Coralee Pérez-Pedrogo Bianca Y. Planas-García Sugeily Rivera-Suazo Jesús Ortega-Guzmán Carmen E. Albizu-García

Resumen

La Terapia de Aceptación y Compromiso (TAC) ha demostrado ser una intervención prometedora para el estigma internalizado en personas con virus de la inmunodeficiencia humana (VIH) y trastornos por uso de drogas (TUD). Sin embargo, hay incertidumbre sobre si esta intervención es apropiada para latinx hispanx hablantes. Este estudio preliminar evaluamos la viabilidad y aceptabilidad de una intervención TAC culturalmente adaptada y desarrollada para reducir el estigma internalizado del VIH y TUD en una muestra de latinxs de habla hispana. Ocho pacientes de clínicas primarias con diagnóstico de VIH y TUD participaron en este estudio. Se recopilaron medidas de viabilidad y aceptabilidad, así como tasa de asistencia. Todas las personas participantes describieron la intervención como aceptable, alcanzable, fácil de usar e indicaron estar receptivas a la terapia. La TAC parece ser una intervención aceptable y viable para las personas pacientes de atención primaria de descendencia latina de habla hispana. Un estudio de control aleatorizado es requerido para explorar mejor la eficacia de la intervención.

##plugins.generic.articleMetricsGraph.articlePageHeading##

##plugins.themes.bootstrap3.article.details##

Keywords

Estigma internalizado, Intervenciones conductuales, Trastorno por uso de drogas, VIH

References
Alegría, M., Canino, G., Ríos, R., Vera, M., Calderón, J., Rusch, D., & Ortega, A. N. (2002). Mental health care for latinos: Inequalities in use of specialty mental health services among Latinos, African Americans, and non-Latino whites. Psychiatric Services, 53(12), 1547–1555. https://doi.org/10.1176/appi.ps.53.12.1547
Alegría, M., Page, J. B., Hansen, H., Cauce, A. M., Robles, R., Blanco, C., Cortes, D. E., Amaro, H., Morales, A., & Berry, P. (2006). Improving drug treatment services for Hispanics: Research gaps and scientific opportunities. Drug and Alcohol Dependence, 84 Suppl 1, S76–S84. https://doi.org/10.1016/j.drugalcdep.2006.05.009
Alegría, M., Alvarez, K., Ishikawa, R. Z., DiMarzio, K., & McPeck, S. (2016). Removing obstacles to eliminating racial and ethnic disparities in behavioral health care. Health Affairs, 35(6), 991-999. https://doi.org/10.1377/hlthaff.2016.0029
Andrinopoulos K., Peacock, E. Hembling J. (2014). Alcohol consumption patterns, illicit drug use, and sexual risk behavior among MSM and transgender women in San Salvador. Chapel Hill, NC: MEASURE Evaluation.
Batinić, B., Lemonis, E., & Opačić, G. (2014). Effects of internalized stigma of mental disorder on quality of life and self-esteem in panic disorder patients. Journal of Clinical Research & Bioethics, 5, 1-5. http://dx.doi.org/10.4172/2155-9627.1000196
Bernal, G., Bonilla, J., & Bellido, C. (1995). Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispa-nics. Journal of Abnormal Child Psychology, 23(1), 67–82.
https://doi.org/10.1007/BF01447045
Bernal, G., Jiménez-Chafey, M. I., & Domenech Rodríguez, M. M. (2009). Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40(4), 361-368.
https://doi.org/10.1037/a0016401
Cabassa, L. J., Zayas, L. H., & Hansen, M. C. (2006). Latino adults’ access to mental health care: A review of epidemiological studies. Administration and Policy in Mental Health, 33(3), 316-330.
https://doi.org/10.1007/s10488-006-0040-8
Center for Disease Control and Prevention. (2021, May). HIV Surveillance Report, 2019, 32.
https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2018-updated-vol-32.pdf
Center for Disease Control and Prevention. (2020, May). Estimated HIV incidence and prevalence in the United States, 2014–2018. HIV Surveillance Supplemental Report 2020, 25(1). https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-25-1.pdf
Cook, B. L., Trinh, N. H., Li, Z., Hou, S. S., & Progovac, A. M. (2017). Trends in racial-ethnic disparities in access to mental health care, 2004-2012. Psychiatric services, 68(1), 9–16.
https://doi.org/10.1176/appi.ps.201500453
Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. The Canadian Journal of Psychiatry, 57(8), 464–469.
https://doi.org/10.1177/070674371205700804
Guerrero, E. G., Marsh, J. C., Khachikian, T., Amaro, H., & Vega, W. A. (2013). Disparities in Latino substance use, service use, and treatment: implications for culturally and evidence-based interventions under health care reform. Drug and Alcohol Dependence, 133(3), 805–813.
https://doi.org/10.1016/j.drugalcdep.2013.07.027
Handtke, O., Schilgen, B., & Mösko, M. (2019). Culturally competent healthcare - A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision. PloS one, 14(7), e0219971. https://doi.org/10.1371/journal.pone.0219971
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes, and outcomes. Behaviour Research and Therapy, 44(1), 1–25. https://doi.org/10.1016/j.brat.2005.06.006
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. Guilford Press.
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd edition). The Guilford Press.
Healey, P., Stager, M. L., Woodmass, K., Dettlaff, A. J., Vergara, A., Janke, R., & Wells, S. J. (2017). Cultural adaptations to augment health and mental health services: A systematic review. BMC Health Services Research, 17(1), 8. https://doi.org/10.1186/s12913-016-1953-x
HIV/AIDS Surveillance System, Epidemiology Division, Puerto Rico Department of Health. (2019). Puerto Rico HIV/AIDS Surveillance Summary.
Hall, G. C., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-analysis of cultural adaptations of psychological interventions. Behavior therapy, 47(6), 993–1014. https://doi.org/10.1016/j.beth.2016.09.005
Holubova, M., Prasko, J., Ociskova, M., Marackova, M., Grambal, A., & Slepecky, M. (2016). Self-stigma and quality of life in patients with depressive disorder: A cross-sectional study. Neuropsychiatric Disease and Treatment, 12, 2677–2687. https://doi.org/10.2147/NDT.S118593
Howarth, A., Smith, J., Perkin-Porras, L., & Ussher, M. (2019). Effects of brief mindfulness-based interventions on health-related outcomes: A systematic review. Mindfulness, 19, 1957-1958. https://doi.org/10.1007/s12671-019-01163-1
Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. National Academies Press (US).
https://doi.org/10.17226/12875
International Planned Parenthood Federation. (2014). “Stigma is still my most serious challenge” People living with HIV share their experiences.
https://www.ippf.org/sites/default/files/web_ippf_otw_hiv_stigma1_2.pdf
Jones, A. L., Cochran, S. D., Leibowitz, A., Wells, K. B., Kominski, G., & Mays, V. M. (2018). Racial, ethnic, and nativity differences in mental health visits to primary care and specialty mental health providers: Analysis of the medical expenditures panel survey, 2010-2015. Healthcare, 6(2), 29.
https://doi.org/10.3390/healthcare6020029
Latalova, K., Prasko, J., Kamaradova, D., Ociskova, M., Cinculova, A., Grambal, A., Kubinek, R., Mainerova, B., Smoldasova, J., Tichackova, A., & Sigmundova, Z. (2014). Self-stigma and suicidality in patients with neurotic spectrum disorder - a cross sectional study. Neuro Endocrinology Letters, 35(6), 474–480.
Lee, E. B., An, W., Levin, M. E., & Twohig, M. P. (2015). An initial meta-analysis of Acceptance and Commitment Therapy for treating substance use disorders. Drug and Alcohol Dependence, 155, 1–7. https://doi.org/10.1016/j.drugalcdep.2015.08.004
Lillis, J., & Hayes, S. C. (2007). Applying acceptance, mindfulness, and values to the reduction of prejudice: a pilot study. Behavior Modification, 31(4), 389–411. https://doi.org/10.1177/0145445506298413
Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Theory, 16(2), 149–165.
https://doi.org/10.1080/16066350701850295
Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., & Fletcher, L. (2012). Slow and steady wins the race: A randomized clinical trial of acceptance and commitment therapy targeting shame in substance use disorders. Journal of Consulting and Clinical psychology, 80(1), 43–53. https://doi.org/10.1037/a0026070
Luoma, J. B., Nobles, R. H., Drake, C. E., Hayes, S. C., O'Hair, A., Fletcher, L., & Kohlenberg, B. S. (2013). Self-stigma in substance abuse: Development of a new measure. Journal of Psychopathology and Behavioral Assessment, 35(2), 223–234.
https://doi.org/10.1007/s10862-012-9323-4
Luoma, J. B. & Platt, M. G. (2015). Shame, self-criticism, self-stigma, and compas-sion in Acceptance and Commitment Therapy. Current Opinion on Psycho-logy, 2(1), 97-101.
https://doi.org/10.1016/j.copsyc.2014.12.016
Masuda, A., Hayes, S. C., Lillis, J., Bunting, K., Herbst, S. A., & Fletcher, L. B. (2009). The relation between psychological flexibility and mental health stigma in Acceptance and Commitment Therapy: A preliminary process investigation. Behavior and Social Issues, 18(1), 1–16. https://doi.org/10.5210/bsi.v18i1.2525
McCrabb, S., Lane, C., Hall, A., Milat, A., Bauman, A., Sutherland, R., Yoong, S., & Wolfenden, L. (2019). Scaling-up evidence-based obesity interventions: A systematic review assessing intervention adaptations and effectiveness and quantifying the scale-up penalty. Obesity reviews: An official journal of the International Association for the Study of Obesity, 20(7), 964–982.
https://doi.org/10.1111/obr.12845
Mills, E. J., Nachega, J. B., Buchan, I., Orbinski, J., Attaran, A., Singh, S., Rachlis, B., Wu, P., Cooper, C., Thabane, L., Wilson, K., Guyatt, G. H., & Bangsberg, D. R. (2006). Adherence to antiretroviral therapy in sub-Saharan Africa and North America: A meta-analysis. JAMA, 296(6), 679–690.
https://doi.org/10.1001/jama.296.6.679
NIDA. (2020, July 30). Drug Use and Viral Infections (HIV, Hepatitis) DrugFacts. https://nida.nih.gov/publications/drugfacts/drug-use-viral-infections-hiv-hepatitis
Oexle, N., Rüsch, N., Viering, S., Wyss, C., Seifritz, E., Xu, Z., & Kawohl, W. (2017). Self-stigma and suicidality: A longitudinal study. European Archives of Psychiatry and Clinical Neuroscience, 267(4), 359–361. https://doi.org/10.1007/s00406-016-0698-1
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and policy in mental health, 38(2), 65–76.
https://doi.org/10.1007/s10488-010-0319-7
Room R. (2005). Stigma, social inequality and alcohol and drug use. Drug and Alcohol Review, 24(2), 143–155.
https://doi.org/10.1080/09595230500102434
Skinta, M. D., Lezama, M., Wells, G., & Dilley, J. W. (2015). Acceptance and compassion-based group therapy to reduce HIV stigma. Cognitive and Behavioral Practice, 22(4), 481–490. https://doi.org/10.1016/j.cbpra.2014.05.006
Smout M. (2012). Acceptance and commitment therapy - pathways for general practitioners. Australian Family Physician, 41(9), 672–676.
Substance Abuse and Mental Health Services Administration (US), & Office of the Surgeon General (US). (2016). Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health. US Department of Health and Human Services.
Substance Abuse and Mental Health Services Administration. (2021). Treating substance use disorders among people with HIV. Advisory.
Tsai, A. C., Kiang, M. V., Barnett, M. L., Beletsky, L., Keyes, K. M., McGinty, E. E., Smith, L. R., Strathdee, S. A., Wakeman, S. E., & Venkataramani, A. S. (2019). Stigma as a fundamental hindrance to the United States opioid overdose crisis response. PLoS Medicine, 16(11), e1002969.
https://doi.org/10.1371/journal.pmed.1002969
Vera, M., Obén, A., Juarbe, D., Hernández, N., & Pérez-Pedrogo, C. (2021). Randomized pilot trial of cognitive-behavioral therapy and acceptance-based behavioral therapy in the treatment of Spanish-speaking Latino primary care patients with Generalized Anxiety Disorder. Journal of Behavioral and Cognitive Therapy, 31(2), 91-103. https://doi.org/10.1016/j.jbct.2020.11.007
Watson, A. C., Corrigan, P., Larson, J. E., & Sells, M. (2007). Self-stigma in people with mental illness. Schizophrenia Bulletin, 33(6), 1312–1318.
https://doi.org/10.1093/schbul/sbl076
Weiner, B. J., Lewis, C. C., Stanick, C., Powell, B. J., Dorsey, C. N., Clary, A. S., Boynton, M. H., & Halko, H. (2017). Psychometric assessment of three newly developed implementation outcome measures. Implementation science, 12(1), 108.
https://doi.org/10.1186/s13012-017-0635-3
Yalom, I. D., & Leszcz, M. (Collaborator). (2005). The theory and practice of group psychotherapy (5th ed.). Basic Books/Hachette Book Group.
Cómo citar
Pérez-Pedrogo, C., Planas-García, B. Y., Rivera-Suazo, S., Ortega-Guzmán, J., & Albizu-García, C. E. (2022). Viabilidad preliminar y aceptabilidad de una adaptación cultural de la terapia de aceptación y compromiso para latinxs con VIH y trastornos por uso de drogas en Puerto Rico. Revista Puertorriqueña De Psicologí­a, 33(2), 232–243. https://doi.org/10.55611/reps.3302.03
Sección
Artículo de investigación