The aim of this study was to compare the effect of cognitive behavioral intervention (CBI) combined with the resilience model (CBI + R) vs CBI alone on depression symptoms, anxiety symptoms, and quality of life of end-stage renal disease (ESRD) patients undergoing hemodialysis replacement therapy. Method: Fifty-three subjects were randomly assigned to one of two treatment groups. The control group (n = 25) was provided with treatment strategies based on a cognitive behavioral approach, while the experimental group (n = 28) were given the same techniques plus resilience model strategies. Five psychological instruments were applied: Beck Depression Inventory, Beck Anxiety Inventory, Mexican Resilience Scale, cognitive distortions scale, and the Kidney Disease related Quality of Life questionnaire. Participants were assessed at baseline (before treatment), eight weeks later (end of treatment), and four weeks after the end of treatment (follow up). The results were analyzed by ANOVA for repeated measures with a Bonferroni-adjusted test method, with p < 0.05 considered significant. Results: The experimental group had significant differences in total and somatic depression as well as differences in the dimensions of cognitive distortions and a significant increase in the dimensions of resilience. The control group had significant differences in all variables but showed lower scores in the evaluated times. Conclusions: The resilience model strengthens and enhances the effectiveness of the cognitive behavioral approach to reduce symptoms of depression and anxiety in patients with ESRD.
Negative emotional states, specifically depression and anxiety, are common disorders present in patients with end-stage renal disease (ESRD) [1–3]. Replacement therapies such as hemodialysis are invasive and affect the quality of life of a patient with ERSD [4,5]. Increased mortality and an increase in the rate of hospitalizations are associated with depression and anxiety symptoms in this population [6,7]. Shulman and Spinelli found that the survival of hemodialysis patients with a score <14 on the Beck Inventory was 85%, while those with scores greater than 25 in the same instrument had a survival rate of 25% . A study by Kellerman estimated that, for every point increase in the inventory of Beck, the mortality risk increased by 2.7% .
Some psychological models have implemented several strategies to reduce depression and anxiety [9–11]. However, cognitive behavioral therapy has shown stronger evidence of results in the treatment of these symptoms [12–14]. In the resilience model, the psychological resilience of the individual emerges as a resource in adverse situations . Resilience is a construct that has been defined in a broad range of models and, because there is no shared definition, the concept of resilience is complex. However, resilience is much more than resistance to trauma—it expresses the ability to react positively despite difficulties, turning them into opportunities for growth . Resilience consists of personalized skills to cope with adverse situations and to even emerge stronger from them. In chronic disease, resilience can be associated with adherence to treatment and well-being [17–24]. Although there is evidence that psychological resilience acts as a protective factor against depression and anxiety, resilience has scarcely been evaluated in ESRD patients [18,19,23–28]. The dimensions of resilience (i.e., strength, self-confidence, social competence, social support, family support, and self-structure) can be mediators in the reduction of negative emotional states in ESRD patients . In chronic patients, resilience can be a modulator of depression and anxiety [23,29–32], and can serve as a therapeutic target for enhancing models whose results have shown evidence of effectiveness. Psychological resilience is considered an important factor for protecting mental health and is a moderating variable in depression and anxiety symptoms [32–36]. In ESRD patients, there are significant correlations between depression, anxiety, and resilience [20,32], which suggests that resilience may function as a protective factor against these symptoms. Resilience acts as a personality factor and promotes physical and mental health .
Compared to CBI alone, the resilience model (CBI + R) has a similar clinical effect on decreasing depression and anxiety symptoms while increasing the quality-of-life perception in ESRD patients undergoing hemodialysis replacement therapy. The CBI + R group did better than the CBI group on the cognitive restructuring outcomes (i.e., cognitive distortion scores). Furthermore, the resilience model is a novel and strategic way to integrate salutogenic variables into a psychological intervention that promotes positive aspects and mediating resources to cope with stressors in the face of disease.