Miedo a hablar en público y aceptación psicológica: un protocolo de intervención mediante realidad virtual basado en la Terapia de Aceptación y Compromiso
Palabras clave:
Resumen
Se describe un protocolo de intervención de 5 sesiones basado en la Terapia de Aceptación y Compromiso (ACT) dirigido a estudiantes universitarios que presentan miedo a hablar en público (MHP) y promueve los procesos centrales de ACT para el fomento de la flexibilidad psicológica. Dichos procesos son abordados durante la intervención a través de un entrenamiento que combina la exposición en vivo o mediante realidad virtual (RV) desde la perspectiva de la aceptación psicológica. Se presentan los resultados de la aplicación de las dos modalidades del protocolo en sendas estudiantes universitarias que reflejaron reducciones clínicamente significativas del MHP y la ansiedad social. Se concluye que la adaptación de los métodos clínicos de ACT en el ámbito del MHP en combinación con la RV puede suponer un avance significativo en el abordaje de este problema en el ámbito académico.
Descargas
Altmetrics
Citas
Anderson P. L., Edwards, S. M., & Goodnight, J. R. (2017). Virtual Reality and exposure group therapy for social anxiety disorder. Cognitive Therapy Research, 41, 230-236. DOI: 10.1007/s10608-016-9820-y
Anderson P. L, Price M., Edwards S. M, Obasaju M. A, Schmertz S. K, Zimand, E. & Calamaras, M. R. (2013). Virtual reality exposure therapy for social anxiety disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 81(5), 751–760. DOI: 10.1037/a0033559
Anderson, P. L., Zimand, E., Hodges, L. F., & Rothbaum, B. O. (2005). Cognitive behavioral therapy for public‐speaking anxiety using virtual reality for exposure. Depression and Anxiety, 22(3), 156-158. DOI: 10.1002/da.20090
Bados, A. (2009). Miedo a hablar en público: naturaleza, evaluación y tratamiento. Barcelona: Publicacions i Edicions de la Universitat de Barcelona. http://hdl.handle. net/2445/6323
Block, J, & Wulfert, E. (2000). Acceptance or change: Treating socially anxious college students with ACT or CBGT. The behavior analyst today, 1(2), 3-28. DOI:10.1037/ h0099879
Block, J. (2002). Acceptance or change of private experiences: A comparative analysis in college students with public speaking anxiety (Tesis doctoral). University at Albany, State University of New York.
Bobes, J., Badía, X., Luque, A., García, M., González, M. P., Dal-Ré, R., Soria, J., Martínez, R, de la Torre, J., Doménech, R, González- Quirós, M., Bascarán, M. T., González, J. L & Martínez de la Cruz, F. (1999). Validación de las versiones en español de los cuestionarios Liebowitz Social Anxiety Scale, Social Anxiety and Distress Scale y Sheenan Disability Inventory para la evaluación de la fobia social. Medical Clinical, 112, 530-538. https://www.researchgate.net/ publication/285820981_Validacion_de_ las_versiones_en_espano_de_los_cuestionarios_Liebowitz_Social_Anxiety_Scale_Social_Anxiety_and_Distres_Scale_y_ Sheehan_Disability_Inventory_para_la_ evaluacion_de_la_fobia_social
Boetje, J, & Van Ginkel, S (2021). The added benefit of an extra practice session in virtual reality on the development of presentation skills: A randomized control trial. Journal of Compute Assisted Learning, 37, 253-264. DOI:10.1111/jcal.12484
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K. & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676- 688. DOI: 10.1016/j.beth.2011.03.007
Bouchard, S., Dumoulin, S., Robillard, G., Guitard, T., Klinger, E., Forget, H., Loranger, C. & Roucaut, F. X. (2017). Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: a three-arm randomized controlled trial. The British Journal of Psychiatry, 210, 276–283. DOI: 10.1192/ bjp.bp.116.184234
Brandrick, C., Hooper, N., Roche, B., Kanter, J & Tyndall, J. (2021). A comparison of ultra-brief cognitive defusion and positive affirmation interventions on the reduction of public speaking anxiety. The psychological Record, 71, 109-117.DOI:10.1007/s40732- 020-00432-z
Brown, M., Glendenning, A. C., Hoon, A. E., & John, A. (2016). Effectiveness of web-delivered acceptance and commitment therapy in relation to mental health and well-being: a systematic review and meta-analysis. Journal of Medical Internet Research, 18(8), e221.DOI: 10.2196/jmir.6200
Ebrahimi, O. V., Pallesen, S., F.Kenter, R. & Noordgreen, T. (2019). Psychological Interventions for the Fear of Public Speaking: A Meta-Analysis. Frontiers in Psychology, 10, 1-27.DOI: 10.3389/fpsyg.2019.00488
England, E. L., Herbert, J. D., Forman, E. M., Rabin, S. J., Juarascio, A., & Goldstein, S. P. (2012). Acceptance-based exposure therapy for public speaking anxiety. Journal of Contextual Behavioral Science, 1(1–2), 66–72. https://doi.org/10.1016/j.jcbs.2012.07.001
Fedoroff, I., & Taylor, S. (2001). Psychological and pharmacological treatments of social phobia: A meta-analysis. Journal of Clinical Psychopharmacology, 21, 311-324. DOI: 10.1097/00004714-200106000-00011
Feliu-Soler, A., Montesinos, F., Gutiérrez-Martínez, O., Scott, W., McCracken, L. M., & Luciano, J. V. (2018). Current status of acceptance and commitment therapy for chronic pain: a narrative review. Journal of pain research, 11, 2145-2159.DOI: 10.2147/JPR. S144631
Ferreira A.C., Mesquita A., Côrtes A.C. & Caldas, L. (2017). Fear of public speaking: Perception of college students and correlates. Journal of voice, 31 (1), 7-11. DOI:10.1016/j. jvoice.2015.12.012
Feske, U. & Chambless, D. L. (1995). Cognitive behavioral versus exposure only treatment for social phobia: A meta-analysis. Behavior Therapy, 26, 695-720. https://doi. org/10.1016/S0005-7894(05)80040-1
Foa, E. B, & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35. https://psycnet.apa.org/doi/10.1037/0033- 2909.99.1.20
García, E. S., Rosa, A. I. & Olivares, J.P. (2011). Terapia de exposición mediante realidad virtual e internet en el trastorno de ansiedad/ fobia social: Una revisión cualitativa. Terapia Psicológica, 29(2), 233-243. https://dx.doi. org/10.4067/S0718-48082011000200010
Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L. & Masley, S. (2014). The development and initial validation of the cognitive fusion questionnaire. Behavior therapy, 45(1), 83-101. DOI: 10.1016/j.beth.2013.09.001
Glassman, L. H., Forman, E. M., Herbert, J. D., Bradley, L. E., Foster, E. E., Izzetoglu, M., & Ruocco, A. C. (2016). The effects of a brief acceptance-based behavioral treatment versus traditional cognitive-behavioral treatment for public speaking anxiety: An exploratory trial examining differential effects on performance and neurophysiology. Behavior Modification, 40(5), 748–776. DOI: 10.1177/0145445516629939
Gloster, A. T., Walder, N., Levin, M.E., Twohig, M. P & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181-192. DOI:10.1016/j.jcbs.2020.09.009
Goldfarb, J. A. (2009). Effects of acceptance versus cognitive restructuring on public speaking anxiety in college students. Hofstra University.
Gould, R. A., Buckminster, S., Pollack, M. H., Otto, M. W. & Yap, L. (1997). Cognitive-behavioral and pharmacological treatment for social phobia: A meta-analysis. Clinical Psychology: Science and Practice, 4, 291-306.https://psycnet.apa.org/ doi/10.1111/j.1468-2850.1997.tb00123.x
Harris, R. (2010). La trampa de la felicidad. Barcelona: Planeta.
Harris, S. R., Kemmerling, R. L. & North, M. M. (2002). Brief virtual reality therapy for public speaking anxiety. Cyberpsychology & behavior, 5(6), 543-550.DOI: 10.1089/1094 93102321018187
Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy, 35(4), 639-665. https://doi.org/10.1016/S0005- 7894(04)80013-3
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, 1-25. DOI: 10.1016/j.brat.2005.06.006
Hayes, S. C. & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process‐based care. World Psychiatry, 16(3), 245. DOI: 10.1002/ wps.20442
Hayes, S. C., & Hofmann, S.G. (2021). “Third-waves” cognitive and behavioral therapies and the emergence of a process-based approach to intervention in psychiatry. World psychiatry, 20, 363-375. https://doi. org/10.1002/wps.20884
Hayes, S. C., Strosahl, K. & Wilson, K.G. (2014). Terapia de Aceptación y Compromiso. Proceso y práctica del cambio consciente. Bilbao: Descleé de Brower.
Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual review of clinical psychology, 7, 141-168. DOI: 10.1146/annurev-clinpsy-032210-104449
Hofmann, S. G., Heering, S., Sawyer, A.T. & Asnaani, A. (2009). How to Handle Anxiety: The Effects of Reappraisal, Acceptance, and Suppression Strategies on Anxious Arousal. Behavioral Research Therapy, 47(5), 389- 394. DOI: 10.1016/j.brat.2009.02.010
Hope, D. A., Herbert, J. D. & White, A. (1995). Diagnostic subtype, avoidant personality disorder, and efficacy of cognitive-behavioral group therapy for social phobia. Cognitive Therapy and Research, 19, 399- 417. https://psycnet.apa.org/doi/10.1007/ BF02230408
Iraguri, I. (2010). Evaluación de resultados clínicos (y III): Índices de Cambio Fiable (ICF) como estimadores del cambio clínicamente significativo. Norte de Salud Mental, 36(3), 105-122. https://dialnet.unirioja.es/servlet/ articulo?codigo=4830423
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12-19. DOI: 10.1037//0022- 006x.59.1.12
Kim, H. E., & Kim, D. Y. (2012). The Effects of Acceptance and Commitment therapy on Anxiety Thought, Anxiety Sensitivity, and Acceptive Attitude: Focused on Public Speaking Anxiety. The Korean Journal of Health Psychology, 17(17), 299-310. https:// doi.org/10.17315/kjhp.2012.17.2.001
Klinger, E., Bouchard, S., Légeron, P., Roy, S., Lauer, F., Chemin, I. & Nugues, P. (2005). Virtual reality therapy versus cognitive behavior therapy for social phobia: A preliminary controlled study. CyberPsychology & Behavior, 8, 76–88. DOI: 10.1089/cpb.2005.8.76
Liebowitz, M. R. (1987). Social phobia. Modern problems of pharmacopsychiatry, 22, 141- 173. http://dx.doi.org/10.1159/000414022
Méndez, F. X., Inglés, C. J., & Hidalgo, M. D. (2004). La versión española abreviada del “Cuestionario de Confianza para Hablar en Público” (Personal Report of Confidence as Speaker): fiabilidad y validez en población adolescente. Psicología Conductual, 12(1), 25-42.
https://www.behavioralpsycho.com/wp-content/uploads/2020/04/02.Mendez_12- 1oa-1.pdf
Observatorio de Innovación en el Empleo (2017). Informe OIE sobre jóvenes y mercado laboral: El camino del aula a la empresa. https://oie.es/wp-content/ uploads/2015/07/oie_estudio_2017.pdf
Páez, M., & Montesinos, F. (2016). Tratando con Terapia de Aceptación y Compromiso. Habilidades terapéuticas centrales para la aplicación eficaz. Madrid: Pirámide.
Paul, G.L. (1966). Insight vs. desensitization in psychotherapy. Stanford University Press.
Ruiz, F. J. (2010). A review of Acceptance and Commitment Therapy (ACT) empirical evidence: Correlational, experimental psychopathology, component and outcome studies. International Journal of Psychology and Psychological Therapy, 10(1), 125- 162.https://www.ijpsy.com/volumen10/ num1/256.html
Ruiz, F. J. (2012). Acceptance and commitment therapy versus traditional cognitive behavioral therapy: A systematic review and meta-analysis of current empirical evidence. International journal of psychology and psychological therapy, 12(3), 333- 358. https://dialnet.unirioja.es/servlet/ articulo?codigo=4019738
Ruiz, F. J., Luciano, C., Cangas, A. J., & Beltrán, I. (2013). Measuring experiential avoidance and psychological inflexibility: the Spanish version of the Acceptance and Action Questionnaire-II. Psicothema, 25(1), 123- 129. DOI: 10.7334/psicothema2011.239
Ruiz, F. J., Suárez-Falcón, J. C., Riaño-Hernández, D., & Gillanders, D. (2017). Psychometric properties of the Cognitive Fusion Questionnaire in Colombia. Revista Latinoamericana de Psicología, 49(1), 80-87. https://doi. org/10.1016/j.rlp.2016.09.006
Salaberría, K., & Echeburúa, E. (1995). La exposición como tratamiento psicológico en un caso de fobia social de tipo generalizado. Análisis y Modificación de Conducta, 21, 305-326. https://dialnet.unirioja.es/servlet/articulo?codigo=7073829
Sanz, J., & García-Vera, M. P. (2015). Técnicas para el análisis de diseños de caso único en la práctica clínica: ejemplos de aplicación en el tratamiento de víctimas de atentados terroristas. Clínica y Salud, 26(3), 167-180. https://dx.doi.org/10.1016/j.clysa.2015.09.004.
Scholing, A., & Emmelkamp, P.M.G. (1993). Exposure with and without cognitive therapy for generalized social phobia: Effects of individual and group treatment. BehaviourResearch and Therapy, 31, 667-681. DOI: 10.1016/0005-7967(93)90120-j
Smout, M. F., Hayes, L., Atkins, P. W., Klausen, J., & Duguid, J. E. (2012). The empirically supported status of acceptance and commitment therapy: An update. Clinical Psychologist, 16(3), 97-109. https://doi. org/10.1111/j.1742-9552.2012.00051.x
Spencer, S. D., Buchanan, J. A., & Masuda, A. (2020). Effects of Brief Acceptance and Cognitive Reappraisal Interventions on Experiential Avoidance in Socially Anxious Individuals: A Preliminary Investigation. Behavior modification, 44(6), 841-864. DOI: 10.1177/0145445519854321
Taylor, S. (1996). Meta-analysis of cognitive-behavioral treatment for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 27, 1-9. DOI: 10.1016/0005- 7916(95)00058-5
Takac, M., Collet, J., Blom, K. J., Conduit, R., Rehm, I. & De Foe, A. (2019). Public speaking anxiety decreases within repeated virtual reality training sessions. Plos One, 14(5), 1-17. DOI:10.1371/journal.pone.0216288
Taylor, S. (1996). Meta-analysis of cognitive-behavioral treatment for social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 27, 1-9. https://doi. org/10.1016/0005-7916(95)00058-5
Van Ginkel, S., Gulikers, J., Biemans, H. & Mulder, M. (2015). Towards a set of design principles for developing oral presentation competence: A synthesis of research in higher education. Educational Research Review, 14, 62–80. https://doi.org/10.1016/j. edurev.2015.02.002
Veehof, M. M., Trompetter, H. R., Bohlmeijer, E. T. & Schreurs, K. M. G. (2016). Acceptance-and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cognitive behaviour therapy, 45(1), 5-31. DOI: 10.1080/16506073.2015.1098724
Wallach, H. S., Safir, M. P., & Bar-Zvi, M. (2009). Virtual reality cognitive behavior therapy for public speaking anxiety: a randomized clinical trial. Behavior modification, 33(3), 314-338. DOI: 10.1177/0145445509331926
Wechsler, F. T., Kümpers, F. & Mühlberger, A. (2019). Inferiority or Even Superiority of Virtual Reality Exposure Therapy in Phobias? Frontiers in Psychology, 10, 1-25. DOI: 10.3389/fpsyg.2019.01758
Wörtwein, T., Morency, L. P. &Scherer, S. (2015). Automatic Assessment and Analysis of Public Speaking Anxiety: A Virtual Audience Case Study. International Conference on Affective Computing and Intelligent Interaction: 21-24 de septiembre. Xi’an, China: IEE Xplore.https://www.semanticscholar. org/paper/Automatic-assessment-and-analysis-of-public-A-case-Wörtwein- Morency/2fefdd6a5cb7efc840d978e5f79ee32fae463c3f
Wilson, K. G. & Luciano, C. (2002). Terapia de Aceptación y Compromiso (ACT). Un tratamiento conductual orientado a los valores. Madrid: Pirámide.
Wolpe, J. (1958). Psychotherapy by Reciprocal Inhibition. Stanford University Press.
Yuen, E. K., Goetter, E. M., Stasio, M. J., Ash, P., Mansour, B., McNally, E., & Watkins, J. (2019). A pilot of acceptance and commitment therapy for public speaking anxiety delivered with group videoconferencing and virtual reality exposure. Journal of Contextual Behavioral Science, 12, 47-54. https://psycnet.apa.org/doi/10.1016/j.jcbs.2019.01.006
Al remitir una propuesta, el/la autor/a acuerda con los términos siguientes:
a) El/la autor/a conserva los derechos de autor y cede a la revista el derecho de primera publicación de la obra.
b) Los textos se difundirán con la licencia de reconocimiento Creative Commons 4.0. BY-NC-SA que permite a terceros recombinar, retocar y desarrollar la obra para fines no comerciales, siempre y cuando reconozcan la autoría y licencien sus creaciones nuevas bajo condiciones idénticas.
