Salud Mental

Comparison of two psychotherapies in cortisol response and their efficacy in reducing symptoms of anxiety and depression in women victims of intimate partner violence

##plugins.themes.bootstrap3.article.main##

Beatriz Cerda-De la O
Ana Lilia Cerda-Molina
Marcela Biagini-Alarcón
Lilian Mayagoitia-Novales
Margarita De La Cruz-López
Jesús Alfredo Whaley-Sánchez

Abstract

Introduction. There is a growing need to implement evidence-based psychological treatments for women victims of intimate partner violence (IPV) who commonly experience stress-related disorders such as anxiety, depression, or suicide risk, as well as altered cortisol reactivity.

Objective. 1. To compare the changes in depressive and anxious symptomatology, quality of life, and cortisol reactivity after two different interventions, Acceptance and Commitment Therapy (ACT, based on psychological flexibility) or Interpersonal Therapy (IPT, based on empowerment) in women exposed to IPV. 2. To compare the changes in relation to the presence of suicide thoughts.

Method. A clinical sample of 50 women (ages 21-74) randomly assigned to attend ACT or IPT, completed pre- and post-intervention questionnaires about intimate partner violence, quality of life, depression, anxiety, and measurements of salivary cortisol reactivity (basal, 15, 30, and 45 minutes after a cognitive challenge). We used Generalized Estimating Equation Models for data analysis.

Results. There was a significant improvement post-intervention in all variables, regardless of the type of psychotherapy or the presence of suicide thoughts. Before interventions, women that reported suicide thoughts had severe symptoms of depression, anxiety, worse quality of life, and a cortisol hyper-response profile, in contrast to women without suicide thoughts who had moderate symptoms and no cortisol response. Cortisol response to the cognitive test decreased in all women after both therapies.

Discussion and conclusion. Although different psychological approach, ACT, and IPT effectively improved mental health, quality of life, and changed cortisol reactivity of women exposed to IPV, including women at suicide risk.
Keywords:
Cortisol, psychotherapies, depression, anxiety, intimate partner violence

Downloads

Download data is not yet available.

References

Achchappa, B., Bhandary, M., Unnikrishnan, B., Ramapuram, J. T., Kulkarni, V., Rao, S., ... Priyadarshni, S. (2017). Intimate Partner Violence, Depression, and Quality of Life among Women Living with HIV/AIDS in a Coastal City of South India. Journal of the International Association of Providers of AIDS Care, 16(5), 455-459. doi: 10.1177/2325957417691137

Ahmadabadi, Z., Najman, J. M., Williams, G. M., Clavarino, A. M., d’Abbs, P., & Tran, N. (2020). Intimate partner violence and subsequent depression and anxiety disorders. Social Psychiatry and Psychiatric Epidemiology, 55(5), 611-620. doi: 10.1007/s00127-019-01828-1

Alsaker, K., Moen, B. E., Morken, T., & Baste, V. (2018). Intimate partner violence associated with low quality of life-a cross-sectional study. BMC Women’s Health, 18(1), 1-7. doi: 10.1186/s12905-018-0638-5

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5™ (5th ed). American Psychiatric Publishing, Inc. doi: 10.1176/appi.books.9780890425596

Asplund, M., Rück, C., Lenhard, F., Gunnarsson, T., Bellander, M., Delby, H., & Ivanov, V. Z. (2021). ACT-enhanced group behavior therapy for trichotillomania and skin-picking disorder: A feasibility study. Journal of Clinical Psychology, 77(7), 1537-1555. doi: 10.1002/jclp.23147

Basu, A., Levendosky, A. A., & Lonstein, J. S. (2013). Trauma sequelae and cortisol levels in women exposed to intimate partner violence. Psychodynamic Psychiatry, 41(2), 247-275. doi: 10.1521/pdps.2013.41.2.247

Biagini-Alarcón, M. (2016). Modelo de intervención terapéutica grupal para mujeres receptoras de violencia. In: Primero-Rivas, L, & Biagini-Alarcón, M. (Eds). The New Epistemology and Mental Health in Mexico, (pp. 95-108). Mexico: Educational Horizons, National Pedagogical University (UPN).

Biagini-Alarcón, M., Cerda-de la O. B., & Cerda-Molina, A. L. (2020). Violencia de pareja, modelos explicativos e intervenciones psicoterapéuticas en víctimas. In: Martínez López, J. N. I. (Ed). Salud Mental Forense, (pp. 497-518). México: Tirant Lo Blanch, INPRFM.

Burlingame, G., Fuhriman, A., & Johnson, J. (2001). Cohesion in group psychotherapy. Psychotherapy: Theory, Research, Practice, Training, 38(4), 373-379. doi.10.1037/0033-3204.38.4.373

Cerda-Molina, A. L., Borráz-León, J. I., Mayagoitia-Novales, L., & Gaspar del Río, A. T. (2018). Reactividad del cortisol y salud mental en adultos expuestos a violencia temprana: revisión sistemática. Revista Panamericana de Salud Pública, 41, e171. doi: 10.26633/RPSP.2017.171

Chandan, J. S., Thomas, T., Bradbury-Jones, C., Russell, R., Bandyopadhyay, S., Nirantharakumar, K., & Taylor, J. (2020). Female survivors of intimate partner violence and risk of depression, anxiety and serious mental illness. The British Journal of Psychiatry, 217(4), 562-567. doi: 10.1192/bjp.2019.124

Devries, K. M., Mak, J. Y., Bacchus, L. J., Child, J. C., Falder, G., Petzold, M., & Watts, C. H. (2013). Intimate partner violence and incident depressivesymptoms and suicide Attempts: A Systematic Review of Longitudinal Studies. PLoS Medicine, 10(5), e1001439. doi: 10.1371/journal.pmed.1001439

Dwivedi, Y. (Ed.). (2012). The Neurobiological Basis of Suicide. Boca Raton, FL: CRC Press/Taylor & Francis Group.

Elzinga, B. M., Roelofs, K., Tollenaar, M. S., Bakvis, P., van Pelt, J., & Spinhoven, P. (2008). Diminished cortisol responses to psychosocial stress associated with lifetime adverse events: a study among healthy young subjects. Psychoneuroendocrinology, 33(2), 227-237. doi: 10.1016/j.psyneuen.2007.11.004

Fischer, S., Strawbridge, R., Vives, A. H., & Cleare, A. J. (2017). Cortisol as a predictor of psychological therapy response in depressive disorders: Systematic review and meta-analysis. The British Journal of Psychiatry, 210(2), 105-109. doi: 10.1192/bjp.bp.115.180653

Giletta, M., Calhoun, C. D., Hastings, P. D., Rudolph, K. D., Nock, M. K., & Prinstein, M. J. (2015). Multi-level risk factors for suicidal ideation among at-risk adolescent females: the role of hypothalamic-pituitary-adrenal axis responses to stress. Journal of Abnormal Child Psychology, 43(5), 807-820. doi: 10.1007/s10802-014-9897-2

Gordon, J. L., Eisenlohr-Moul, T. A., Rubinow, D. R., Schrubbe, L., & Girdler, S. S. (2016). Naturally occurring changes in estradiol concentrations in the menopause transition predict morning cortisol and negative mood in perimenopausal depression. Clinical Psychological Science, 4(5), 919-935. doi: 10.1177/2167702616647924

Hameed, M., O’Doherty, L., Gilchrist, G., Tirado-Muñoz, J., Taft, A., Chondros, P., … Hegarty, K. (2020). Psychological therapies for women experience intimate partner violence. The Cochrane Database of Systematic Reviews, 7(7). doi: 10.1002/14651858.CD013017.pub2

Hansen, N. B., Eriksen, S. B., & Elklit, A. (2014). Effects of an intervention program for female victims of intimate partner violence on psychological symptoms and perceived social support. European Journal of Psychotraumatology, 5(1). doi: 10.3402/ejpt.v5.24797

Hayes, S. C, Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change. New York, NY: The Guilford Press. ISBN 9781462528943

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behavior Research and Therapy, 44(1), 1-25. doi: 10.1016/j.brat.2005.06.006

Hegarty, K., O’Doherty, L., Taft, A., Chondros, P., Brown, S., Valpied, J., … Gunn, J. (2013). Screening and counseling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial. Lancet, 382(9888), 249-258. doi: 10.1016/S0140-6736(13)60052-5

Heim, C., Newport, D. J., Heit, S., Graham, Y. P., Wilcox, M., Bonsall, R., … Nemeroff, C. B. (2000). Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. Jama, 284(5), 592-597. doi: 10.1001/jama.284.5.592

Jurado, S., Villegas, M. E., Mendez, L., Rodriguez, F., Loperena, V., & Varela, R. (1998). Standardization of the Beck depression inventory for residents of Mexico City. Salud Mental, 21(3), 26-31.

Keynejad, R. C., Hanlon, C., & Howard, L. M. (2020). Psychological interventions for common mental disorders in women experiencing intimate partner violence in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet Psychiatry, 7(2), 173-190. doi: 10.1016/S2215-0366(19)30510-3

Li, S. H., & Graham, B. M. (2017). Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones. The Lancet Psychiatry, 4(1), 73-82. doi: 10.1016/S2215-0366(16)30358-3

Mielock, A. S., Morris, M. C., & Rao, U. (2017). Patterns of cortisol and alpha-amylase reactivity to psychosocial stress in maltreated women. Journal of Affective Disorders, 209, 46-52. doi: 10.1016/j.jad.2016.11.009

Morfín López, T., & Sánchez-Loyo, L. M. (2015). Violencia doméstica y conducta suicida: relatos de mujeres sobre la violencia y sus efectos. Acta Universitaria, 25(2), 57-61. doi: 10.15174/au.2015.886

Morris, M., Okoth, V., Prigmore, H. L., Ressler, D. J., Mbeya, J., Rogers, A., … Audet, C. M. (2020). The prevalence of interpersonal violence (IPV) against women and its associated variables: an exploratory study in the Rongo Sub-County of Migori County, Kenya. Journal of Interpersonal Violence, 37(5-6), 2083-2101. doi: 10.1177/0886260520935484

O’Connor, D. B., Ferguson, E., Green, J. A., O’Carroll, R. E., & O’Connor, R. C. (2016). Cortisol levels and suicidal behavior: A meta-analysis. Psychoneuroendocrinology, 63, 370-379. doi: 10.1016/j.psyneuen.2015.10.011

O’Connor, D. B., Gartland, N., & O’Connor, R. C. (2020). Stress, cortisol and suicide risk. International Review of Neurobiology, 152, 101-130. Academic Press. doi: 10.1016/bs.irn.2019.11.006

Páez Blarrina, M., & Gutiérrez Martínez, O. (2012). Multiple applications of Acceptance and Commitment Therapy (ACT). Madrid: Ediciones Pirámide. ISBN-13:9788436826487

Pan American Health Organization [PAHO]. (2016). Health care for women who have experienced intimate partner violence or sexual violence. Clinical Handbook. Retrieved from: https://iris.paho.org/bitstream/handle/10665.2/31381/OPSFGL16016-spa.pdf

Pekár, S., & Brabec, M. (2018). Generalized estimating equations: A pragmatic and flexible approach to the marginal GLM modeling of correlated data in the behavioral sciences. Ethology, 124(2), 86-93. doi: 10.1111/eth.12713

Pinna, K. L., Johnson, D. M., & Delahanty, D. L. (2014). PTSD, comorbid depression, and the cortisol waking response in victims of intimate partner violence: preliminary evidence. Anxiety, Stress &Coping, 27(3), 253-269. doi: 10.1080/10615806.2013.852185

Reyes-Ortega, M., & Vargas-Salinas, A. (2016). Intervention Manual in Acceptance and Commitment Therapy for victim care. Single module. Mexico. Institute of Behavioral and Contextual Therapies.

Reynolds, T. A., Makhanova, A., Marcinkowska, U. M., Jasienska, G., McNulty, J. K., Eckel, L. A., ... Maner, J. K. (2018). Progesterone and women’s anxiety across the menstrual cycle. Hormones and Behavior, 102, 34-40. doi: 10.1016/j.yhbeh.2018.04.008

Robles, R., Varela, R., Jurado, S., & Páez, F. (2001). Versión mexicana del inventario de ansiedad de Beck: propiedades psicométricas. Revista Mexicana de Psicología, 18(2), 211-218. Retrieved from: https://scinapse.io/papers/1597953883

Ruiz, F. J., Flórez, C. L., García-Martín, M. B., Monroy-Cifuentes, A., Barreto-Montero, K., García-Beltrán, D. M., … Gil-Luciano, B. (2018). A multiple-baseline evaluation of a brief acceptance and commitment therapy protocol focused on repetitive negative thinking for moderate emotional disorders. Journal of Contextual Behavioral Science, 9, 1-14. doi: 10.1016/j.jcbs.2018.04.004

Sabri, B., & Granger, D. A. (2018). Gender-based violence and trauma in marginalized populations of women: Role of biological embedding and toxic stress. Health Care for Women International, 39(9), 1038-1055. doi: 10.1080/07399332.2018.1491046

Sarasua, B., Zubizarreta, I., Echeburúa, E., & del Corral, P. (2007) Perfil psicopatológico diferencial de las víctimas de violencia de pareja en función de la edad. Psicotema, 19(3), 459-66.

Schultheiss, O. C., Dargel, A., & Rohde, W., (2003). Implicit motives and gonadal steroid hormones: effects of menstrual cycle phase, oral contraceptive use, and relationship status. Hormones and Behavior, 43(2), 293-301. doi: 10.1016/S0018-506X(03)00003-5

Secretaría de Salud. (2012). Norma Oficial Mexicana NOM-012-SSA3-2012, que establece los criterios para la ejecución de proyectos de investigación para la salud en seres humanos. México: Diario Oficial de la Federación. Retrieved from: http://www.dof.gob.mx/nota_detalle.php?codigo=5284148&fecha=04/01/2013

Seedat, S., Stein, M. B., Kennedy, C. M., & Hauger, R. L. (2003). Plasma cortisol and neuropeptide Y in female victims of intimate partner violence. Psychoneuroendocrinology, 28(6), 796-808. doi: 10.1016/s0306-4530(02)00086-0

Skevington, S. M., Lotfy, M., & O’Connell, K. A. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group. Quality of Life Research, 13(2), 299-310. doi: 1023/B:QURE.0000018486.91360.00

Terlizzi, E. P., & Villarroel, M. A. (2020). Symptoms of generalized anxiety disorder among adults: United States, 2019. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db378.htm

Tirado-Muñoz, J., Gilchrist, G., Lligoña, E., Gilbert, L., & Torrens, M. (2015). A group intervention to reduce intimate partner violence among female drug users. Results from a randomized controlled pilot trial in a community substance-abuse center. Adicciones, 27(3), 168-178.

Valdéz-Santiago, R., Híjar-Medina, M. C., Salgado de Snyder, V. N., Rivera-Rivera, L., Avila-Burgos, L., & Rojas, R. (2006). Violence scale and severity index: a methodological proposal for measuring violence by the partner in Mexican women. Salud Pública de México, 48(Supp. 2), 221-231. Retrieved from: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0036-36342006000800002&lng=es&tlng=es

Vargas-Salinas, A., & Reyes-Ortega, M. (2016). Acceptance and Commitment Therapy (ACT) intervention manual for victim care. Módulo Grupal. México. Instituto de Terapias Conductuales y Contextuales.

Whoqol Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551-558. doi: 10.1017/S0033291798006667

World Health Organization [WHO]. (2013). Responding to intimate partner violence and sexual violence against women. World Health Organization. ISBN 978 92 4 154859 5

World Health Organization [WHO]. (2005). WHO multi-country study on women’s health and domestic violence against women: initial results on prevalence, health events and women’s responses to domestic violence against women. to such violence. Summary Report. Geneva: World Health Organization. ISBN 92 4 159358 X

Wüst, S., Federenko, I. S., van Rossum, E. F., Koper, J. W., & Hellhammer, D. H. (2005). Habituation of cortisol responses to repeated psychosocial stress—further characterization and impact of genetic factors. Psychoneuroendocrinology, 30(2), 199-211. doi: 10.1016/j.psyneuen.2004.07.002

Wynne, B., McHugh, L., Gao, W., Keegan, D., Byrne, K., Rowan, C., … Mulcahy, H. E. (2019). Acceptance and commitment therapy reduces psychological stress in patients with inflammatory bowel diseases. Gastroenterology, 156(4), 935-945.doi: 10.1053/j.gastro.2018.11.030

Yalom, I. (1986). Theory and practice of group psychotherapy. México: Fondo de Cultura Económica. ISBN 9681621662 9789681621667

Zhang, C. Q., Leeming, E., Smith, P., Chung, P. K., Hagger, M. S., & Hayes, S. C. (2018). Acceptance and commitment therapy for health behavior change: acontext-driven approach. Frontiers in Psychology, 8, 2350. doi: 10.3389/fpsyg.2017.02350