Publications by authors named "Azucena Garcia-Palacios"

103 Publications

Resilience as a predictor of quality of life in participants with borderline personality disorder before and after treatment.

BMC Psychiatry 2021 Jun 12;21(1):305. Epub 2021 Jun 12.

Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Av. Blasco Ibañez 21, 46010, Valencia, Spain.

Background: Studies have suggested that psychotherapy improves the Quality of Life (QoL) of participants with Borderline Personality Disorder (BPD). However, there are no studies on the differential efficacy of treatments on the QoL of participants with BPD. Moreover, the relationship between QoL and resilience has rarely been studied in participants with BPD.

Objectives: a) to examine whether people with BPD have worse QoL than the non-clinical population; b) to examine whether there are statistically significant differences between Dialectical Behavioural Therapy (DBT), Systems Training for Emotional Predictability and Problem Solving (STEPPS), or Cognitive Behavioural Therapy-Treatment at Usual (CBT-TAU) in the improvement of QoL; c) to examine whether participants show clinically significant improvements in QoL after treatment; d) to analyse whether resilience is associated with QoL before and after the BPD treatment; e) to analyse whether resilience is a predictor of QoL at pre-treatment and posttreatment.

Method: The sample comprised 403 participants (n = 202 participants diagnosed with BPD and n = 201 non-clinical). Participants filled out the Quality of Life Index, Resilience Scale, and Beck Depression Inventory. The clinical participants received one of these possible treatments, DBT, STEPPS, or CBT-TAU. MANOVA and regression analyses were performed.

Results: a) participants diagnosed with BPD had statistically significant lower resilience than the non-clinical population; b) all three forms of psychotherapy statistically improved QoL, but there were no statistically significant differences between DBT, STEPPS, and CBT-TAU in the improvement of QoL; c) participants did not show clinically significant improvements in QoL after treatment; d) resilience was associated with QoL before and after treatment; and e) resilience was a predictor of QoL before and after treatment.

Conclusion: It is necessary to assess QoL and Resilience in studies on psychotherapy with BPD patients.
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http://dx.doi.org/10.1186/s12888-021-03312-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199796PMC
June 2021

Savoring the present: The reciprocal influence between positive emotions and positive emotion regulation in everyday life.

PLoS One 2021 11;16(5):e0251561. Epub 2021 May 11.

Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón, Spain.

A growing body of research has investigated the regulation of negative emotions in ecological settings, but little is known about the mechanisms underlying positive emotion regulation in everyday life. Although some evidence suggests that adopting positive strategies is beneficial for emotional well-being, the literature is inconsistent about the effects of positive emotions on subsequent regulatory processes. In the present study, we adopted a two-week ecological momentary assessment to explore the association between positive emotions and positive emotion regulation in daily life. According to our results, the less individuals felt positive emotions at one point, the more they tended to enhance their use of positive strategies from this time to the next, which in turn resulted in subsequent higher levels of positive emotions. This prototype of positive regulation can be seen as a highly adaptive mechanism that makes it possible to compensate for a lack of positive emotions by enhancing the deployment of positive strategies. The theoretical and clinical implications of these findings are discussed.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0251561PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8112694PMC
May 2021

Behavioural mimicry as an indicator of affiliation.

PLoS One 2021 3;16(5):e0250105. Epub 2021 May 3.

Aston University, Birmingham, United Kingdom.

Previous research has shown that behavioural mimicry fosters affiliation, and can be used to infer whether people belong to the same social unit. However, we still know very little about the generalizability of these findings and the individual factors involved. The present study intends to disentangle two important variables and assess their importance for affiliation: the matching in time of the behaviours versus their matching in form. In order to address this issue, we presented participants with short videos in which two actors displayed a set of small movements (e.g. crossing their legs, folding their arms, tapping their fingers) arranged to be either contingent in time or in form. A dark filter was used to eliminate ostensive group marks, such us phenotype or clothing. Participants attributed the highest degree of affiliation to the actors when their subsequent movements matched in form, but were delayed by 4-5 seconds, and the lowest degree when the timing of their movements matched, but they differed in form. To assess the generalizability of our findings, we took our study outside the usual Western context and tested a matching sample of participants from a traditional small-scale society in Kenya. In all, our results suggest that movements are used to judge the degree of affiliation between two individuals in both large- and small-scale societies. While moving in different ways at the same time seems to increase the perceived distance between two individuals, movements which match in form seem to invoke closeness.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250105PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092663PMC
May 2021

Confirmatory factor analysis and psychometric properties of the Emotion Regulation Questionnaire in participants with personality disorders.

Clin Psychol Psychother 2021 Apr 28. Epub 2021 Apr 28.

Facultad de Psicología, Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad de Valencia, Valencia, Spain.

Emotional dysregulation is a key symptom in participants with personality disorders. The Emotional Regulation Questionnaire (ERQ) has been studied with nonclinical samples; however, it is necessary to confirm the factorial structure of the ERQ in participants with personality disorders. The aims of the present study were to confirm the factorial structure of the Spanish version of the ERQ and analyse its psychometric properties as well as the association between the ERQ and the Borderline Symptoms List (BSL-23) and the Difficulties in Emotion Regulation Scale (DERS). The overall sample was composed of 250 patients with personality disorders, of whom 195 met the criteria for borderline personality disorder. Confirmatory factor analysis was conducted. The two-factor model showed an acceptable fit, similar to the original structure, in the participants with personality disorders and with borderline personality disorder. Cognitive reappraisal was negatively correlated with the DERS and BSL-23, and expressive suppression was positively correlated with the BSL-23. The ERQ is a reliable and valid instrument to evaluate emotional dysregulation in participants with personality disorders and participants with borderline personality disorder.
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http://dx.doi.org/10.1002/cpp.2605DOI Listing
April 2021

Effectiveness of a Web-Based Intervention on Parental Psychological Flexibility and Emotion Regulation: A Pilot Open Trial.

Int J Environ Res Public Health 2021 03 13;18(6). Epub 2021 Mar 13.

Department of Psychology, University of Almeria, 04120 Almeria, Spain.

"Parenting Forest" is an informed contextual therapy parenting program for improving parental emotion regulation strategies and psychological flexibility. The aim of this study was to evaluate the preliminary effectiveness of a self-guided web-based intervention of the Parenting Forest program. The intervention program consists of six self-applied sequential modules that use strategies from contextual therapies for providing a parenting style open to experience, mindful and committed to its actions. A pilot controlled open trial was conducted. Eligible parents ( = 12) enrolled in the web-based intervention completed baseline (T1) and post-intervention (T2) assessment instruments. Parental psychological flexibility, avoidance, emotional regulation, parental stress, satisfaction with life, children's psychological adjustment and client satisfaction were measured to assess the effects of the intervention. Mood, coping, and value-related actions were assessed as measures of progress. The results showed positive effects on the parents' psychological flexibility and emotion regulation. Parents' mood and coping skills improved throughout the intervention program. These results provide preliminary evidence of the web-based Parenting Forest's efficacy, although further research is needed to assess its effectiveness for prevention and in clinical populations.
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http://dx.doi.org/10.3390/ijerph18062958DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7998718PMC
March 2021

Hypnotic Enhancement of Virtual Reality Distraction Analgesia during Thermal Pain: .

Int J Clin Exp Hypn 2021 Apr-Jun;69(2):225-245. Epub 2021 Mar 16.

Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA.

Excessive pain during medical procedures is a pervasive health challenge. This study tested the (additive) analgesic efficacy of combining hypnotic analgesia and virtual reality (VR) pain distraction. A single blind, randomized, and controlled trial was used to study 205 undergraduate volunteers aged 18 to 20. The individual and combined effects of hypnotic analgesia (H) and VR distraction on experimentally induced acute thermal pain were examined using a 2 X 2, between-groups parallel design (4 groups total). Participants in groups that received hypnosis remained hypnotized during the test phase pain stimulus. The main outcome measure was "worst pain" ratings. Hypnosis reduced acute pain even for people who scored low on hypnotizability. As predicted, H+ VR was significantly more effective than VR distraction alone. However, H+ VR was not significantly more effective than hypnotic analgesia alone. Being hypnotized during thermal pain enhanced VR distraction analgesia.
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http://dx.doi.org/10.1080/00207144.2021.1882259DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8141382PMC
March 2021

Predictors of Adherence in Three Low-Intensity Intervention Programs Applied by ICTs for Depression in Primary Care.

Int J Environ Res Public Health 2021 02 11;18(4). Epub 2021 Feb 11.

Research Institute of Health Sciences (IUNICS), University of Balearic Islands, 07122 Palma de Mallorca, Spain.

Depression is one of the most common disorders in psychiatric and primary care settings, and is associated with disability, loss in quality of life, and economic costs. Internet-based psychological interventions have been shown to be effective in depression treatment but present problems with a low degree of adherence. The main aim of this study is to analyze the adherence predictors in three low-intensity interventions programs applied by Information and Communication Technologies (ICTs) for depression. A multi-center, randomized, controlled clinical trial was conducted with 164 participants with depression, who were allocated to: Healthy Lifestyle Program, Positive Affect Promotion Program or Mindfulness Program. Sociodemographic characteristics, Patient Health Questionnaire-9, Visual Analog Scale, Short Form Health Survey, Positive and Negative Affect Schedule, Five Facets Mindfulness Questionnaire, Pemberton Happiness Index and Treatment Expectancy Questionnaire were used to study adherence. Results showed that positive affect resulted in a predictor variable for Healthy Lifestyle Program and Positive Affect Promotion Program. Perceived health was also a negative adherence predictor for the Positive Affect Promotion Program. Our findings demonstrate that there are differences in clinical variables between treatment completers and non-completers and we provide adherence predictors in two intervention groups. Although new additional predictors have been examined, further research is essential in order to improve tailored interventions and increase adherence treatment.
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http://dx.doi.org/10.3390/ijerph18041774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7918657PMC
February 2021

Negative and Positive Affect Regulation in a Transdiagnostic Internet-Based Protocol for Emotional Disorders: Randomized Controlled Trial.

J Med Internet Res 2021 02 1;23(2):e21335. Epub 2021 Feb 1.

Universitat Jaume I, Castellón de la Plana, Spain.

Background: Emotional disorders (EDs) are among the most prevalent mental disorders. Existing evidence-based psychological treatments are not sufficient to reduce the disease burden of mental disorders. It is therefore essential to implement innovative solutions to achieve a successful dissemination of psychological treatment protocols, and in this regard, the use of information and communication technologies such as the internet can be very useful. Furthermore, the literature suggests that not everyone with an ED receives the appropriate treatment. This situation has led to the development of new intervention proposals based on the transdiagnostic perspective, which attempts to address the underlying processes common to EDs. Most of these transdiagnostic interventions focus primarily on downregulating negative affectivity (NA), and less attention has been paid to strengths and the upregulation of positive affectivity, despite its importance for well-being and mental health.

Objective: This study aims to evaluate the efficacy of a transdiagnostic internet-based treatment for EDs in a community sample.

Methods: A 3-armed randomized controlled trial was conducted. A total of 216 participants were randomly assigned to a transdiagnostic internet-based protocol (TIBP), a TIBP+ positive affect (PA) component, or a waiting list (WL) control group. The treatment protocol contained core components mainly addressed to downregulate NA (ie, present-focused emotional awareness and acceptance, cognitive flexibility, behavioral and emotional avoidance patterns, and interoceptive and situational exposure) as well as a PA regulation component to promote psychological strengths and enhance well-being. Data on depression, anxiety, quality of life, neuroticism and extraversion, and PA/NA before and after treatment were analyzed. Expectations and opinions of treatment were also analyzed.

Results: Within-group comparisons indicated significant pre-post reductions in the two experimental conditions. In the TIBP+PA condition, the effect sizes were large for all primary outcomes (d=1.42, Beck Depression Inventory [BDI-II]; d=0.91, Beck Anxiety Inventory [BAI]; d=1.27, Positive and Negative Affect Schedule-Positive [PANAS-P]; d=1.26, Positive and Negative Affect Schedule-Negative [PANAS-N]), whereas the TIBP condition yielded large effect sizes for BDI-II (d=1.19) and PANAS-N (d=1.28) and medium effect sizes for BAI (d=0.63) and PANAS-P (d=0.69). Between-group comparisons revealed that participants who received one of the two active treatments scored better at posttreatment than WL participants. Although there were no statistically significant differences between the two intervention groups on the PA measure, effect sizes were consistently larger in the TIBP+PA condition than in the standard transdiagnostic protocol.

Conclusions: Overall, the findings indicate that EDs can be effectively treated with a transdiagnostic intervention via the internet, as significant improvements in depression, anxiety, and quality of life measures were observed. Regarding PA measures, promising effects were found, but more research is needed to study the role of PA as a therapeutic component.

Trial Registration: ClinicalTrials.gov NCT02578758; https://clinicaltrials.gov/ct2/show/NCT02578758.

International Registered Report Identifier (irrid): RR2-10.1186/s12888-017-1297-z.
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http://dx.doi.org/10.2196/21335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884218PMC
February 2021

Blended transdiagnostic group CBT for emotional disorders: A feasibility trial protocol.

Internet Interv 2021 Mar 7;23:100363. Epub 2021 Jan 7.

Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellon, Spain.

Introduction: Emotional disorders (anxiety and depressive disorders) are a relevant public health concern associated with high prevalence, high costs, and important disability. Therefore, research priorities include designing and testing cost-effective interventions to reach everyone in need. Internet-delivered interventions for emotional disorders are effective and can help to disseminate and implement evidence-based treatments. However, although these treatments are generally effective, not all patients benefit from this treatment format equally. Blended treatments are a new form of intervention that combines the strengths of face-to-face and Internet approaches. Nevertheless, research on blended interventions has focused primarily on individual therapy, and less attention has been paid to the potential of using this format in group psychotherapy. This study aims to analyze the feasibility of blended transdiagnostic group CBT for emotional disorders. The current article describes the study protocol for this trial.

Method And Analysis: A one-armed pilot trial will be conducted. Participants will be 30 adults suffering from DSM-5 anxiety and/or depressive disorders. The treatment consists of a blended transdiagnostic group intervention delivered during a period of 24 weeks. Groups of 6 to 10 patients will attend a total of eight 2-hour, face-to-face sessions, alternated with the use of an online platform where they will find the contents of the treatment protocol. The intervention has four core components: present-focused awareness, cognitive flexibility, identification and modification of behavioral and cognitive patterns of emotional avoidance, and interoceptive and situational exposure. These components are delivered in 16 modules. Assessments will be performed at baseline, during the treatment, at post-treatment, and at 3-month follow-up. Clinical and treatment acceptability outcomes will be included. Quantitative and qualitative data (participants' views about blended group psychotherapy) will be analyzed.

Ethics And Dissemination: The trial has received ethical approval from the Ethics Committee of Universitat Jaume I (September 2019) and will be conducted in accordance with the study protocol, the Declaration of Helsinki, and good clinical practice. The results of this study will be disseminated by presentation at conferences and will be submitted for publication in a peer-reviewed journal.

Trial Registration: ClinicalTrials.gov Identifier: NCT04008576. Registered 05 July 2019, https://clinicaltrials.gov/ct2/show/NCT04008576.
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http://dx.doi.org/10.1016/j.invent.2021.100363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820549PMC
March 2021

Cultural adaptation of the ing program for the treatment of depression in the Ecuadorian public health care system: A study protocol for a randomized controlled trial.

Internet Interv 2021 Mar 28;23:100352. Epub 2020 Nov 28.

Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Valencia, Spain.

Background: Depression is one of the world's major health problems. Due to its high prevalence, it constitutes the first cause of disability among the Americas, where only a very low percentage of the population receives the adequate evidence-based psychological treatment. Internet-Based Interventions (IBIs) are a great alternative to reduce the treatment gap for mental disorders. Although there are several studies in low-and middle-income countries proving IBIs' feasibility and acceptability, there is still little evidence of the effectiveness in diverse social and cultural contexts such as Latin America.

Methods: Two studies will be described: Study 1 is focused on the cultural adaptation of a cognitive-behavioral IBI (Botella et al. 2012, 2015) for Ecuadorian population with depression based on the procedure by Salamanca-Sanabria et al. (2018). Study 2 describes the design of a randomized controlled trial to test the preliminary efficacy of the culturally adapted intervention in a Public Health Care setting. A total of 153 patients with mild to moderate degree of depression as assessed with the Mini-International Neuropsychiatric Interview (M.I.N.I.) and the Patient Health Questionnaire-9 (PHQ-9) will be randomly assigned to either an IBI group using only automated support by the system; an IBI group including also minimal human support; or a waiting list group. The primary outcome (depression) and secondary outcomes (e.g., anxiety, affect, quality of life) will be collected at baseline, 3, 6 and 12 months. Mixed-model analyses with no ad hoc imputations will be conducted.

Discussion: This paper is pioneering in exploring the role of an Internet-based culturally adapted intervention for depression in a public care context in Ecuador. Results obtained will offer new insights into the viability and effectiveness of digital technologies for the psychological treatment of mental illnesses in developing countries.
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http://dx.doi.org/10.1016/j.invent.2020.100352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733006PMC
March 2021

A Low-Intensity Internet-Based Intervention Focused on the Promotion of Positive Affect for the Treatment of Depression in Spanish Primary Care: Secondary Analysis of a Randomized Controlled Trial.

Int J Environ Res Public Health 2020 11 3;17(21). Epub 2020 Nov 3.

Polibienestar Research Institute, University of Valencia, 46022 Valencia, Spain.

: A large number of low-intensity Internet-based interventions (IBIs) for the treatment of depression have emerged in Primary Care; most of them focused on decreasing negative emotions. However, recent studies have highlighted the importance of addressing positive affect (PA) as well. This study is a secondary analysis of a randomized control trial. We examine the role of an IBI focused on promoting PA in patients with depression in Primary Care (PC). The specific objectives were to explore the profile of the patients who benefit the most and to analyze the change mechanisms that predict a significantly greater improvement in positive functioning measures. : 56 patients were included. Measures of depression, affect, well-being, health-related quality of life, and health status were administered. : Participants who benefited the most were those who had lower incomes and education levels and worse mental health scores and well-being at baseline (7.9%-39.5% of explained variance). Improvements in depression severity and PA were significant predictors of long-term change in well-being, (3,55) = 17.78, < 0.001, R = 47.8%. : This study highlights the importance of implementing IBIs in PC and the relevance of PA as a key target in Major Depressive Disorder treatment.
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http://dx.doi.org/10.3390/ijerph17218094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662551PMC
November 2020

Brief Acceptance and Commitment Therapy for Fibromyalgia: Feasibility and Effectiveness of a Replicated Single-Case Design.

Pain Res Manag 2020 17;2020:7897268. Epub 2020 Oct 17.

Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Castellón de la Plana, Spain.

Objective: Overall, the literature on the effectiveness of psychological treatments in general and those for fibromyalgia in particular has been dominated by research designs that focus on large groups and explore changes on average, so the treatment impact at the individual level remains unclear. In this quasi-experimental, replicated single-case design, we will test the feasibility and effectiveness of a brief acceptance and committed therapy intervention using ecological momentary assessment supported by technology.

Methods: The sample comprised 7 patients (3 in the individual condition and 4 in the group condition) who received a brief, 5-week psychological treatment. Patient evolution was assessed one week prior to treatment onset and during the whole study with a smartphone app. Because ecological momentary assessment and the use of an app are not frequent practices in routine care, we also evaluated the feasibility of this assessment methodology (i.e., compliance with the app). Change was investigated with a nonoverlap of all pairs index. Outcomes were pain interference with sleep and social activities, fatigue, sadness, and pain intensity.

Results: Patient change was not uniform across outcomes. Four patients (two in each condition) showed relatively moderate levels of change (approximately 60% nonoverlap in several outcomes). The remaining patients showed more modest improvements which affected a reduced number of outcomes. Based on nonoverlapping indices, there was no clear evidence in favor of any treatment format.

Conclusions: An alternative design to large-scale trials, one that focuses on the individual change, exists and it can be implemented in pain research. The use of technology (e.g., smartphones) simplifies such designs by facilitating ecological momentary assessment. Based on our findings showing that changes were not homogeneous across patients or outcomes, more single-case designs and patient-centered analyses (e.g., responder and moderation analyses) are required.
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http://dx.doi.org/10.1155/2020/7897268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7586182PMC
March 2021

Telemonitoring in Chronic Pain Management Using Smartphone Apps: A Randomized Controlled Trial Comparing Usual Assessment against App-Based Monitoring with and without Clinical Alarms.

Int J Environ Res Public Health 2020 09 9;17(18). Epub 2020 Sep 9.

Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, 12071 Castellón, Spain.

Background: The usefulness of mHealth in helping to target face-to-face interventions for chronic pain more effectively remains unclear. In the present study, we aim to test whether the Pain Monitor mobile phone application (app) is well accepted by clinicians, and can help improve existent medical treatments for patients with chronic musculoskeletal pain. Regarding this last goal, we compared three treatment conditions, namely usual treatment, usual treatment with an app without alarms and usual treatment with an app with alarms. All treatments lasted one month. The three treatments were compared for all outcomes, i.e., pain severity and interference, fatigue, depressed mood, anxiety and anger.

Methods: In this randomized controlled trial, the usual monitoring method (i.e., onsite; = 44) was compared with daily ecological momentary assessment using the Pain Monitor app-both with ( = 43) and without alarms ( = 45). Alarms were sent to the clinicians in the presence of pre-established undesired clinical events and could be used to make treatment adjustments throughout the one-month study.

Results: With the exception of anger, clinically significant changes (CSC; 30% improvement) were greater in the app + alarm condition across outcomes (e.g., 43.6% of patients experienced a CSC in depressed mood in the app + alarm condition, which occurred in less than 29% of patients in the other groups). The clinicians were willing to use the app, especially the version with alarms.

Conclusions: The use of apps may have some benefits in individual health care, especially when using alarms to tailor treatments.
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http://dx.doi.org/10.3390/ijerph17186568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7559749PMC
September 2020

Working Alliance Inventory for Online Interventions-Short Form (WAI-TECH-SF): The Role of the Therapeutic Alliance between Patient and Online Program in Therapeutic Outcomes.

Int J Environ Res Public Health 2020 08 25;17(17). Epub 2020 Aug 25.

Polibienestar Research Institute, University of Valencia, 46022 Valencia, Spain.

Background: Therapeutic alliance (TA) between the patient and therapist has been related to positive therapeutic outcomes. Because Internet-based interventions are increasingly being implemented, a tool is needed to measure the TA with Internet-based self-guided programs. The Working Alliance Inventory for online interventions (WAI-TECH-SF) was adapted based on the WAI Short Form (Hatcher & Gillaspy, 2006). The objectives of this study were: (1) to analyse the psychometric properties of the WAI-TECH-SF; (2) to explore the differences in the WAI-TECH-SF scores according to different categories of the sample; and (3) to analyse whether the WAI-TECH-SF can predict therapeutic outcomes and satisfaction with the treatment.

Methods: 193 patients diagnosed with depression were included and received blended Cognitive-Behavioural Therapy. Measures of preferences, satisfaction, and credibility about the treatment, TA with the online program, depressive symptoms, and satisfaction with the treatment were administered.

Results: An exploratory factor analysis revealed a one-dimensional structure with adequate internal consistency. Linear regression analyses showed that the WAI-TECH-SF predicted changes in depressive symptoms and satisfaction with the treatment.

Conclusions: WAI-TECH-SF is a reliable questionnaire to assess the TA between the patient and the online program, which is associated with positive therapeutic outcomes and satisfaction with the treatment.
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http://dx.doi.org/10.3390/ijerph17176169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7503297PMC
August 2020

Efficacy, cost-utility and physiological effects of Acceptance and Commitment Therapy (ACT) and Behavioural Activation Treatment for Depression (BATD) in patients with chronic low back pain and depression: study protocol of a randomised, controlled trial including mobile-technology-based ecological momentary assessment (IMPACT study).

BMJ Open 2020 07 23;10(7):e038107. Epub 2020 Jul 23.

Parc Sanitari Sant Joan de Deu, Sant Boi de Llobregat, Catalunya, Spain

Introduction: The IMPACT study focuses on chronic low back pain (CLBP) and depression symptoms, a prevalent and complex problem that represents a challenge for health professionals. Acceptance and Commitment Therapy (ACT) and Brief Behavioural Activation Treatment for Depression (BATD) are effective treatments for patients with persistent pain and depression, respectively. The objectives of this 12 month, multicentre, randomised, controlled trial (RCT) are (i) to examine the efficacy and cost-utility of adding a group-based form of ACT or BATD to treatment-as-usual (TAU) for patients with CLBP and moderate to severe levels of depressive symptoms; (ii) identify pre-post differences in levels of some physiological variables and (iii) analyse the role of polymorphisms in the gene, psychological process measures and physiological variables as mediators or moderators of long-term clinical changes.

Methods And Analysis: Participants will be 225 patients with CLBP and moderate to severe depression symptoms recruited at Parc Sanitari Sant Joan de Déu (St. Boi de Llobregat, Spain) and Hospital del Mar (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs TAU+ACT versus TAU+BATD. A comprehensive assessment to collect clinical variables and costs will be conducted pretreatment, post-treatment and at 12 months follow-up, being pain interference the primary outcome measure. The following physiological variables will be considered at pretreatment and post-treatment assessments in 50% of the sample: immune-inflammatory markers, hair cortisol and cortisone, serum cortisol, corticosteroid-binding globulin and vitamin D. Polymorphisms in the gene (rs3800373, rs9296158, rs1360780, rs9470080 and rs4713916) will be analysed at baseline assessment. Moreover, we will include mobile-technology-based ecological momentary assessment, through the Pain Monitor app, to track ongoing clinical status during ACT and BATD treatments. Linear mixed-effects models using restricted maximum likelihood, and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed.

Ethics And Dissemination: This study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu and Hospital del Mar. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities.

Trial Registration Number: NCT04140838.
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http://dx.doi.org/10.1136/bmjopen-2020-038107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380881PMC
July 2020

Designing ICTs for Users with Mild Cognitive Impairment: A Usability Study.

Int J Environ Res Public Health 2020 07 17;17(14). Epub 2020 Jul 17.

Department of Basic Psychology, Clinical Psychology and Psychobiology, Universitat Jaume I, 12071 Castellón, Spain.

Background: Research has supported the cost-effectiveness of cognitive training tools enhanced by information and communication technologies (ICT) in several populations, including individuals with mild cognitive impairment (MCI) and age-related cognitive decline. The implementation of ICTs in this population, however, is sometimes challenging to their cognitive and age characteristics. Ultimately, this might compromise the effectiveness of ICT-enhanced therapies in this population. The aim of this study is to test the usability and acceptability of a Euopean project prototype for elderly care, in an attempt to explore the ICT design needs of users with MCI.

Methods: Participants were 28 individuals aged 58-95 years and with a diagnosis of MCI.

Results: The results showed a low perception of peripheral elements and the need to place main interaction elements in the centre of the screen. The correlation between the general level of autonomy (daily life activities) and the ICT autonomy level was significant and positive. The speed of audio help had a significant impact on performance.

Conclusion: The present work contributes to the literature on ICT usability needs of users with MCI. Some usability recommendations for designing interfaces for this type of user are provided in the text.
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http://dx.doi.org/10.3390/ijerph17145153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399939PMC
July 2020

Effectiveness of a Transdiagnostic Guided Internet-Delivered Protocol for Emotional Disorders Versus Treatment as Usual in Specialized Care: Randomized Controlled Trial.

J Med Internet Res 2020 07 7;22(7):e18220. Epub 2020 Jul 7.

Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.

Background: Anxiety disorders and depression (emotional disorders) are highly prevalent mental disorders. Extensive empirical evidence supports the efficacy of cognitive behavioral therapy (CBT) for the treatment of these disorders. However, there are still some barriers related to their dissemination and implementation, which make it difficult for patients to receive these treatments, especially in public health care settings where resources are limited. Recent advances in improving CBT dissemination encompass different perspectives. One is the transdiagnostic approach, which offers treatment protocols that can be used for a range of emotional disorders. Another approach is the use of the internet to reach a larger number of people who could benefit from CBT.

Objective: This study aimed to analyze the effectiveness and acceptability of a transdiagnostic internet-delivered protocol (EmotionRegulation) with human and automated guidance in patients from public specialized mental health care settings.

Methods: A 2-armed randomized controlled trial (RCT) was conducted to compare the effectiveness of EmotionRegulation with treatment as usual (TAU) in specialized mental health care. In all, 214 participants were randomly assigned to receive either EmotionRegulation (n=106) or TAU (n=108). Measurement assessments were conducted at pre- and postintervention and at a 3-month follow-up.

Results: The results revealed the superiority of EmotionRegulation over TAU on measures of depression (d=0.41), anxiety (d=0.35), and health-related quality of life (d=-0.45) at posttreatment, and these gains were maintained at the 3-month follow-up. Furthermore, the results for expectations and opinions showed that EmotionRegulation was well accepted by participants.

Conclusions: EmotionRegulation was more effective than TAU for the treatment of emotional disorders in the Spanish public mental health system. The implications of this RCT, limitations, and suggestions for future research are discussed.

Trial Registration: ClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668.
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http://dx.doi.org/10.2196/18220DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7381075PMC
July 2020

Biased Affective Forecasting: A Potential Mechanism That Enhances Resilience and Well-Being.

Front Psychol 2020 12;11:1333. Epub 2020 Jun 12.

Department of Basic Psychology, Clinic and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain.

According to a growing body of studies, people's ability to forecast future emotional experiences is generally biased. Nonetheless, the existing literature has mainly explored affective forecasting in relation to specific events, whereas little is still known about the ability to make general estimations of future emotional states. Based on existing evidence suggesting future-oriented disposition as a key factor for mental health, the aims of the current study were (1) to investigate the relationship between negative (NA) and positive (PA) affective forecasting biases and perceived psychological well-being, and (2) to explore whether positively biased predictions are associated with resilience and foster one's skills to cope with stressful events. To do so, we asked 85 undergraduate students to forecast PA and NA over 2 weeks, as well as to report their daily affect through a web-based Ecological Momentary Assessment. According to the results, positively biased PA forecasting (i.e., overestimating positive emotional states) was associated with greater perceived psychological well-being and higher resilience. When high levels of stress were experienced, participants holding an optimistic, yet biased, estimation of future PA were more likely to successfully manage stressors, thus maintaining lower levels of NA and higher levels of positive emotions. We suggest that positively biased PA forecasting is an adaptive cognitive distortion that boosts people's resilience and mental health, thus opening new avenues for the promotion of psychological well-being.
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http://dx.doi.org/10.3389/fpsyg.2020.01333DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304283PMC
June 2020

Spanish validation of the Parental Acceptance Questionnaire (6-PAQ).

Int J Clin Health Psychol 2020 May-Aug;20(2):163-172. Epub 2020 Apr 16.

Department of Psychology of University of Almeria, Spain.

Background/objective: Psychological flexibility is an ability with positive effects in health, also in the field parenting. The aim of this study is to validate the Parental Acceptance Questionnaire (6-PAQ) in Spanish sample.

Method: A total of 426 parents (96.3% female), with an average age of 38.25 years (S = 5.76) and with at least one child between 3 and 16 years old participated. Participants completed the 6PAQ and other instruments assessing experiential avoidance, thought suppression, satisfaction with life and symptoms of anxiety and depression.

Results: In comparison with the original model, the three-factor structural solution with 16 items obtained a better adjustment (CFI = .996; GFI = .998; TLI = .995; RMSE = .016) that refer to response styles related to psychological flexibility (open, aware and active). The 6-PAQ adaptation has shown good internal consistency, with a Cronbach alpha of .81 and a McDonald's omega of .86 for the scale, and evidence of convergent validity with significant correlations with measure of avoidance, thought suppression, satisfaction with life and anxiety.

Conclusions: The Spanish version of the 6-PAQ with the three-factor structure presents psychometric property to be considered a reliable measure and a valid instrument for the evaluation of parental psychological flexibility.
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http://dx.doi.org/10.1016/j.ijchp.2020.03.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296241PMC
April 2020

Efficacy of "Family Connections", a program for relatives of people with borderline personality disorder, in the Spanish population: study protocol for a randomized controlled trial.

BMC Psychiatry 2020 06 15;20(1):302. Epub 2020 Jun 15.

Universitat Jaume I, Castellón, Spain.

Background: Patients with borderline personality disorder (BPD) experience significant affect regulation difficulties that cause serious consequences in their work, emotional, and social environments. This dysfunctional pattern also produces great suffering and a heavy burden on their relatives. Fortunately, some studies show that treatment of relatives of people with BPD begins to be important in the patients' recovery and in improving family dynamics. One of the treatments that has obtained the most empirical support is Family connections (FC). This 12-session program is an adaptation of different Dialectical Behavior Therapy strategies. To test the efficacy of FC, five uncontrolled clinical trials were conducted, with pre-post treatment and follow-up assessments. The results of these studies and subsequent replications showed an improvement in family attitudes and caregiver burnout. Our research team adapted FC for delivery in the Spanish population. We intend to test the efficacy of this program versus a treatment as usual condition. Moreover, we aim to test the efficacy of this program and study its effectiveness (in terms of participants' acceptance). This paper presents the study protocol.

Methods: The study is a randomized controlled trial. The participants will be recruited in a Personality Disorders Unit and randomly assigned to one of two treatment conditions: Family Connections group (FC) or Treatment As Usual (TAU). Primary outcome measures will be the BAS and FAD-GFS. Secondary outcomes will include DASS-21, FES, GS, and QLI. Participants' treatment acceptance and degree of satisfaction will also be measured. Participants will be assessed at pre-, post-treatment, and 6-month follow-up. Intention to treat and per protocol analyses will be performed.

Discussion: This is the first study on FC for relatives of people with borderline personality disorder (BPD) compared to an active condition (TAU), and this is the first time relatives' and patients' data will be analyzed. In addition, it is the first study to test the efficacy of the program in Spain. This intervention could contribute to improving the efficiency and effectiveness of current treatment programs for relatives of people with BPD, help to decrease burden, and improve the family connection.

Trial Registration: ClinicalTrials.gov ID: NCT04160871. Registered November 15th 2019.
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http://dx.doi.org/10.1186/s12888-020-02708-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296953PMC
June 2020

The impact of chronic pain on patients and spouses: Consequences on occupational status, distribution of household chores and care-giving burden.

Eur J Pain 2020 10 20;24(9):1730-1740. Epub 2020 Jul 20.

Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castelló de la Plana, Spain.

Background: Informal care-giving by spouses has become frequent in chronic pain settings. However, the impact of pain on occupational, functional and health outcomes in spouses has not been systematically investigated.

Aims: The goal of the present study was to examine the impact of pain on both patient and spousal outcomes.

Methods: In the present study, the impact of chronic pain on 114 heterosexual dyads was explored (patients: 59% females, average age = 57.81 years, SD = 11.85; spouses: 41% females, average age = 57.32 years, SD = 12.15).

Results: Overall, both patients and spouses reported important consequences of pain on outcomes, including occupational status distribution of household chores and marital satisfaction). Almost 52% of spouses indicated a high-to-severe burden. A multivariate model with spouse and patient factors accounted for 37.8% of the variance of this burden. In the model, patient disability (β = 0.36, p = .002), spouses' change in occupational status (β = 0.26, p = .002) and spousal perception of marital adjustment (β = -0.36, p < .001) were uniquely associated with burden.

Conclusions: The results indicate that the impact of chronic pain should be evaluated both for patients and spouses and point to patient and spouse factors that might contribute to spousal burden, which might help guide family interventions in a more effective manner.

Significance: Research has shown that chronic pain poses a significant burden on individuals, which increases their reliance on others for assistance. However, the burden of informal care-giving assumed by spouses of patients with chronic pain has not been systematically investigated. This study offers new insights into the impact of chronic pain on patients and their spouses, which might provide empirical foundation for the development of new avenues for intervention aimed at promoting adjustment in patients with chronic pain and spouses who act as informal caregivers.
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http://dx.doi.org/10.1002/ejp.1616DOI Listing
October 2020

Efficacy of Three Low-Intensity, Internet-Based Psychological Interventions for the Treatment of Depression in Primary Care: Randomized Controlled Trial.

J Med Internet Res 2020 06 5;22(6):e15845. Epub 2020 Jun 5.

Biomedical Research Center Network (CIBER) Physiopathology Obesity and Nutrition (CIBERobn), Carlos III Health Institute, Madrid, Spain.

Background: Primary care is a major access point for the initial treatment of depression, but the management of these patients is far from optimal. The lack of time in primary care is one of the major difficulties for the delivery of evidence-based psychotherapy. During the last decade, research has focused on the development of brief psychotherapy and cost-effective internet-based interventions mostly based on cognitive behavioral therapy (CBT). Very little research has focused on alternative methods of treatment for depression using CBT. Thus, there is a need for research into other therapeutic approaches.

Objective: This study aimed to assess the effectiveness of 3 low-intensity, internet-based psychological interventions (healthy lifestyle psychoeducational program [HLP], focused program on positive affect promotion [PAPP], and brief intervention based on mindfulness [MP]) compared with a control condition (improved treatment as usual [iTAU]).

Methods: A multicenter, 4-arm, parallel randomized controlled trial was conducted between March 2015 and March 2016, with a follow-up of 12 months. In total, 221 adults with mild or moderate major depression were recruited in primary care settings from 3 Spanish regions. Patients were randomly distributed to iTAU (n=57), HLP (n=54), PAPP (n=56), and MP (n=54). All patients received iTAU from their general practitioners. The main outcome was the Spanish version of the Patient Health Questionnaire-9 (PHQ-9) from pretreatment (time 1) to posttreatment (time 2) and up to 6 (time 3) and 12 (time 4) months' follow-up. Secondary outcomes included the visual analog scale of the EuroQol, the Short-Form Health Survey (SF-12), the Positive and Negative Affect Schedule (PANAS), and the Pemberton Happiness Index (PHI). We conducted regression models to estimate outcome differences along study stages.

Results: A moderate decrease was detected in PHQ-9 scores from HLP (β=-3.05; P=.01) and MP (β=-3.00; P=.01) compared with iTAU at posttreatment. There were significant differences between all intervention groups and iTAU in physical SF-12 scores at 6 months after treatment. Regarding well-being, MP and PAPP reported better PHI results than iTAU at 6 months post treatment. PAPP intervention significantly decreased PANAS negative affect scores compared with iTAU 12 months after treatment.

Conclusions: The low-intensity, internet-based psychological interventions (HLP and MP) for the treatment of depression in primary care are more effective than iTAU at posttreatment. Moreover, all low-intensity psychological interventions are also effective in improving medium- and long-term quality of life. PAPP is effective for improving health-related quality of life, negative affect, and well-being in patients with depression. Nevertheless, it is important to examine possible reasons that could be implicated for PAPP not being effective in reducing depressive symptomatology; in addition, more research is still needed to assess the cost-effectiveness analysis of these interventions.

Trial Registration: ISRCTN Registry ISRCTN82388279; http://www.isrctn.com/ISRCTN82388279.

International Registered Report Identifier (irrid): RR2-10.1186/s12888-015-0475-0.
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http://dx.doi.org/10.2196/15845DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7305559PMC
June 2020

Interventions for Family Members and Carers of Patients with Borderline Personality Disorder: A Systematic Review.

Fam Process 2021 Mar 17;60(1):134-144. Epub 2020 Apr 17.

CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain.

Carers of patients with borderline personality disorder (BPD) experience high levels of distress. Several studies have been carried out on interventions designed to decrease their burden. However, the evidence from these studies has not been summarized. The objective of this work is to explore the clinical utility of interventions developed for family members of patients with BPD. A systematic review was conducted following the PRISMA guidelines (registration number CRD42018107318), including psychological interventions focused on relatives of patients with BPD. The following databases were used: PsycINFO, PubMed, EBSCOhost, and Web of Science. Two independent researchers reviewed the studies to determine whether the eligibility criteria were met. A total of 2,303 abstracts were identified. After duplicates had been removed, 1,746 studies were screened. Finally, 433 full-text articles were reviewed, yielding 11 studies that satisfied the inclusion criteria. Results show that these interventions with different clinical formats and settings are effective. The quality of the included studies varies, and the empirical support for these programs is still preliminary. The results help to establish a general framework for interventions specifically developed for family members of patients with BPD, but additional efforts should be made to improve the methodological quality of this field of research and more solidly determine the utility of these interventions. Given the paucity of data so far, this information may open up new lines of research to improve the effectiveness of future programs for carers of patients with BPD and help to reduce their burden.
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http://dx.doi.org/10.1111/famp.12537DOI Listing
March 2021

Exploring the Effectiveness of Dialectical Behavior Therapy Versus Systems Training for Emotional Predictability and Problem Solving in a Sample of Patients With Borderline Personality Disorder.

J Pers Disord 2021 Mar 6;35(Supplement A):21-38. Epub 2020 Apr 6.

Universidad de Valencia, Valencia, Spain.

Dialectical behavior therapy (DBT) and systems training for emotional predictability and problem solving (STEPPS) are two treatment protocols for people with borderline personality disorder (BPD) that have received important empirical support. However, their possible differential effectiveness has not yet been studied. The objective of this study is to explore the effectiveness of these two treatment programs. A nonrandomized clinical trial was carried out in which both treatments were applied for six months. The sample consisted of 72 patients diagnosed with BPD. The results indicate that both groups experienced a statistically significant reduction in BPD symptom, emotional regulation, impulsiveness, dissociative experiences, suicidal risk, depression, or anger. However, the DBT condition obtained statistically significant differences in BPD behavioral symptoms and fear of suicide. DBT and STEPPS treatment are effective treatments for participants with BPD, and DBT was more effective for the behavioral symptoms of BPD.
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http://dx.doi.org/10.1521/pedi_2020_34_477DOI Listing
March 2021

Efficacy of a self-applied online program to promote resilience and coping skills in university students in four Spanish-speaking countries: study protocol for a randomized controlled trial.

BMC Psychiatry 2020 04 5;20(1):148. Epub 2020 Apr 5.

Universitat Jaume I, Castellón, Spain.

Background: There is evidence of a high prevalence of depression and anxiety in university students. Therefore, college time is a key period where prevention of mental disorders through interventions that promote resilience and mental health can be relevant. Currently, there are interventions available, but these are insufficient for those who need them. Online interventions are tools that can facilitate global accessibility and are easy for young people to use. CORE (Cultivating Our Resilience) is a self-administered online program, based on Ryff's psychological well-being model, to promote resilience and coping skills in university students at risk of developing symptoms of depression or anxiety. The objective is to evaluate the effectiveness of this intervention protocol in comparison with an active control condition targeting healthy lifestyle, and a waiting list control condition. The study will be conducted in four populations of Spanish-speaking university students (Spain, Argentina, Colombia, and Mexico).

Methods: The study design is a randomized controlled trial (RCT). At least 324 university students will be randomly assigned to three conditions: 1) CORE, a 6-week training program to improve resilience; 2) HLP, a 6-week training to promote a healthy lifestyle; and 3) WL, waiting list control condition. The primary outcome measure will be the Connor-Davidson resilience scale. Additionally, measures of anxiety, depression, quality of life and socio-demographic variables (age, sex, incomes, marital status, among others) will be collected. Participants will be evaluated at pre-treatment, after each module, 6 weeks after allocation, and at 3-month follow-up. Intention-to-treat and per-protocol analyses will be performed.

Discussion: The results of this study will contribute to research on Internet-administered interventions and the implementation of a protocol that includes a series of components designed to improve resilience and coping skills, increase psychological well-being, and prevent depression and anxiety disorders in Spanish-speaking university students. In addition, avenues will be opened up for new research on the effectiveness of these interventions focused on the prevention and promotion of mental health in Spanish-speaking countries.

Trial Registration: Registered at ClinicalTrials.gov NCT03903978 on April 2, 2019.
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http://dx.doi.org/10.1186/s12888-020-02536-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7133009PMC
April 2020

Positive and Negative Affect Schedule (PANAS): psychometric properties of the online Spanish version in a clinical sample with emotional disorders.

BMC Psychiatry 2020 02 10;20(1):56. Epub 2020 Feb 10.

Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Castellón, Spain.

Background: The Positive and Negative Affect Schedule (PANAS) is the most widely and frequently used scale to assess positive and negative affect. The PANAS has been validated in several languages, and it has shown excellent psychometric properties in the general population and some clinical samples, such as forensic samples, substance users, and adult women with fibromyalgia. Nevertheless, the psychometric properties of the scale have not yet been examined in clinical samples with anxiety, depressive, and adjustment disorders. In addition, the proliferation of Internet-based treatments has led to the development of a wide range of assessments conducted online with digital versions of pen and paper self-report questionnaires. However, no validations have been carried out to analyze the psychometric properties of the online version of the PANAS. The present study investigates the psychometric properties of the online Spanish version of the PANAS in a clinical sample of individuals with emotional disorders.

Methods: The sample was composed of 595 Spanish adult volunteers with a diagnosis of depressive disorder (n = 237), anxiety disorder (n = 284), or adjustment disorder (n = 74). Factor structure, construct validity, internal consistency, and sensitivity to change were analyzed.

Results: Confirmatory factor analysis yielded a latent structure of two independent factors, consistent with previous validations of the instrument. The analyses showed adequate convergent and discriminant validity, good internal consistency as well as sensitivity to change.

Conclusions: Overall, the results obtained in this study show that the online version of the PANAS has adequate psychometric properties for the assessment of positive and negative affect in a Spanish clinical population.
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http://dx.doi.org/10.1186/s12888-020-2472-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008531PMC
February 2020

The need for change: Understanding emotion regulation antecedents and consequences using ecological momentary assessment.

Emotion 2020 Feb;20(1):30-36

Department of Basic Psychology, Clinic and Psychobiology, Jaume I University.

In recent decades, emotion regulation (ER) has been one of the most widely studied constructs within the psychological field. Nevertheless, laboratory experiments and retrospective assessments have been the 2 most common strands of ER research; thus, leaving open several crucial questions about ER antecedents and consequences in daily life. Beyond traditional methods, ecological momentary assessment (EMA) has the potential to capture ER dynamics during the flow of daily experiences, in real-life settings and through repeated measurements. Here, we discuss what we currently know about ER antecedents and consequences. We will compare findings from previous literature to findings from EMA studies, pointing out both similarities and differences, as well as questions that can be answered better with the EMA approach. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/emo0000671DOI Listing
February 2020

Improving chronic pain management with eHealth and mHealth: study protocol for a randomised controlled trial.

BMJ Open 2019 12 29;9(12):e033586. Epub 2019 Dec 29.

Pain Clinic, Hospital General de Castellon, Castellon de la Plana, Spain.

Introduction: Chronic pain has become a matter of public health concern due to its high prevalence and because public costs associated with treatment and disability increase each year. Research suggests that limitations in the traditional assessment of chronic pain patients limit the effectiveness of current medical treatments. The use of technology might serve change patient traditional monitoring into ecological momentary assessments, which might be visualised by physicians live. This study describes a randomised control trial designed to test the utility of a technology-based solution for pain telemonitoring consisting of a smartphone app for patients and a web application for physicians. The goal of this study will be to explore whether this combination of eHealth and mHealth improves the effectiveness of existing pain treatments.

Methods And Analysis: Participants will be 250 patients randomly assigned to one of these two conditions: treatment-as-usual (TAU) and TAU +app+ web. All participants will receive the usual treatment for their pain. Only the TAU +app+ web group use Pain Monitor app, which generates alarms that are sent to the physicians in the face of previously established undesired events. Physicians will be able to monitor app reports using a web application, which might result in an adjustment of treatment. We anticipate that the use of Pain Monitor plus the therapist web will result in a reduction of pain intensity and side effects of the medication. Improvements on secondary outcomes, namely fatigue, mood, pain interference, rescue medication use and quality of life, are also expected. Mixed repeated-measure multivariate analyses of variances will be conducted to investigate whether there are differences between preassessment and postassessment scores as a function of the experimental condition.

Ethics And Dissemination: Ethical approval from the Hospital General Universitari de Castellon was obtained. The findings will be published in peer-reviewed journals.

Trial Registration Number: NCT03606265.
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http://dx.doi.org/10.1136/bmjopen-2019-033586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937108PMC
December 2019

Interventions of computerized psychotherapies for depression in Primary Care in Spain.

Actas Esp Psiquiatr 2019 Nov 1;47(6):236-46. Epub 2019 Nov 1.

CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Madrid, España Universitat Jaume I, Castellón, España.

Currently, depression is a global health problem recognized by the WHO. The prevalence of this pathology in Primary Care is estimated at 19.5% worldwide, and 20.2% in Spain. In addition, the current intervention policies and protocols involve significant costs, both personal and economic, for people suffering from this disorder, as well as for society in general. On the other hand, the relapse rates after pharmacological interventions that are currently applied and the lack of effective specialized attention in mental health services reflect the need to develop new therapeutic strategies that are more accessible and profitable. Therefore, one of the proposals that are being investigated in different parts of the world is the design and evaluation of therapeutic protocols applied through Information and Communication Technologies, especially through the Internet and computer programs. The objective of this work was to present the current situation in Spain regarding the use of these interventions for the treatment of depression in Primary Care. The main conclusion is that although there is scientific evidence on the effectiveness of these programs, there are still important barriers that hinder their application in the public system, and also the need to develop implementation studies that facilitate the transition from research to clinical practice.
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November 2019

How and for whom does a positive affect intervention work in fibromyalgia: An analysis of mediators and moderators.

Eur J Pain 2020 01 13;24(1):248-262. Epub 2019 Oct 13.

CIBER of Physiopathology of Obesity and Nutrition CIBERObn, Instituto de Salud Carlos III, Madrid, Spain.

Objectives: Psychological interventions designed to enhance positive affect are promising ways to promote adaptive functioning in people with chronic pain. However, few studies have addressed the efficacy of positive affect interventions in chronic pain populations and examined which patients can benefit more from them. The aim of the present study was to identify mediators and moderators of the best possible self intervention (BPS) in fibromyalgia patients.

Methods: We used data from a previous randomized controlled trial that examined changes in pain interference, depression, self-efficacy and quality of life after the BPS intervention.

Results: Mediation analyses showed that depression mediated changes in pain interference. Positive and negative affect were significant mediators of the change in depression and quality of life. No significant mediators of the change in self-efficacy were found. Baseline levels of quality of life, emotion regulation strategies of negative and positive affect, and rumination moderated the effects of the intervention on depressive symptomatology.

Discussion: In fibromyalgia patients, the effects of the BPS on the outcomes seem to be more related to changes in affect than to changes in future expectations.

Significance: This study presents evidence about who can benefit from an intervention designed to augment positive affect and promote positive functioning in FMS patients and how these changes occur. It extends previous findings on patient characteristics associated with the response to pain management interventions.
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http://dx.doi.org/10.1002/ejp.1481DOI Listing
January 2020