponible en www.nice.org.uk
Nutt, D. J., Ballenger, J. C., Sheehan, D., Wittchen, H. U. (2002). Generalized anxiety disorder: comorbidity, comparative biology and treatment. The International Journal of Neuropsychopharmacology, 4, 315-325.
Olatunji, B. O., Cisler, J. M. & Tolin, D. F. (2007). Quality of life in the anxiety disorders: a meta-analytic review. Clinical psychology review, 27(5), 572-581.
Roemer, L. & Orsillo, S. M. (2005). An Acceptance-Based Behavior Therapy for Generalized Anxiety Disorder. En S. M. Orsillo & L. Roemer (Eds.), Acceptance and Mindfulness-Based Approaches to Anxiety. Conceptualization and Treatment (pp. 213-240). New York: Springer.
Rosales, M. G. & Rebok, F. (2016). Trastorno de ansiedad generalizada. En C. J. Garay (Comp.), Terapia cognitivo-conductual y psicofarmacología. Una guía para combinar tratamientos en salud mental (pp. 151-181). Buenos Aires: Akadia.
Ruscio, A. M., Hallion, L. S., Lim, C. C. W.,… Scott, K. M. (2017). Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe. JAMA Psychiatry, 74(5), 465-475.
Sadock, B. J., Sadock, V. A., Ruiz, P. (2015). Kaplan and Sadock’s synopsis of psychiatry (11ª ed.). United States of America, Philadelphia: Wolters Kluwer.
Smith, J. P. & Book, S. W. (2010). Comorbidity of generalized anxiety disorder and alcohol use disorders among individuals seeking outpatient substance abuse treatment. Addictive Behaviors, 35, 42-45.
Stein D., Lerer B., Stahl S. (2012). Essential evidence-based psychopharmacology. Cambridge: Cambridge University Press.
Van der Heiden, C., Methorst, G., Muris, P., & Van der Molen, H. T. (2010). Generalized Anxiety Disorder: Clinical Presentation, Diagnostic Features, and Guidelines for Clinical Practice. Journal of Clinical Psychology, 67, 58-73.
Vormfelde, S. V., Hoell, I., Tzvetkov, M., Jamrozinski, K., Sehrt, D., ller, J., Leibing, D. (2006). Anxiety- and novelty seeking-related personality traits and serotonin transporter gene polymorphisms. Journal of Psychiatric Research, 40, 568–576.
Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. New York: Guilford.
Wells, A. (1995). Metacognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and cognitive psychotherapy, 23(3), 301-320.
Wells, A. (1999). A metacognitive model and therapy for generalized anxiety disorder. Clinical Psychology & Psychotherapy, 6(2), 86-95.
Wells, A. (2004). A cognitive model of GAD: Metacognition and Pathological Worry. En R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 164-186). New York: Guilford.
Wittchen, H. U. (2002). Generalized anxiety disorder: prevalence, burden, and cost to society. Depression and anxiety, 16(4), 162-171.
Yonkers, K. A., Dyck, I. R., Warshaw, M., & Keller, M. B. (2000). Factors predicting the course of generalised anxiety disorder. British Journal of Psychiatry, 176, 544–549.
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