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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.

Eating disorders, life stressful events and body image: A systematic review Abstract: Our objective was to clarify the relationship between adverse life events and the altered body image in eatingdisorders. We reviewed English and Spanish papers indexed in MEDLINE, PsycINFO and ScienceDirect from the last 10years. We included 16 studies of which 37.5% focus on eating disorders. Sexual abuse, physical abuse, domestic violence,bullying and having experienced multiples adverse life events have been associated with overweight patients and high body dissatisfaction. Emotional abuse has been associated with underweight and body shape concerns. Posttraumatic symptoms and emotion dysregulation have been identified as mediating factors. Eating disorder psychopathology could be the response to a bad regulation of negative emotion coming from different adverse life events and this mechanism could underlie patiens’ body dissatisfaction. Keywords: eating disorders; adverse life events; bulimia nervosa; anorexia nervosa; binge-eating disorder; body image; body dissatisfaction; traumatic events. Resumen: El objetivo de este trabajo es esclarecer la relación entre experiencias adversas vitales y la alteración de la imagen corporal en los trastornos alimentarios. Se han revisado trabajos en inglés y castellano indexados en MEDLINE, PsychoINFO y ScienceDirect en los últimos 10 años. Se han incluido 16 estudios de los cuales, el 37.5% se centra en trastornos de la alimentación. El abuso sexual, el físico, la violencia intrafamiliar, el acoso escolar y la suma de diferentes experiencias adversas vitales identifican pacientes con sobrepeso y alta insatisfacción corporal. El abuso emocional se ha asociado a bajo peso y preocupación entorno a la figura. La relación con la imagen corporal está mediada por clínica postraumática y la desregulación emocional. La clínica alimentaria es una respuesta a un mal manejo de emociones negativas derivadas de diferentes experiencias adversas y este mecanismo podría estar en la base de la insatisfacción corporal de los pacientes. Palabras clave: trastornos de la alimentación; experiencias adversas vitales; bulimia nerviosa; anorexia nerviosa; trastorno de atracón; imagen corporal; insatisfacción corporal; eventos traumáticos.

Gambling disorder in youth is an emerging public health problem, with adolescents and young adults constituting a vulnerable age group for the development of gambling-related problems. Although research has been conducted on the risk factors for gambling disorder, very few rigorous studies can be found on the efficacy of preventive interventions in young people. The aim of this study was to provide best practice recommendations for the prevention of disordered gambling in adolescents and young adults. We reviewed and synthesized the results of existing RCTs and quasi-experimental studies covering nonpharmacological prevention programs for gambling disorder in young adults and adolescents. We applied the PRISMA 2020 statement and guidelines to identify 1483 studies, of which 32 were included in the systematic review. All studies targeted the educational setting, i.e., high school and university students. Most studies followed a universal prevention strategy, that particularly targeted adolescents, and an indicated prevention strategy for university students. The reviewed gambling prevention programs generally showed good results in terms of reducing the frequency and severity of gambling, and also regarding cognitive variables, such as misconceptions, fallacies, knowledge, and attitudes towards gambling. Finally, we highlight the need to develop more comprehensive prevention programs that incorporate rigorous methodological and assessment procedures before they are widely implemented and disseminated.

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.

Research on the use of Acceptance and Commitment Therapy (ACT) for patients with degenerative lumbar pathology awaiting surgery are limited. However, there is evidence to suggest that this psychological therapy may be effective in improving pain interference, anxiety, depression, and quality of life. This is the protocol for a randomized controlled trial (RCT) to evaluate the effectiveness of ACT compared to treatment as usual (TAU) for people with degenerative lumbar pathology who are candidates for surgery in the short term. A total of 102 patients with degenerative lumbar spine pathology will be randomly assigned to TAU (control group) or ACT + TAU (intervention group). Participants will be assessed after treatment and at 3-, 6-, and 12-month follow-ups. The primary outcome will be the mean change from baseline on the Brief Pain Inventory (pain interference). Secondary outcomes will include changes in pain intensity, anxiety, depression, pain catastrophizing, fear of movement, quality of life, disability due to low back pain (LBP), pain acceptance, and psychological inflexibility. Linear mixed models will be used to analyze the data. Additionally, effect sizes and number needed to treat (NNT) will be calculated. We posit that ACT may be used to help patients cope with the stress and uncertainty associated with their condition and the surgery itself.

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.

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.

The aim of this study was to compare meditators and non-meditators in terms of their tendency to have peak experiences and their dream lucidity, while examining the associations between these outcomes and some related variables such as non-dual awareness, mindfulness facets and absorption. In this cross-sectional study, 237 participants from general Spanish population completed an online survey that included ad hoc questions related to the study aim, along with the Five Facet Mindfulness Questionnaire (FFMQ), the Non-dual Embodiment Thematic Inventory (NETI), the Tellegen Absorption Scale (TAS) and the Lucidity and Consciousness in Dreams Scale (LUCID). Of the total, 110 participants were identified as meditators and 127 as non-meditators. More than half of the sample (58.2%) reported having experienced at least one peak experience in their life; these showed no differences in the number, intensity, or self-inducing ability of these experiences between both groups but were significantly more common among meditators (71.8% vs. 46.8%; p < 0.001), who also presented higher scores in most of the questionnaires, except for some LUCID subscales. Regression models demonstrated that being a meditator was a significant predictor of having had a peak experience, but not of LUCID scores. These results, which need to be interpreted considering the study limitations, support the potential of meditation to facilitate having peak experiences, while its impact on lucid dreams remains unclear.

Altres ajuts: acords transformatius de la UAB Objective: The primary aim of this study was to analyse the efficacy of a 'mindful eating' program for reducing emotional eating in patients with overweight or obesity. Method: A cluster randomized controlled trial (reg. NCT03927534) was conducted with 76 participants with overweight/obesity who were assigned to 'mindful eating' + treatment as usual (TAU), or to TAU alone. They were assessed at baseline, posttreatment and 12-month follow-up. The main outcome was 'emotional eating' (Dutch Eating Behavior Questionnaire, DEBQ); other eating behaviours were also assessed along with psychological and physiological variables. Results: 'Mindful eating' + TAU reduced emotional eating both at posttreatment (B=-0.27; p=.006; d=0.35) and follow-up (B=-0.53; p< .001; d=0.69). 'External eating' (DEBQ) was also significantly improved by the intervention at both timepoints. Significant effects at follow-up were observed for some secondary outcomes related to bulimic behaviours, mindful eating, mindfulness, and self-compassion. Weight and other physiological parameters were not significantly affected by 'mindful eating' + TAU. Conclusions: These findings support the efficacy of the 'mindful eating' + TAU program for reducing emotional and external eating, along with some other secondary measures, but no significant changes in weight reduction were appreciated.

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.

Los trastornos emocionales (ansiedad, depresión y trastornos relacionados) son los trastornos psicológicos más prevalentes se- gún estudios epidemiológicos recientes. Debido a su alta prevalencia en la población, encontrar un tratamiento coste-efectivo para estos trastornos se ha convertido en un objetivo clave para la psicología clínica, sobre todo en contextos públicos donde cuentan con re- cursos limitados y se enfrentan a largas listas de espera. Con este panorama asistencial, nos planteamos buscar nuevos abordajes terapéuticos que puedan sostener la creciente prevalencia de los trastornos ansioso-depresivos. En este contexto, las intervenciones grupales basadas en Mindfulness cuentan con numerosos estudios que abalan su eficacia en la reducción de los síntomas de ansiedad y depresión. En esta línea de trabajo, en el Hospital Universitario de la Plana (Vila-Real, Castellón) se ha llevado a cabo una Intervención Basada en Mindfulness para el tratamiento de los síntomas ansioso-de- presivos en un contexto público de Salud Mental Especializada. La muestra estuvo compuesta 58 pacientes (82,8% mujeres, edad media 39,16 años; DT = 11,52) con síntomas del espectro ansio- so-depresivo, pertenecientes a la Unidad de Salud Mental de Ca- rinyena (Vila-Real, Castellón) que asistieron a 8 sesiones grupales de tratamiento basado en atención plena, impartidas por dos Psi- cólogos Internos Residentes. Las sesiones de tratamiento abarcan los contenidos teóricos y prácticos de los dos principales proto- colos de Mindfulness que existen, el Programa de Reducción del Estrés basado en la atención plena (MBSR); y la Terapia Cognitiva basada en Mindfulness (MBCT). Los participantes respondieron los cuestionarios BDI-II y STAI, que evalúan depresión y ansiedad respectivamente. Los análisis indicaron un descenso significativo en ambas variables de estudio tras el tratamiento, con tamaños del efecto entre medios y altos. Así, los resultados van en la línea de trabajos anteriores y apoyan la implantación Intervenciones grupales Basadas en Mindfulness en el Sistema Público de Salud Mental Español., Psicosomàtica y Psiquiatría, Núm. 16 (2021)

La depresión es, desde hace ya unos años, un proble-ma de salud pública a nivel mundial reconocido por la OMS. La prevalencia actual de esta patología, en los servicios de Atención Primaria, se estima en 19,5% a nivel mundial y en 20,2% en España. Además, las políticas y protocolos de intervención actuales están suponiendo unos importantes costes, tanto personales como económicos, para las personas que padecen este trastorno, así como para la sociedad en ge-neral. Por otro lado, los índices de recaídas tras las interven-ciones farmacológicas que se aplican actualmente y la falta de una atención especializada eficaz en los servicios de salud mental, ponen de relieve la necesidad de desarrollar nuevas estrategias terapéuticas más accesibles y coste-efectivas. En esta línea, una de las propuestas que se están investigando en diferentes partes del mundo es el diseño y evaluación de protocolos terapéuticos aplicados a través de las Tecno-logías de la Información y la Comunicación, especialmente, a través de internet y de programas de ordenador. Por ello, el objetivo de este trabajo es presentar la situación actual de la atención en España respecto a la utilización de estas intervenciones para el tratamiento de la depresión en Atención Primaria. La conclusión principal es que, aunque existe evidencia científica sobre la eficacia de estos programas, to-davía existen barreras importantes que dificultan su implan-tación en el sistema público, y, por otro lado, la necesidad de desarrollar estudios de implementación que faciliten la transición de la investigación a la práctica clínica. Currently, depression is a global health problem recog-nized by the WHO. The prevalence of this pathology in Pri-mary 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 eco-nomic, 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 ap-plied and the lack of effective specialized attention in mental health services reflect the need to develop new therapeutic strategies that are more accessible and profit-able. Therefore, one of the proposals that are being inves-tigated in different parts of the world is the design and evaluation of therapeutic protocols applied through Infor-mation and Communication Technologies, especially through the Internet and computer programs. The objec-tive 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 conclu-sion 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.

The important inflow of foreign population to western countries has boosted the study of acculturation processes among scholars in the last decades. By using the case of Catalonia, a receiver region of international and national migration since the fifties, this paper seeks to intersect a classic acculturation model and a newly reemerging literature in political science on contextual determinants on individual behavior. Does the context matters for understanding individual's subjective national identity and, therefore, its voting behavior? Multilevel models show that environment matters. Percentage of Spain-born population in the town is statistically significant to account for variance in the subjective national identity and nationalist vote, even after controlling for age, sex, origin, language and left - right orientation and other contextual factors. This conclusion invites researchers not to underestimate the direct effect of the environment on individual outcomes such as feelings of belonging and vote orientation in contexts of rival identities.

AIMS: To explore the relationship between mindfulness, self-compassion and psychological flexibility, and the burnout subtypes in university students of the Psychology and Nursing degrees, and to analyse possible risk factors for developing burnout among socio-demographic and studies-related characteristics. DESIGN: Cross-sectional study conducted on a sample of 644 undergraduate students of Nursing and Psychology from two Spanish universities. METHODS: The study was conducted between December 2015 and May 2016. Bivariate Pearson's correlations were computed to analyse the association between mindfulness facets, self-compassion and psychological flexibility, and levels of burnout. Multivariate linear regression models and bivariate and multivariate binary logistic regressions were also computed. RESULTS: The three subtypes of burnout presented significant correlations with psychological flexibility, self-compassion and some mindfulness facets. Psychological flexibility, self-compassion and the mindfulness facets of observing and acting with awareness were significantly associated to burnout. Among the risk factors, 'year of study' was the only variable to show significantly higher risk for every burnout subtype. CONCLUSION: The significant associations found between mindfulness, self-compassion, psychological flexibility and burnout levels underline the need of including these variables as therapeutic targets when addressing the burnout syndrome in university students. IMPACT: Undergraduate students, especially those of health sciences, often experience burnout. This study delves into the protective role of some psychological variables: mindfulness, self-compassion and psychological flexibility. These should be considered as potentially protective skills for developing burnout, and therefore, undergraduate students could be trained on these abilities to face their studies and their future profession to prevent experiencing burnout syndrome.

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.

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 (beta=-3.05; P=.01) and MP (beta=-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., This study was financed by the Instituto de Salud Carlos III of the Spanish Ministry of Economy and Competitiveness with the PI13/01171 grant (Efficacy and cost-effectiveness of the low-intensity psychological interventions applied by ICTs for the treatment of depression in primary care: a controlled trial). The authors would like to thank the Institut d'Investigacio Sanitaria de les Illes Balears (IdiSBa) for the assistance received on statistical analysis queries.

La depresión es un problema de salud pública en todo el mundo reconocido por la OMS, cuya prevalencia en los servicios de Atención Primaria se estima en 19,5% a nivel mundial, y en 20% en España. Debido a la necesidad de diseñar nuevas estrategias terapéuticas que permitan hacer frente a este problema, en los últimos años se ha venido desarrollado una línea de investigación dirigida a la creación y evaluación de protocolos de intervención psicológica aplicados a través de las Tecnologías de la Información y la Comunicación, y especialmente las realizadas a través de internet. De hecho, la literatura científica disponible sugiere que estos tratamientos pueden ser alternativas eficaces para el tratamiento de la depresión. Por otro lado, las terapias de tercera generación, y concretamente las intervenciones basadas en mindfulness, han mostrado ser efectivas para el tratamiento de diferentes psicopatologías. Sin embargo, apenas se cuenta con estudios científicos llevados a cabo en España, en los que se evalúen programas de psicoterapia por ordenador para la depresión, en el ámbito de Atención Primaria. El objetivo principal de esta tesis es evaluar la eficacia de un protocolo de intervención psicológica breve basada en mindfulness y aplicada a través de internet para el tratamiento de la depresión leve-moderada, dentro del contexto sanitario español de Atención Primaria. El estudio de investigación que se presenta fue un ensayo clínico multicéntrico controlado y aleatorizado en dos grupos paralelos. Los pacientes con depresión leve o moderada, incluidos en el estudio, fueron asignados al azar entre las dos condiciones experimentales: a) tratamiento breve de psicoterapia por ordenador basado en mindfulness + tratamiento habitual mejorado (mindfulness + iTAU); b) tratamiento habitual mejorado (iTAU). La gravedad de la depresión, variable principal del estudio, se evaluó con el cuestionario sobre la salud del paciente, por sus siglas en inglés PHQ-9. Además, también se recogieron las siguientes variables: calidad de vida (SF-12), afecto positivo y negativo (PANAS); mindfulness (FFMQ); y bienestar (PHI). Las medidas de evaluación se llevaron a cabo en el pre-tratamiento (momento 1), en el post-tratamiento (momento 2), a los 6 meses (momento 3) y 12 meses del post-tratamiento (momento 4). Finalmente, de los 111 pacientes reclutados, 54 fueron asignados al grupo mindfulness y 57 al grupo control. El tratamiento breve de psicoterapia por ordenador basado en mindfulness mostró mejoras significativas en la gravedad de depresión, en comparación al grupo control, al finalizar el tratamiento (p = 0,001). Sin embargo, estas diferencias no se mantuvieron a los 6 meses de seguimiento, puesto que los sujetos de ambos grupos experimentaron el mismo perfil de mejoría en esta variable. Para las variables afecto negativo y calidad de vida mental se observó un patrón similar al seguido por la depresión, de manera que las diferencias halladas en el post-tratamiento no se mantenían en el seguimiento a los 6 meses. Por otro lado, las variables que mejor predecían una mejora en el nivel de depresión fueron: nivel de estudios, sexo, contrato de trabajo, tiempo de tratamiento, y días de repaso antes del post-test. La principal conclusión extraída a partir de los resultados obtenidos del estudio, es que el protocolo de intervención psicológico breve basado en mindfulness y aplicado a través de internet es eficaz, a corto plazo, en la mejora de la sintomatología depresiva leve-moderada, y que podría ser una adecuada estrategia de prevención secundaria en el ámbito de Atención Primaria de España.Abstract:Depression is, nowadays, a global health problem recognized by the World Health Organization. The prevalence of this pathology in Primary Care is estimated at 19.5% worldwide, and 20.2% in Spain. Due to the need to create new therapeutic strategies to address this problem, a line of research has been developed in recent years, whose objective is creating and evaluating psychological intervention protocols applied through Information and Communication Technologies, and especially those applied over the Internet. In fact, scientific literature suggests that these treatments may be effective alternatives for the treatment of depression. On the other hand, third generation therapies, and specifically mindfulness-based interventions, have been proven effective for the treatment of different psychopathologies. However, there is an absence of scientific studies carried out in Spain in which computer psychotherapy programs are evaluated for depression in Primary Care. The main objective of this thesis is to evaluate the efficacy of a brief psychological mindfulness-based intervention applied through the internet for the treatment of mild-moderate depression in Spanish Primary Care. A multicenter, two-arm, parallel, randomized controlled trial was carried out. Participants were randomized into two experimental conditions: a) brief online mindfulness-based intervention + improved usual treatment (mindfulness + iTAU); b) improved usual treatment (iTAU). The main outcome of the study was depression, which was evaluated with the Patient Health Questionnaire (PHQ-9). In addition, the following variables were also evaluated: quality of life (SF-12), positive and negative affect (PANAS); mindfulness (FFMQ); and well-being (PHI). The evaluations were collected from the pre-treatment (time 1) to the post-treatment (time 2), and up to 6 (time 3) and 12 months (time 4) follow up. Finally, of the 111 patients recruited, 54 were assigned to the mindfulness group and 57 to the control group. The mindfulness intervention showed significant improvements in the severity of depression compared to control at post-treatment (p = 0,001). However, these differences were not maintained at time 3, since both groups’ participants experienced the same improvement profile regarding this variable. For the negative affect and mental quality of life, the pattern was similar to that followed by depression, so that the differences found in the post-treatment were not maintained in the 6-month follow-up. On the other hand, the variables that best predicted an improvement in the depression levels were: level of studies, sex, employment contract, treatment time, and days of revision before the post-test. The main conclusion of the study is that the brief online mindfulness-based intervention is effective in the short term in the improvement of mild-moderate depressive symptomatology, and that it could be an appropriate secondary prevention strategy in the context of Spanish Primary Care.

There is a high prevalence of stress in the logistics sector owing to very demanding, fast-paced and unpredictable tasks. Mindfulness-based programmes may reduce stress but require considerable practice. Our aim was to evaluate the feasibility and effectiveness of a shortened, workplace-adapted mindfulness-based programme for the logistics sector (WA-MBP-LS) for the purpose of reducing stress. A nonblinded, nonrandomised, two-arm controlled trial was conducted. The WA-MBP-LS (n = 32) consisted of six weekly 90-min mindfulness sessions. The control group (n = 36) attended a psycho-educational seminar. The Perceived Stress Scale (PSS) and Five Facets of Mindfulness Questionnaire (FFMQ) were measured at pretest, posttest and 6-month follow-up. Differences between groups were evaluated using mixed-effects models. Qualitative methods were used to analyse implementation issues. A 64.2% reduction was observed between initial volunteers and actual participants. Attrition at six-month follow-up was 45.6%. Participants attended a median of five sessions. Decreases in PSS favoured the WA-MBP-LS group at posttest and follow-up. FFMQ played a mediating role in PSS reductions. Barriers were disinterest, lack of programming, work overload and absences from work. Facilitators were curiosity, timing, company facilities and audio recordings. The WA-MBP-LS was feasible and effective in reducing stress, but more efforts to improve the practicalities of implementation are desirable.

Mindfulness-Based Interventions (MBIs) present positive effects on mental health in diverse populations. However, the detailed associations between MBIs and biomarkers in patients with psychiatric disorders remain poorly understood. The aim of this study was to examine the effects of MBIs on biomarkers in psychiatric illness used to summarise the effects of low-grade inflammation. A systematic review of PubMed, EMBASE, PsycINFO, and the Cochrane Library was conducted. Effect sizes (ESs) were determined by Hedges’ g and the number needed to treat (NNT). Heterogeneity was evaluated. A total of 10 trials with 998 participants were included. MBIs showed significant improvements in the event-related potential amplitudes in attention-deficit hyperactivity disorder, the methylation of serotonin transporter genes in post-traumatic stress disorder, the salivary levels of interleukin 6 (IL-6) and tumour necrosis factor alpha (TNF-α) in depression, and the blood levels of adrenocorticotropic hormone (ACTH), IL-6, and TNF-α in generalised anxiety disorder. MBIs showed low but significant effects on health status related to biomarkers of low-grade inflammation (g = −0.21; 95% confidence interval (CI) –0.41 to −0.01; NNT = 8.47), with no heterogeneity (I2 = 0; 95% CI 0 to 79). More trials are needed to establish the impact of MBIs on biomarkers in psychiatric illness.