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Aims: To evaluate the effectiveness of eHealth interventions to reduce stress and promote mental health in healthcare professionals, and to compare the efficacy of different types of programs (guided vs. self-guided; ‘third-wave’ psychotherapies vs. other types). Background: Healthcare workers present high levels of stress, which constitutes a risk factor for developing mental health problems such as depression and anxiety. eHealth interventions have been designed to reduce these professional's stress considering that the characteristics of this delivery method make it a cost-effective and very appealing alternative because of its fast and easy access. Design: A systematic review of quantitative studies. Methods: A comprehensive database search for quantitative studies was conducted in PubMed, EMBASE and Cochrane (until 1 April 2022). The systematic review was conducted in accordance with the PRISMA and SWiM reporting guidelines. The quality of the studies was assessed using the National Heart, Lung and Blood Institute tools. Results: The abstracts of 6349 articles were assessed and 60 underwent in-depth review, with 27 fulfilling the inclusion criteria. The interventions were classified according to their format (self-guided vs. guided) and contents (‘third-wave’ psychotherapies vs. others). Twenty-two interventions emerged, 13 of which produced significant posttreatment reductions in stress levels of health professionals (9 self-guided, 8 ‘third wave’ psychotherapies). Significant effects in improving depressive symptomatology, anxiety, burnout, resilience and mindfulness, amongst others, were also found. Conclusion: The evidence gathered in this review highlights the heterogeneity of the eHealth interventions that have been studied; self-guided and ‘third-wave’ psychotherapy programs are the most common, often with promising results, although the methodological shortcomings of most studies hinder the extraction of sound conclusions. Protocol registration: PROSPERO CRD42022310199. No Patient or Public Contribution.

Background The World Health Organization has formally recognized that healthcare professionals are at risk of developing mental health problems; finding ways to reduce their stress is mandatory to improve both their quality of life and, indirectly, their job performance. In recent years, particularly since the COVID-19 pandemic outbreak, there has been a proliferation of online interventions with promising results. The purpose of the present study is twofold: to test the effectiveness of an online, self-guided intervention, MINDxYOU, to reduce the stress levels of healthcare workers; and to conduct an implementation study of this intervention. Additionally, an economic evaluation of the intervention will be conducted. Methods The current study has a hybrid effectiveness-implementation type 2 design. A stepped wedge cluster randomized trial design will be used, with a cohort of 180 healthcare workers recruited in two Spanish provinces (Malaga and Zaragoza). The recruitment stage will commence in October 2022. Frontline health workers who provide direct care to people in a hospital, primary care center, or nursing home setting in both regions will participate. The effectiveness of the intervention will be studied, with perceived stress as the main outcome (Perceived Stress Scale), while other psychopathological symptoms and process variables (e.g., mindfulness, compassion, resilience, and psychological flexibility) will be also assessed as secondary outcomes. The implementation study will include analysis of feasibility, acceptability, adoption, appropriateness, fidelity, penetration, and sustainability. The incremental costs and benefits, in terms of quality-adjusted life years, will be examined by means of cost-utility and cost-effectiveness analyses. Discussion MINDxYOU is designed to reduce healthcare workers’ stress levels through the practice of mindfulness, acceptance, and compassion, with a special focus on how to apply these skills to healthy habits and considering the particular stressors that these professionals face on a daily basis. The present study will show how implementation studies are useful for establishing the framework in which to address barriers to and promote facilitators for acceptability, appropriateness, adoption, feasibility, fidelity, penetration, and sustainability of online interventions. The ultimate goal is to reduce the research-to-practice gap. Trial registration This study was registered in ClinicalTrials.gov on 29/06/2022; registration number: NCT05436717.

Objectives: To study the effectiveness of attachment-based compassion therapy (ABCT) for reducing affective distress in a sample of outpatients with depressive, anxiety, or adjustment disorders, and to explore its mechanisms of action. Methods: This randomized controlled trial involved the assessment time points of pretreatment, posttreatment and 6-month follow-up. A total of 90 patients from three mental health units in Castellón, Spain, were recruited and randomly assigned to “ABCT + treatment as usual (TAU), ” “Mindfulness-based stress reduction (MBSR) + TAU” or “TAU” alone. Affective distress, as measured by the “Depression, Anxiety and Stress Scales” (DASS-21) was the main outcome; self-compassion and mindfulness were also assessed. Multilevel mixed-effects models were used to estimate the effectiveness of the program, and path analyses were conducted to study the potential mechanistic role of mindfulness and self-compassion. Results: ABCT was not superior to MBSR in any outcome or at any assessment point. ABCT was superior to TAU alone both posttreatment (B = -13.20; 95% confidence interval [CI]: -19.57, -6.84) and at 6-month follow-up (B = -7.20; 95% CI: -13.63, -0.76) for reducing DASS-21, and MBSR was superior to TAU alone both posttreatment (B = -11.51; 95% CI: -17.97, -5.05) and at 6-month follow-up (B = -8.59; 95% CI: -15.09, -2.10), with large effects (d = 0.90). Changes produced by ABCT in DASS-21 were mediated by self-compassion, whereas changes produced by MBSR were mediated by both mindfulness and self-compassion. Conclusion: ABCT is effective for reducing affective distress in patients with anxiety, depressive and adjustment disorders, although its effect is not superior to that offered by MBSR. Self-compassion seems to be a significant mediator of the effects of ABCT. © 2021 Wiley Periodicals LLC

Bipolar disorder (BD) is a mental disorder characterised by episodes of extremal mood changes. In recent years, some researchers found neurodegeneration in patients with BD using Magnetic Resonance Imaging. Evaluation of the optic nerve and the retinal layers using optical coherence tomography (OCT) has proved to be a useful, non-invasive tool for diagnosis and monitoring of neurodegenerative diseases. Accordingly, a decrease in the retinal nerve fibre layer and the ganglion cell complex measured by OCT was found in patients with BD in different studies, suggesting that BD is a neurodegenerative process in addition to a psychiatric disorder. Therefore, the neuro-ophthalmological evaluation of these patients could be used as a marker for diagnosis of this disease. This work analyses literature on retinal degeneration in bipolar disorder patients, and evaluates the ability of OCT devices in the detection of neuronal degeneration affecting the different retinal layers in these patients, and its possible role in the diagnosis and monitoring of the disease.

Resumen El trastorno bipolar (TB) es una enfermedad mental caracterizada por episodios de alteraciones extremas del humor en la que existe evidencia de presencia de neurodegeneracion, determinada mediante resonancia magnetica nuclear. En los ultimos anos, la evaluacion del nervio optico y de las capas de la retina mediante tomografia de coherencia optica (OCT) en enfermedades neurodegenerativas ha demostrado su utilidad como biomarcador no invasivo de diagnostico y progresion. En pacientes con TB diversos estudios han encontrado disminucion de la capa de fibras nerviosas de la retina y del complejo de celulas ganglionares objetivables mediante OCT, lo que apoyaria la hipotesis de que el TB se trata de una enfermedad neurodegenerativa ademas de un proceso psiquiatrico. Por ello, el estudio neuro-oftalmologico de estos pacientes podria servir como marcador diagnostico de esta patologia. Este trabajo revisa la bibliografia reciente sobre degeneracion retiniana en pacientes con TB y evalua la capacidad de los dispositivos de OCT en la deteccion de degeneracion neuronal que afecta a las diferentes capas de la retina en estos pacientes y su posible papel en el diagnostico y seguimiento de la enfermedad.

Mindfulness-, compassion-, and acceptance-based (i.e., “third wave”) psychotherapies are effective for treating chronic pain conditions. Many of these programs require that patients engage in the systematic home practice of meditation experiences so they can develop meditation skills. This systematic review aimed at evaluating the frequency, duration, and effects of home practice in patients with chronic pain undergoing a “third wave” psychotherapy. A comprehensive database search for quantitative studies was conducted in PubMed, Embase, and Web of Sciences Core Collection; 31 studies fulfilled the inclusion criteria. The reviewed studies tended to indicate a pattern of moderately frequent practice (around four days/week), with very high variability in terms of time invested; most studies observed significant associations between the amount of practice and positive health outcomes. Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy were the most common interventions and presented low levels of adherence to home practice (39.6% of the recommended time). Some studies were conducted on samples of adolescents, who practiced very few minutes, and a few tested eHealth interventions with heterogeneous adherence levels. In conclusion, some adaptations may be required so that patients with chronic pain can engage more easily and, thus, effectively in home meditation practices.

Twenty-five eyes of 25 patients with bipolar disorder and 74 eyes of 74 healthy controls underwent retinal measurements of retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness. Measurements were obtained using the Spectralis-OCT device with the new Posterior Pole protocol which assesses the macular area by analyzing retinal thickness in a grid of 64 (8*8) cells.Significant differences (Posterior Pole OCT protocol is a useful tool to assess changes in the inner retinal layers in bipolar disorder. These observed changes, especially those affecting the GCL, may be associated with disease evolution and may be predictive of the presence of the disease. OCT data could potentially be a useful tool for clinicians to diagnose and monitor BD patients.

Altres ajuts: The publication was funded by the Diputación General de Aragón group (B17-20R). Gambling has become a routine form of entertainment for many young people. The aim of this study was to describe the gambling behavior that university students are developing in Aragon, Spain, and to analyze whether these habits are more common among students of sports science, on the assumption that they are more likely to have a higher exposure to betting company marketing. A cross-sectional design was applied, with data collected on advertising exposure, gambling habits and experiences, and opinions on the impact of gambling and its regulation from 516 undergraduate students from the University of Zaragoza. The online survey included ad hoc questions and the "Pathological Gambling Short Questionnaire" to screen for potential gambling disorders. Almost half of the sample had bet money at least once in their life (48.1%), and 2.4% screened positive for consideration of a possible diagnosis of pathological gambling. Betting shops (44.2%) were the most common gambling option, and students of sports science showed a higher prevalence of pathological gambling and had greater tendencies to make bets. Gambling is perceived as a normal leisure activity by a significant part of university students. The development of transversal strategies is required to raise awareness towards the potential dangers of gambling.

Objetivo: analizar un curso en linea sobre promocion de la salud basado en la atencion plena (mindfulness) a traves de la teoria de la semiotica discursiva en uno de sus desarrollos mas recientes, el aspecto visual o plastico. El objetivo es identificar como el texto verbal-visual del curso produce significados y como puede ayudar en el diseno de otros cursos. Metodo: se llevo a cabo un analisis semiotico de dos practicas y una impresion de pantalla del curso llamado Programa de autocuidado basado en la atencion plena, en educacion a distancia, desarrollado por el Centro Brasileno de Mindfulness y Promocion de la Salud (“Mente Abierta”), del Departamento de Medicina Preventivade de la Universidad Federal de Sao Paulo. Resultados: se evaluaronlos elementos esteticos que contribuyeron a la construccion de un entorno de practica euforica (vinculado a la salud) y se establecieron relaciones entre el plan de contenido y el plan de expresion de practica, responsables de la construccion de relaciones semi-simbolicas. Conclusion: se confirmo la valoracion de una estetica de simplicidad de colores y formas, que convergio en una afirmacion de los valores de calma y bienestar compatibles con las practicas de mindfulness.

Mindfulness-based programs (MBPs) have been tested as promising alternatives for managing stress in Primary health care (PHC) providers. The study compared the feasibility and efficacy of an MBP on burnout symptoms in Brazilian PHC providers with a briefer relaxation-based program and with a nonactive control group. A nonrandomized controlled trial was conducted with mixed-methods evaluation on self-reported symptoms of burnout, and positive and negative affection, mindfulness, self-compassion, decentering, and rumination. The MBP arm (MF) (n = 62) consisted of eight mindfulness sessions, the relaxation arm (RE) (n = 35) attended four relaxation sessions, and the control arm (CO) (n = 45) comprised a waitlist group. The reduction in exhaustion was significantly higher in MF compared with CO (d = − 0.58; p = 0.020), and in RE compared with CO (d = − 0.63; p = 0.017). MF was significantly superior to CO for reducing cynicism (d = − 0.48; p = 0.024). There was also significant superiority of MF compared with CO in positive and negative affect, observing, describing, nonreacting, mindfulness, identification, and rumination. MF and RE were significantly superior to CO for reducing criticism and isolation. Finally, MF was significantly superior to RE and CO for improving nonjudging, self-kindness, and decentering. Mindfulness and relaxation may be efficacious in addressing burnout symptoms in PHC providers, probably with synergistic effects and distinct mechanisms of action. Further studies with a randomized design and larger sample sizes should be performed to confirm these preliminary data and to test whether a mix of mindfulness and relaxation techniques would be more effective than either program on its own.

There is a growing interest in researching the effects of meditative practices on the mental health of students. However, less enthusiasm has been shown for research into their effects on social and pro-environmental attitudes. The main aim of the present study was to evaluate the effects of a training program to promote mindful, empathic, and pro-environmental attitudes in elementary school students. A nonrandomized controlled exploratory study with two arms (treated and controls) and pre-post measurements was performed. The training program (3 weekly 5-min practice sessions over 4 months) was implemented in a classroom of 25 students between the ages of 10 and 12 years (64% boys). All the students completed self-report measures of mindfulness (Child and Adolescent Mindfulness Measure), empathy (Interpersonal Reactivity Index), and environmental attitudes (New Ecological Paradigm Scale for Children). Compared to the control group, the students who participated in the training program showed significant improvements in mindfulness skills with large effects, in considerate social style and cognitive empathy with medium effects, and in pro-environmental attitudes with large effects. This is one of the first studies to attempt to implement a training program integrated into the school curriculum to develop mindful, empathic, and pro-environmental attitudes in elementary school students without disrupting the flow of lessons. The program, which consists of very short sessions, may contribute to increasing children’s sense of connectedness, humanity, and nature in a feasible and effective way. However, more sophisticated trial designs are required in order to assess the scope of our results.

Mindfulness training (MT) is considered appropriate for school teachers and enhances well-being. Most research has investigated the efficacy of instructor-led MT. However, little is known about the benefits of using self-taught formats, nor what the key mechanisms of change are that contribute to enhanced teacher well-being. This study compared instructor-led and self-taught MT based on a book (Williams & Penman, 2011) in a sample of secondary school teachers. We assessed expectancy, the degree to which participants believed the intervention was effective, their program engagement, well-being and psychological distress, and evaluated whether mindfulness and self-compassion skills acted as mediators of outcomes. In total, 206 teachers from 43 schools were randomized by school to an instructor-led or self-taught course—77% female, mean age 39 years (SD = 9.0). Both MT formats showed similar rates of participant expectancy and engagement, but the instructor-led arm was perceived as more credible. Using linear mixed-effects models, we found the self-taught arm showed significant pre-post improvements in self-compassion and well-being, while the instructor-led arm showed such improvements in mindfulness, self-compassion, well-being, perceived stress, anxiety, depression, and burnout. Changes over time significantly differed between the groups in all these outcomes, favoring the instructor-led arm. The instructor-led arm, compared with the self-taught, indirectly improved teacher outcomes by enhancing mindfulness and self-compassion as mediating factors. Mindfulness practice frequency had indirect effects on teacher outcomes through mindfulness in both self-taught and instructor-led arms. Our results suggest both formats are considered reasonable, but the instructor-led is more effective than the self-taught. Trial registration: ISRCTN18013311., Educational Impact and Implications Statement Mindfulness training enhances teachers’ well-being. This study compared two different mindfulness training formats with a sample of 206 secondary school teachers using an experimental design. Results suggested that teachers’ well-being was increased in both formats of delivery and both generated similar expectancy and engagement with the mindfulness practice; but the instructor-led format appeared to be more credible and effective and was also able to reduce teachers’ stress, anxiety, depressive symptomatology, and burnout. In contrast, the self-taught program might be useful for those teachers who cannot access or commit to an instructor-led program, provided they engage with mindfulness practice. This study suggests two forms for teachers to learn mindfulness, instructor-led and self-taught, as a way to support well-being, each with its own advantages.

Purpose Health factors that enhance an individual's ability to perceive and maintain health and well-being are referred to as "health assets". Of these assets, resilience, mindfulness and self-compassion are considered to be of special importance. The objective of this study was to analyze the association between these psychological constructs on the perception of physical and mental health in a general population. Patients and methods A descriptive and analytical cross-sectional study was conducted with 845 participating subjects. The outcome variable was the individual´s perception of physical and mental health, measured using the SF-36 questionnaire. The independent variables were: sociodemographic variables, medical information, physical activity performance (using the International Physical Activity Questionnaire), tobacco and alcohol consumption, anxiety and/or depression (using the Goldberg Anxiety and Depression Scale), resilience (using the Connor-Davidson Resilience Scale), mindfulness (with the Five Facets of Mindfulness Questionnaire Short Form) and self-compassion (using the Self-compassion scale-short form). A correlation analysis, simple linear regression and multiple linear regression were carried out, controlling for the influence of the distinct independent variables. Results The constructs of resilience, mindfulness and self-compassion are significant, in the perception of both physical and mental health. Other factors appearing in the multiple regression are gender, age, educational level, physical activity and tobacco consumption, in a positive or negative sense. Conclusion The study of these associations is fundamental for the understanding of underlying regulation processes of healthy lifestyles in the general population.

Background: Most programmes developed to reduce aggressive attitudes among teenagers are based on cultivating nonviolence, a construct that has been related to compassion and, more indirectly, mindfulness. This study aims at testing the efficacy of ‘Unlearning’, a mindfulness and compassion-based programme, for reducing aggressive attitudes in adolescents.Method: A sample of 164 students from three high schools in Zaragoza (Spain) participated in the study. They were randomly assigned to (1) ‘Unlearning’, or (2) relaxation programme. Three assessment points were established: baseline, post-treatment and a 4-month follow-up. The outcome variables were the subscales of the ‘Attitudes Toward Social Aggression Scale’. Mindfulness and compassion were assessed as secondary outcomes.Results: ‘Unlearning’ did not produce changes in the primary outcomes, but significant effects were observed post-treatment in self-compassion; and in the follow-up, in self-compassion and mindfulness. The control group did not experience any change post-treatment, but a significant effect in mindfulness was observed in the follow-up. The intergroup analyses indicated that ‘Unlearning’ improved self-compassion, both post-treatment (t = −2.48, p = 0.014) and after 4-months (t = −2.03, p = 0.044), although these results were not statistically significant after correcting for multiple comparisons.Conclusion: ‘Unlearning’ did not produce significant reductions in aggressive attitudes compared to the control group. The low baseline levels may have hindered the efficacy of the interventions. ‘Unlearning’ showed potential to improve self-compassion, which is related to nonviolence, and this may have positive implications for the adolescents. Future interventions should include teachers and families to enhance the effectiveness of the programmes.

Background: A sizeable proportion of Brazilian Primary Care (PC) providers suffer from common mental disorders, such as anxiety and depression. In an effort to cope with job-related distress, PC workers are likely to implement maladaptive strategies such as experiential avoidance (EA). The Acceptance and Action Questionnaire (AAQ-II) is a widely used instrument that evaluates EA but has shown questionable internal consistency in specific populations. This study assesses the psychometric properties of the AAQ-II among Brazilian PC providers, evaluates its convergence and divergence with self-criticism and mindfulness skills, and explores its criterion validity on anxiety and depressive symptoms. Methods: A cross-sectional design was conducted in Brazilian PC services, and the sample included 407 PC workers. The measures evaluated EA, self-criticism, mindfulness, depression, and anxiety. Results: The one-factor model of the AAQ-II replicated the original version structure. The AAQ-II presented good internal consistency among Brazilian PC providers. A multiple regression model demonstrated higher relationships with self-criticism than mindfulness skills. The criterion validity of the AAQ-II on anxiety and depression was stronger in the context of more severe symptoms. Conclusions: The AAQ-II is an appropriate questionnaire to measure the lack of psychological flexibility among Brazilian PC workers in the sense of EA.

To evaluate visual and retinal changes in patients with bipolar disorder. To analyze the correlation between structural changes and visual function parameters.Thirty patients with bipolar disorder and 80 healthy controls underwent visual function evaluation with Early Treatment Diabetic Retinopathy Study charts at 100%, 2.50%, and 1.25% contrast, Pelli-Robson chart, and color vision Farnsworth and Lanthony tests. Analysis of the different retinal layers was performed using Spectralis optical coherence tomography with automated segmentation software. Correlation analysis between structural and functional parameters was conducted.Patients with bipolar disorder presented worse color vision compared with controls (Lanthony's index, P = 0.002). Full macular thickness, the retinal nerve fiber layer (RNFL), ganglion cell layer, and inner plexiform layer were reduced in patients compared with healthy individuals (P0.005). The inner nuclear layer was significantly thickened in patients (P0.005). Peripapillary RNFL thickness was reduced in all temporal sectors (P0.005). Significant correlations were found between visual acuity and the RNFL thickness, the Pelli-Robson score and the inner plexiform layer, and between the Lanthony's color index and the ganglion cell layer thickness.Patients with bipolar disorder present quantifiable thinning of the macular RNFL, ganglion cell layer, and inner plexiform layer, as well as in the peripapillary RNFL thickness, and increasing thinning in the inner nuclear layer.

Health professionals are among the most vulnerable to work stress and emotional exhaustion problems. These health professionals include tutors and resident intern specialists, due to the growing demand for the former and the high work overload of the latter. Mindfulness training programs can support these professionals during times of crisis, such as the current global pandemic caused by the coronavirus-19 disease. The objective of this study was to compare the effectiveness of an abbreviated Mindfulness-Based Stress Reduction (MBSR) and Mindful Self-Compassion (MSC) training program in relation to a standard training program on the levels of mindfulness, self-compassion, and self-perceived empathy in tutors and resident intern specialists of Family and Community Medicine and Nursing. A total of 112 professionals attached to six Spanish National Health System teaching units (TUs) participated in this randomized and controlled clinical trial. Experimental Group (GE) participants were included in the standard or abbreviated MBSR programs. The Five Facet Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale short form (SCS-SF), and the Jefferson Scale of Physician Empathy (JSPE) were administered three times during the study: before, immediately after, and 3 months after the intervention. Adjusted covariance analysis (ANCOVA), using pretest scores as the covariate, showed a significant increase in mindfulness (F(2,91) = 3.271, p = 0.042, η2 = 0.067) and self-compassion (F(2,91) = 6.046, p = 0.003, η2 = 0.117) in the post-test visit, and in self-compassion (F(2,79) = 3.880, p = 0.025, η2 = 0.089) in the follow-up visit, attributable to the implementation of the standard training program. The standard MBSR and MSC training program improves levels of mindfulness and self-compassion, and promotes long-lasting effects in tutors and resident intern specialists. New studies are needed to demonstrate the effectiveness of abbreviated training programs.

BackgroundQuality-adjusted life years (QALYs) are widely used to measure the impact of various diseases on both the quality and quantity of life and in their economic valuations. It will be clinically important and informative if we can estimate QALYs based on measurements of depression severity.ObjectiveTo construct a conversion table from the Patient Health Questionnaire-9 (PHQ-9), the most frequently used depression scale in recent years, to the Euro-Qol Five Dimensions Three Levels (EQ-5D-3L), one of the most commonly used instruments to assess QALYs.MethodsWe obtained individual participant data of randomised controlled trials of internet cognitive-behavioural therapy which had administered depression severity scales and the EQ-5D-3L at baseline and at end of treatment. Scores from depression scales were all converted into the PHQ-9 according to the validated algorithms. We used equipercentile linking to establish correspondences between the PHQ-9 and the EQ-5D-3L.FindingsIndividual-level data from five trials (total N=2457) were available. Subthreshold depression (PHQ-9 scores between 5 and 10) corresponded with EQ-5D-3L index values of 0.9–0.8, mild major depression (10–15) with 0.8–0.7, moderate depression (15–20) with 0.7–0.5 and severe depression (20 or higher) with 0.6–0.0. A five-point improvement in PHQ-9 corresponded approximately with an increase in EQ-5D-3L score by 0.03 and a ten-point improvement by approximately 0.25.Conclusions and Clinical ImplicationsThe conversion table between the PHQ-9 and the EQ-5D-3L scores will enable fine-grained assessment of burden of depression at its various levels of severity and of impacts of its various treatments.

Importance: Personalized treatment choices would increase the effectiveness of internet-based cognitive behavioral therapy (iCBT) for depression to the extent that patients differ in interventions that better suit them.Objective: To provide personalized estimates of short-term and long-term relative efficacy of guided and unguided iCBT for depression using patient-level information.Data Sources: We searched PubMed, Embase, PsycInfo, and Cochrane Library to identify randomized clinical trials (RCTs) published up to January 1, 2019.Study Selection: Eligible RCTs were those comparing guided or unguided iCBT against each other or against any control intervention in individuals with depression. Available individual patient data (IPD) was collected from all eligible studies. Depression symptom severity was assessed after treatment, 6 months, and 12 months after randomization.Data Extraction and Synthesis: We conducted a systematic review and IPD network meta-analysis and estimated relative treatment effect sizes across different patient characteristics through IPD network meta-regression.Main Outcomes and Measures: Patient Health Questionnaire-9 (PHQ-9) scores.Results: Of 42 eligible RCTs, 39 studies comprising 9751 participants with depression contributed IPD to the IPD network meta-analysis, of which 8107 IPD were synthesized. Overall, both guided and unguided iCBT were associated with more effectiveness as measured by PHQ-0 scores than control treatments over the short term and the long term. Guided iCBT was associated with more effectiveness than unguided iCBT (mean difference [MD] in posttreatment PHQ-9 scores, -0.8; 95% CI, -1.4 to -0.2), but we found no evidence of a difference at 6 or 12 months following randomization. Baseline depression was found to be the most important modifier of the relative association for efficacy of guided vs unguided iCBT. Differences between unguided and guided iCBT in people with baseline symptoms of subthreshold depression (PHQ-9 scores 5-9) were small, while guided iCBT was associated with overall better outcomes in patients with baseline PHQ-9 greater than 9.Conclusions and Relevance: In this network meta-analysis with IPD, guided iCBT was associated with more effectiveness than unguided iCBT for individuals with depression, benefits were more substantial in individuals with moderate to severe depression. Unguided iCBT was associated with similar effectiveness among individuals with symptoms of mild/subthreshold depression. Personalized treatment selection is entirely possible and necessary to ensure the best allocation of treatment resources for depression.

BACKGROUND The global health emergency generated by the COVID-19 pandemic is posing an unprecedented challenge to health care workers, who are facing heavy workloads under psychologically difficult situations. Mental mobile Health (mHealth) interventions are now being widely deployed due to their attractive implementation features, despite the lack of evidence about their efficacy in this specific population and context. OBJECTIVE The aim of this trial is to evaluate the effectiveness of a psychoeducational, mindfulness-based mHealth intervention to reduce mental health problems in health care workers during the COVID-19 pandemic. METHODS We conducted a blinded, parallel-group, controlled trial in Spain. Health care workers providing face-to-face health care to patients with COVID-19 were randomly assigned (1:1) to receive the PsyCovidApp intervention (an app targeting emotional skills, healthy lifestyle behavior, burnout, and social support) or a control app (general recommendations about mental health care) for 2 weeks. The participants were blinded to their group allocation. Data were collected telephonically at baseline and after 2 weeks by trained health psychologists. The primary outcome was a composite of depression, anxiety, and stress (overall score on the Depression Anxiety Stress Scale-21 [DASS-21]). Secondary outcomes were insomnia (Insomnia Severity Index), burnout (Maslach Burnout Inventory Human Services Survey), posttraumatic stress (Davidson Trauma Scale), self-efficacy (General Self-Efficacy Scale), and DASS-21 individual scale scores. Differences between groups were analyzed using general linear modeling according to an intention-to-treat protocol. Additionally, we measured the usability of the PsyCovidApp (System Usability Scale). The outcome data collectors and trial statisticians were unaware of the treatment allocation. RESULTS Between May 14 and July 25, 2020, 482 health care workers were recruited and randomly assigned to PsyCovidApp (n=248) or the control app (n=234). At 2 weeks, complete outcome data were available for 436/482 participants (90.5%). No significant differences were observed between the groups at 2 weeks in the primary outcome (standardized mean difference –0.04; 95% CI –0.11 to 0.04; P=.15) or in the other outcomes. In our prespecified subgroup analyses, we observed significant improvements among health care workers consuming psychotropic medications (n=79) in the primary outcome (–0.29; 95% CI –0.48 to –0.09; P=.004), and in posttraumatic stress, insomnia, anxiety, and stress. Similarly, among health care workers receiving psychotherapy (n=43), we observed improvements in the primary outcome (–0.25; 95% CI –0.49 to –0.02; P=.02), and in insomnia, anxiety, and stress. The mean usability score of PsyCovidApp was high (87.21/100, SD 12.65). After the trial, 208/221 participants in the intervention group (94.1%) asked to regain access to PsyCovidApp, indicating high acceptability. CONCLUSIONS In health care workers assisting patients with COVID-19 in Spain, PsyCovidApp, compared with a control app, reduced mental health problems at 2 weeks only among health care workers receiving psychotherapy or psychotropic medications. CLINICALTRIAL ClinicalTrials.gov NCT04393818; https://clinicaltrials.gov/ct2/show/NCT04393818.

AimTo evaluate the impact of a psychoeducational, mobile health intervention based on cognitive behavioural therapy and mindfulness-based approaches on the mental health of healthcare workers at the frontline against COVID-19 in Spain.DesignWe will carry out a two-week, individually randomised, parallel group, controlled trial. Participants will be individually randomised to receive the PsyCovidApp intervention or control App intervention.MethodsThe PsyCovidApp intervention will include five modules: emotional skills, lifestyle behaviour, work stress and burnout, social support, and practical tools. Healthcare workers having attended COVID-19 patients will be randomized to receive the PsyCovidApp intervention (intervention group) or a control App intervention (control group). A total of 440 healthcare workers will be necessary to assure statistical power. Measures will be collected telephonically by a team of psychologists at baseline and immediately after the two weeks intervention period. Measures will include stress, depression and anxiety (DASS-21 questionnaire – primary endpoint), insomnia (ISI), burnout (MBI-HSS), post-traumatic stress disorder (DTS), and self-efficacy (GSE). The study was funded in May 2020, and was ethically approved in June 2020. Trial participants, outcome assessors and data analysts will be blinded to group allocation.DiscussionDespite the increasing use of mobile health interventions to deliver mental health care, this area of research is still on its infancy. This study will help increase the scientific evidence regarding the effectiveness of this type of intervention on this specific population and context.ImpactDespite the lack of solid evidence about their effectiveness, mobile-based health interventions are already being widely implemented because of their low cost and high scalability. The findings from this study will help health services and organizations to make informed decisions in relation to the development and implementation of this type of interventions, allowing them pondering not only their attractive implementability features, but also empirical data about its benefits.Clinical trial registrationNCT04393818 (ClinicalTrials.gov identifier)

Diabetic patients have increased depression rates, diminished quality of life, and higher death rates due to depression comorbidity or diabetes complications. Treatment adherence (TA) and the maintenance of an adequate and competent self-care are crucial factors to reach optimal glycaemic control and stable quality of life in these patients. In this report, we present the baseline population analyses in phase I of the TELE-DD project, a three-phased population-based study in 23 Health Centres from the Aragonian Health Service Sector II in Zaragoza, Spain. The objectives of the present report are: (1) to determine the point prevalence of T2D and clinical depression comorbidity and treatment nonadherence; (2) to test if HbA1c and LDL-C, as primary DM outcomes, are related to TA in this population; and (3) to test if these DM primary outcomes are associated with TA independently of shared risk factors for DM and depression, and patients’ health behaviours. A population of 7,271 patients with type-2 diabetes and comorbid clinical depression was investigated for inclusion. Individuals with confirmed diagnoses and drug treatment for both illnesses (n = 3340) were included in the current phase I. A point prevalence of 1.9% was found for the T2D-depression comorbidity. The prevalence of patients nonadherent to treatment for these diseases was 35.4%. Multivariate analyses confirmed that lower diabetes duration, increased yearly PCS visits, HbA1c and LDL-C levels were independently related to treatment nonadherence. These findings informed the development of a telephonic monitoring platform for treatment of nonadherence for people with diabetes and comorbid depression and further trial, cost-effectiveness, and prognostic studies (phases II and III).

Objectives There is burgeoning interest in studying the effectiveness of mindfulness-based and traditional contemplative practices, and brief yet suitably and comprehensive measures of mindfulness are needed to assess related changes. There is preliminary evidence that pilgrimage may share some aspects with contemplative practices. This study examined the psychometric properties of the Spanish version of the 15-item Five Facets Mindfulness Questionnaire (FFMQ-15) in a large sample of pilgrims and explored the effects of pilgrimage on mindfulness. Methods The FFMQ-15 along with distress and wellbeing measures were administered via online to a large sample of participants undertaking a pilgrimage (i.e., the Way of Saint James) in Spain (baseline: n = 800; pre-post analyses: n = 314). Confirmatory factor analyses were computed to find the best-fitting model of the FFMQ-15; reliability and construct validity analyses were also performed. Results The four-facet bifactor structure (mindfulness plus four specific facets, excluding observing) was the best-fitting model for the FFMQ-15 (CFI = .956; TLI = .931; RMSEA = .058 [.048-.068]; SRMR = .046). Overall, we found satisfactory reliability (Cronbach's alpha ranged from .56 to .85) and small to moderate correlations with distress and wellbeing measures. Conclusions The FFMQ-15 showed a four-facet bifactor structure and an overall satisfactory internal consistency and construct validity despite its shortness. We observed that mindfulness can be cultivated by pilgrimage, but further studies including long-term assessments and control groups are warranted before firm conclusions can be drawn.

This chapter reflects on two fundamentals for facilitating interpersonal mindfulness: a secure attachment style and the reduction in the strength of the self. The term “attachment” refers to the emotional bonds that humans form with other people throughout their lifetime. There are one secure attachment style and three insecure styles. Compassion is “the feeling that arises in witnessing another’s suffering and that motivates a subsequent desire to help”. There are several protocols for the development of compassion for use with psychiatric patients and healthy individuals. The Attachment-Based Compassion Therapy (ABCT) is a protocol structured into eight weekly sessions that significantly increases secure attachment style, mediated by changes in self-compassion, and improves interpersonal relationships. The self-concept is the set of ideas that a person has about him-/herself and about his/her characteristics. It is defined by a sense of continuity over the time and by identification with the body. The self distorts the world and interprets it in a biased way. We focus on the main biases in interpersonal relationships caused by the self, and we try to make lecturers aware of these so that they can avoid being trapped by them when relating to other people.

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.

The aim of this study was to evaluate the efficacy of Attachment-Based Compassion Therapy (ABCT)—a standardised programme that includes practices to improve compassionate awareness with the aim of addressing maladaptive attachment—for improving mindfulness and self-compassion in fibromyalgia (FM) patients, and to determine whether gains in mindfulness and self-compassion mediate improvements in FM functional status together with comorbid anxiety and depression. The study comprised a randomised controlled trial of individuals undergoing ABCT, with a Relaxation condition as an active control group. Baseline, post-test, and 3-month follow-up assessments were included. Participants (n = 42) were FM patients randomly assigned to ABCT or relaxation. Outcomes were functional status (FIQ), anxiety (HADS-A), depression (HADS-D), mindfulness (FFMQ), and self-compassion (SCS). Differences between groups were estimated using mixed-effects regression models, and mediation analyses were conducted using path analyses. Compared with the Relaxation condition, the ABCT group was more effective for improving mindfulness and self-compassion, as it observed through changes in the FFMQ and SCS subscales. Effect sizes were in the moderately large to large range (Cohen’s d between 0.60–2.20). Reductions in FM functional status were not mediated by either mindfulness or self-compassion. However, the self-compassion facet of common humanity was a mediator for reductions in both anxiety (B = − 2.04; bootstrapped 95% CI = − 4.44, − 0.04) and depression (B = − 2.12; bootstrapped 95% CI = − 4.40, − 0.45). The improvement of common humanity via ABCT might be an active component for the reduction of comorbid anxiety and depression in FM patients. NCT02454244

The lack of highly effective treatments for fibromyalgia (FM) represents a great challenge for public health. The objective of this parallel, pilot randomized controlled trial (RCT) was two-fold: (1) to analyze the clinical effects of mindfulness plus amygdala and insula retraining (MAIR) compared to a structurally equivalent active control group of relaxation therapy (RT) in the treatment of FM; and (2) to evaluate its impact on immune-inflammatory markers and brain-derived neurotrophic factor (BDNF) in serum. A total of 41 FM patients were randomized into two study arms: MAIR (intervention group) and RT (active control group), both as add-ons of treatment as usual. MAIR demonstrated significantly greater reductions in functional impairment, anxiety, and depression, as well as higher improvements in mindfulness, and self-compassion at post-treatment and follow-up, with moderate to large effect sizes. Significant decreases in pain catastrophizing and psychological inflexibility and improvements in clinical severity and health-related quality of life were found at follow-up, but not at post-treatment, showing large effect sizes. The number needed to treat was three based on the criteria of ≥50% Fibromyalgia Impact Questionnaire (FIQ) reduction post-treatment. Compared to RT, the MAIR showed significant decreases in BDNF. No effect of MAIR was observed in immune-inflammatory biomarkers (i.e., TNF-α, IL-6, IL-10, and hs-CRP). In conclusion, these results suggest that MAIR, as an adjuvant of treatment-as-usual (TAU), appears to be effective for the management of FM symptoms and for reducing BDNF levels in serum.

Background Compassion-based interventions delivered over the internet are showing promising results for the promotion of psychological health and well-being. Several studies have highlighted their feasibility, acceptance, and preliminary efficacy. However, this is an incipient field of research, and to the best of our knowledge, there are no data available from Spanish-speaking countries. Objective The aim of this study is to investigate the feasibility, acceptance, and preliminary efficacy of the Internet Attachment–Based Compassion Therapy (iABCT), a web-based version of the Attachment-Based Compassion Therapy, in Spanish speakers from the general population. Methods This feasibility study features a single-arm, uncontrolled, within-group design with an embedded qualitative and quantitative process evaluation at baseline, immediately after the intervention and at the 3-month follow-up. A minimum of 35 participants from the general population will be allocated to iABCT. Feasibility measures will include attrition rate, patterns of use of the web-based system, and participants’ acceptability, usability, and opinion. The primary outcome was measured using the Pemberton Happiness Index. Secondary outcomes were measured using the Compassion Scale, Self-Compassion Scale, Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short form, Five Facets of Mindfulness Questionnaire, Relationships Questionnaire, General Health Questionnaire, Non-Attachment Scale, International Positive and Negative Affect Schedule Short Form, Purpose-In-Life Test, and difficulties regarding the practice of compassion (Compassion Practice Quality Questionnaire). Mixed models will be used to evaluate primary and secondary outcome measures. A qualitative content analysis of the participants’ qualitative responses will also be performed. Results Enrollment started in February 2020 and will be finished in April 2020. Data analysis will start in October 2020. Conclusions To our knowledge, this study will, for the first time, show data on the feasibility, acceptability, and preliminary efficacy of web-based compassion (and self-compassion) training—that is, the adapted iABCT—in Spanish speakers from the general population. Further aspects of their implementation (ie, facilitators, barriers, and unwanted effects) and mechanisms of change will be investigated. This study will allow the revision and fine-tuning of the developed intervention, study design, and planning procedures, as well as the initiation of a future randomized controlled trial. Trial Registration Clinicaltrials.gov: NCT03918746. Registered on April 17, 2019. Protocol version 1, 6 March 2019. International Registered Report Identifier (IRRID) PRR1-10.2196/16717

Background: 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. Methods: 56 patients were included. Measures of depression, affect, well-being, health-related quality of life, and health status were administered. Results: 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%&ndash, 39.5% of explained variance). Improvements in depression severity and PA were significant predictors of long-term change in well-being, F (3,55) = 17.78, p &lt, 0.001, R2 = 47.8%. Conclusions: This study highlights the importance of implementing IBIs in PC and the relevance of PA as a key target in Major Depressive Disorder treatment.

Mindfulness and meditation techniques have proven successful for the reduction of stress and improvement in general health. In addition, meditation is linked to longevity and longer telomere length, a proposed biomarker of human aging. Interestingly, DNA methylation changes have been described at specific subtelomeric regions in long-term meditators compared to controls. However, the molecular basis underlying these beneficial effects of meditation on human health still remains unclear. Here we show that DNA methylation levels, measured by the Infinium HumanMethylation450 BeadChip (Illumina) array, at specific subtelomeric regions containing GPR31 and SERPINB9 genes were associated with telomere length in long-term meditators with a strong statistical trend when correcting for multiple testing. Notably, age showed no association with telomere length in the group of long-term meditators. These results may suggest that long-term meditation could be related to epigenetic mechanisms, in particular gene-specific DNA methylation changes at distinct subtelomeric regions. The project has received funding from the Network for Prevention and Health Promotion in primary Care (RD12/0005 and RD16/0007/0005) grant and a FIS grant (PI16/00962) from the Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness, co-financed with European Union ERDF funds. MM has received a grant 'intensificación' from Fundación LaCaixa.

A recent study has supported the efficacy of Attachment-Based Compassion Therapy (ABCT) compared to relaxation (REL) for the management of fibromyalgia (FM). The main objective of this paper is to examine the cost-utility of ABCT compared to REL in terms of effects on quality-adjusted life years (QALYs) as well as healthcare costs. Forty-two Spanish patients with FM received 8 weekly group sessions of ABCT or REL. Data collection took place at pre- and 3-month follow-up. Cost-utility of the two treatment groups (ABCT vs. REL) was compared by examining treatment outcomes in terms of QALYs (obtained with the EQ-5D-3L) and healthcare costs (data about service use obtained with the Client Service Receipt Inventory). Data analyses were computed from a completers, ITT, and per protocol approach. Data analysis from the healthcare perspective revealed that those patients receiving ABCT exhibited larger improvements in quality of life than those doing relaxation, while being less costly 3 months after their 8-week treatment program had ended (completers: incremental cost M, 95% CI = &euro, &minus, 194.1 (&minus, 450.3 to 356.1), incremental effect M, 95% CI = 0.023 QALYs (0.010 to 0.141)). Results were similar using an ITT approach (incremental cost M, 95% CI = &euro, 256.3 (&minus, 447.4 to &minus, 65.3), incremental effect M, 95% CI = 0.021 QALYs (0.009 to 0.033)). A similar pattern of results were obtained from the per protocol approach. This RCT has contributed to the evidence base of compassion-based interventions and provided useful information about the cost-utility of ABCT for FM patients when compared to relaxation. However, the small sample size and short follow-up period limited the generalizability of the findings.

As dimensions of effortful control (EC), activation control, attentional control, and inhibitory control could mediate the relationship between mindfulness meditation practice and the facets of mindfulness (i.e., observing, describing, acting with awareness, non-judging and non-reacting to inner experience). In this study, we tested whether participant status: meditators (n = 330), healthy non-meditators (n = 254) and individuals with borderline personality disorder (BPD) diagnosis (n = 46) predicted the facets of mindfulness and if these potential effects were mediated through the three effortful control (EC) dimensions (activation, attentional and inhibitory control). Meditators scored higher than non-meditators on attentional and inhibitory control and on the facets of mindfulness with attentional and inhibitory control partially mediating this relationship between meditation status and mindfulness facets. Participants with BPD showed lower scores on EC along with lower scores on the facets of mindfulness compared with healthy non-meditators. All three aspects of EC partially mediated the relationship between BPD and mindfulness facets. Copyright © 2018 John Wiley & Sons, Ltd.

Spanish Research Network on Preventative Activities and Health Promotion (RD06/0018/0017) and the Aragon Health Sciences Institute.

The benefits of mindfulness on human health are well-documented, but the mechanisms underlying these effects are not well-understood. Our aim was to identify molecular alterations related to mindfulness by profiling the epigenetic response in long-term meditators. We performed a genome-wide screen of DNA methylation by using the Illumina HumanMethylation450 platform in peripheral blood leukocytes from 17 long-term meditators and 17 matched controls. Top-ranked genes were validated by bisulfite cloning sequencing. Database for Annotation, Visualization, and Integrated Discovery and Ingenuity Pathways Analysis bioinformatic tools were used to characterize key processes underling the methylation changes. We found 64 differentially methylated regions (DMRs) in meditators compared to controls, corresponding to 43 genes. Most of the mindfulness-related DMRs (70.3%) were hypomethylated in meditators, and 23.4% of mindfulness-related DMRs clustered in telomeric chromosomal regions. Notably, almost half of the mindfulness-related DMRs (48.4%) involved genes linked to common human diseases, such as neurological and psychiatric disorders, cardiovascular diseases, and cancer. Lipid metabolism and atherosclerosis signaling pathway were significantly enriched in our set of DMRs. Functional in silico analysis also revealed tumor necrosis factor (TNF) and NF-κB signaling as crucial regulators of the mindfulness-related genes. Our study suggests that there is a consistent epigenetic response to long-term meditation practice in blood leukocytes with predominant loss of cytosine-phosphate-guanine methylation in distinct genomic regions, such as telomeres. Further research is warranted to confirm that the molecular response to mindfulness practice involves crucial transcriptional regulators related to a wide range of human common diseases, such as TNF and NF-κB.

Objectives To evaluate the efficacy of a mindfulness-based programme (MBP) for reducing stress in university students and its action mechanisms and to explore the capacity of virtual reality (VR) exposure to enhance adherence to the intervention. Methods This randomized controlled trial (RCT) involved assessment time points of baseline, posttreatment, and 6-month follow-up. A total of 280 students from two Spanish universities were randomly assigned to ‘MBP’, ‘MBP + VR’, or ‘Relaxation’ (active controls). Perceived stress posttreatment was the primary outcome; wellbeing and academic functional outcomes were assessed as well. Multilevel mixed-effects models were performed to estimate the efficacy of the programme. Results Both ‘MBP’ (B = −2.77, d = −0.72, p = .006) and ‘MBP + VR’ (B = −2.44, d = −0.59, p = .014) were superior to ‘Relaxation’ in improving stress, as well as most of the secondary outcomes, with medium-to-large effects posttreatment and at follow-up. The long-term effects of MBPs on stress were mediated by mindfulness and self-compassion in parallel. Treatment adherence was improved in the ‘MBP + VR’ group, with higher retention rates and session attendance (p Conclusions This RCT supports the efficacy of an MBP compared to relaxation for reducing stress in university students through mindfulness and self-compassion as mechanisms of change. VR exposure may enhance treatment adherence. Trial registration: ClinicalTrials.gov NCT03771300.

Objective: Research has shown that there is an association between Inflammatory Bowel Disease, anxiety and mood disorders, however little is known about their association with Eating Disorders. In this paper we will present a case of a young female with a comorbid diagnosis of Inflammatory Bowel Disease and Eating Disorder, and then discuss the results from a systematic review of the literature, describing published cases of patients with the same condition. Methods: A systematized review of the literature was conducted according to MOOSE guidelines. A computerized literature search of MEDLINE, PsycINFO and EMBASE, and a manual search through reference lists of selected original articles were performed to identify all published case-reports, case series and studies of Inflammatory Bowel Disease and Eating Disorders. Results: Fourteen articles were included, encompassing 219 cases, including ours. The vast majority were females ranging from 10 to 44 years old. Anorexia Nervosa (n = 156) and Crohn's Disease (n = 129) was the most frequent combination (n = 90) reported in the literature. These cases present a poor prognosis because of corticoid refusal, medication abandon and/or deliberate exacerbation of IBD symptoms, in the context of trying to lose weight. Conclusion: Recent evidence suggests there is a possible association between Inflammatory Bowel Disease and Eating Disorders, although the mechanisms involved in its ethiopathogenesis are still unknown. To be aware of this association is important because a delayed diagnosis of this comorbidity may lead to worse prognosis. Further research and a multidisciplinary approach could facilitate earlier diagnosis and provide therapeutic interventions.

Internet-delivered psychotherapy has been demonstrated to be effective in the treatment of depression. Nevertheless, the study of the adherence in this type of the treatment reported divergent results. The main objective of this study is to analyze predictors of adherence in a primary care Internet-based intervention for depression in Spain. A multi-center, three arm, parallel, randomized controlled trial was conducted with 194 depressive patients, who were allocated in self-guided or supported-guided intervention. Sociodemographic and clinical characteristics were gathered using a case report form. The Mini international neuropsychiatric interview diagnoses major depression. Beck Depression Inventory was used to assess depression severity. The visual analogic scale assesses the respondent’s self-rated health and Short Form Health Survey was used to measure the health-related quality of life. Age results a predictor variable for both intervention groups (with and without therapist support). Perceived health is a negative predictor of adherence for the self-guided intervention when change in depression severity was included in the model. Change in depression severity results a predictor of adherence in the support-guided intervention. Our findings demonstrate that in our sample, there are differences in sociodemographic and clinical variables between active and dropout participants and we provide adherence predictors in each intervention condition of this Internet-based program for depression (self-guided and support-guided). It is important to point that further research in this area is essential to improve tailored interventions and to know specific patients groups can benefit from these interventions.

Background and objective Different review articles support the usefulness and effectiveness of mindfulness techniques in health and wellbeing. In this paper we present a first prototype of a mobile application to help with the training and practice of mindfulness, taking into account the lacks detected in a previous literature review. Our aim was to measure acceptance and perceived quality, as well as gather data about app usage. Their dependence on demographic variables and the change in mindful level was also measured. Materials and methods Two versions of a new application were developed, “Mindfulness” and “Mindfulness Sci”. The application has been tested in two pilot studies: in traditional face-to-face mindfulness groups and in individual and independent use. Results 3977 users were involved in this study: 26 in the first trial during an 8-week usage period and 3951 in the second trial during 17 months. In the first study, participants assessed the app with high scores. They considered it as a helping tool for mindfulness practice, user-friendly and with high quality of use. The positive perception was maintained after 8-weeks meditation workshops, and participants considered that its use could contribute to obtain benefits for mental and physical health. In the second study, we found rather weak associations between usage time and age, nationality and educational level. The mindful level showed a weak positive correlation with the session accomplished but slightly above the boundary of statistical significance (p-value = 0.051). Videos and information stood out as the most accessed resources. Conclusions Up to our knowledge, this is the first app developed with the help of health professionals in Spanish that could be used with a general aim, in health and wellbeing. The results are promising with a positive evaluation in face-to-face and independent use situations. Therefore, the number of potential users is enormous in a global worldwide context.

Los índices de depresión en el mundo desarrollado se han incrementado en las últimas décadas. Según el informe de la OMS, publicado en 2012, aproximadamente el 5% de la población refiere haber experimentado un episodio depresivo en algún momento de su vida. En los últimos años se están investigado qué factores pueden ser los responsables, como la merma de la calidad de la dieta, de las horas de sueño, de la actividad física, de la exposición a luz ambiental o del lazo social. Todos estos factores aumentan la vulnerabilidad para la depresión hasta el punto de que, lo mismo que le ocurre a la diabetes o las enfermedades cardiovasculares, la depresión se considera como una «enfermedad de la modernidad», aludiendo a que los cambios en nuestras rutinas pueden predisponer la aparición de las mismas. En coherencia con ello, ayudar a que el paciente mejore sus hábitos de vida podría tener un impacto positivo en su clínica depresiva, como efectivamente se está demostrando. Los tratamientos de los que disponemos en la actualidad, como los fármacos o la psicoterapia, no siempre demuestran ser totalmente eficaces, y hay estimaciones de que solo en torno al 50% de los pacientes tratados por depresión presentan remisión total sin precisar otro tipo de intervenciones. En este trabajo describimos un programa multimodal de estilo de vida para pacientes con depresión que aborda los factores mencionados y que se ha denominado programa de «estilo de vida mediterráneo». Concluimos planteando que el estilo de vida saludable, aunque está en retroceso en muchas partes del mundo, es un factor protector frente a la depresión y muchos pacientes pueden recuperarlo con ayuda específica. Depression rates have increased in recent decades in the developed world. According to the WHO report published in 2012, approximately 5% of the population refer to having experienced a depressive episode at some point in their life. In the last few years, the factors responsible for reducing the quality of diet, sleeping hours, physical activity, exposure to ambient lighting, or social environment are being investigated. All of these factors increase the vulnerability to depression to the point that, like diabetes or cardiovascular disease, depression is considered as a “modern disease” referring to the changes we make in our lifestyles that may predispose to the appearance of these diseases. Consequently, helping patients to improve their lifestyles could have a positive impact on their depressive symptoms, as is being demonstrated. Current available treatments, such as drugs or psychotherapy, do not always prove to be fully effective, and there are estimates that only about 50% of patients treated for depression have total remission without requiring other interventions. In this paper, we describe a multimodal lifestyle program for patients with depression that addresses the above factors and has been labelled as the “Mediterranean lifestyle” program. It is concluded that healthy lifestyle (a regressive lifestyle in many parts of the world), is a protective factor against depression, and many patients can recover from it with specific help.

Electroencephalogram (EEG) studies of mindfulness have shown it can lead to increases in alpha power, which are similar to those obtained by alpha-based neurofeedback (NF) interventions. It has been hypothesized there may be relationships between mindfulness and NF in terms of the neural pathways through which they induce salutary outcomes. The aim of the study was to evaluate possible changes in mindfulness and cognitive functioning following an alpha-based NF intervention, and the role of alpha power as a mediator of improvements. A controlled, non-randomized, trial with 50 healthy participants was conducted with two experimental conditions: a six-session NF intervention and a waiting-list control group. Both groups were administered mindfulness questionnaires (Mindful Attention Awareness Scale (MAAS), Five Facet Mindfulness Questionnaire (FFMQ)) and cognitive measures (Paced Auditory Serial Addition Task (PASAT)), at pre- and post-test. The NF intervention focused on the up-regulation of upper alpha power. Differences among groups were estimated using ANCOVAs, and mediation assessment through path analyses. Compared to controls, the NF group showed enhanced task-related upper alpha power (effect size (ES) = 1.16, p

Fibromyalgia (FMS) is a prevalent, disabling syndrome characterized by chronic widespread musculoskeletal pain and symptoms such as sleep disturbance, fatigue, stiffness, distress, cognitive impairments and a high comorbidity with anxiety and depressive disorders. Although no curative treatment has yet been found, various therapeutic approaches have been developed in the fields of pharmacology and psychology. The present paper aims to offer a narrative review and a description for clinicians and researchers of psychological therapies that have been applied in a format group in FMS with strong or promising empirical support: i.e., Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), Mindfulness-Based Stress Reduction (MBSR), Psychoeducational program for FMS (FibroQoL), Amygdala Retraining Therapy (ART), and Attachment-Based Compassion Therapy (ABCT). This review will offer a brief practical summary of each therapy protocol (session-by-session), their rationale and available evidence of their effectiveness.

The aim of this study was to analyze the cost utility of a group-based form of acceptance and commitment therapy (GACT) in patients with fibromyalgia (FM) compared with patients receiving recommended pharmacological treatment (RPT) or on a waiting list (WL). The data were derived from a previously published study, a randomized controlled trial that focused on clinical outcomes. Health economic outcomes included health-related quality of life and health care use at baseline and at 6-month follow-up using the EuroQoL and the Client Service Receipt Inventory, respectively. Analyses included quality-adjusted life years, direct and indirect cost differences, and incremental cost effectiveness ratios. A total of 156 FM patients were randomized (51 GACT, 52 RPT, 53 WL). GACT was related to significantly less direct costs over the 6-month study period compared with both control arms (GACT €824.2 ± 1,062.7 vs RPT €1,730.7 ± 1,656.8 vs WL €2,462.7 ± 2,822.0). Lower direct costs for GACT compared with RPT were due to lower costs from primary care visits and FM-related medications. The incremental cost effectiveness ratios were dominant in the completers’ analysis and remained robust in the sensitivity analyses. In conclusion, acceptance and commitment therapy appears to be a cost-effective treatment compared with RPT in patients with FM. Perspective Decision-makers have to prioritize their budget on the treatment option that is the most cost effective for the management of a specific patient group. From government as well as health care perspectives, this study shows that a GACT is more cost effective than pharmacological treatment in management of FM.

General practitioners (GPs) report high levels of distress. This study examined whether a brief blended web-based mindfulness intervention could be effective at enhancing well-being for GPs and assessed the possible mediating role of awareness. An open uncontrolled trial, with pre-post measurements, was conducted. The programme comprised one face-to-face meeting (4 h) and eight online practice sessions with no support (two weekly sessions over 4 weeks). The primary outcome was positive affect (PANAS-positive). The secondary outcomes were as follows: negative affect (PANAS-negative), awareness (MAAS), resilience (CDRISC), and the burnout subtypes (BCSQ-12). Mixed-effects analysis for repeated measures and mediation analysis by regression models were performed. Two hundred ninety Spanish GPs took part in the study, attending the face-to-face meeting. Nearly one out 10 participants (n = 28) completed ‘one weekly practice’, and 10.4% (n = 30) accomplished ‘two or more weekly practices’. There were benefits for those with ‘two or more weekly practices’ in PANAS-positive (B = 2.97; p = 0.007), and MAAS (B = 4.65; p = 0.023). We found no benefits for those with ‘one weekly practice’ in any of the outcomes. There were mediating effects of MAAS in PANAS-positive (explaining a 60.8% of total effects). A brief blended mindfulness intervention, with minimum face-to-face contact and web-based practice sessions, seems to confer improvements in the well-being of Spanish GPs. The benefits may be mediated by awareness. The implementation of this kind of programme might enhance the well-being among GPs, but there is a need to improve adherence to practice. Further research using randomized controlled designs will be needed to support the evidence found in our study.

This meta-analysis aims to determine the effects of regular swimming on bone mineral density (BMD) in young adults (18-30 years). A systematic search was performed in Pubmed, SPORTDiscus and the Cochrane Library from the earliest possible year to March 2016. Swimmers were compared to non-athletic controls (CG) and to high-impact athletes (HIGH). Effect sizes with the Hedges g in random effects models were developed. Fourteen studies met the inclusion criteria and were included in the meta-analyses. Swimmers presented similar BMD values to CG in whole-body (g = -0.20; P = 0.251), femoral neck (g = -0.05; P = 0.818) and lumbar spine (g = 0.18; P = 0.492); and lower BMD in the whole-body (g = -1.21; P 0.001), femoral neck (g = -1.51; P 0.001) and lumbar spine (g = -0.84; P = 0.017) than the HIGH. For the whole-body differences, the higher the latitude the smaller the differences between swimmers and HIGH (B = 0.10; P = 0.001). For the femoral neck differences, age also seemed to reduce the differences between groups (B = 0.19; P = 0.020). Young adult swimmers present similar BMD values than CG and lower values than HIGH.

IntroductionLittle is known about the applicability of mindfulness-based interventions in Spanish adults with overweight/obesity. The objective of the present study protocol is to describe the methods that will be used in a cluster randomised trial (CRT) that aims to evaluate the effectiveness of a mindfulness eating (ME) programme to reduce emotional eating (EE) in adults with overweight/obesity in primary care (PC) settings.Methods and analysisA CRT will be conducted with approximately 76 adults with overweight/obesity from four PC health centres (clusters) in the city of Zaragoza, Spain. Health centres matched to the average per capita income of the assigned population will be randomly allocated into two groups: ‘ME +treatment as usual (TAU)’ and ‘TAU alone’. The ME programme will be composed of seven sessions delivered by a clinical psychologist, and TAU will be offered by general practitioners. The primary outcome will be EE measured by the Dutch Eating Behaviour Questionnaire (DEBQ) at post test as primary endpoint. Other outcomes will be external and restrained eating (DEBQ), binge eating (Bulimic Investigatory Test Edinburgh), eating disorder (Eating Attitude Test), anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), mindful eating (Mindful Eating Scale), dispositional mindfulness (Five Facet Mindfulness Questionnaire) and self-compassion (Self-Compassion Scale). Anthropometric measures, vital signs and blood tests will be taken. A primary intention-to-treat analysis on EE will be conducted using linear mixed models. Supplementary analyses will include secondary outcomes and 1-year follow-up measures; adjusted models controlling for sex, weight status and levels of anxiety and depression; the complier average causal effect of treatment; and the clinical significance of improvements.Ethics and disseminationPositive results of this study may have a significant impact on one of the most important current health-related problems. Approval was obtained from the Ethics Committee of the Regional Authority. The results will be submitted to peer-reviewed journals, and reports will be sent to participants.Trial registration numberNCT03927534(5/2019).