Development and validation of an online treatment program for adjustment disorders

Resumen

Adjustment disorder (AjD) is one of the most common mental disorders. Besides causing significant distress, AjD also leads to an important functional impairment. In fact, it is among the most prevalent causes of sickness absence. And, despite the fact that it is considered a transient condition with a generally good prognosis, AjD is associated with high risk of suicide. Likewise, evidence suggests that it is an important problem which is worthy of professional attention. Nevertheless, since its first inclusion in DSM and ICD classifications of mental disorders, AjD has been poorly investigated. The lack of research led to an important scarcity of evidence based assessment instruments and psychological treatments. Another current problem in the field of mental health is the access to psychotherapy, which is hampered by different barriers such as time constraints, waiting lists, stigma, or financial affordability. As a consequence, most people with mental disorders do not receive the assistance they need. The advent of internet and its widespread use have motivated the investigation into the potential of internet delivered intervention to improve the access to evidence-based treatments. Today, these interventions are effectively used for the treatment of a wide range of mental disorders, producing similar effects as face-to-face therapy. However, despite their proven efficacy, internet delivered interventions have not yet been implemented in health care settings. The acceptability might be one key barrier. The aim of the present thesis is to contribute to the assessment and treatment of AjD. The work is organized into five chapters. Chapter 1 presents the first semi-structured diagnostic interview for AjD and reports the preliminary results on its validity and reliability properties. Chapter 2 presents the results of the feasibility study conducted to assess the acceptability and usability of TAO, an internet-delivered intervention for AjD. The other three chapters are devoted to the randomized controlled trial (RCT) carried out to investigate the efficacy and acceptability of TAO: Chapter 3 presents a detailed description of the study protocol; Chapter 4 and Chapter 5 report outcomes of the trial regarding the TAO efficacy and acceptability, respectively. The results of the work represent an important advance in the field of AjD. First, it provides the preliminary evidence to support the use of the first semi-structured diagnostic interview in Spanish to assess and identify cases of AjD. Second, to the best of our knowledge, this is the first completed RCT on the efficacy and acceptability of an internet-delivered intervention for AjD. TAO was found to be well accepted and more effective than the mere passage of time in reducing distress among patients with AjD. The intervention also had additional benefits in terms of posttraumatic growth, positive affect, and quality of life. The evaluation of patients' opinion about the treatment revealed the important impact of intervention characteristics on treatment engagement.