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

Resum

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 study 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 and 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 self–management 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<.000], vulnerability to stress [F(1 .50) = 1 05.25; 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 integrated view of the patients with lupus, treating the clinical and psychological aspects.