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Introduction Health care providers face heightened stress and increased rates of anxiety and depression post-COVID-19. The pandemic, officially declared over in May 2023, continues to impact their wellbeing significantly, with ongoing mental health monitoring and tailored interventions crucial for support. Objectives The aim of this study was to describe the frequency of job stressors in a sample of Spanish health care providers post-COVID and to explore potential differences between physicians and nurses, hypothesizing that while both professional categories could experience similar job stressors, some of them could have a differential impact on the mental health of each subgroup. Methods This cross-sectional substudy is part of the MINDxYOU project. The data were collected from 191 health care providers from two regions in Spain. Participants completed the UNIPSICO test battery, used to assess job stressors, and questionnaires to evaluate perceived stress, depressive symptomatology, anxiety, and resilience. Descriptive analyses, bivariate correlations, and linear regression models were performed to compare the two professions that were the most representative of our sample: physicians (n = 82) and nurses (n = 54). Results The most frequent job stressors were workload, lack of positive feedback, and inequity in social interactions. Physicians reported worse outcomes in terms of workload, autonomy, role conflicts, inequity in social interactions, and work-family balance compared to nurses. Mobbing, despite not being very frequent, significantly predicted different mental health outcomes for both physicians and nurses. Inequity in social interactions and job satisfaction were significant predictors of physicians’ mental health, while role ambiguity, interpersonal conflicts, and career turnover intentions predicted nurses’ mental health. Conclusion As hypothesized, our findings highlight that certain job stressors (i.e., inequity in social interactions, conflicts in the workplace) might be affecting physicians’ and nurses’ mental health differently. Therefore, effective strategies addressing each subgroup's specific stressors would be necessary to prevent the development of burnout syndrome and other serious mental health conditions associated with occupational stress. These strategies would imply organizational changes in most cases.

IntroductionBrazilian Primary Health Care (PHC) is responsible for all-sanitary actions for a community-based population, including health promotion and mental health care. Mindfulness Based Health Promotion (MBHP) is an intervention that can promote self-care and psychosocial support in PHC.ObjectiveTo discuss the effects of mindfulness based psychosocial group interventions for health promotion in primary care units in Rio de Janeiro, Brazil.MethodsThe intervention was based on the MBHP model adapted for SUS. Nine groups were held in Rio de Janeiro. A quali-quanti research was held with two parts: (a) quantitative study, pre and after the 8 weeks intervention, evaluating the effect on mindfulness and self-compassion and their association with levels of anxiety, depression, and quality of life. (b) Qualitative research using Focus Groups with the participants to investigate their experience at the end of the mindfulness groups.Results and discussionSixty-two participants finished the 9 groups where 86% were women, mostly between 30 and 59 years of age and low income, and around 80% under regular medical care in PHC in SUS. In the studied sample 80% had at least one chronic health condition under treatment, including 42% with anxiety and 35% with depression. The effects included significant improvement in Anxiety and Depression and in Quality of Life, mainly in the psychological but also in the physical and interrelation domains. The qualitative study showed that most patients joined the group on the recommendation of health professionals for managing physical and mental health symptoms. Patients reported being able to use the practices taught in the sessions to manage symptoms such as insomnia and emotionally distressing situations in their daily lives. Including family members in mindfulness practices was a strategy to negotiate not only a space at home to meditate, but also to obtain a different approach to health problems. Participants pointed to mindfulness as a complementary therapeutic option to medication and psychotherapy.ConclusionMindfulness-Based Intervention have shown to be a feasible, well-accepted and efficacious method of offering psychosocial support and promoting well-being for low-income patients in primary care in LAMIC.

BackgroundDepressive disorder and type 2 diabetes mellitus (T2DM) are prevalent in primary care (PC). Pharmacological treatment, despite controversy, is commonly chosen due to resource limitations and difficulties in accessing face-to-face interventions. Depression significantly impacts various aspects of a person’s life, affecting adherence to medical prescriptions and glycemic control and leading to future complications and increased health care costs. To address these challenges, information and communication technologies (eg, eHealth) have been introduced, showing promise in improving treatment continuity and accessibility. However, while eHealth programs have demonstrated effectiveness in alleviating depressive symptoms, evidence regarding glycemic control remains inconclusive. This randomized controlled trial aimed to test the efficacy of a low-intensity psychological intervention via a web app for mild-moderate depressive symptoms in individuals with T2DM compared with treatment as usual (TAU) in PC. ObjectiveThis study aimed to analyze the cost-effectiveness and cost-utility of a web-based psychological intervention to treat depressive symptomatology in people with T2DM compared with TAU in a PC setting. MethodsA multicenter randomized controlled trial was conducted with 49 patients with T2DM, depressive symptoms of moderate severity, and glycosylated hemoglobin (HbA1c) of 7.47% in PC settings. Patients were randomized to TAU (n=27) or a web-based psychological treatment group (n=22). This web-based treatment consisted of cognitive behavioral therapy, improvement of diabetes self-care behaviors, and mindfulness. Cost-effectiveness analysis for the improvement of depressive symptomatology was conducted based on reductions in 3, 5, or 50 points on the Patient Health Questionnaire–9 (PHQ-9). The efficacy of diabetes control was estimated based on a 0.5% reduction in HbA1c levels. Follow-up was performed at 3 and 6 months. The cost-utility analysis was performed based on quality-adjusted life years. ResultsEfficacy analysis showed that the web-based treatment program was more effective in improving depressive symptoms than TAU but showed only a slight improvement in HbA1c. Incremental cost-effectiveness ratios of 186.76 for a 3-point reduction in PHQ-9 and 206.31 for reductions of 5 and 50 percentage points were obtained. In contrast, the incremental cost-effectiveness ratio for improving HbA1c levels amounted to €1510.90 (€1=US $1.18 in 2018) per participant. The incremental cost-utility ratio resulted in €4119.33 per quality-adjusted life year gained. ConclusionsThe intervention, using web-based modules incorporating cognitive behavioral therapy tools, diabetes self-care promotion, and mindfulness, effectively reduced depressive symptoms and enhanced glycemic control in patients with T2DM. Notably, it demonstrated clinical efficacy and economic efficiency. This supports the idea that eHealth interventions not only benefit patients clinically but also offer cost-effectiveness for health care systems. The study emphasizes the importance of including specific modules to enhance diabetes self-care behaviors in future web-based psychological interventions, emphasizing personalization and adaptation for this population. Trial RegistrationClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709 International Registered Report Identifier (IRRID)RR2-10.1186/S12888-019-2037-3

Abstract Background There has been growing clinical awareness in recent years of the long-term physical and psychological consequences of the SARS-CoV-2 virus, known as Long COVID. The prevalence of Long COVID is approximately 10% of those infected by the virus. Long COVID is associated with physical and neuropsychological symptoms, including those related to mental health, psychological wellbeing, and cognition. However, research on psychological interventions is still in its early stages, in which means that available results are still limited. The main objective of this study is to evaluate the effects of a program based on amygdala and insula retraining (AIR) combined with mindfulness training (AIR + Mindfulness) on the improvement of quality of life, psychological well-being, and cognition in patients with Long COVID. Methods This study protocol presents a single-blind randomized controlled trial (RCT) that encompasses baseline, post-treatment, and six-month follow-up assessment time points. A total of 100 patients diagnosed with Long COVID by the Spanish National Health Service will be randomly assigned to either AIR + Mindfulness (n = 50) or relaxation intervention (n = 50), the latter as a control group. The primary outcome will be quality of life assessed using the Short Form-36 Health Survey (SF-36). Additional outcomes such as fatigue, pain, anxiety, memory, and sleep quality will also be evaluated. Mixed effects regression models will be used to estimate the effectiveness of the program, and effect size calculations will be made. Discussion Long COVID syndrome is a clinical condition characterized by the persistence of symptoms for at least 12 weeks after the onset of COVID-19 that significantly affects people’s quality of life. This will be the first RCT conducted in Spain to apply a psychotherapy program for the management of symptoms derived from Long COVID. Positive results from this RCT may have a significant impact on the clinical context by confirming the beneficial effect of the intervention program being evaluated on improving the symptoms of Long COVID syndrome and aiding the development of better action strategies for these patients. Trial registration Clinical Trials.gov NCT05956405. Registered on July 20, 2023.

BackgroundMindfulness-based programmes (MBPs) have shown beneficial effects on mental health. There is emerging evidence that MBPs may also be associated with marked deviations in the subjective experience of waking consciousness. We aimed to explore whether MBPs can have a causal role in different types of such states.MethodsWe conducted a pragmatic randomised controlled trial (ACTRN12615001160527). University of Cambridge students without severe mental illness were randomised to an 8-week MBP plus mental health support as usual (SAU), or to SAU alone. We adapted the Altered States of Consciousness Rating Scale (OAV, 0-100-point range) to assess spontaneous experiences in daily life, and included it as a post-hoc secondary outcome at the end of the one-year follow-up questionnaire. Two-part model analyses compared trial arms, and estimated dose-response effects of formal (meditation) and informal (daily activities) mindfulness practice during the year. Sensitivity analyses correcting for multiple comparisons were conducted.ResultsWe randomised 670 participants; 205 (33%) completed the OAV. In comparison with SAU, MBP participants experienced unity more frequently and intensively (two-part marginal effect (ME) = 6.26 OAV scale points, 95% confidence interval (CI) = 2.24, 10.27, p = 0.006, Cohen's d = 0.33) and disembodiment more frequently (ME = 4.84, 95% CI = 0.86, 8.83, p = 0.019, Cohen's d = 0.26). Formal practice predicted spiritual, blissful and unity experiences, insightfulness, disembodiment, and changed meanings. Informal practice predicted unity and blissful experiences. Trial arm comparisons and informal practice effects lost significance after corrections for multiple comparisons, but formal practice dose-response effects remained significant.ConclusionsResults provide a novel suggestion of causal links between mindfulness practice and specific altered states of consciousness. To optimise their impact, practitioners and teachers need to anticipate and handle them appropriately. Future studies need to confirm findings and assess mechanisms and clinical implications.

Resumen: La Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), una red de referencia e impulsora de la investigación en atención primaria fue creada en 2003 gracias al programa Redes Temáticas de Investigación Cooperativa en Salud (RETICS) del Instituto de Salud Carlos III (ISCIII). Su creación ha supuesto un cambio radical en la situación de la investigación en atención primaria. A lo largo de sus 19 años (2003-2021) han participado distintos grupos de investigación y comunidades autónomas, y se han desarrollado distintas líneas de investigación con numerosos proyectos y publicaciones. A pesar de las dificultades sufridas, ha creado una experiencia de investigación colaborativa entre distintas comunidades autónomas con gran vitalidad y con importantes resultados para la atención primaria. La redIAPP, por tanto, ha sido un gran referente para la investigación en atención primaria y para la profundización de su área de conocimiento. Se sugieren varias líneas de mejora para el futuro de la investigación en atención primaria. Summary: The Research Network on Preventive Activities and Health Promotion (redIAPP), a reference network and promoter of primary care research was created in 2003 thanks to the program Thematic Networks for Cooperative Research in Health (RETICS) of the Instituto de Salud Carlos III (ISCIII). Its creation has meant a radical change in the situation of research in primary care. Throughout its 19 years (2003-2021), different research groups and autonomous communities have participated, and different lines of research have been developed with numerous projects and publications. Despite the difficulties suffered, it has created a collaborative research experience between different autonomous communities with great vitality and with important results for primary care. The redIAPP, therefore, has been a great reference for research in primary care and for the deepening of its area of knowledge. Several lines of improvement are suggested for the future of primary care research.

Abstract Introduction The efficacy of interventions based on mindfulness and compassion has been demonstrated in both clinical and general population, and in different social contexts. These interventions include so-called attentional and constructive meditation practices, respectively. However, there is a third group, known as deconstructive meditation practices, which has not been scientifically studied. Deconstructive practices aim to undo maladaptive cognitive patterns and generate knowledge about internal models of oneself, others and the world. Although there are theoretical and philosophical studies on the origin of addiction to the self or on the mechanisms of action associated with the deconstruction of the self, there are no randomized controlled trials evaluating these techniques in either a healthy population or clinical samples. This study aims to evaluate the effect of three deconstructive techniques by comparing them to mindfulness in the general population. Methods and analysis A randomized controlled clinical trial will be conducted with about 240 participants allocated to four groups: (a) mindful breathing, (b) prostrations, according to Tibetan Buddhist tradition; (c) the Koan Mu, according to Zen Buddhist tradition; and (d) the mirror exercise, according to Toltec tradition. The primary outcome will be the qualities of the non-dual experience and spiritual awakening, measured by the Nondual Embodiment Thematic Inventory, assessed at pre- and post-treatment and at 3- and 6-month follow-ups. Other outcomes will be mindfulness, happiness, compassion, affectivity and altered state of consciousness. Quantitative data will be compared using mixed-effects linear regression models, and qualitative data will be analysed through thematic analysis and using the constant comparative method from grounded theory. Ethics and dissemination Approval was obtained from the Research Ethics Committee of Aragon, Spain. The results will be submitted to peer-reviewed specialized journals, and brief reports will be sent to participants on request. Trial registration ClinicalTrials.gov NCT05317754. Registered on August 2,2022.

IntroductionHigher education, particularly university, is a challenge for many students that can lead to their mental health being seriously affected. The stress to which they are subject throughout their time at university can lead to anxiety and depression. “Third wave” psychotherapies, including compassion-based therapy, have been used to improve psychological outcomes, such as stress, anxiety, emotional distress and well-being. There are some signs that third wave psychotherapies reduce psychological distress in university students, but more and higher-quality studies are needed. In this randomised controlled trial (RCT), we hypothesise that the provision of attachment-based compassion therapy (ABCT) will be more effective than an active control group based on relaxation therapy for improving psychological distress in university students.Methods and analysisA two-arm RCT will be conducted involving 140 university undergraduate and postgraduate students from the University of Zaragoza and the National University of Distance Education (UNED) who reside in the autonomous community of Aragon, Spain. Interventions with either ABCT or relaxation therapy will be implemented, with an allocation ratio of 1:1 between groups. Both interventions will last six weeks and consist of six weekly group sessions lasting 1.5 h each. Data will be collected before and after the intervention, and there will be a follow-up at six months. The primary outcome will be psychological distress at post-intervention. Secondary outcomes will be depression, anxiety, stress and burnout symptoms, affectivity and emotional regulation. Attachment style, experiential avoidance, compassion (for others/oneself) and mindfulness skills will be measured as potential mechanistic variables. Intention-to-treat analysis will be performed using linear mixed regression models. The clinical significance of improvements will be calculated. Potential side effects will be monitored by an independent clinical psychologist.Ethics and disseminationThis study was approved by the Clinical Research Ethics Committee of Aragón. Participant data will remain anonymous, and results will be submitted to peer-reviewed open-access journals and disseminated via conferences.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT05197595.

ObjectivesThe Toronto Mindfulness Scale (TMS) and the State Mindfulness Scale (SMS) are two relevant self-report measures of state mindfulness. The purpose of this study was to examine the internal structure and to offer evidence of the reliability and validity of the Spanish versions of the TMS and SMS.MethodsData from six distinct non-clinical samples in Spain were obtained. They responded to the TMS (n = 119), SMS (n = 223), and measures of trait mindfulness, decentering, non-attachment, depression, anxiety, stress, positive and negative affect, self-criticism, and self-reassurance. The internal structure of the TMS and SMS was analyzed through confirmatory factor analysis. Reliability, construct validity, and sensitivity to change analyses were performed.ResultsThe correlated two-factor structure (curiosity and decentering) was the best-fitting model for the TMS (CFI = 0.932; TLI = 0.913; RMSEA = 0.100 [0.077–0.123]; WRMR = 0.908). The bifactor structure (general factor, mindfulness of body, and mindfulness of mind) was the best-fitting model for the SMS (CFI = 0.961; TLI = 0.950; RMSEA = 0.096 [0.086–0.106]; WRMR = 0.993). Adequate reliability was found for both measures. The reliability of the SMS specific factors was very poor when controlling for the general factor. The patterns of correlations were mainly as expected and according to previous literature. The TMS and SMS have been able to detect state mindfulness changes after different meditation practices.ConclusionValidity evidence is provided to support the use of the TMS and SMS in Spanish populations, though the reliability of the SMS specific factors merit revision.

Abstract 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.

IntroductionPsychotherapies delivered via the Internet have been promoted as an alternative for improving access to psychological treatments. A conceptual working alliance model of blended (i.e., traditional face-to-face consultation combined with Internet-delivered psychotherapy) cognitive-behavioral therapy (b-CBT) for depression has been developed in the UK. However, little is known about how this important therapeutic process, namely the working alliance (WA), is developed and maintained in Internet-delivered cognitive-behavioral therapy without face-to-face consultation (i-CBT). The aim of this study was to evaluate the validity of the WA model of b-CBT in Spanish patients with depression receiving i-CBT.MethodsForty-one patients suffering from mild-moderate depression were interviewed to assess their experiences of an i-CBT program. Interviews were conducted with participants who received a self-guided application (n = 9), and low-intensity support (n = 10). Three group interviews were also conducted with patients who either did not start the program (n = 8) or did not complete it (n = 6), and with patients who did complete it (n = 8).ResultsQualitative thematic content analysis was performed using the constant comparative method, which revealed four main themes: “bond,” “goals,” “task,” and “usability heuristics,” all consistent with the existing literature. However, a new subcategory emerged, called “anonymity,” which may highlight the social stigma that mental illness still has in the Spanish context.ConclusionResults suggest that the development and maintenance of the WA through i-CBT could offer a better experience of the therapeutic process and improve the clinical impact.Clinical Trial RegistrationClinicaltrials.gov, identifier: NCT01611818.

Abstract 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).

BackgroundChronic medical illnesses significantly and negatively affect the quality of life of individuals who suffer them and represent one of the most important challenges faced by healthcare providers and policy-makers due to its rising prevalence and high rates of comorbidity. Compassion-based interventions delivered over the Internet may be a useful approach to facilitate illness management and improve the quality of life of individuals with chronic medical conditions.ObjectivesThe purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Internet Attachment-Based Compassion Therapy (iABCT) to improve the quality of life and well-being of patients with chronic medical illnesses.MethodA two-arm, parallel-group, randomized controlled trial (RCT) will be carried out, with three assessment points (baseline, 3-month, and 6-month) under two conditions: intervention group and control group (waiting list). The primary outcomes include the quality of life on the EuroQol 5-Dimensions Questionnaire (EQ-5D) and the Pemberton Happiness Index (PHI). Secondary outcomes, such as compassion, self-care behaviors, illness interference, self-criticism, symptomatology, attachment styles, social support, and illness perception, will be considered. Moreover, an assessment on satisfaction and usability will be carried out. A total of 68 participants as minimum will be recruited (34 per arm). Intent-to-treat mixed-model analyses without any ad hoc imputations will be conducted.ConclusionsFindings of this study will provide new insights into the potential of self-applied compassion-based interventions (CBI) delivered online in the context of chronic medical illnesses, considering aspects of their implementation (e.g., facilitators, barriers) and mechanisms of change.Trial registrationThe study is registered under Clinicaltrials.gov (NCT04809610) and it is currently in the participant recruitment phase.

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.

Among mindfulness measures the three constructs acceptance, decentering, and non-attachment are psychometrically closely related, despite their apparent semantic differences. These three facets present robust psychometric features and can be considered core themes in most “third wave” clinical models. The aim of the present study was to explore the apparently different content domains (acceptance, decentering, and non-attachment) by administering various psychometric scales in a large sample of 608 volunteers. Resilience and depression were also assessed. Exploratory and confirmatory factor analyses performed in two randomly selected subsamples showed a bifactor approximation. The explained common variance suggested a unidimensional nature for the general factor, with good psychometric properties, which we named “Delusion of Me” (DoM). This construct is also strongly correlated with resilience and depression, and appears to be a solid latent general construct closely related to the concept of “ego.” DoM emerges as a potentially transdiagnostic construct with influence on well-being and clinical indexes such as resilience and depression. Further studies should analyze the potential utility of this new construct at a therapeutic level.

Lucid dreaming, a specific phenomenon of dream consciousness, refers to the experience being aware that one is dreaming. The primary aim of this research was to validate a Spanish version of the Lucidity and Consciousness in Dreams scale (LuCiD). A secondary aim was to explore whether meditation experience and mindfulness trait were related to LuCiD scores. Data from 367 Spanish men (34.6%) and women (65.4%) who completed LuCiD, the Five Facets of Mindfulness Questionnaire (FFMQ), and the Positive and Negative Affect Schedule (PANAS) were examined. From the total sample, 40.3% indicated some experience with formal meditation (meditators), while 59.7% did not have any meditation experience (non-meditators). A random subsample of 101 participants, who completed LuCiD for a second time after a period of 10–15days, was used for test–retest reliability analysis. The LuCiD scale comprises 28 items distributed across eight factors: insight, control, thought, realism, memory, dissociation, negative emotion, and positive emotion. Factor structure, reliability by both internal consistency and test–retest reliability, and construct and concurrent validity were tested. Confirmatory factor analysis (CFA) confirmed the original eight-factor model, showing goodness of fit in contrast to a single-factor model. Item 15 was deleted from the Dissociation factor as it performed poorly (i.e., skewness and kurtosis, non-normal distribution of responses, and corrected item–total correlation under 0.40). The scale showed adequate values of internal consistency (between α=0.65 for Memory and α=0.83 for Positive Emotion) and test–retest reliability by significant Pearson correlations (p

Abstract Background Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents. Methods The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression). Discussion If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well. Trial registration The study has been registered at ClinicalTrials.gov (NCT03629457; date of registration: 13.08.2018).

Abstract Background The World Health Organization (WHO) has included comorbidity between depression and a chronic disease among the 10 leading global health priorities. Although there is a high prevalence of multimorbidity, health care systems are mainly designed for the management of individual diseases. Given the difficulty in delivering face-to-face psychological treatments, alternative models of treatment delivery have been proposed, emphasizing the role of technologies such as the Internet. The aim of this study is to assess the efficacy in Primary Care (PC) of a blended low-intensity psychological intervention applied using information and communication technologies (ICTs) for the treatment of multimorbidity in PC (depression and type 2 diabetes/low back pain) by means of a randomized controlled trial (RCT). Our main hypothesis is that improved usual care combined with psychological therapy applied using ICTs will be more efficacious for improvement in the symptomatology of multimorbidity, compared to a group with only improved treatment as usual six months after the end of treatment. Methods A protocol has been designed combining a face-to-face intervention with a supporting online programme that will be tested by an RCT conducted in three different regions (Andalusia, Aragon and the Balearic Islands). The RCT will evaluate three hundred participants diagnosed with depression and type 2 diabetes/low back pain. Four highly experienced research groups specializing in clinical psychology are involved in this trial, and there will be ample possibilities for translation and transfer to usual clinical practice. Discussion This clinical trial will lead to improvement in financial sustainability, maximizing the use of resources and responding to principles of efficiency and effectiveness. Furthermore, based on the evaluation of the feasibility of implementing this intervention in primary care facilities, we expect to be able to suggest the intervention for incorporation into public policy. In conclusion, positive results of this study could have a significant impact on one of the most important health-related problems, multimorbidity. Trial registration ClinicalTrials.gov, NCT03426709. Registered retrospectively on 08 February 2018.

Background: Police officers' high-stress levels and its deleterious consequences are raising awareness to an epidemic of mental health problems and quality of life (QoL) impairment. There is a growing evidence that mindfulness-based interventions are efficacious to promote mental health and well-being among high-stress occupations.Methods: The POLICE study is a multicenter randomized controlled trial (RCT) with three assessment points (baseline, post-intervention, and 6-month follow-up) where police officers were randomized to mindfulness-based health promotion (MBHP) (n = 88) or a waiting list (n = 82). This article focuses on QoL, depression and anxiety symptoms, and religiosity outcomes. Mechanisms of change and MBHP feasibility were evaluated.Results: Significant group × time interaction was found for QoL, depression and anxiety symptoms, and non-organizational religiosity. Between-group analysis showed that MBHP group exhibited greater improvements in QoL, and depression and anxiety symptoms at both post-intervention (QoL d = 0.69 to 1.01; depression d = 0.97; anxiety d = 0.73) and 6-month follow-up (QoL d = 0.41 to 0.74; depression d = 0.60; anxiety d = 0.51), in addition to increasing non-organizational religiosity at post-intervention (d = 0.31). Changes on self-compassion mediated the relationship between group and pre-to-post changes for all QoL domains and facets. Group effect on QoL overall health facet at post-intervention was moderated by mindfulness trait and spirituality changes.Conclusion: MBHP is feasible and efficacious to improve QoL, and depression and anxiety symptoms among Brazilian officers. Results were maintained after 6 months. MBHP increased non-organizational religiosity, although the effect was not sustained 6 months later. To our knowledge, this is the first mindfulness-based intervention RCT to empirically demonstrate these effects among police officers. Self-compassion, mindfulness trait, and spirituality mechanisms of change are examined.Clinical Trial Registration:www.ClinicalTrials.gov. identifier: NCT03114605.

Objective: To evaluate the psychological consequences (anxiety, depression and body image dissatisfaction) of symptomatic macromastia and the effectiveness of breast reduction surgery in re-establishing the mental health of the patient in the short and long term. Method: 119 patients over 18 years old who had been diagnosed with symptomatic macromastia were assessed, before surgery, one month after the operation and one year later. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the Body Image Dissatisfaction subscale of the Eating Disorders Inventory (EDI-2). Participants were also asked about their physical appearance, social relationships and their satisfaction with regards to clothing and dress. Results: The average age of the patients was 40.7 (SD = 12.02), 80.2% had a body mass index ≥25 kg/m2. Before surgery, we found psychological distress with values indicating clinical anxiety and body image dissatisfaction. Younger women (

Resilience is characterized by effective coping with stressful events and depends on the specific characteristics of stressful situations and individuals, as well as the interaction of the person and their human environment. Resilience in health has been conceptualized as the ability to maintain good health in the midst of great adversity, a capacity that can emerge in relational development, acquiring in the environment. Research on established relationships between resilience and physical health is scarce; however, research on resilience and mental health is extensive, focusing mainly on psychological variables and pathologies such as stress, anxiety and depression. This paper reviews the positive impact on the physical and mental health of resilience from current knowledge.

Although mindfulness is included in many positive psychology manuals as a “positive” technique, the implications of its use have scarcely been developed and the relationship between mindfulness and human well-being has barely been researched. Analyzing the main strengths of the two fields, the possibilities for their integration and the potential contradictions between their messages is essential in order to establish connections. Mindfulness is more than a meditation technique. It has implicit within it a set of values and ethical conditions that coincide to a great extent with the proposed assumptions from positive psychology, such as the development of kindness, compassion, and positive emotions. The aim of this paper is to present, on the one hand, the commonalities and similarities, and on the other, the differences between mindfulness and positive psychology. We also present the main studies that have investigated the role of mindfulness and contemplative practices on human well-being. Finally future research will be discussed and intervention suggested in order to bring the two proposals together.

Background: Depression is one of the most prevalent psychological disorders worldwide. Although psychotherapy for depression is effective, there are barriers to its implementation in primary care in Spain. The use of the Internet has been shown to be a feasible solution. However, the acceptability of Internet-based interventions has not been studied sufficiently.Objective: To assess the acceptability of an Internet-based intervention (IBI) for depression in primary care, and explore the relationship between expectations and satisfaction and the improvement in the clinical variables in primary care patients receiving this intervention. Furthermore, it offers data about the effects of some sociodemographic characteristics on these acceptability variables and analyzes whether the expectations are related to finalizing the intervention.Methods: Data were based on depressive patients who were participants in a randomized controlled trial. In the present study, we present the data from all the participants in the Internet intervention groups (N = 198). All the participants filled out the expectation and satisfaction scales (six-item scales regarding treatment logic, satisfaction, recommending, usefulness for other disorders, usefulness for the patient, and unpleasantness), the Beck Depression Inventory-II, and the secondary outcome measures: depression and anxiety impairment, and positive and negative affect.Results: Results showed that participants’ expectations and satisfaction with the program were both high and differences in expectations and satisfaction depended on some sociodemographic variables (age: older people have higher expectations; sex: women have greater satisfaction). A positive relationship between these variables and intervention efficacy was found: expectations related to “usefulness for the patient” were a statistically related predictor to the results on the BDI-II (Beta = 0.364), and the perception of how logical the treatment is (Beta = 0.528) was associated with change in the clinical variable. Furthermore, the higher the expectations, the higher the improvements exhibited by the patients in all measures evaluated during the ten intervention modules. High expectations were also directly related to finalizing the intervention.Conclusions: This is the first study in Spain to address this issue in the field of IBIs for depression in primary care. The IBI showed high acceptance related to the intervention’s efficacy and completion. Research on IBI acceptability could help to implement the treatment offered.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01611818.

Research suggests that mindfulness can induce changes in the social domain, such as enhancing emotional connection to others, prosocial behavior, and empathy. However, despite growing interest in mindfulness in social psychology, very little is known about the effects of mindfulness on social cognition. Consequently, the aim of this study was to explore the relationship between mindfulness and social cognition by comparing meditators with non-meditators on several social cognition measures. A total of 60 participants (meditators, n = 30; non-meditators, n = 30) were matched on sex, age, and ethnic group, and then asked to complete the following assessment measures: Mindful Awareness Attention Scale (MAAS), Five Facet Mindfulness Questionnaire Short Form (FFMQ-SF), Interpersonal Reactivity Index (IRI), Revised Eyes Test, Hinting Task, Ambiguous Intentions and Hostility Questionnaire (AIHQ), Hospital Anxiety and Depression Scale (HADS), and Screening for Cognitive Impairment in Psychiatry (SCIP). The results showed that meditators reported higher empathy (except for the personal distress subscale), higher emotional recognition, higher theory of mind (ToM), and lower hostile attributional style/bias. The findings also demonstrated that dispositional mindfulness (both total score assessed with MAAS and mindfulness facets using the FFMQ) was associated with social cognition, although it was not equally correlated with all social cognition outcomes, and correlation patterns differ when analyses were conducted separately for meditators and non-meditators. In addition, results showed potential predictors for each social cognition variable, highlighting non-reactivity to inner experience as a key component of mindfulness in order to explain social cognition performance. In summary, the findings indicated that the meditator sample performed better on certain qualities (i.e., empathy, emotional recognition, ToM, hostile attributional style/bias) in comparison to non-meditators and, furthermore, support the notion that mindfulness is related to social cognition, which may have implications for the design of mindfulness-based approaches for use in clinical and non-clinical settings.

The present study examined the effects of mindfulness on depression and anxiety, both direct and indirect through the mediation of four mechanisms of emotional regulation: worry, rumination, reappraisal and suppression. Path analysis was applied to data collected from an international and non-clinical sample of 1151 adults, including both meditators and non-meditators, who completed an online questionnaire battery. Our results show that mindfulness are related to lower levels of depression and anxiety both directly and indirectly. Suppression, reappraisal, worry and rumination all acted as significant mediators of the relationship between mindfulness and depression. A similar picture emerged for the relationship between mindfulness and anxiety, with the difference that suppression was not a mediator. Our data also revealed that the estimated number of hours of mindfulness meditation practice did not affect depression or anxiety directly but did reduce these indirectly by increasing mindfulness. Worry and rumination proved to be the most potent mediating variables. Altogether, our results confirm that emotional regulation plays a significant mediating role between mindfulness and symptoms of depression and anxiety in the general population and suggest that meditation focusing on reducing worry and rumination may be especially useful in reducing the risk of developing clinical depression.

The validation of Five Facets Mindfulness Questionnaire (FFMQ)-short version was performed in a general population of a city in a region of Galicia (Spain), the sample was composed of randomly selected Spanish Health Care patients (N = 845). The results on the goodness of fit of the non-hierarchical, five-dimensional factorial model met the criteria for good and acceptable model adjustment (after eliminating item 18 and despite the correlations detected among the errors included in the model), explaining a 55.5%.of the variance. As the second objective has been analysed the association between the scores obtained in the different facets of the FFMQ-SF and the risk of suffering an episode of depression. (The Odd Ratio, the Hosmer-Lemeshow test and the ROC curve were calculated.) Participants who were currently suffering from an episode of depression were more likely to have low scores in "describing" facet of Mindfulness (adjusted OR = 1.58, 95% CI = 1.04-2.40, linear trend: χ2 = 3.74, df = 1, p = 0.053) as well as low scores on "acting with awareness" (adjusted OR = 2.19, 95% CI = 1.461-3.30, linear trend: χ2 = 9.52, df = 1; = 0.002) and "non judging" (adjusted OR = 2.05, 95% CI = 1.36-3.09, linear trend: χ2 = 143.21, df = 1; p

Eating Disorders (ED) have been associated with dysfunctional coping strategies, such as rumination. Promoting alternative ways of experiencing mental events, based on a mindfulness approach, might be the clue for learning more effective coping and regulatory strategies among young women with ED. This study examined the comparison between patients with ED diagnosis and healthy subjects in mindfulness, rumination and effective coping. In addition, we analyzed the independent association of those with the presence of ED. The study sample was formed by two groups of young women ranged 13-21 years: Twenty-five with an ED diagnosis and 25 healthy subjects. They were assessed by using the Freiburg Mindfulness Inventory (FMI) and the Responses Styles Questionnaire (RSQ). Our findings show that ED patients have significantly lesser average scores in mindfulness and effective coping than the healthy sample (p < .05). Also, our data concludes that mindfulness and effective coping independently predict the presence or absence of ED in young women. The study results suggest that training mindfulness abilities may contribute to making effective coping strategies more likely to occur in ED patients, which is incompatible with some eating-related symptoms. Further studies are needed, trough prospective and experimental designs, to evaluate clinical outcomes of mindfulness training among young women with ED.

The study of social cognition (SC) has emerged as a key domain of mental health, supporting the notion that poorer performance in SC tasks is linked to psychopathology, although most studies have primarily addressed only schizophrenia (SZ). Some recent studies have also shown deficits of SC in obsessive-compulsive disorder (OCD) patients; however, little is known about how individuals with OCD may differ on SC performance from individuals with SZ. Moreover, initial research in this field suggests that mindfulness skills may be related to SC abilities such as theory of mind (ToM), emotion processing and empathy. Given the potential benefits of mindfulness for treating OCD and SZ, further efforts are needed to understand the association between mindfulness and SC in these populations. The main objective of this study was to compare samples of patients with SZ and OCD to healthy controls (HCs) on several social cognition (SC) domains and mindfulness measures. In total, 30 outpatients diagnosed with SZ, 31 outpatients diagnosed with OCD and 30 healthy controls were assessed in emotion recognition (the Eyes Test), ToM (the Hinting Task), attributional style (the Ambiguous Intentions and Hostility Questionnaire), empathy (the Interpersonal Reactivity Index) and dispositional mindfulness (the MAAS and the FFMQ). Both clinical groups showed poorer performance in emotion recognition and ToM than the HCs. The OCD and SZ patients did not significantly differ in impairment in SC, but the OCD group had higher scores in attributional style (intentionality and anger bias). With regard to mindfulness, the results found lower levels of acting with awareness for the HCs than for either clinical group and higher non-reactivity to inner experience for the HCs than for the individuals with OCD; the results also yielded significant correlations between SC and mindfulness. In conclusion, these findings revealed that SC abilities were impaired in the SZ and OCD groups compared to the HC group, suggesting a similar disrupted pattern in both clinical groups. Aspects of dispositional mindfulness were differentially associated with SC, which may suggest their potential role in novel transdiagnostic interventions.

Generalized Anxiety Disorder (GAD) is a very prevalent disorder in primary care (PC). Most patients with GAD never seek treatment, and those who do seek treatment often drop out before completing treatment. Although it is an understudied treatment, Mindfulness-Based Interventions (MBIs) indicate preliminary efficacy for the treatment of GAD symptoms, but many patients with GAD present other associated symptoms (e.g., attention deficits) that complicate the treatment. Virtual Reality DBT® Mindfulness Skills learning has recently been developed to make learning mindfulness easier for patients with emotion dysregulation who have trouble concentrating. Virtual Reality (VR) might serve as a visual guide for practicing mindfulness as it gives patients the illusion of “being there” in the 3D computer generated world. The main goal of this study was to evaluate the effect of two MBIs (a MBI in a group setting alone and the same MBI plus 10 min VR DBT® Mindfulness skills training) to reduce GAD symptoms. A secondary aim was to explore the effect in depression, emotion regulation, mindfulness, and interoceptive awareness. Other exploratory aims regarding the use of VR DBT® Mindfulness skills were also carried out. The sample was composed of 42 patients (roughly half in each group) with GAD attending PC visits. After treatment, both groups of patients showed significant improvements in General Anxiety Disorder measured by the GAD-7 using mixed regression models [MBI alone (B = -5.70; p < 0.001; d = -1.36), MBI+VR DBT® Mindfulness skills (B = -4.38; p < 0.001; d = -1.33)]. Both groups also showed significant improvements in anxiety, depression, difficulties of emotion regulation and several aspects of mindfulness and interoceptive awareness. Patients in the group that received additional 10 min VR DBT Mindfulness Skills training were significantly more adherent to the treatment than those receiving only standard MBI (100% completion rate in MBI + VR vs. 70% completion rate in MBI alone; Fisher = 0.020). Although randomized controlled studies with larger samples are needed, this pilot study shows preliminary effectiveness of MBI to treat GAD, and preliminary evidence that adjunctive VR DBT® Mindfulness Skills may reduce dropouts.

Self-compassion is natural, trainable and multi-faceted human capacity. To date there has been little research into the role of culture in influencing the conceptual structure of the underlying construct, the relative importance of different facets of self-compassion, nor its relationships to cultural values. This study employed a cross-cultural design, with 4,124 participants from 11 purposively sampled datasets drawn from different countries. We aimed to assess the relevance of positive and negative items when building the self-compassion construct, the convergence among the self-compassion components, and the possible influence of cultural values. Each dataset comprised undergraduate students who completed the “Self-Compassion Scale” (SCS). We used a confirmatory factor analysis (CFA) approach to the multitrait-multimethod (MTMM) model, separating the variability into self-compassion components (self-kindness, common humanity, mindfulness), method (positive and negative valence), and error (uniqueness). The normative scores of the Values Survey Module (VSM) in each country, according to the cultural dimensions of individualism, masculinity, power distance, long-term orientation, uncertainty avoidance, and indulgence, were considered. We used Spearman coefficients (rs) to assess the degree of association between the cultural values and the variance coming from the positive and negative items to explain self-compassion traits, as well as the variance shared among the self-compassion traits, after removing the method effects produced by the item valence. The CFA applied to the MTMM model provided acceptable fit in all the samples. Positive items made a greater contribution to capturing the traits comprising self-compassion when the long-term orientation cultural value was higher (rs = 0.62; p = 0.042). Negative items did not make significant contributions to building the construct when the individualism cultural value was higher, but moderate effects were found (rs = 0.40; p = 0.228). The level of common variance among the self-compassion trait factors was inversely related to the indulgence cultural value (rs = -0.65; p = 0.030). The extent to which the positive and negative items contribute to explain self-compassion, and that different self-compassion facets might be regarded as reflecting a broader construct, might differ across cultural backgrounds.

Major depression etiopathogenesis is related to a wide variety of genetics, demographic and psychosocial factors, as well as to environmental factors. The objective of this study is to analyze sociodemographic and environmental variables that are related to the prevalence of depression through correlation analysis and to develop a regression model that explains the behavior of this disease from an ecological perspective. This is an ecological, retrospective, cross-sectional study. The target population was 1,148,430 individuals over the age of 16 who were registered in Aragon (Spain) during 2010, with electronic medical records in the community’s primary health care centers. The spatial unit was the Basic Health Area (BHA). The dependent variable was the diagnosis of Depression and the ecological independent variables were: Demographic variables (gender and age), population distribution, typology of the entity, population structure by sex and age, by nationality, by education, by work, by salary, by marital status, structure of the household by number of members, and state of the buildings. The results show moderate and positive correlations with higher rates of depression in areas having a higher femininity index, higher population density, areas with a higher unemployment rate and higher average salary. The results of the linear regression show that aging +75 and rural entities act as protective factors for depression, while urban areas and deficient buildings act as risk factors. In conclusion, the ecological methodology may be a useful tool which, together with the statistical epidemiological analysis, can help in the political decision making process.

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.

Although we have made significant progress in the development of preventive tools and especially in the efficacy of the psychological treatments, we are still far from an optimal situation. This paper focuses on two major issues which we consider fundamental challenges and urges in this area: (a) the need for improving and spreading prevention, early intervention, and the promotion of mental health and (b) the need for greater dissemination of effective psychological treatments, the development of new interventions and greater understanding of the mechanisms of action of psychological treatments. The aim is to promote discussion among all stakeholders and debate on those lines we think as priority.

The magnitude and impact of mental disorders does not correspond to the resources devoted to research and attention. Although we have made significant progress in their understanding and the efficacy of the psychological treatments, we are still far from an optimal situation. This paper focuses on one of the major issues which we consider fundamental challenges and needs in this area, the increase in research focusing on psychopathology, especially on the mechanisms and processes that explain and maintain mental disorders, as a key point for the design and development of new psychological interventions for the prevention, treatment, and promotion of mental health. The aim is to promote discussion among all stakeholders and debate on those lines we think as a priority.

La creciente evidencia científica de mindfulness permite su expansión en distintos contextos, entre ellos el contexto educativo. Sin embargo, unida a esta rápida expansión, existe la preocupación de que los profesionales que enseñen mindfulness no tengan la suficiente formación personal y no posean las competencias y las habilidades necesarias para desempeñar esta tarea. Este artículo se basa en la información obtenida a partir de una búsqueda realizada en diferentes bases de datos, y referida a los principales artículos y trabajos publicados sobre mindfulness dirigidos al profesorado. Se exponen aspectos relativos a la formación en mindfulness y a las competencias, las habilidades y los principios necesarios para que los profesores apliquen mindfulness en las aulas; también se exponen las principales dificultades encontradas, los factores que contribuyen al éxito y las sugerencias de mejora respecto a la puesta en práctica de estos programas.

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 = €−194.1 (−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 = €−256.3 (−447.4 to −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.

Introduction: Personal wisdom has demonstrated important implications for the health of individuals. The aim of the present study was to validate a Spanish version of the Three-Dimensional Wisdom Scale (3D-WS), exploring the structure of a possible general factor, and assessing its explanatory power on psychological health-related variables.Methods: A cross-sectional study design was used, with a total sample of 624 Spanish participants recruited on the Internet and randomly split into two halves. The following instruments were applied: 3D-WS, Purpose in Life (PIL), Multidimensional State Boredom Scale (MSBS), Positive and Negative Affect Scale (PANAS), and Difficulties in Emotion Regulation Scale (DERS). Factorial structures were analyzed through exploratory and confirmatory factor analysis (EFA and CFA), and the general factor was characterized by using bifactor models. The explanatory power of the 3D-WS was established by multiple regression.Results: The original long and short versions of the 3D-WS were not replicated in the first subsample using EFA, and there was a high rate of cross-loadings. Thus, a new short 3D-WS was proposed by ordering the original items according to factorial weights. This three-correlated-factor (reflective, cognitive, and affective) proposal was tested by means of CFA in the second subsample, with adequate psychometrics and invariance, and a good fit (χ2/df = 1.98; CFI = 0.946; RMSEA = 0.056; 90% CI = 0.040-0.072). A bifactor structure, in which the reflective trait of wisdom was integrated into a general factor (G-Reflective) improved the model fit (χ2/df = 1.85; CFI = 0.959; RMSEA = 0.052; 90% CI = 0.035-0.070). The explained common variance of G-Reflective was 0.53; therefore, the new short 3D-WS should not be considered essentially unidimensional. The new short 3D-WS showed positive relationships with the PIL and PANAS-positive, and negative associations with the MSBS, PANAS-negative and DERS, contributing to explain all the referred variables. These results were consistent across subsamples.Conclusion: The new short 3D-WS appears to be a reliable instrument for measuring wisdom in the Spanish general population. The reflective facet might influence the cognitive and affective wisdom components through the G-Reflective general factor. There seems to be a high explanatory power of the 3D-WS on psychological health-related variables. This study will facilitate the development of future research and psychological knowledge regarding wisdom.

Background: The therapeutic effects of the Amazonian plant tea ayahuasca may relate to its ability to enhance mindfulness capacities. Ayahuasca induces a modified state of awareness through the combined action of its active principles: the psychedelic N,N-dimethyltryptamine (DMT) and a series of centrally acting β-carbolines, mainly harmine and tetrahydroharmine. To better understand the therapeutic potential of ayahuasca, here we compared the impact on mindfulness capacities induced by two independent interventions: (a) participation in four ayahuasca sessions without any specific purpose related to improving mindfulness capacities; and (b) participation in a standard mindfulness training course: 8 weeks mindfulness-based stress reduction (MBSR), with the specific goal of improving these skills.Methods: Participants of two independent groups completed two self-report instruments: The Five Facet Mindfulness Questionnaire (FFMQ) and the Experiences Questionnaire (EQ). The MINDSENS Composite Index was also calculated, including those EQ and FFMQ items that have proven to be the most sensitive to meditation practice. Group A (n = 10) was assessed before and after the last of four closely spaced consecutive ayahuasca sessions. Group B (n = 10) was assessed before and after completion of a standard 8-week MBSR course.Results: MBSR training led to greater increases in overall mindfulness scores after the 8-week period. MBSR but not ayahuasca led to increases in the MINDSENS Composite Index. However, the ayahuasca sessions induced comparable increases in the Non-Judging subscale of the FFMQ, specifically measuring “acceptance.” Improving this capacity allows for a more detached and less judgmental stance toward potentially distressing thoughts and emotions.Results: The present findings suggest that a small number of ayahuasca sessions can be as effective at improving acceptance as more lengthy and costly interventions. Future studies should address the benefits of combining ayahuasca administration with mindfulness-based interventions. This will allow us to investigate if ayahuasca will improve the outcome of psychotherapeutic interventions.

ObjectiveThere is a growing interest in evaluating the effectiveness of compassion interventions for treating psychological disorders. The present study evaluated the effectiveness of “attachment-based compassion therapy” (ABCT) in the treatment of fibromyalgia (FM), and the role of psychological flexibility as a mediator of improvements.MethodsA total of 42 patients with FM were randomly assigned to ABCT or relaxation (active control group). Both the intervention and control condition were combined with treatment as usual (TAU). The primary outcome was functional status (FIQ), and the secondary outcomes were clinical severity (CGI-S), pain catastrophizing (PCS), anxiety (HADS-A), depression (HADS-D), quality of life (EQ-5D), and psychological flexibility (AAQ-II). Differences between the groups were estimated using mixed-effects models, and mediation assessments were conducted using path analyses.ResultsThe ABCT group demonstrated superior outcomes compared to the relaxation group, including better FIQ values after treatment (B = −3.01; p = 0.003). Differences in FIQ were maintained at 3-month follow-up (B = −3.33; p = 0.001). The absolute risk reduction in ABCT compared to relaxation increased by 40.0%, with an NNT = 3 based on criteria of ≥50% FIQ reduction after treatment. Psychological flexibility had a significant mediating effect on improvements.ConclusionThese results suggest that ABCT combined with TAU appears to be effective in the treatment of FM symptoms.Clinical Trial Registrationhttp://ClinicalTrials.gov, identifier NCT02454244.

Given that Fibromyalgia Syndrome (FMS) is associated with problems in emotion regulation, the importance of assessing this construct is widely acknowledged by clinical psychologists and pain specialists. Although the Cognitive Emotion Regulation Questionnaire (CERQ) is a self-report measure used worldwide, there are no data on its psychometric properties in patients with FMS. This study analyzed the dimensionality, reliability, and validity of the CERQ in a sample of 231 patients with FMS. Given that “fibrofog” is one of the most disabling FMS symptoms, in the present study, items in the CERQ were grouped by dimension. This change in item presentation was conceived as an efficient way of facilitating responses as a result of a clear understanding of what the items related to each dimension are attempting to measure. The following battery of measures was administered: the CERQ, the Revised Fibromyalgia Impact Questionnaire, the Pain Catastrophizing Scale, the Center for Epidemiologic Studies Depression Scale, and the State-Trait Anxiety Inventory. Four models of the CERQ structure were examined and confirmatory factor analyses supported the original factor model, consisting of nine factors—Self-blame, Acceptance, Rumination, Positive refocusing, Refocus on planning, Positive reappraisal, Putting into perspective, Catastrophizing, and Other-blame. There was minimal overlap between CERQ subscales and their internal consistency was adequate. Correlational and regression analyses supported the construct validity of the CERQ. Our findings indicate that the CERQ (items-grouped version) is a sound instrument for assessing cognitive emotion regulation in patients with FMS.

Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants' attention and gives users the illusion of "being there" in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT®) mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT®) mindfulness skills training technique and whether they would show any benefit. Forty four participants attending a mindfulness conference put on an Oculus Rift DK2 Virtual Reality helmet and floated down a calm 3D computer generated virtual river while listening to digitized DBT® mindfulness skills training instructions. On subjective questionnaires completed by the participants before and after the VR DBT® mindfulness skills training session, participants reported increases/improvements in state of mindfulness, and reductions in negative emotional states. After VR, participants reported significantly less sadness, anger, and anxiety, and reported being significantly more relaxed. Participants reported a moderate to strong illusion of going inside the 3D computer generated world (i.e., moderate to high "presence" in VR) and showed high acceptance of VR as a technique to practice mindfulness. These results show encouraging preliminary evidence of the feasibility and acceptability of using VR to practice mindfulness based on clinical expert feedback. VR is a technology with potential to increase computerized dissemination of DBT® skills training modules. Future research is warranted.

Exploring the pertinence of a "sociotype" construct, established along the conceptual chain genotype-phenotype-sociotype, is the essential purpose of the present paper. Further, by following the sociotype's conceptual guidelines, a new psychometric indicator has been developed in order to gauge the level of social interaction around each individual-the sociotype questionnaire (SOCQ). A first version of this questionnaire has been elaborated by gathering data about the different classes of social bonds (family, friends, acquaintances, and work/study colleagues) in general population and about the dynamic update of these bonds via face-to-face conversation and other modes of interaction. A specific fieldwork was undertaken, involving 1,075 participants, all of them Spanish adults (with diverse social and regional backgrounds). The data obtained were analyzed by means of the correlational method with an analytical cross-sectional design: the number of factors and the consistency and reliability of the resulting scales were evaluated and correlated. The new sociotype indicator resulting from that fieldwork, in spite of its limitations, seems to be valid and reliable, as well as closely associated with widely used metrics of loneliness and psychological distress. It is interesting that the construct noticeably varies throughout the life course and circumstances of individuals, based on their gender and age, and adjusting to the different situations of social networking. This is the first study, to the best of our knowledge, which has tried to reach both a theoretical and an operational formulation of the sociotype construct, by establishing an ad hoc psychometric questionnaire. We think that the information provided by this operational definition opens a new direction of work that could be useful to guide the development and evaluation of programs aimed at improving and strengthening social networking in people at risk, especially for the elderly.

Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain, and physical and emotional symptoms. Although its pathophysiology is largely unknown, immune-inflammatory pathways may be involved. We examined serum interleukin (IL)-6, high sensitivity C-reactive protein (hs-CRP), CXCL-8, and IL-10 in 67 female FM patients and 35 healthy women while adjusting for age, body mass index (BMI), and comorbid disorders. We scored the Fibromyalgia Severity Score, Widespread Pain Index (WPI), Symptom Severity Scale (SSS), Hospital Anxiety (HADS-A), and Depression Scale and the Perceived Stress Scale (PSS-10). Clinical rating scales were significantly higher in FM patients than in controls. After adjusting for covariates, IL-6, IL-10, and CXCL-8 were lower in FM than in HC, whereas hs-CRP did not show any difference. Binary regression analyses showed that the diagnosis FM was associated with lowered IL-10, quality of sleep, aerobic activities, and increased HADS-A and comorbidities. Neural networks showed that WPI was best predicted by quality of sleep, PSS-10, HADS-A, and the cytokines, while SSS was best predicted by PSS-10, HADS-A, and IL-10. Lowered levels of cytokines are associated with FM independently from confounders. Lowered IL-6 and IL-10 signaling may play a role in the pathophysiology of FM.

Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost−utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention (“FibroQoL”) and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost−utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.

El propósito de este trabajo es identificar factores determinantes de carácter socio-demográficos, de salud y de actividad física que influyan en la aparición de la discapacidad para las actividades básicas e instrumentales de la vida diaria en 380 individuos mayores de 64 años que asisten a centros sociales de Zaragoza. Un modelo multivariante de regresión logística analizó la capacidad funcional por sexo. Variables sociodemográficas, enfermedades crónicas y actividad física fueron variables explicativas Conclusiones: las condiciones médicas son el principal marcador de la discapacidad, y la actividad física es una medida que se puede promover en la Atención Primaria para reducir el riesgo de discapacidad.

Communication between physicians and patients is a key pillar of psychosocial support for enhancing the healing process of patients and for increasing their well-being and quality of life. Physicians and other health professionals might benefit from interventions that increase their self-care, awareness, compassion, and other-focused concern, and reduce the chances of distress and burnout. There is substantial evidence for the contribution of different management strategies to achieve these aims. The goal of this article is to review the potential effect of mindfulness and compassion-based strategies for the improvement of physician-patient interactions. The acquisition of the necessary skills by physicians requires continuous education. Future research will be useful for identifying more evidence on the cost-effectiveness of this type of intervention.

Mindfulness has been described as an inherent human capability that can be learned and trained, and its improvement has been associated with better health outcomes in both medicine and psychology. Although the role of practice is central to most mindfulness programs, practice-related improvements in mindfulness skills is not consistently reported and little is known about how the characteristics of meditative practice affect different components of mindfulness. The present study explores the role of practice parameters on self-reported mindfulness skills. A total of 670 voluntary participants with and without previous meditation experience (n = 384 and n = 286, respectively) responded to an internet-based survey on various aspects of their meditative practice (type of meditation, length of session, frequency, and lifetime practice). Participants also completed the Five Facets Mindfulness Questionnaire (FFMQ), and the Experiences Questionnaire (EQ). The group with meditation experience obtained significantly higher scores on all facets of FFMQ and EQ questionnaires compared to the group without experience. However different effect sizes were observed, with stronger effects for the Observing and Non-Reactivity facets of the FFMQ, moderate effects for Decentering in EQ, and a weak effect for Non-judging, Describing, and Acting with awareness on the FFMQ. Our results indicate that not all practice variables are equally relevant in terms of developing mindfulness skills. Frequency and lifetime practice--but not session length or meditation type--were associated with higher mindfulness skills. Given that these 6 mindfulness aspects show variable sensitivity to practice, we created a composite index (MINDSENS) consisting of those items from FFMQ and EQ that showed the strongest response to practice. The MINDSENS index was able to correctly discriminate daily meditators from non-meditators in 82.3% of cases. These findings may contribute to the understanding of the development of mindfulness skills and support trainers and researchers in improving mindfulness-oriented practices and programs.

BackgroundBurnout occurs when professionals use ineffective coping strategies to try to protect themselves from work-related stress. The dimensions of 'overload', 'lack of development' and 'neglect', belonging to the 'frenetic', 'under-challenged' and 'worn-out' subtypes, respectively, comprise a brief typological definition of burnout. The aim of the present study was to estimate the explanatory power of the different coping strategies on the development of burnout subtypes.MethodsThis was a cross-sectional survey with a random sample of university employees, stratified by occupation (n = 429). Multivariate linear regression models were constructed between the 'Burnout Clinical Subtypes Questionnaire', with its three dimensions -overload, lack of development and neglect- as dependent variables, and the 'Coping Orientation for Problem Experiences', with its fifteen dimensions, as independent variables. Adjusted multiple determination coefficients and beta coefficients were calculated to evaluate and compare the explanatory capacity of the different coping strategies.ResultsThe 'Coping Orientation for Problem Experiences' subscales together explained 15% of the 'overload' (pConclusionsThese findings further our understanding of the way in which the effectiveness of interventions for burnout may be improved, by influencing new treatments and preventive programmes using features of the strategies for handling stress in the workplace.