TRANSDIAGNOSTIC MODEL OF ANXIETY AND DEPRESSION ACCORDING TO THE RELATIONSHIP WITH AFFECT, INTOLERANCE OF UNCERTAINLY, AND ANXIETY SENSITIVITY (Modelo transdiagnóstico de ansiedad y depresión según la relación con el afecto, intolerancia a la incertidumbre y sensibilidad a la ansiedad)

Autores/as

Resumen

Abstract

The transdiagnostic model allows explaining and developing treatments based on the etiology and maintenance factors of comorbid psychopathologies; however, the relationships between its explanatory variables still require investigation. The purpose of this paper was to develop a structural model that includes these transdiagnostic variables: positive and negative affect, intolerance to uncertainty and anxiety sensitivity, in emotional problems such as anxiety and depression. Quantitative research was carried out with an explanatory cross-sectional design in which a structural network of relationships between constructs was defined using a diagram of paths and structural equations. 486 Colombians between the ages of 20 and 40 were intentionally randomly sampled. The following instruments were used to assess the fitting of the model: Positive and Negative Affect Scale (PANAS), Anxiety Sensitivity Index-3 (ASI-3), Intolerance of Uncertainty Scale (IUS), Beck Anxiety Inventory (BAI) and Beck Depression Inventory, second edition, Spanish version (BDI-II). The results showed significant correlations between transdiagnostic and symptomatic variables (depression and anxiety symptoms), using an adjusted model that explained the predictive capacity of anxiety sensitivity with anxiety symptoms, and intolerance of uncertainty with depression symptoms, both transdiagnostic variables associated with positive and negative affect as predictors of anxious and depressive emotional symptoms (R2 = .74).

 

Keywords

Transdiagnostic, anxiety sensitivity, intolerance of uncertainly, affect, anxiety, depression.

 

Resumen

El modelo transdiagnóstico permite explicar y desarrollar tratamientos basados en la etiología y factores mantenedores de las psicopatologías comórbidas, no obstante, las relaciones entre sus variables explicativas aún requieren investigación. El objetivo del presente trabajo fue desarrollar un modelo estructural que incluye las variables transdiagnósticas: afecto positivo y negativo, intolerancia a la incertidumbre y sensibilidad a la ansiedad, en problemas emocionales como ansiedad y depresión. Se llevó a cabo una investigación cuantitativa con un diseño transversal explicativo en el cual se definió una red estructural de relaciones entre constructos mediante un diagrama de senderos y ecuaciones estructurales. Se conformó una muestra no probabilística intencional de 486 colombianos entre 20 y 40 años. Para evaluar el ajuste del modelo se utilizaron los siguientes instrumentos: Positive and Negative Affect Scale (PANAS), Anxiety Sensitivity Index-3 (ASI-3), Intolerance Uncertainty Scale (IUS), Beck Anxiety Inventory (BAI) y Beck Depression Inventory, second edition, Spanish version (BDI-II). Los resultados indicaron correlaciones significativas entre las variables transdiagnósticas y las sintomáticas (síntomas de depresión y ansiedad), mediante un modelo ajustado que permitió explicar la capacidad predictiva de la sensibilidad a la ansiedad con los síntomas de ansiedad, y la intolerancia a la incertidumbre con los síntomas de depresión, ambas variables transdiagnósticas asociadas al afecto positivo y negativo como predictores de los síntomas emocionales ansiosos y depresivos (R2 = .74).

Descargas

Los datos de descargas todavía no están disponibles.

Biografía del autor/a

Ronald Alberto Toro Tobar, Universidad Católica de Colombia

Psicólogo, Magister en Psicología. Docente e investigador en psicología clínica.

Bertha Lucía Avendaño-Prieto, Universidad Católica de Colombia

PhD. en Psicología. Psicóloga. Docente e investigadora de la Facultad de Psicología Universidad Católica de Colombia, Bogotá, Colombia.

Nancy Vargas, Universidad Católica de Colombia

Magister en Desarrollo Educativo y Social. Psicóloga. Docente e investigadora de la Facultad de Psicología Universidad Católica de Colombia, Bogotá, Colombia.

Citas

Allan, N. P., Capron, D. W., Raines, A. M., & Schmidt, N. B. (2014). Unique relations among anxiety sensitivity factors and anxiety, depression, and suicidal ideation. Journal of Anxiety Disorders, 28(2), 266-275. doi: https://doi.org/10.1016/j.janxdis.2013.12.004
American Psychiatric Association, APA (1994). Diagnostic and statistical manual of mental disorders DSM (4th ed.). Washington, DC: Author.
Ato, M., López, J. J., & Benavente, A. (2013). Un sistema de clasificación de los diseños de investigación en psicología. Anales de Psicología, 29(3), 1038-1059. doi: https://doi.org/10.6018/analesps.29.3.178511
Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic. Second edition. New York: Guilford Press.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893-897. doi: https://doi.org/10.1037/0022-006X.56.6.893
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory-II. USA, San Antonio, TX: Psychological Corporation.
Belloch, A. (2012). Propuestas para un enfoque transdiagnóstico de los trastornos mentales y del comportamiento: evidencia, utilidad y limitaciones. Revista de Psicopatología y Psicología Clínica, 17(3), 295-311. Recuperado de: http://www.aepcp.net/arc/08_2012_n3_belloch.pdf
Bomyea, J., Ramsawh, H., Ball, T. M., Taylor, C. T., Paulus, M. P., Lang, A. J., & Stein, M. B. (2015). Intolerance of uncertainty as a mediator of reductions in worry in a cognitive behavioral treatment program for generalized anxiety disorder. Journal of Anxiety Disorders, 33, 90-94. doi: https://doi.org/2117/10.1016/j.janxdis.2015.05.004
Bradley, B., DeFife, J. A., Guarnaccia, C., Phifer, J., Fani, N., Ressler, K. J., & Westen, D. (2011). Emotion dysregulation and negative affect: association with psychiatric symptoms. The Journal of clinical psychiatry, 72(5), 685-691. doi: https://doi.org/10.4088/JCP.10m06409blu
Brenlla, M., & Rodríguez, C. (2006). Manual de Inventario de Depresión de Beck BDI II. Adaptación Argentina. Buenos Aires: Paidós.
Brereton, R. G. (2015). The Mahalanobis distance and its relationship to principal component scores. Journal of Chemometrics, 29(3), 143-145. doi: https://doi.org/10.1002/cem.2692
Brown T. A., & Barlow, D. H. (2009). A proposal for a dimensional classification system based on the shared features of the DSM-IV Anxiety and Mood Disorders: Implications for assessment and treatment. Psychological Assessment, 21(3), 256-271. doi: https://doi.org/10.1037/a0016608
Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107(2), 179-192. doi: https://doi.org/10.1037/0021-843x.107.2.179
Brown, H. M., Meiser-Stedman, R., Woods, H., & Lester, K. J. (2016). Cognitive vulnerabilities for depression and anxiety in childhood: Specificity of anxiety sensitivity and rumination. Behavioural and Cognitive Psychotherapy, 44(1), 30-42. doi: https://doi.org/10.1017/S1352465814000472
Bullis, J. R., Boettcher, H., Sauer-Zavala, S., & Barlow, D. H. (2019). What is an emotional disorder? A transdiagnostic mechanistic definition with implications for assessment, treatment, and prevention. Clinical Psychology: Science and Practice, e12278. doi: https://doi.org/10.1111/cpsp.12278
Carleton, R. N. (2012). The intolerance of uncertainty construct in the context of anxiety disorders: Theoretical and practical perspectives. Expert Review of Neurotherapeutics, 12(8), 937-47. doi: https://doi.org/2117/10.1586/ern.12.82
Carleton, R. N., Fetzner, M. G., Hackl, J. L., & McEvoy, P. (2013). Intolerance of uncertainty as a contributor to fear and avoidance symptoms of panic attacks. Cognitive Behaviour Therapy, 42(4), 328. doi: https://doi.org/1461974619?accountid=45660
Chalmers, J. A., Heathers, J. A. J., Abbott, M. J., Kemp, A. H., & Quintana, D. S. (2016). Worry is associated with robust reductions in heart rate variability: A transdiagnostic study of anxiety psychopathology. BMC Psychology, 4, 1-9. doi: https://doi.org/10.1186/s40359-016-0138-z
Chavarria, J., Allan, N. P., Boffa, J. W., Albanese, B. J., Schmidt, N. B., & Zvolensky, M. J. (2015). Decomposing the relationship between anxiety sensitivity and alcohol use. Journal of Studies on Alcohol and Drugs, 76(6), 957-964. doi: https://doi.org/10.15288/jsad.2015.76.957
Cohen, J. N., Dryman, M. T., Morrison, A. S., Gilbert, K. E., Heimberg, R. G., & Gruber, J. (2017). Positive and Negative Affect as links between social anxiety and depression: predicting concurrent and prospective mood symptoms in unipolar and bipolar mood disorders. Behavior Therapy, 48(6), 820-833. doi: https://doi.org/10.1016/j.beth.2017.07.003
Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100(3), 316-336. doi: https://doi.org/10.1037/0021-843X.100.3.316
Clark, L. A., Watson, D., & Reynolds, S. (1995). Diagnosis and classification of psychopathology: Challenges to the current system and future directions. Annual Review of Psychology, 46, 121-153. doi: https://doi.org/10.1146/annurev.ps.46.020195.001005
Culbert, K. M., Lavender, J. M., Crosby, R. D., Wonderlich, S. A., Engel, S. G., Peterson, C. B., ... Fischer, S. (2016). Associations between negative affect and binge/purge behaviors in women with anorexia nervosa: Considering the role of negative urgency. Comprehensive Psychiatry, 66, 104-112. doi: https://doi.org/10.1016/j.comppsych.2016.01.010
Dunkley, D. M., Lewkowski, M., Lee, I. A., Preacher, K. J., Zuroff, D. C., Berg, J. L., … Westreich, R. (2017). Daily stress, coping, and negative and positive affect in depression: complex trigger and maintenance patterns. Behavior Therapy, 48(3), 349-365. doi: https://doi.org/10.1016/j.beth.2016.06.001
Ebesutani, C., Mcleish, A. C., Luberto, C. M., Young, J., & Maack, D. J. (2014). A bifactor model of anxiety sensitivity: Analysis of the anxiety sensitivity index-3. Journal of Psychopathology and Behavioral Assessment, 36(3), 452-464. doi: https://doi.org/10.1007/s10862-013-9400-3
Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., … Barlow, D. H. (2012). Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: A Randomized Controlled Trial. Behavior Therapy, 43(3), 666-678. doi: https://doi.org/10.1016/j.beth.2012.01.001
Feldman-Barrett, L., & Russell, J. A. (1998). Independence and bipolarity in the structure of current affect. Journal of Personality and Social Psychology, 74(4), 967-984. doi: https://doi.org/10.1037/0022-3514.74.4.967
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17(6), 791-802. doi: https://doi.org/10.1016/0191-8869(94)90048-5
González, R. M., Cubas, L. R., Rovella, A. T., & Darias, H. M. (2006). Adaptación española de la Escala de Intolerancia a la Incertidumbre: procesos cognitivos, ansiedad y depresión. Psicología y Salud, 16(2), 219-233.
Gros, D. F., Allan, N. P., & Szafranski, D. D. (2016). Movement towards transdiagnostic psychotherapeutic practices for the affective disorders. Evidence - Based Mental Health, 19(3), e10. doi: https://doi.org/10.1136/eb-2015-102286
Harding, K. A. (2016). Integrating cognitive mechanisms in the relationship between trait affect and depressive symptoms: the role of affect amplification (Doctoral dissertation). Retrieved from Clinical Psychology Dissertations, 9(Order No. 10046476). Recuperado de: http://digitalcommons.spu.edu/cpy_etd/9
Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and Anxiety, 29(5), 409-416. doi: https://doi.org/10.1002/da.21888
Hu, L., & Bentler, P. M. (1988). Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychological Methods, 3(4), 424-453. doi: https://doi.org/10.1037/1082-989X.3.4.424
Kemper, C. J., Lutz, J., Bähr, T., Rüddel, H., & Hock, M. (2012). Construct validity of the Anxiety Sensitivity Index-3 in clinical samples. Assessment, 19(1), 89-100. doi: https://doi.org/10.1177/1073191111429389
Kim, H. Y. (2013). Statistical notes for clinical researchers: assessing normal distribution using skewness and kurtosis. Restorative Dentistry & Endodontics, 38(1), 52-54. doi: https://doi.org/10.5395/rde.2013.38.1.52
Koerner, N., & Dugas, M. J. (2008). An investigation of appraisals in individuals vulnerable to excessive worry: The role of intolerance of uncertainty. Cognitive Therapy and Research, 32(5), 619–638. doi: https://doi.org/10.1007/s10608-007-9125-2
Mahoney, A. E. J., & McEvoy, P. M. (2012). A Transdiagnostic Examination of Intolerance of Uncertainty across Anxiety and Depressive Disorders. Cognitive Behaviour Therapy, 41(3), 212-222. doi: https://doi.org/10.1080/16506073.2011.622130
McEvoy, P. M., & Mahoney, A. E. (2012). To be sure, to be sure: intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behavior Therapy, 43(3), 533-545. doi: https://doi.org/10.1016/j.beth.2011.02.007
Norton, P. J., Barrera, T. L., Mathew, A. R., Chamberlain, L. D., Szafranski, D. D., Reddy, R., & Smith, A. H. (2013). Effect of transdiagnostic CBT for anxiety disorders on comorbid diagnoses. Depression and Anxiety, 30(2), 168-173. doi: https://doi.org/10.1002/da.22018
Padrós-Blázquez, F., Soriano-Mas, C., & Navarro-Contreras, G. (2012). Afecto positivo y negativo: ¿Una dimensión bipolar o dos dimensiones unipolares independientes? Interdisciplinaria Revista de Psicología y Ciencias Afines, 29(1), 151–164. doi: https://doi.org/10.16888/interd.2012.29.1.9
Paulus, D. J., Talkovsky, A. M., Heggeness, L. F., & Norton, P. J. (2015). Beyond Negative Affectivity: A Hierarchical Model of Global and Transdiagnostic Vulnerabilities for Emotional Disorders. Cognitive Behaviour Research, 44(5), 389-405. doi: https://doi.org/10.1080/16506073.2015
Rector, N. A., Man, V., & Lerman, B. (2014). The expanding cognitive-behavioural therapy treatment umbrella for the anxiety disorders: Disorder-specific and transdiagnostic approaches. Canadian Journal of Psychiatry, 59(6), 301-309. doi: https://doi.org/10.1177/070674371405900603
Rifkin, L. S., Beard, C., Hsu, K. J., Garner, L., & Björgvinsson, T. (2015). Psychometric properties of the anxiety sensitivity index-3 in an acute and heterogeneous treatment sample. Journal of Anxiety Disorders, 36, 99-102. doi: https://doi.org/10.1016/j.janxdis.2015.09.010
Riskind, J. H., Kleiman, E. M., & Schafer, K. E. (2013). "Undoing" effects of positive affect: Does it buffer the effects of negative affect in predicting changes in depression? Journal of Social and Clinical Psychology, 32(4), 363-380. doi: https://doi.org/101521jscp2013324363
Robles, R., & Páez, F. (2003). Estudio sobre la traducción al español y las propiedades psicométricas de las escalas de afecto positivo y negativo (PANAS). Salud Mental, 26(1), 69-75. Recuperado de: https://www.redalyc.org/pdf/582/58212608.pdf
Rosellini, A. J., Bourgeois, M. L., Correa, J., Tung, E. S., Goncharenko, S., & Brown, T. A. (2018). Anxious distress in depressed outpatients: Prevalence, comorbidity and incremental validity. Journal of Psychiatric Research, 103, 54-60. doi: https://doi.org/10.1016/j.jpsychires.2018.05.006
Rubin, D. C., Hoyle, R. H., & Leary, M. R. (2012). Differential predictability of four dimensions of affect intensity. Cognition & Emotion, 26(1), 25-41. doi: https://doi.org/10.1080/02699931.2011.561564
Sandín, B., Chorot, P., & Valiente, R. M. (2012). Transdiagnóstico: nueva frontera en psicología clínica. Revista de Psicopatología y Psicología Clínica, 17(3), 185-203. Recuperado de: http://www.aepcp.net/arc/02_2012_n3_sandin_chorot_valiente.pdf
Sandín, B., Valiente, R. M., Chorot, P., & Santed, M. A. (2007). ASI-3: Nueva escala para la evaluación de la sensibilidad a la ansiedad. Revista de Psicopatología y Psicología Clínica, 12(2), 91-104. Recuperado de: http://aepcp.net/arc/02_2007(2)_Sandin_et_al.pdf
Sanz, J., García-Vera, M., & Fortun, M. (2012). El "Inventario de Ansiedad de Beck" (BAI): Propiedades psicométricas de la versión española en pacientes con trastornos psicológicos. Behavioral Psychology/Psicología Conductual, 20(3), 563-583.
Shihata, S., McEvoy, P. M., Mullan, B. A., & Carleton, R. N. (2016). Intolerance of uncertainty in emotional disorders: What uncertainties remain? Journal of anxiety disorders, 41, 115-124. doi: https://doi.org/10.1016/j.janxdis.2016.05.001
Talkovsky, A. M., & Norton, P. J. (2016). Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety. Journal of Anxiety Disorders, 41, 108-114. doi: https://doi.org/10.1016/j.janxdis.2016.05.002
Talkovsky, A. M., & Norton, P. J. (2018). Negative affect and intolerance of uncertainty as potential mediators of change in comorbid depression in transdiagnostic CBT for anxiety. Journal of Affective Disorders, 236, 259-265. doi: https://doi.org/10.1016/j.jad.2018.04.104
Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R. … Cárdenas, S. J. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3 (ASI-3). Psychological Assessment, 19(2), 176-188. doi: https://doi.org/10.1037/1040-3590.19.2.176
Thibodeau, M. A., Carleton, R. N., Collimore, K. C., & Asmundson, G. J. (2013). From higher-order to underlying constructs: Examining the relationships between affect and fundamental fears. Cognitive Therapy and Research, 37(2), 324-331. doi: https://doi.org/10.1007/s10608-012-9468-1
Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 96, 465-490. doi: https://doi.org/10.1037/0033-2909.96.3.465
Watson, D., & Clark, L. A. (1992). Affects separable and inseparable: On the hierarchical arrangement of the negative affects. Journal of Personality and Social Psychology, 62(3), 489-505. doi: https://doi.org/10.1037/0022-3514.62.3.489
Wirtz, C. M., Radkovsky, A., Ebert, D. D., & Berking, M. (2014). Successful application of adaptive emotion regulation skills predicts the subsequent reduction of depressive symptom severity but neither the reduction of anxiety nor the reduction of general distress during the treatment of major depressive disorder. PLoS One, 9(10), e108288. doi: https://doi.org/10.1371/journal.pone.0108288
Zvolensky, M. J., Paulus, D. J., Bakhshaie, J., Garza, M., Valdivieso, J., Ochoa-Perez, M., …Collado, A. (2018). Anxiety sensitivity and rumination: Transdiagnostic factors involved in the relation between subjective social status and anxiety and depressive symptoms and disorders among economically disadvantaged Latinos in primary care. American Journal of Orthopsychiatry, 88(5), 571-581. doi: https://doi.org/10.1037/ort0000307

Publicado

2019-12-12

Número

Sección

Artículos Originales