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Órgano Oficial del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz

2009, Number 3

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Salud Mental 2009; 32 (3)

Aplicación de la terapia de afrontamiento del estrés en dos poblaciones con alto estrés: pacientes crónicos y personas sanas

Peralta-Ramírez MI, Robles-Ortega H, Navarrete-Navarrete N, Jiménez-Alonso J

Language: Spanish
References: 154
Page: 251-258
PDF size: 122.22 Kb.


ABSTRACT

Introduction Stress is currently considered a health risk factor. Numerous studies have shown that people with high levels of perceived stress present a greater number of complaints at both the physical and psychological levels. In this context, programs have been developed directed toward adequately coping with stress, and the effectiveness of these programs on the symptomatology of a psychological nature in healthy persons with a high level of perceived stress has been shown. However, there have been fewer studies that have shown whether this type of therapy affects the somatic symptomatology of healthy people in any way. On the other hand, programs for chronically ill patients directed toward achieving a better adaptation to their life conditions are equally effective. A population that presents considerably high levels of stress is the one consisting of people suffering from a chronic illness. Thus, through the immunological modulation it produces, the stress may be exacerbating the course of the disease. One prototype of this is systemic lupus erythematosus (SLE). SLE is a syndrome whose clinical expression depends on the degree to which there is a convergence of an immune regulation disorder and a strong genetic base, hormonal influence, and various exogenous agents. SLE can be manifested by general malaise, fever, fatigue, weight loss, skin rashes, joint inflammation, anemia, inflammation of the lymphatic glands, lowering of the defenses against infection, and cardiac, kidney, neurological, and pulmonary alterations. This autoimmune disease is usually associated with high levels of pain and impairment in different systems, producing high levels of stress in the patients who suffer from it. Nevertheless, although stress has already been shown to be one environmental factor that can produce a worsening in lupus symptoms, there have been no studies carried out with the objective of testing the effectiveness of stress management therapy and its physical and emotional consequences in these patients. For this reason, this st udy has a double objective: on the one hand, to corroborate, once again, the efficacy of cognitive-behavioural stress management therapy in the control of certain psychological processes and, on the other hand, to take one more step by testing whether there is a reduction in the perception of self-reported somatic symptoms both in healthy people and in those with a chronic disease. Material and method Fifty-two people participated in this study. Twenty-two were patients with lupus from the University Hospital in Granada. The other 30 were people without chronic diseases who attended the Psychological Attention Service at the University of Granada to receive therapy for coping with stress, as they claimed to have high levels of it. To evaluate the level of stress, we used the Stress Vulnerability Inventory by Beech, Burns and Scheefield, and the Scale of Recent Life Experiences (SRLE) by Kohn and Macdonald. To evaluate depression, we used the Beck Depression Inventory (BDI), and for anxiety, the Trait Anxiety Inventory (STAI-R) by Spielberger, Gorsuch nd Lushene. For the self-reported somatic symptoms, we used the Revised Somatic Symptoms Scale (SSS-R) by Sandín, Valiente and Chorot. In addition, in the patients with SLE, the SLEDAI index, or Index of Activity of the Disease, was obtained. The therapy received was cognitive-behavioural in nature, and it was carried out during 13 sessions which were grouped in the following blocks: Conceptualization of the stress, cognitive restructuring; Deactivation techniques; Approaching the selfmanagement of the pain; Social skills; Time control and organization; Personality pattern and its relationship with health; Anger management; Humour and optimism as coping strategies. Results Results showed that both groups presented a statistically significant reduction in stressful life experiences [F(1.50)=28.6; p‹0.000], vulnerability to stress [F(1.50)=105.25; p‹0.000], depression [F(1.50)=68.33; p‹0.000], and anxiety [F(1.49)=54.53; p‹0.000] after the treatment. Moreover, the effect size of these variables was high in the group of patients with lupus and in the group of healthy patients, although it was higher in the latter group. Likewise, both groups presented a statistically significant improvement in the physical function, producing a reduction in the perceived somatic symptoms [F(1.48)=37.7; p‹0.000] after the treatment. Furthermore, the effect of the treatment was high in both groups. Discussion This paper addresses a critically important issue: the effectiveness of cognitive-behavioral intervention in ameliorating psychosocial stress and enhancing the well-being of individuals with lupus and the group of people with high stress. In this improvement, there was not only a significant reduction in the score on vulnerability to stress and stressful life experiences, but a reduction in the levels of anxiety and depression and somatic symptoms. The findings of improvements in somatic symptoms suggest that this intervention might facilitate coping and change the cognitive appraisals of symptoms. Likewise, the impact of the intervention on psychosocial outcomes (depression, anxiety and perceived vulnerability to stress) may have implications for longer-term health behaviors and health outcomes. Although this reduction is significant in both groups, the effect size is greater in the group of people with high stress than in the group of lupus patients. Specifically, the somatic symptoms where a lower effect of the therapy was observed were the immunological, respiratory, musculoskeletal, and dermatological symptoms, which coincide with the most characteristic symptoms of lupus. This study supports, therefore, the importance of stress management programs not only to reduce the amount of stress, but also to improve the emotional variables and physical condition, both in people with chronic diseases and in healthy people with a high level of stress. The cognitive-behavior therapy is a new effective line of action in dealing with lupus, being necessary an overall in tegrated view of the patients with lupus, treating the clinical and psychological aspects.


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  102. significación estadística. Psicothema 2005;12:236-40.

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  116. Orejudo Hernández S, Froján Parga MX. Síntomas somáticos: Predicción diferencial a través de variables psicológicas, sociodemográficas, estilos de vida y enfermedades. Anales Psicología 2005;21:276-85.

  117. Moya-Albiol L, Serrano MA, González-Bono E, Rodríguez-Alarcón G, Salvador A. Respuesta psicofisiológica de estrés en una jornada laboral. Psicothema 2005;17:205-11.

  118. Ritvanen T, Louhevaara V, Helin P, Jalonen T, Aniñen O. Psychophysiological stress in high school teachers. Int J Occupational Medicine Environmental Health 2003;16:255-64.

  119. Brannon L, Feist J. Psicología de la salud. Madrid: Paraninfo Thomson Learning; 2001.

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  122. Cohen S. Psychological stress, immunity and upper respiratory infections. Cur Directions Psychol Science 1996; 5:86-90.

  123. Kessler RC. The effects of stressful life events on depression. Annu Rev Psychol 1997;48:191-124.

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  125. Cohen S, Doyle WJ, Skoner PP, Fireman P, Twalney JMJ et al. State and trait negative effect as predictors of objective and subjective symptoms of respiratory viral infections. J Pers Soc Psychol 1995;68:159-69.

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  128. Meichenbaum D. Stress inoculation training for coping with stressors. Clin Psychologist 1996;49:4-7.

  129. Saunders T, Driskell JE, Johnston JH, Salas E. The effect of stress inoculation training on anxiety and performance. J Occupational Health Psychology 1996;1:170-86.

  130. Labrador FJ. El estrés: nuevas técnicas para su control. Madrid: Temas de Hoy; 1992.

  131. Coín-Mejías MA, Peralta-Ramírez MI, Callejas-Rubio JL, Pérez-García M. Personality disorder and emotional variables in patients with lupus/Trastornos de personalidad y variables emocionales en pacientes con lupus. Salud Mental 2007;30:19-24.

  132. Pawlak CR, Witte T, Heiken H, Hundt M et. al. Flares in patients with systemic lupus erythematosus are associated with daily psychological stress. Psychother Psychosom 2003;72:159-65.

  133. Peralta-Ramírez MI, Jiménez-Alonso J, Godoy-García JF, Pérez-García M. The effects of daily stress and stressful life events on the clinical symptomatology of patients with lupus erythematosus. Psychosom Med 2004;66:788-94.

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  135. Peralta-Ramírez MI, Navarrete-Navarrete N, Pérez-García M. La importancia del estrés psicosocial y su abordaje psicológico y educativo en una enfermedad autoinmune: Lupus eritematoso sistémico. En: Añaños FT (coord). Educación social, formación, realidad y retos. Granada: Grupo Editorial Universitario Granada; 2006.

  136. Peralta-Ramírez MI, Pérez-García M. The effect of psycho-social stress on Systemic Lupus Erythematosus: A theoretical review. En: Ulrich C, Bellinger KA (eds). Systemic Lupus Erythematosus research developments. New York: NovaPublisher; 2007.

  137. Greco CM, Rudy TE, Manzi S. Effects of a stress-reduction program on psychological function, pain, and physical function of systemic lupus erythematosus patients: a randomized controlled trial. Arthritis Rheum 2004;15:625-34.

  138. Haupt M, Millen S, Janner M, Falagan D, Fischer-Betz R et al. Improvement of coping abilities in patients with systemic lupus erythematosus: a prospective study. Ann Rheum Dis 2005;64:1618-23.

  139. Karlson EW, Liang MH, Etaon H. A Randomized clinical trial of psychoeducional intervencion to improve outcomes in Systemic Lupus Erythematosus. Arthritis Rheumatism 2004;50:1832-41.

  140. Sohng KY. Effect of a self-management course for patients with systemic lupus erythematosus. J Advanced Nursing 2003;42:479-86.

  141. Remor E. Psychometric properties of a European Spanish Version of the Perceived Stress Scale (PSS). Span J Psychol 2006;9:86-93.

  142. Tan EM, Cohen AS, Fries JF, Masi AT, McShane DJ et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982;25:1271-7.

  143. Robles-Ortega H, Peralta-Ramírez MI, Navarrete-Navarrete N. Validación de la versión española del inventarío de vulnerabilidad al estrés de Beech, Burns y Scheffield. En: Avances en psicología de la salud. Granada: Ediciones Sider; 2006.

  144. Sandín B, Chorot P, Santed MA. Escala SRLE de Kohn-Macdonald 1992. En: Sandín B (ed). El estrés psicosocial: Conceptos y consecuencias clínicas. Madrid: UNED-FUE; 1999.

  145. Sanz J, Vázquez C. Fiabilidad, validez y datos normativos del inventario para la depresión de Beck. Psicothema 1998;10:303-18.

  146. Spielberger CD, Gorsuch RL, Lushene RE. STAI. Cuestionario de ansiedad estado-rasgo. Manual. Cuarta edición. Madrid: TEA Ediciones SA; 1993.

  147. Sandín B, Valiente RM, Chorot P: Evaluación del estrés psicosocial: Material de apoyo. En: Sandín B (ed). El estrés psicosocial: Conceptos y consecuencias clínicas. Madrid: Klinik; 1999.

  148. Bombardier C, Gladman DD, Urowitz MB, Caron D, Changch. The development and validation of the SLE Disease Activity Index (SLEDAI). Arthritis Rheum 1992;35:630-640.

  149. Robles Ortega H, Peralta Ramírez MI. Programa para el control del estrés. Madrid: Pirámide; 2006.

  150. Frias MD, Llobell JP, García JF. Tamaño del efecto del tratamiento y significación estadística. Psicothema 2005;12:236-40.

  151. Irwin MR. Human psychoneuroimmunology: 20 years of discovery. Brain Behav Immun 2008;22:129-39.

  152. Kemeny ME, Schedlowski M. Understanding the interaction between psychosocial stress and immune-related diseases: a stepwise progression. Brain Behav Immun 2007;21:1009-18.

  153. Denburg SD, Carbotte RM, Denburg JA. Psychological aspects of systemic lupus erythematosus: cognitive function, mood, and self-report. J Rheumatol 1997;24:998-1003.

  154. Rehse B, Pukrop R. Effects of psichosocial interventions on quality of life in adult cancer patients: meta-analisys of 37 published control outcome studies. Patient Educ Counsel 2002;1658:1-8.




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