Association between type 2 diabetes and depressive symptoms after a 1-year follow-up in an older adult Mediterranean population

OBJECTIVES

To examine the cross-sectional association between baseline depressive symptoms and the presence of type 2 diabetes (T2D), and its association with glycated hemoglobin (HbA1c) and other metabolic variables, and the prospective association of depressive symptoms and HbA1c after 1 year of follow-up.

METHODS

n = 6224 Mediterranean older adults with overweight/obesity and metabolic syndrome (48% females, mean age 64.9 ± 4.9 years) were evaluated in the framework of the PREDIMED-Plus study cohort. Depressive symptoms were assessed using the Beck Depression Inventory-II and HbA1c was used to measure metabolic control.

RESULTS

The presence of T2D increased the likelihood of higher levels of depressive symptoms (χ2 = 15.84, p = 0.001). Polynomial contrast revealed a positive linear relationship (χ2 = 13.49, p = 0.001), the higher the depressive symptoms levels, the higher the prevalence of T2D. Longitudinal analyses showed that the higher baseline depressive symptoms levels, the higher the likelihood of being within the HbA1c ≥ 7% at 1-year level (Wald-χ2 = 24.06, df = 3, p < .001, for the full adjusted model). Additionally, depressive levels at baseline and duration of T2D predicted higher HbA1c and body mass index, and lower physical activity and adherence to Mediterranean Diet at 1 year of follow-up.

CONCLUSIONS

This study supports an association between T2D and the severity of depressive symptoms, suggesting a worse metabolic control from mild severity levels in the short-medium term, influenced by lifestyle habits related to diabetes care. Screening for depressive symptoms and a multidisciplinary integrative therapeutic approach should be ensured in patients with T2D.

Effectiveness of the Internet Attachment-Based Compassion Therapy (iABCT) to improve the quality of life and well-being in a population with chronic medical illness: A study protocol of a randomized controlled trial (SPIRIT compliant)

BACKGROUND

Chronic 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.

OBJECTIVES

The 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.

METHOD

A 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.

CONCLUSIONS

Findings 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 REGISTRATION

The study is registered under Clinicaltrials.gov (NCT04809610) and it is currently in the participant recruitment phase.

Is there evidence that emotional reasoning processing underlies emotional disorders in adults? A systematic review

The prevalence of emotional disorders has increased in recent times. Emotional Reasoning (ER), which is a transdiagnostic process, occurs when feelings, rather than objective evidence, are used as a source of information to make judgements about the valence of a situation. Differences in ER may explain the existence and maintenance of emotional disorders. The objective is to systematically review the role of ER in the occurrence and severity of emotional disorders. Following PRISMA guidelines, we searched through: PubMed, PsycInfo, Scopus and The Cochrane Library. Search terms were "Emotional Reasoning", "ex-consequentia reasoning", "Affect-as-information"; and "emotional disorders", "anxiety", "depression", "depressive". Nine articles were included. An association was demonstrated between ER and a greater degree of anxious symptomatological severity. In depressive symptomatology, no significant differences were found. One study reported the effect of Cognitive Behavioural Therapy on ER bias, finding no changes after the intervention. Finally, another study evaluated the efficacy of computerised experiential training in reducing ER bias, showing significant differences. There are few studies on ER and its evolution in research has not been uniform over time. Encouragingly, though, research to date suggests that ER is a transdiagnostic process involved in several anxiety disorders. More investigation is needed to dilucidate whether ER also underlies the onset and maintenance of depressive disorders.

mHealth intervention to improve quality of life in patients with chronic diseases during the COVID-19 crisis in Paraguay: A study protocol for a randomized controlled trial

BACKGROUND

Patients with chronic disease represent an at-risk group in the face of the COVID-19 crisis as they need to regularly monitor their lifestyle and emotional management. Coping with the illness becomes a challenge due to supply problems and lack of access to health care facilities. It is expected these limitations, along with lockdown and social distancing measures, have affected the routine disease management of these patients, being more pronounced in low- and middle-income countries with a flawed health care system.

OBJECTIVES

The purpose of this study is to describe a protocol for a randomized controlled trial to test the efficacy of the Adhera® MejoraCare Digital Program, an mHealth intervention aimed at improving the quality of life of patients with chronic diseases during the COVID-19 outbreak in Paraguay.

METHOD

A two-arm randomized controlled trial will be carried out, with repeated measures (baseline, 1-month, 3-month, 6-month, and 12-month) under two conditions: Adhera® MejoraCare Digital Program or waiting list. The primary outcome is a change in the quality of life on the EuroQol 5-Dimensions 3-Levels Questionnaire (EQ-5D-3L). Other secondary outcomes, as the effect on anxiety and health empowerment, will be considered. All participants must be 18 years of age or older and meet the criteria for chronic disease. A total of 96 participants will be recruited (48 per arm).

CONCLUSIONS

It is expected that the Adhera® MejoraCare Digital Program will show significant improvements in quality of life and emotional distress compared to the waiting list condition. Additionally, it is hypothesized that this intervention will be positively evaluated by the participants in terms of usability and satisfaction. The findings will provide new insights into the viability and efficacy of mHealth solutions for chronic disease management in developing countries and in times of pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04659746.

How the COVID-19 Pandemic and its Consequences Affect the Presence of and Search for Meaning of Life: A Longitudinal Study

The presence of meaning in life (PML) and the search for meaning in life (SML) are crucial when facing difficult times. Although several theoretical frameworks have tried to explain the dynamics of meaning in life during adversity, empirical evidence about interactions among both constructs using longitudinal designs is scarce. This study examined the trajectories of both PML and SML during the COVID-19 lockdown period in Spain. In total, 220 adults fulfilled an online survey during two periods: a strict and a relaxed lockdown period. Latent growth models showed that both PML and SML declined slightly during the strict lockdown, but they reached a plateau during the relaxed lockdown. Results also showed that age and having a partner predicted higher PML and lower SML at baseline, whereas being male predicted higher scores on PML. PML and SML were negatively associated at baseline, higher SML at baseline was related to a steeper decreasing PML slope during the strict lockdown, and the PML and SML slopes in the relaxed lockdown period were negatively related. This study contributes to better understanding longitudinal fluctuations of meaning in life in situations of adversity.

Too many lemons to make lemonade? Disentangling mental health during the third wave of COVID-19 infections in Spain

The study aimed to analyze the longitudinal change in mental health during the third wave of COVID-19 infections in Spain. Negative (e.g., emotional distress) and positive (e.g., positive functioning variables) outcomes were analyzed. Protective factors (e.g., resilience) as predictors of psychological adjustment (i.e., positive mental health, openness to the future, and low burden due to COVID-19) after ten months of the pandemic were also examined. The sample consisted of 164 participants, and self-reported questionnaires were administered at the beginning of the lockdown (March 2020), at the end of the lockdown (June 2020), and during the third wave (January 2021). Linear mixed models showed that individuals' emotional distress increased, and positive functioning variables (i.e., meaning in life, gratitude, resilience, and life satisfaction) decreased over time, but an increase was observed in some dimensions of posttraumatic growth. Regression analyses showed that resilience scores at all three data collection time points were significant predictors of positive mental health, openness to the future, and burden during the third wave. Mediation analyses showed that positive mental health and openness to the future were mediators of the effect of resilience on burden. The prolonged situation of the COVID-19 crisis had an important impact on positive and negative mental health. However, resilience may help to build up resources that can act as a buffer against adverse psychological effects.

Psychometric properties of the Spanish version of the Patient Health Questionnaire-9 in users of the Ecuadorian public health care system

Introduction: Depression is one of the most prevalent public health problems worldwide and remains an underdiagnosed disease, especially in developing countries. The availability of instruments that permit detecting this problem is essential for reducing the burden of this disorder. The aim of this study was to examine the psychometric properties (factor structure, sex invariance, internal consistency, and convergent and divergent validity) of the Spanish version of the PHQ-9 (Patient Health Questionnaire-9). Method: A sample of 366 public hospital users in Ecuador was recruited and accordingly completed a survey that included sociodemographic data, the PHQ-9, and other standards of measurement such as the Beck Depression Inventory-II (BDI-II), the Generalised Anxiety Disorder Scale (GAD-7), the Positive and Negative Affect Scale (PANAS), and the Quality-of-Life Index (QLI). Results: The unidimensional factor model of the PHQ-9 provided the best fit for the data. The PHQ-9 assesses depressive symptoms equivalently in both sexes, and presents high internal consistency, as well as good convergent and divergent validity with the other constructs. Conclusion: The application of the PHQ-9 could aid in the screening of patients with depressive symptomatology in the Ecuadorian public health system (EPHS).

Exploring the Heterogeneity and Trajectories of Positive Functioning Variables, Emotional Distress, and Post-traumatic Growth During Strict Confinement Due to COVID-19

COVID-19 pandemic-related confinement may be a fruitful opportunity to use individual resources to deal with it or experience psychological functioning changes. This study aimed to analyze the evolution of different psychological variables during the first coronavirus wave to identify the different psychological response clusters, as well as to keep a follow-up on the changes among these clusters. The sample included 459 Spanish residents (77.8% female, M_age = 35.21 years, SD_age = 13.00). Participants completed several online self-reported questionnaires to assess positive functioning variables (MLQ, Steger et al. in J Loss Trauma 13(6):511-527, 2006. 10.1080/15325020802173660; GQ-6, McCullough et al. in J Person Soc Psychol 82:112-127, 2002. 10.1037/0022-3514.82.1.112; CD-RISC, Campbell-Sills and Stein in J Traum Stress 20(6):1019-1028, 2007. 10.1002/jts.20271; CLS-H, Chiesi et al. in BMC Psychol 8(1):1-9, 2020. 10.1186/s40359-020-0386-9; SWLS; Diener et al. in J Person Assess, 49(1), 71-75, 1985), emotional distress (PHQ-2, Kroenke et al. in Med Care 41(11):1284-1292, 2003. 10.1097/01.MLR.0000093487.78664.3C; GAD-2, Kroenke et al. in Ann Internal Med 146(5):317-325, 2007. 10.7326/0003-4819-146-5-200703060-00004; PANAS, Watson et al. in J Person Soc Psychol 47:1063-1070, 1988; Perceived Stress, ad hoc), and post-traumatic growth (PTGI-SF; Cann et al. in Anxiety Stress Coping 23(2):127-137, 2010. 10.1080/10615800903094273), four times throughout the 3 months of the confinement. Linear mixed models showed that the scores on positive functioning variables worsened from the beginning of the confinement, while emotional distress and personal strength improved by the end of the state of alarm. Clustering analyses revealed four different patterns of psychological response: "Survival", "Resurgent", "Resilient", and "Thriving" individuals. Four different profiles were identified during mandatory confinement and most participants remained in the same cluster. The "Resilient" cluster gathered the largest number of individuals (30-37%). We conclude that both the heterogeneity of psychological profiles and analysis of positive functioning variables, emotional distress, and post-traumatic growth must be considered to better understand the response to prolonged adverse situations.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-021-00469-z.

Corrigendum: Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol

[This corrects the article DOI: 10.3389/fpubh.2021.625640.].

Elena+ Care for COVID-19, a Pandemic Lifestyle Care Intervention: Intervention Design and Study Protocol

Background: The current COVID-19 coronavirus pandemic is an emergency on a global scale, with huge swathes of the population required to remain indoors for prolonged periods to tackle the virus. In this new context, individuals' health-promoting routines are under greater strain, contributing to poorer mental and physical health. Additionally, individuals are required to keep up to date with latest health guidelines about the virus, which may be confusing in an age of social-media disinformation and shifting guidelines. To tackle these factors, we developed Elena+, a smartphone-based and conversational agent (CA) delivered pandemic lifestyle care intervention. Methods: Elena+ utilizes varied intervention components to deliver a psychoeducation-focused coaching program on the topics of: COVID-19 information, physical activity, mental health (anxiety, loneliness, mental resources), sleep and diet and nutrition. Over 43 subtopics, a CA guides individuals through content and tracks progress over time, such as changes in health outcome assessments per topic, alongside user-set behavioral intentions and user-reported actual behaviors. Ratings of the usage experience, social demographics and the user profile are also captured. Elena+ is available for public download on iOS and Android devices in English, European Spanish and Latin American Spanish with future languages and launch countries planned, and no limits on planned recruitment. Panel data methods will be used to track user progress over time in subsequent analyses. The Elena+ intervention is open-source under the Apache 2 license (MobileCoach software) and the Creative Commons 4.0 license CC BY-NC-SA (intervention logic and content), allowing future collaborations; such as cultural adaptions, integration of new sensor-related features or the development of new topics. Discussion: Digital health applications offer a low-cost and scalable route to meet challenges to public health. As Elena+ was developed by an international and interdisciplinary team in a short time frame to meet the COVID-19 pandemic, empirical data are required to discern how effective such solutions can be in meeting real world, emergent health crises. Additionally, clustering Elena+ users based on characteristics and usage behaviors could help public health practitioners understand how population-level digital health interventions can reach at-risk and sub-populations.

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

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.

Understanding the Influence of Eating Patterns on Binge Drinking: A Mediation Model

BACKGROUND

Binge drinking is an important health problem, and it has been related to binge eating and fat intake in animal models, but this relationship has not been tested in humans. The first objective of this study was to analyze whether binge eating and fat intake are related to binge drinking in a youth sample. The second objective was to analyze whether binge eating and fat intake mediate the relationship between individual factors associated with binge eating and fat intake (sex, body mass index (BMI), drive for thinness, body dissatisfaction, eating styles, impulsivity, and food addiction) and binge drinking.

METHODS

A sample of 428 undergraduate students filled out several questionnaires on binge drinking, binge eating, fat intake, drive for thinness, body dissatisfaction, eating styles, food addiction, and impulsivity.

RESULTS

Results showed an excellent model fit: χ2(25) = 30.342 (p = 0.212), comparative fit index (CFI) = 0.992, root mean squared error of approximation (RMSEA) = 0.022 [90% CI = 0.000, 0.047]. Binge eating and fat intake were positively related to binge drinking. Furthermore, emotional eating, external eating, and food addiction showed positive and statistically significant indirect relationships with binge drinking, whereas the relationship with restrained eating was negative.

CONCLUSIONS

These findings point to the need to use a broader approach in understanding and preventing binge drinking in the youth population by showing the influence of the eating pattern on this problem. This information could be helpful in preventing future behaviors and improving interventions that address health risk behaviors.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Trial Registration

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

International Registered Report Identifier (IRRID)

RR2-10.1186/s12888-015-0475-0

Efficacy and cost-effectiveness of a blended cognitive behavioral therapy for depression in Spanish primary health care: study protocol for a randomised non-inferiority trial

BACKGROUND

Data from primary health care in Spain show a high prevalence of the major depressive disorder. Blended treatment (combination of face-to-face and online components) seems to be a very promising tool for the optimization and dissemination of psychological treatments in a cost-effective form. Although there is growing data that confirm the advantages of blended therapies, few studies have analyzed their application in regular clinical practice. The objective of the present paper is to describe the protocol for a clinical study aimed at exploring the clinical and cost-effectiveness of a blended cognitive behavioral therapy (b-CBT) for depression, compared to treatment as usual (TAU) in a primary health care setting.

METHODS

A two-arm randomised controlled non-inferiority trial will be carried out, with repeated measures (baseline, 3 months, 6 months, and 12 months) under two conditions: b-CBT and TAU. The b-CBT program will consist in three face-to-face sessions and eight online sessions. The TAU is defined as the routine care delivered by the general practitioner for the treatment of depression in primary care. The primary outcome is a symptomatic change of depressive symptoms on the patient-health questionnaire (PHQ-9). Other secondary outcomes will be considered (e.g., quality of life, treatment preference). All participants must be 18 years of age or older and meet the diagnostic criteria for major depressive disorder according to the Diagnostic and Statistical Manual of Mental disorders 4th edition. 156 participants will be recruited (78 per arm).

DISCUSSION

It is expected that b-CBT is clinically non-inferior when compared to TAU. This is the first study in Spain to use a b-CBT format in primary and specialized care, and this format could be an efficacious and cost-effective therapeutic strategy for the treatment of depression.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02361684. Registered on 8 January 2015. Currently recruiting participants.

Ecological momentary assessment for chronic pain in fibromyalgia using a smartphone: a randomized crossover study

BACKGROUND

Daily diaries are a useful way of measuring fluctuations in pain-related symptoms. However, traditional diaries do not assure the gathering of data in real time, not solving the problem of retrospective assessment. Ecological momentary assessment (EMA) by means of electronic diaries helps to improve repeated assessment. However, it is important to test its feasibility in specific populations in order to reach a wider number of people who could benefit from these procedures.

METHODS

The present study compares the compliance and acceptability of an electronic diary running on a smartphone using a crossover design for a sample with a specific pain condition, fibromyalgia and low familiarity with technology. Forty-seven participants were randomly assigned to one of two conditions: (1) paper diary - smartphone diary and (2) smartphone diary - paper diary, using each assessment method for 1 week.

RESULTS

The findings of this study showed that the smartphone diary made it possible to gather more accurate and complete ratings. Besides, this method was well accepted by a sample of patients with fibromyalgia referred by a public hospital, with an important proportion of participants with low level of education and low familiarity with technology.

CONCLUSIONS

The findings of this study support the use of smartphones for EMA even in specific populations with a specific pain condition, fibromyalgia and with low familiarity with technology. These methods could help clinicians and researchers to gather more accurate ratings of relevant pain-related variables even in populations with low familiarity with technology.

Efficacy and acceptability of an Internet platform to improve the learning of nutritional knowledge in children: the ETIOBE Mates

Possessing sufficient nutritional knowledge is a necessary component in the prevention and treatment of obesity. A solid understanding of nutrition can help people make appropriate food selections and can also help correct irrational ideas or myths people may believe about food. It is a challenge to provide this information to children in ways that are exciting. Thus, we propose an online video game platform to deliver the information. The objective of this study was to study the efficacy and acceptability of an online game called 'ETIOBE Mates' that was designed to improve children's nutritional knowledge; furthermore, we compare it with the traditional paper-pencil mode of information delivery. A sample of 228 children participated in the study. Participants were divided into two groups: an experimental group (who used ETIOBE Mates) and a control group (who were given a pamphlet). Both groups increased their scores for nutritional knowledge. The interaction between group × time was also statistically significant; it indicated that acquisition of nutritional knowledge was superior in the experimental group. The children considered the serious games platform to be a useful medium for improving their nutritional knowledge. Online games can be an effective method of delivery for preventive and treatment tasks that are otherwise tedious for children.

Validation of the Dutch Eating Behavior Questionnaire for Children (DEBQ-C) for use with Spanish children

INTRODUCTION

The Dutch Eating Behaviour Questionnaire for children was developed by Van Strien and Oosterveld (2008) to measure three different eating behaviors (emotional eating, restrained eating and external eating); it is an adaptation of the DEBQ for adults.

OBJECTIVE

The purpose of this study is to analyze the psychometric properties of the Dutch Eating Behavior Questionnaire for Children (DEBQ-C) with a Spanish sample.

METHOD

The DEBQ-C was administered to 473 children (240 boys and 233 girls), from 10 to 14 years old. The sample included a Clinical Overweight Group (COG; n = 81) comprising children who were receiving weight loss treatments, a Non Clinical Overweight Group (NCOG, n = 31) comprising children who were overweight but not in treatment, and a Normal Weight Group (NWG, n = 280).

RESULTS

Results showed that the DEBQ-C had acceptable internal consistency (a = 0.70). Temporal stability was good for "External Eating" and "Restrained Eating" scales. Confirmatory factor analysis showed that the three-factor solution had good fit indices. Furthermore, the clinical overweight participants scored significantly higher on "External Eating" and "Restrained Eating" compared to the normal weight children.

CONCLUSION

The DEBQ-C proved to be an effective instrument for researching children's eating behaviors.

An Internet-based self-help treatment for fear of public speaking: a controlled trial

This study offers data about the efficacy of "Talk to Me," an Internet-based telepsychology program for the treatment of fear of public speaking that includes the most active components in cognitive-behavior therapy (CBT) for social phobia (exposure and cognitive therapies). One hundred twenty-seven participants with social phobia were randomly assigned to three experimental conditions: (a) an Internet-based self-administered program; (b) the same program applied by a therapist; (c) a waiting-list control group. Results showed that both treatment conditions were equally efficacious. In addition, Talk to Me and the same treatment applied by a therapist were more efficacious than the waiting-list condition. Treatment gains were maintained at 1-year follow-up. The results from this study support the utility of Internet-delivered CBT programs in order to reach a higher number of people who could benefit from CBT. Internet-delivered CBT programs could also play a valuable role in the dissemination of CBT.

Detection and distraction effects for threatening information in social phobia and change after treatment

This work examines differences in the detection and distraction by social-threat-related information between a social phobia group (SP; N=33) and a normal control group (NC; N=32). The change obtained after psychological treatment is also studied for the SP group. A paper-and-pencil visual search task is used, in which the emotional valence of the "target" (social threat, physical threat, and neutral words) and "distractor" (social threat, physical threat, neutral, and nonsense words) verbal stimuli is manipulated. Results indicate that there are no differences in the detection of social-threat targets between SP and NC participants. However, the performance of SP individuals is more impaired when distractor stimuli related to social threat are presented, regardless of the target valence. This increased distraction by social-threat-related stimuli is reduced after psychological treatment, and this decrease is maintained at 6-month follow-up.

The social phobia and anxiety inventory: psychometric properties in a Spanish sample

This study is a validation of the Spanish version of the Social Phobia and Anxiety Inventory using a nonclinical sample (198 participants) and a clinical sample (72 participants with social phobia). The factor structure and concurrent validity with Fear of Negative Evaluation and Social Avoidance and Distress scales were analyzed. The Social Phobia and Anxiety Inventory demonstrated good concurrent validity, showing statistically significant relationships with Fear of Negative Evaluation and Social Avoidance and Distress. Results confirmed the rationale for the division of the SPAI into two subscales. Results also demonstrated the utility of the Social Phobia and Anxiety Inventory for differentiating between a nonclinical sample and participants with a social phobia, and its adequate reliability.

Mixing realities? An application of augmented reality for the treatment of cockroach phobia

Augmented reality (AR) refers to the introduction of virtual elements in the real world. That is, the person is seeing an image composed of a visualization of the real world, and a series of virtual elements that, at that same moment, are super-imposed on the real world. The most important aspect of AR is that the virtual elements supply to the person relevant and useful information that is not contained in the real world. AR has notable potential, and has already been used in diverse fields, such as medicine, the army, coaching, engineering, design, and robotics. Until now, AR has never been used in the scope of psychological treatment. Nevertheless, AR presents various advantages. Just like in the classical systems of virtual reality, it is possible to have total control over the virtual elements that are super-imposed on the real world, and how one interacts with those elements. AR could involve additional advantages; on one side it could be less expensive since it also uses the real world (this does not need to be modeled), and it could facilitate the feeling of presence (the sensation of being there), and reality judgment (the fact of judging the experience as real) of the person since the environment he or she is in, and what he or she is seeing is, in fact the "reality." In this paper, we present the data of the first case study in which AR has been used for the treatment of a specific phobia, cockroaches phobia. It addresses a system of AR that permits exposure to virtual cockroaches super-imposed on the real world. In order to carry out the exposure, the guidelines of Ost with respect to "one-session treatment" were followed. The results are promising. The participant demonstrated notable fear and avoidance in the behavioral avoidance test before the treatment, and not only was an important decrease in the scores of fear and avoidance observed after the treatment, but also the participant was capable of approaching, interacting, and killing live cockroaches immediately following the treatment. The results are maintained in a follow-up conducted 1 month after the termination of the treatment.

Immersion and Emotion: Their Impact on the Sense of Presence

The present study is designed to test the role of immersion and media content in the sense of presence. Specifically, we are interested in the affective valence of the virtual environments. This paper describes an experiment that compares three immersive systems (a PC monitor, a rear projected video wall, and a head-mounted display) and two virtual environments, one involving emotional content and the other not. The purpose of the experiment was to test the interactive role of these two media characteristics (form and content). Scores on two self-report presence measurements were compared among six groups of 10 people each. The results suggest that both immersion and affective content have an impact on presence. However, immersion was more relevant for non-emotional environments than for emotional ones.

Explicit and implicit memory biases in depression and panic disorder

The purpose of the present study was to investigate the presence of a bias for emotional information (panic-related, depression-related, positive and neutral) in explicit memory and implicit memory (by means of free recall and word-stem completion tasks, respectively) among depressed (N=20) and panic (N=20) patients. Three different encoding conditions (graphemic, semantic and self-reference) were used. The results of this study failed to show the existence of a mood-congruent memory bias for both implicit and explicit memory in these emotional disorders. According to the correlational analyses performed, differences among categories of emotional words meant less than the difference among various types of encoding and memory bias in order to differentiate among groups.

Psychometric characteristics in normal and social phobic samples for a Spanish version of the Rosenberg Self-Esteem Scale

The present paper had three purposes: (a) presenting normative data for the Rosenberg Self-esteem Scale in a Spanish sample, (b) studying whether there are significant sex or age differences in self-esteem, and (c) studying whether there are significant differences between a Control group with no psychological diagnosis and a group of social phobics. Of the total sample of 266 persons, 214 belonged to the Control group and 52 to the Social Phobic group. Item-total score correlations and alpha reliabilities supported the internal consistency of the scale. There were statistically significant differences between the Control and Social Phobic groups, but not by sex or age.

Virtual reality: a new clinical setting lab

Virtual Reality (VR) is a new technology halfway between television and computer. It constitutes another step in the evolution of our use of a tool that allows us to see, to hear and to feel in a world created graphically in three dimensions, and to interact with it. VR is, mainly, a mental experience which makes the user believe that "he is there", that he is present in the virtual world. With this new tool, the user is no longer a mere observer of that which is happening on a screen, but he "feels" that he is immersed in that world and participates in it, in spite of the fact that they are spaces and objects that only exist in the memory of the computer and in the user's mind. This chapter seeks to carry out different reflections at different levels. First, we will analyze the relationships between VR and Psychology, one of the disciplines that has made more efforts in order to understand how we obtain knowledge from the world and from ourselves. We will also analyze the impact VR can have in one of the applied disciplines of Psychology, which is Clinical Psychology. With regard to this application environment, VR becomes a tool which can generate useful models for Psychology (both normal and abnormal), and it is offered as a research context for Clinical Psychology; as a "realistic" laboratory where we can study behaviours, emotions, thoughts, etc.; and a new means to develop psychological treatments.

Virtual reality treatment of claustrophobia: a case report

The efficacy of a treatment for claustrophobia using only Virtual Reality (VR) exposure was examined. The subject was a 43-year-old female who suffered from clinically significant distress and impairment and sought psychological therapy. Eight individual VR graded exposure sessions were conducted. All self-report measures were reduced following VR exposure and were maintained at one month follow-up. The necessity of a theoretical framework for this new medium for exposure therapy is discussed.

Self-consciousness Scale: a study of Spanish housewives

The purpose of this study was to examine the applicability with 93 Spanish housewives of the translated Self-consciousness Scale. We present reliability measures and normative data, and we also include data for two clinical samples (31 depressive and 31 asthmatic women patients).