Desarrollo de un instrumento para la evaluación de las creencias disfuncionales específicas en víctimas del terrorismo que sufren Trastorno de Estrés Postraumático
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2021
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26/01/2021
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Universidad Complutense de Madrid
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El alcance internacional del terrorismo arroja cifras importantes de víctimas, convirtiéndolo en uno de los problemas más graves a nivel mundial. La literatura científica indica que entre un 19-40% de las víctimas directas, entre un 17-29% de las víctimas indirectas (familiares de fallecidos y heridos), el 3-11% de la población general residente en la zona afectada y el 5-12% de los intervinientes desarrollarán un trastorno de estrés postraumático (DiMaggio y Galea, 2006; García-Vera y Sanz, 2016; Gutiérrez Camacho, 2016). Diversos factores cognitivos (creencias y actitudes, pensamientos, procesos, etc.) desempeñan un rol fundamental a la hora de dar una explicación a la etiología, curso, mantenimiento y respuesta al tratamiento del TEPT (Dalglesh y Josephs, 1996; Ehlers y Clark, 2000; Foa y Riggs, 1993; Horowitz, 1986; Janoff-Bulman, 1992; McCann y Pearlman, 1990; Resick y Schnicke, 1992; Rothbaum y Foa, 1996). Tal ha sido la relevancia de estos factores cognitivos, que el Manual diagnóstico y estadístico para los trastornos mentales de la Asocación Americana de Psychiatria, en su última edición o DSM-5 (APA, 2013), ha incluido, entre los criterios diagnósticos del TEPT, un grupo de síntomas relativos a alteraciones en las cogniciones y el estado de ánimo que introduce dos nuevos y reformulados síntomas cognitivos con respecto al DSM-IV (APA, 2000).
Dada la importancia de los factores cognitivos, desde los años 90 han surgido algunos instrumentos destinados a medir diferentes constructos cognitivos relacionados con el TEPT, tales como el Posttraumatic Cognitions Inventory (PTCI; Foa, Ehlers, Clark, Tolin y Orsillo, 1999), la Posttraumatic Maladaptive Beliefs Scale (PMBS; Vogt, Shipherd y Resick, 2012), el Trauma Appraisal Questionnaire (TAQ; DePrince, Zurbriggen, Chu y Smart, 2010), por citar solo algunos. No obstante, aunque existe una serie de instrumentos desarrollados específicamente para la evaluación de los factores cognitivos relativos al TEPT, ciertos aspectos ponen en duda bien su calidad como instrumentos de evaluación (problemas en el proceso de análisis factorial, índices de fiabilidad y/o validez no demasiado altos en algunos de los factores, etc.) o bien su capacidad para ser usados de una forma correcta y útil en población víctima de terrorismo, población para que la que no existen en la actualidad instrumentos específicos destinados a evaluar las actitudes disfuncionales traumáticas. Además, solo dos de los instrumentos revisados, el PTCI y el cuestionario de Valoración del Impacto Vital Ontológico (VIVO) (Pérez-Sales et al., 2011) han sido desarrollados y validados con población hispanoparlante, lo que plantea la cuestión de la escasez de instrumentos válidos en España, un país con una historia de terrorismo muy amplia, para valorar los aspectos cognitivos derivados de un atentado terrorista...
The international impact of terrorism yields such a significant number of victims that it has become one of the most serious problems worldwide. Scientific literature indicates that 19- 40% of direct victims, 17-29% of indirect victims (relatives of the deceased and injured), 3-11% of the general population living in the affected area and the 5-12% of the emergency personal working in disasters will develop Post-Traumatic Stress Disorder (DiMaggio & Galea, 2006; García-Vera & Sanz, 2016; Gutiérrez Camacho, 2016). Several cognitive factors (beliefs and attitudes, thoughts, processes, etc.) play a fundamental role explaining the etiology, course, maintenance and treatment outcome of PTSD (Dalglesh & Josephs, 1996; Ehlers & Clark, 2000; Foa & Riggs, 1993; Horowitz, 1986; Janoff-Bulman, 1992; McCann & Pearlman, 1990; Resick & Schnicke, 1992; Rothbaum & Foa, 1996). These cognitive factors have had such a relevance that the Diagnostic and Statistical Manual for Mental Disorders from the American Association of Psychiatry, in its latest edition, or DSM-5 (APA, 2013), included a group of symptoms related to mood and cognition alterations among the diagnostic criterion for PTSD, introducing two new and reformulated cognitive symptoms which were not present in DSMIV (APA, 2000). Given the importance of cognitive factors, some instruments have come up since the 1990s in order to measure different cognitive constructs related to PTSD, such as the Posttraumatic Cognitions Inventory (PTCI; Foa, Ehlers, Clark, Tolin & Orsillo, 1999), the Posttraumatic Maladaptive Beliefs Scale (PMBS; Vogt, Shipherd & Resick, 2012) or the Trauma Appraisal Questionnaire (TAQ; DePrince, Zurbriggen, Chu & Smart, 2010), to name just a few. However, although there are some instruments which have been developed specifically to assess cognitive factors related to PTSD, there are certain aspects that call into question whether their quality as assessment instruments is good enough (problems in the factor analysis process, reliability and / or validity indexes not high enough in some of the factors, etc.) or whether they actually may be used in a correct and useful way in the victims of terrorism population, a population without specific instruments designed to assess traumatic dysfunctional attitudes. Furthermore, only two of the instruments reviewed, the PTCI and the Vital Ontological Impact Assessment Questionnaire (VIVO) (Pérez-Sales et al., 2011) have been developed and validated for Spanish-speaking population, which raises the issue of the scarcity of valid instruments in Spain, a country with a long history of terrorism, to assess the cognitive aspects derived from a terrorist attack...
The international impact of terrorism yields such a significant number of victims that it has become one of the most serious problems worldwide. Scientific literature indicates that 19- 40% of direct victims, 17-29% of indirect victims (relatives of the deceased and injured), 3-11% of the general population living in the affected area and the 5-12% of the emergency personal working in disasters will develop Post-Traumatic Stress Disorder (DiMaggio & Galea, 2006; García-Vera & Sanz, 2016; Gutiérrez Camacho, 2016). Several cognitive factors (beliefs and attitudes, thoughts, processes, etc.) play a fundamental role explaining the etiology, course, maintenance and treatment outcome of PTSD (Dalglesh & Josephs, 1996; Ehlers & Clark, 2000; Foa & Riggs, 1993; Horowitz, 1986; Janoff-Bulman, 1992; McCann & Pearlman, 1990; Resick & Schnicke, 1992; Rothbaum & Foa, 1996). These cognitive factors have had such a relevance that the Diagnostic and Statistical Manual for Mental Disorders from the American Association of Psychiatry, in its latest edition, or DSM-5 (APA, 2013), included a group of symptoms related to mood and cognition alterations among the diagnostic criterion for PTSD, introducing two new and reformulated cognitive symptoms which were not present in DSMIV (APA, 2000). Given the importance of cognitive factors, some instruments have come up since the 1990s in order to measure different cognitive constructs related to PTSD, such as the Posttraumatic Cognitions Inventory (PTCI; Foa, Ehlers, Clark, Tolin & Orsillo, 1999), the Posttraumatic Maladaptive Beliefs Scale (PMBS; Vogt, Shipherd & Resick, 2012) or the Trauma Appraisal Questionnaire (TAQ; DePrince, Zurbriggen, Chu & Smart, 2010), to name just a few. However, although there are some instruments which have been developed specifically to assess cognitive factors related to PTSD, there are certain aspects that call into question whether their quality as assessment instruments is good enough (problems in the factor analysis process, reliability and / or validity indexes not high enough in some of the factors, etc.) or whether they actually may be used in a correct and useful way in the victims of terrorism population, a population without specific instruments designed to assess traumatic dysfunctional attitudes. Furthermore, only two of the instruments reviewed, the PTCI and the Vital Ontological Impact Assessment Questionnaire (VIVO) (Pérez-Sales et al., 2011) have been developed and validated for Spanish-speaking population, which raises the issue of the scarcity of valid instruments in Spain, a country with a long history of terrorism, to assess the cognitive aspects derived from a terrorist attack...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Psicología, leída el 26/01/2021