Corrigendum: Efficacy of an ACT and compassion-based ehealth program for self-management of chronic pain (iACTwithPain): study protocol for a randomized controlled trial

[This corrects the article DOI: 10.3389/fpsyg.2021.630766.].

Self-compassion in Acceptance and Commitment Therapy for chronic pain: a pilot study

OBJECTIVES

Evidence shows that Acceptance and Commitment Therapy (ACT) is an empirically supported psychological approach for chronic pain (CP) management. Although self-compassion is not explicitly a target of ACT, it seems to be one mechanism of change in ACT for CP. However, research is lacking on the benefits of including explicit self-compassionate exercises in ACT for CP. The current study pilot tested a Compassionate ACT 8-session group program (COMP.ACT; n=9), as well as an ACT-only 8-session group program (ACT; n=7), in a sample of women with CP.

METHODS

The current study follows a quasi-experimental design, and conducts Reliable and Significant Change analyses comparing pre- to post-intervention scores of self-report measures.

RESULTS

No differences were found between conditions at baseline, nor between completers and drop-outs. Although preliminary, results showed COMP.ACT led to greater clinical improvements in depression and anxiety, while ACT led to greater improvements in stress and uncompassionate self-responding. Reliable and Significant Change analysis showed that some participants improved significantly (in psychopathological symptoms, valued living and uncompassionate self-responding) in both conditions, while the majority did not change significantly.

CONCLUSIONS

More research is needed to conclude whether explicit self-compassion exercises are useful in ACT for CP. Limitations and implications are further discussed.

Usability Study of the iACTwithPain Platform: An Online Acceptance and Commitment Therapy and Compassion-Based Intervention for Chronic Pain

Background

This pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates.

Methods

Seventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform’s usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention from a practitioner’s point of view.

Results

This study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format.

Conclusion

This study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed.

Experiential avoidance, uncompassionate self-responding, and peritraumatic depersonalization/derealization: A novel mediation model for war-related PTSD symptomatology

OBJECTIVE

To explore a novel model for war-related posttraumatic stress disorder (PTSD) symptomatology including emotion regulation processes, namely experiential avoidance (EA) and uncompassionate self-responding (USR), mediating the impact of childhood threat memories, combat exposure distress, combat and noncombat threats, and peritraumatic depersonalization/derealization (PDD) on PTSD symptomatology.

METHOD

A sample of 650 male Portuguese Overseas War veterans filled self-report instruments.

RESULTS

The model explained 59% of the variance of PTSD symptomatology. Both EA and USR mediated the effects of noncombat threats and PDD on PTSD. Additionally, EA mediated combat exposure distress and USR mediated childhood threat memories. Combat exposure distress, combat and noncombat threats, and PDD showed direct effects on PTSD symptomatology.

CONCLUSION

The findings help to better understand the relationship between predictive factors of war-related PTSD in clinical and research settings, providing novel insights on the effects of combat exposure distress, and the different effects of combat and noncombat-related threats on PTSD.

Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis

Acceptance and Commitment Therapy (ACT) has been widely tested for chronic pain, with demonstrated efficacy. Nevertheless, although there is meta-analytical evidence on the efficacy of face-to-face ACT, no reviews have been performed on online ACT in this population. The aim of this meta-analysis is to determine the efficacy of online ACT for adults with chronic pain, when compared with controls. PubMed, PsycINFO, CENTRAL, and Web of Knowledge were searched for randomized controlled trials (RCTs) of online-delivered ACT for chronic pain. Effects were analyzed at post-treatment and follow-up, by calculating standardized mean differences. Online-delivered ACT was generally favored over controls (5 RCTs, N = 746). At post-treatment, medium effects for pain interference and pain acceptance, and small effects for depression, mindfulness, and psychological flexibility were found. A medium effect for pain interference and acceptance, and small effects for pain intensity, depression, anxiety, mindfulness, and psychological flexibility were found at follow-up. ACT-related effects for pain interference, pain intensity, mindfulness, and anxiety increased from post-treatment to follow-up. Nevertheless, the current findings also highlight the need for more methodologically robust RCTs. Future trials should compare online ACT with active treatments, and use measurement methods with low bias. PERSPECTIVE: This is the first meta-analytical review on the efficacy of online ACT for people with chronic pain. It comprises 5 RCTs that compared online ACT with active and/or inactive controls. Online ACT was more efficacious than controls regarding pain interference, pain intensity, depression, anxiety, mindfulness, and psychological flexibility.

Efficacy of an ACT and Compassion-Based eHealth Program for Self-Management of Chronic Pain (iACTwithPain): Study Protocol for a Randomized Controlled Trial

BACKGROUND

Chronic pain (CP) has serious medical and social consequences and leads to economic burden that threatens the sustainability of healthcare services. Thus, optimized management of pain tools to support CP patients in adjusting to their condition and improving their quality of life is timely. Although acceptance and commitment therapy (ACT) is considered an evidence-based psychological approach for CP, evidence for the efficacy of online-delivered ACT for CP is still scarce. At the same time, studies suggest that self-compassion mediates the change in disability and psychopathological symptoms in ACT interventions for CP, although self-compassion is not a specific target in ACT. Thus, an explicit focus on self-compassion might increase the efficacy of ACT interventions for CP, although this hypothesis has not been tested. This study aims to develop an eHealth ACT and compassion-based self-management intervention for CP, the iACTwithPain, and to compare its efficacy in improving health outcomes to a similar ACT-only intervention and a medical TAU group.

METHODS

The eHealth platform that will host the interventions will be developed using a flat design identity and will be interactive. The iACTwithPain intervention will comprise eight weekly self-management sessions and will be developed taking into consideration the psychological flexibility model applied to CP, with the addition of explicit compassion-based components. To analyze whether the iACTwithPain intervention will present superiority in improving CP's impact and related health markers over the two other conditions, this study will follow an RCT design with three arms. CP patients will be recruited through direct contact with patient associations and healthcare services and a national press release in Portugal. Outcome measurement will be conducted at baseline, post-intervention and at 3- and 6-month follow-ups. The interventions' acceptability will also be assessed.

DISCUSSION

The iACTwithPain intervention is expected to improve CP patients' psychosocial functioning, quality of life, and empowerment, by promoting adaptive disease management and regulation of pain-related internal experiences. Results will contribute to a better understanding on the pertinence of adding compassion elements to ACT for CP and to reach an optimized intervention for CP.

CLINICAL TRIAL REGISTRATION

This trial has been registered at ClinicalTrials.Gov (NCT04200183; 16 December 2019; https://clinicaltrials.gov/ct2/show/NCT04200183). The current manuscript comprises the first version of this clinical trial's protocol.

Personality Pathology Profiles as Moderators of the Growing Pro-Social Program: Outcomes on Cognitive, Emotion, and Behavior Regulation in Male Prison Inmates

This study consisted of secondary data analysis of information collected from inmates who had participated in an earlier independent randomized controlled trial testing the effects of the Growing Pro-Social (GPS) program. The current study assessed personality disorders as moderators of the GPS effects in cognitive malfunctioning, emotion regulation strategies, and prison misconduct in male prison inmates. Participants were 254 inmates randomly assigned to either the GPS (n = 121) or the control group (n = 133). Participants completed self-report measures at four time points, and were interviewed with the SCID-II at baseline. Prison misconduct information was collected from prison records. Latent profile analysis identified four different personality pathology profiles. Mixed ANOVAs showed non-significant time × condition × personality pathology profiles effects, indicating that change on the outcome measures was not affected by personality pathology. Findings suggested that severely disturbed inmates could benefit from the GPS program, which stresses the need to provide appropriate treatment to offenders.

Predictors of poor 6-week outcome in a cohort of major depressive disorder patients treated with antidepressant medication: the role of entrapment

BACKGROUND

Only a small number of consistent processes predict which depressed patients will achieve remission with antidepressant medication. One set of processes is that of social ranking strategies/variables that are related to life events and severe difficulties. Particularly, defeat and entrapment predict poorer response to antidepressants. However, results are inconsistent.

AIM

The current study aimed to evaluate evolutionary strategies, childhood maltreatment, neglect and life events and difficulties (LEDs) as predictors of remission in depressed patients undergoing pharmacological treatment in a psychiatric outpatient sample.

METHODS

A cohort of 139 depressed outpatients undergoing pharmacological treatment was followed prospectively in a naturalistic study for 6 weeks. Two major evaluations were considered at baseline and 6 weeks. We allocated patients to a pharmacological treatment algorithm for depression - the Texas Medication Algorithm Project. Variables evaluated at baseline and tested as predictors of remission included demographic and clinical data, severity of depression, social ranking, evolution informed variables, LEDs and childhood maltreatment.

RESULTS

Of the 139 patients, only 24.5% were remitted at week 6. In univariate analyses, non-remitted patients scored significantly higher in all psychopathology and vulnerability scales except for submissive behaviour and internal entrapment. For the logistic regression, a higher load of LEDs of the entrapment and humiliation dimension in the year before the index episode (OR = 6.62), and higher levels external entrapment in the Entrapment Scale (OR = 1.10) predicted non-remission. These variables accounted for 28.7% of the variance.

CONCLUSIONS

Multivariate analysis revealed that external entrapment was the only predictor of non-remission.

Above and beyond emotional suffering: the unique contribution of compassionate and uncompassionate self-responding in chronic pain

Objectives Studies have shown that self-compassion plays a protective role against depression in women with chronic pain (CP). However, the majority of studies in CP have used the total score of the self-compassion scale (SCS), which have raised concerns due to potential overlap, not only between the uncompassionate self-responding factors and psychopathology, but also between self-compassion as a whole and other well-known psychological processes (e.g., mindfulness, acceptance, psychological flexibility). This calls for a more nuanced understanding of which components of (un)compassionate self-responding adds to better mental health in CP. Methods This study explores the unique contribution of compassionate and uncompassionate self-responding to depressive symptoms in women with CP undergoing pain consultation (n = 49). Results Correlation analyses suggest that compassionate self-responding only significantly correlates with progress in valued living, while the uncompassionate self-responding significantly correlates with pain fusion, pain avoidance, obstructions to valued living and depression. Multiple regression analysis showed that self-compassion contributes to depressive symptoms (R2 = 8%) above and beyond pain intensity and disability (R2 = 12%) and psychological (in) flexibility processes (R2 = 31%), and uncompassionate (but not compassionate) self-responding uniquely contributes to depressive symptoms (sr 2  = 18%). Conclusions Findings suggest that uncompassionate self-responding is a stronger contributor to depression in CP than compassionate self-responding. Clinical implications are further discussed.

Perceived validation and criticism in pain: Development of a new measure in chronic pain

BACKGROUND

Research suggests that the way others react to a pain flare-up impacts on psychological and pain-related symptoms in chronic pain (CP). Experiencing validation from others is associated with less negative emotions and better functioning. Contrarily, experiencing criticism is linked to greater pain intensity and worse functioning. Nonetheless, studies are limited by an exclusive focus on spouses rather than significant other relationships, the use of proxy constructs (e.g. social support, responsiveness, solicitousness) rather than specific measures of validation and criticism and a focus on significant others' behaviour rather than patients' subjective experience. This study examines the psychometric properties of a new measure - Perceived Validation and Criticism in Pain Questionnaire (PVCPQ), and tests its contribution to functional impairment beyond pain intensity, sociodemographic and medical-related variables, positive and negative affect, safeness and compassion from others.

METHODS

Women with CP (N = 172), 130 (75.6%) of whom had fibromyalgia, completed an online battery of questionnaires (PVCPQ; numeric pain rating scale; work and social adjustment scale; positive and negative affect schedule; social and pleasure scale; compassionate engagement and action scale). Exploratory factor analysis (EFA), reliability analysis, correlational analysis and hierarchical regression analysis were performed.

RESULTS

EFA showed a 23-item two-factor solution with good psychometric properties. Criticism in pain (but not validation in pain) contributed to functional impairment above and beyond the variance explained by pain intensity, sociodemographic and medical variables, positive and negative affect, safeness and compassion from others.

CONCLUSIONS

These findings suggest that the PVCPQ is a psychometrically valid new measure of perceived validation and criticism in pain that contributes to explaining pain-related functional impairment.

SIGNIFICANCE

The current study provides a new 23-item measure of perceived validation and criticism by others in chronic pain that overcomes the limitations of existing measures. It adds to the literature by suggesting that perceived criticism (but not validation) contributes to functional impairment beyond sociodemographic variables, pain intensity, affect and related constructs such as social safeness and compassion from others. These results suggest that psychosocial interventions that aim to promote functioning in chronic pain should focus on the subjective experience of being criticized and validated by significant others.

Flexibility between immersion and distancing: A dynamic pattern with effect on depressive symptoms

Objective: Recent studies on immersion (first-person perspective) and distancing (third-person perspective) in psychotherapy have shown the potential of both perspectives in the treatment of depression. High levels of change were associated with transitions between immersion and distancing, suggesting that a dynamic pattern between them may result in a more adaptive view of reality. This study aimed to assess if higher flexibility between these perspectives, during clientś reflection on negative experiences in the intermediate phase, is associated with lower levels of depressive symptoms at the end of treatment. Method: We analyzed the flexibility through frequency and magnitude of transitions between immersion and distancing, in representative sessions of the intermediate phase of therapy in 17 cases with depression. Results: The results showed that the higher frequency and lower magnitude in the intermediate phase predicted lower levels of depressive symptoms at the end of treatment. Conclusion: Immersion and distancing seem to work as dynamic processes, and greater flexibility between them in intermediate phase of therapy, characterized by frequent and fast transitions between the two perspectives, may be an adaptive pattern due to its effect on post treatment depressive symptoms.

Being Afraid of Compassion: Fears of Compassion as Mediators Between Early Emotional Memories and Psychopathological Symptoms in Adulthood

Introduction

There is evidence suggesting that for some individuals self-generating compassion and being open to compassion from others can be difficult or aversive. To date, however, no study has explored how these fears of compassion are associated with early emotional memories, such as shame or safeness memories, and to symptoms of depression and anxiety in adulthood. The current study set out to investigate the mediator effect of fears of compassion on the relationship between the traumatic and centrality features of shame memories, early memories of warmth and safeness, and symptoms of depression and anxiety.

Method

In this cross-sectional study, participants were 302 individuals (171 women; age M = 36.28; SD = 11.45) recruited from the general community population, who completed self-report measures of fears of compassion (for self, for others and from others), shame memories, safeness memories, depression and anxiety.

Results

Path analysis showed that fears of compassion for self and of receiving compassion from others mediated the effects of shame traumatic memory, centrality of shame memory and early memories of warmth and safeness on depressive and anxiety symptoms. Fear of compassion for self was the best predictor of depression and anxiety.

Conclusions

Fears of compassion may render an individual more vulnerable to defeat and threat responses when faced with stressful life events, which can manifest as symptoms of depression or anxiety. Clinical implications might be derived from these findings as these fears, as well as the negative emotional memories fuelling them, may need to be addressed in therapy to assist patients in self-generating and receiving compassion.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Shame and emotion regulation in inflammatory bowel disease: Effects on psychosocial functioning

Although patients with inflammatory bowel disease seem to be prone to high levels of shame, the mechanisms behind the impact of chronic illness–related shame on patients’ functioning have not been explored yet. This study aims to address these gaps using a sample of 161 patients with inflammatory bowel disease who completed self-report measures on an online survey. The results from path analyses showed that chronic illness–related shame presented direct and indirect effects on psychological health ( R2 = .66) and social relationships ( R2 = .46). The indirect effects were mediated by experiential avoidance and uncommitted living. Possible explanations to these findings and clinical implications are discussed.

Portuguese version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Comparison of latent models and other psychometric analyses

OBJECTIVE

This psychometric study explores the Portuguese version of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5). It aims to clarify the best-fitting latent structure among competing PTSD models (Diagnostic and Statistical Manual of Mental Disorders-fifth edition [DSM-5], Dysphoria, Dysphoric Arousal, Anhedonia, Externalizing Behavior, And Hybrid models) and its implications for PTSD measurement.

METHOD

Psychometric analyses were conducted in a sample from the general population of firefighters (N = 446), except the temporal stability, which was tested in a subsample of 100 participants.

RESULTS

The models presented significant differences in a global fit. The Hybrid model presented the best-fitting structure, but the DSM-5 model showed more favorable reliability and convergent validity in Confirmatory Factor Analyses. The DSM-5 model also proved to be internally consistency, temporally stable, and presented convergent validity.

CONCLUSION

The Portuguese version of PCL-5 is reliable and valid. The findings suggest the appropriateness of the DSM-5 model to assess PTSD symptomatology, encouraging its use in clinical, and research settings.

The influence of self-criticism on depression symptoms among ambulatory patients with inflammatory bowel disease

Considering that self-criticism is an important process in the development and maintenance of depression, and taking into account the stigma associated with inflammatory bowel disease (IBD), the present study aimed to analyse whether self-criticism exacerbates the relationships of depression symptoms with IBD symptomatology and chronic illness-related shame. The sample included 53 ambulatory IBD patients (66% females) with ages from 18 to 65. Moderation analyses were conducted using structural equation modelling. Self-criticism exacerbated the associations of depression with IBD symptoms (b = 0.01; standard error [SE] = 0.00; Z = 3.73; P < .001) and illness shame (b = 0.02; SE = 0.01; Z = 2.40; P = .016). For the same level of IBD symptomatology or chronic illness-related shame, those individuals who present more feelings of inadequacy towards the self, experience more symptoms of depression. This exacerbation effect is stronger when IBD symptomatology and chronic illness-related shame are more intense. A high self-critical IBD patient may view the illness and/or symptomatology as a flaw or error that should be self-corrected. Physicians and other health professionals should be attentive to these pathological mechanisms and should attempt to alleviate them. It may be beneficial to refer high self-critical patients to psychological care.

Cognitive fusion and depressive symptoms in women with chronic pain: A longitudinal growth curve modelling study over 12 months

This study aims to (a) explore individual differences in women with chronic pain (CP) in regard to pain intensity, functional impairment, cognitive fusion, and depressive symptoms and (b) longitudinally test whether cognitive fusion is a significant predictor of depression symptoms, while controlling for pain intensity and functional impairment, over a 12-month period. This study follows a longitudinal design and was conducted in a sample of 86 women with CP who responded to an online battery of questionnaires in three equally spaced assessment moments. In order to explore the growth trajectory of variables of interest, latent growth curve models were examined. Also, correlation analyses were conducted between demographic and illness-related variables and depressive symptoms, as well as between all variables in all assessment moments. Cognitive fusion and functional impairment (but not pain intensity) were significantly associated with baseline levels of depressive symptoms. Cognitive fusion significantly predicted the growth trajectory of depressive symptoms, whereas pain intensity and functional impairment did not. No demographic (age, marital status, education, socio-economic) nor illness-related variables (number of CP diagnoses, duration of CP, taking medication) were associated with depressive symptoms at any point. These results suggest that the trajectory of depressive symptoms in women with CP is not predicted by the intensity of pain nor pain-related functional impairment, but rather by the tendency to get entangled with internal experiences (e.g., thoughts, emotions, and physical sensations), which may or may not be related to pain-specific contents. Clinical implications are discussed.

Association study of variants in genes FTO, SLC6A4, DRD2, BDNF and GHRL with binge eating disorder (BED) in Portuguese women

A population based case-control study was conducted in Portuguese women with overweight/obesity to investigate the possible association of variants in genes FTO, SLC6A4, DRD2, BDNF and GHRL with binge eating disorder (BED). The distribution of seven polymorphisms was evaluated in 31 BED patients and 62 controls. No significant associations were found between polymorphisms and BED. Of interest, a markedly lower frequency of the FTO rs9939609 obesity risk A-allele was found in BED patients (0.290) in relation to the control group (0.402). Contrasting with anorexia nervosa and bulimia nervosa, our data suggest that rs9939609 A-allele has no potential role in BED.

A 7-year follow-up study of the Mindfulness-Based Program for Infertility: Are there long-term effects?

The Mindfulness-Based Program for Infertility (MBPI) was developed for people facing infertility and proved effective in cultivating mindfulness skills, improving infertility self-efficacy, and decreasing depression, shame, entrapment, and defeat feelings. Fifty-five women attended the MBPI sessions and completed self-report measures of depression, anxiety, mindfulness, and experiential avoidance at post-MBPI (T1), 6-month follow-up (T2), and 7-year follow-up (T3). There were significant direct time effects regarding experiential avoidance (F = 3.81; p < 0.033; η_p ²  = 0.08), the mindfulness facets describing (F = 3.54; p = 0.037; η_p ²  = 0.13), acting with awareness (F = 6.87; p = 0.002; η_p ²  = 0.22), nonjudging of inner experience (F = 10.66; p < 0.001; η_p ²  = 0.31), and depressive symptoms (F = 4.85; p = 0.020; η_p ²  = 0.10). There was an increase in the describing facet from T1 to T3 (p = 0.036). The act with awareness facet increased from T1 to T2 (p = 0.010) and from T1 to T3 (p = 0.007), as well as the nonjudging of inner experience facet (T1 to T2 [p = 0.030] and T1 to T3 [p = 0.002]). Experiential avoidance decreased from T1 to T3 (p = 0.022) and depressive symptoms from T1 to T2 (p = 0.019). Post-MBPI scores were maintained at T2 and T3 concerning anxiety symptoms and the observing and no-reactivity mindfulness facets. There were long-term effects of MBPI on mindfulness and experiential avoidance. Moreover, therapeutic gains were maintained regarding depression and anxiety symptoms, independently of the reproductive outcome.

The weight of weight self-stigma in unhealthy eating behaviours: the mediator role of weight-related experiential avoidance

Weight stigma plays a damaging role in the life of the individuals with overweight and obesity who may internalise the widespread stigmatisation messages. Weight self-stigma is defined as personal experiences of shame, negative self-evaluations as well as perceived discrimination. It has been found to be related to experiential avoidance patterns and poorer outcomes. The current study aims to conduct a confirmatory factor analysis (CFA) on the Weight Self-Stigma Questionnaire (WSSQ) and explore its psychometric properties. Furthermore, the mediator role of weight-related experiential avoidance on the relationship between weight self-stigma and unhealthy eating behaviour was analysed. Concerning the CFA, the sample comprised 331 women with overweight and obesity seeking nutritional treatment. A second independent sample of 58 overweight and obese women was used to assess WSSQ's temporal validity and internal responsiveness. Results supported the WSSQ two-factor structure and good psychometric properties and responsiveness to change. Also, evidence was found for the mediator role of weight-related experiential avoidance on the relationship between BMI, weight self-stigma and unhealthy eating patterns in women with overweight and obesity. Overall, the current study showed that WSSQ is a reliable measure and highlights the important role of weight self-stigma and weight-related experiential avoidance in women with overweight and obesity. Level of evidence: Level V, descriptive studies.

Development and Evaluation of a Global Burnout Index Derived from the Use of the Copenhagen Burnout Inventory in Portuguese Physicians

INTRODUCTION

The Copenhagen Burnout Inventory was developed to overcome what some authors have proposed as potential limitations of existing burnout measures. Specifically, the Copenhagen Burnout Inventory measures the main component of burnout (i.e. exhaustion) in three domains: personal-, work- and patient-related. Additionally, some authors have argued the necessity to have available a global burnout index.

MATERIAL AND METHODS

This study followed a cross-sectional design in a sample of Portuguese physicians (n = 1348). A confirmatory factor analyses was conducted and the Copenhagen Burnout Inventory´s three-factor structure was tested. In addition, a model with a 2nd order factor was tested with the goal of achieving a one-factor structure that would allow a global burnout index.

RESULTS

The confirmatory factor analyses showed a good model fit for both the three-factor and one-factor model, having the latter a significant better fit. The Copenhagen Burnout Inventory showed good psychometric properties for both structures, with good reliability according to Chronbach`s alphas and average variance extracted between factors. The Copenhagen Burnout Inventory I was statistically and positively correlated with depression, anxiety and stress symptoms, as well as rumination, and negatively correlated with life satisfaction.

DISCUSSION

The current study shows that the Copenhagen Burnout Inventory is a psychometrically valid measure of burnout in Portuguese physicians, and contributes with an instrument able to produce a global index of burnout. This measure provides comprehensive information on different dimensions associated with the development of burnout, as well as presents a global burnout score. Results show that participants who had more burnout also presented higher levels of depressive, anxiety and stress symptoms, as well as present more ruminative thinking, and less life satisfaction.

CONCLUSION

The Copenhagen Burnout Inventory is a psychometrically valid measure of burnout that allows for exploratory studies on the overall level of exhaustion, thus making it possible the comparison between groups in a way that is not restricted to occupation specific aspects.

Is the widely used two-factor structure of the Ruminative Responses Scale invariant across different samples of women?

OBJECTIVES

Although the Ruminative Responses Scale is one of the most widely used measures of rumination, its two-factor structure remains controversial. Taking this into account, we aimed to test the RRS-10 two-factor invariance (Brazilian version) between different samples of women and to study its internal consistency and convergent validity.

METHODS

A sample of 321 women (general population, n = 106; college students, n = 115; and medical population of patients with overweight and obesity, n = 100) participated in the study. The two-factor structure of RRS-10 was assessed by CFA and multigroup analysis using Mplus software. Internal consistency was assessed by Cronbach's alpha and the convergent validity by Pearson correlations.

RESULTS

The two-factor structure of RRS-10 showed a good fit, factorial invariance across three samples, good internal consistency, and adequate convergent validity. Brooding and Reflection subscales were both positively correlated with psychological inflexibility, cognitive fusion, anxiety, depression, and stress symptoms, although Brooding presented significantly stronger associations with these variables than Reflection.

CONCLUSIONS

This study provides further discussion and evidence regarding the RRS-10 two-factor structure, as well as a valid version of RRS-10 to use in Brazil in order to reliably assess rumination in medical and research settings.

PRACTITIONER POINTS

This is the first study to test and confirm the RRS two-factor structure invariance across groups. RRS-10 two-dimensionality was confirmed in medical and non-medical samples of women. Brooding subscale showed significantly stronger relationships with psychopathology and experiential avoidance than Reflection. The study provides evidence that RRS can be used as a valid and sound measure to accurately assess the clinically relevant dimensions of rumination simultaneously across distinct groups.

Mindfulness, selfcompassion, and depressive symptoms in chronic pain: The role of pain acceptance

OBJECTIVE(S)

The aim of this study was to test a theory driven model in which pain acceptance (both pain willingness [PW] and activity engagement [AE]) mediates the relationships of mindfulness and selfcompassion with depressive symptoms, while controlling for pain intensity.

METHODS

A path analysis was conducted using AMOS software to test a meditational model in a sample of women with chronic musculoskeletal pain (N = 231).

RESULTS

Participants with higher levels of mindful awareness and selfcompassion presented lower levels of pain intensity and depressive symptoms, and higher levels of AE. PW did not significantly correlate with any variable in study. The mediation analysis showed that AE mediated the relationship between selfcompassion and depressive symptoms, independently from pain intensity.

CONCLUSIONS

These findings seem to corroborate the hypothesis that selfcompassion is rooted in a motivational system, as it seems to correlate with less depressive symptoms through increasing the engagement with valued actions despite experiencing pain.

The Origins of Fears of Compassion: Shame and Lack of Safeness Memories, Fears of Compassion and Psychopathology

Empirical and clinical research suggests that some individuals find self-generating compassion and receiving compassion from others difficult and aversive. However, it is unclear how these fears of compassion are linked to early experiences and to psychopathological symptoms. This study explores the relationship between shame traumatic memories, centrality of shame memories, early memories of warmth and safeness, fears of compassion, and depression, anxiety and paranoid symptoms. Participants were 302 individuals from the general community population, who completed self-report measures of fears of compassion, shame memories, early affiliative memories, and psychopathology. Shame traumatic and central memories were positively associated with fears of compassion for self, for others and from others, whereas early memories of warmth and safeness were negatively related to such fears. Path analyses revealed that fears of compassion for self and of receiving compassion from others mediated the effects of shame traumatic memory, centrality of shame memory and early memories of warmth and safeness on depressive, anxious and paranoid symptoms. These findings have implications for therapeutic interventions as these fears, as well as the negative shame-based emotional memories fuelling them, may need to be addressed in therapy to assist patients in self-generating and receiving compassion.

Psychosocial roots of paranoid ideation: The role of childhood experiences, social comparison, submission, and shame

BACKGROUND

Social experiences have a significant impact on cognitive functioning and appraisals of social interactions. Specifically, recalls of antipathy from parents, submissiveness, and bullying during childhood can have a significant influence on paranoid ideation later in life.

METHOD

Multiple hierarchical regression analysis was performed on a sample of 91 patients diagnosed with paranoid schizophrenia in remission and active phase, their first-degree relatives (n = 32) and unaffected controls (n = 64).

OBJECTIVES

Exploring the impact of distal (events from childhood) and proximal factors (current cognitive, emotional, and behavioural aspects of social functioning) in the frequency, degree of conviction, and distress resulting from paranoid ideation in the participants from 4 samples.

RESULTS

Proximal and distal factors (shame, submissive behaviour, negative social comparison, antipathy from father) predicted several aspects of paranoid ideation. Those variables had a differential impact in affected patients and healthy controls.

DISCUSSION

Finding suggests different variables being involved in paranoid ideation, and the specificities of patients with paranoid schizophrenia should be considered in the development of more effective psychotherapeutic interventions.

Going beyond social support: Fear of receiving compassion from others predicts depression symptoms in breast cancer patients

BACKGROUND

Recent studies have highlighted the importance of being able to receive compassion and affiliative signals from others. The main aim of the present study was to explore whether social support and fear of receiving compassion from others are predictors of depression symptoms in a sample of breast cancer patients.

METHODS

The sample included 86 female patients with non-metastatic breast cancer. Participants were recruited at a Radiotherapy Service in central Portugal and completed validated self-report instruments. Multiple regression analysis were conducted to examine the predictive effects of clinical (cancer stage, comorbidities) and demographic variables (age, education), social support, and fear of receiving compassion from others on depressive symptoms.

RESULTS

Fear of receiving compassion from others was the only significant predictor of the model, with a positive effect on depression symptomatology (β = 0.44; p < 0.001). These results suggest that the amount of supportive social contacts and networks may not be as important as cancer patients' ability to receive compassion from others.

CONCLUSIONS

This is the first study to focus on fear of receiving compassion from others in cancer patients and seems to be a significant contribution for the study of the social factors that may be associated with depression in breast cancer. Psychological screening interviews in breast cancer, besides assessing patients' level of depression and social support, ought to also evaluate the ability to receive empathy and emotional help and support from other people.

Development of a measure for the assessment of peer-related positive emotional memories

OBJECTIVES

Previous research has demonstrated a link between early experiences of warmth, safeness, and soothing, and positive feelings, health, and well-being outcomes. Although the impact of positive parent-related early relationships and its posterior recall is well documented, research on the recall of warmth and safeness experiences within early peer relationships remains scarce. In fact, it is considered that the protective role of early positive peer relationships deserves intensive research; however, a specific measure that assesses this construct is still to be created. This study describes the development and validation of a new measure designed to assess the recall of early experiences of warmth, safeness, and affection in relation to peers (EMWSS-peers).

DESIGN AND METHODS

Distinct samples, comprising individuals of both genders aged between 18 and 68 years old, were used to test the EMWSS-peers factorial structure through principal axis factoring (PAF) and confirmatory factor analysis (CFA), and to examine its psychometric properties.

RESULTS

Principal axis factoring's results indicated that the 12-item scale presents a one-factor structure explaining a total of 71.50% of the variance. The CFA confirmed the plausibility of this structure. The EMWSS-peers also presented excellent internal consistency and construct, concurrent, and divergent validities.

CONCLUSIONS

The EMWSS-peers seems to be a new avenue for the study of memories of early experiences with friends and colleagues and may entail a relevant contribution to clinical and research fields, particularly for upcoming investigations on the relationship of peer-related affiliative memories with well-being and mental health.

PRACTITIONER POINTS

The EMWSS-peers is a specific measure to assess the recall of warmth and safeness in early peer relationships. The EMWSS-peers is a brief, robust, and reliable self-report instrument. The EMWSS-peers presented excellent internal consistency and construct, concurrent, and divergent validities. The EMWSS-peers may open a new avenue for the study of memories of early peer-related experiences, with potential clinical and research implications.

Propriedades Psicométricas da Escala de Cuidado do Questionário de Experiências de Cuidado e Abuso na Infância (Childhood Experiences of Care and Abuse – CECA.Q)

Certas formas de cuidado, como negligência ou antipatia, o abuso infantil e a adversidade em geral são preditores de patologia na vida adulta. As entrevistas existentes para a sua avaliação são muito longas tornando-se úteis só em pequenas amostras. O estudo das experiências infantis através de um questionário de auto-resposta torna viável a realização de investigação em amostras mais amplas. Neste trabalho apresentam-se as propriedades psicométricas da Escala de Cuidado (EC) da versão em português do Questionário de Experiências de Cuidado e Abuso na Infância (CECA.Q) (Smith, Lam, Bifulco, & Checkley, 2002). A EC avalia as experiencias de cuidado até aos 17 anos. Na versão original apresenta uma escala com 16 itens, respondida duas vezes, uma em relação à mãe e outra em relação ao pai, possuindo duas subescalas, negligência e antipatia. Globalmente, o CECA.Q avalia para além de experiências de negligência e antipatia, perda parental, abuso físico e sexual. A EC foi avaliada num grupo de estudantes (N = 545), num grupo da população geral (N = 262) e num grupo de doentes com depressão major (N = 100). Após um primeira análise dos dados, concluiu-se que os itens 7, 8, 11, e 15 não possuíam qualidades psicométricas para se manterem na versão portuguesa da EC do CECA.Q, resultando então uma versão de 12 itens. A análise factorial demonstrou a existência de dois factores (negligência e antipatia) nas três amostras, verificou-se uma boa consistência interna, entre .70 e .95 considerando os dois factores, ambos os pais, os três grupos e ambos os géneros, bem como uma adequada validade de construto e estabilidade teste-reteste entre .62 e .88 no grupo de estudantes e população geral. A presente versão da Escala de Cuidado do CECA.Q mostrou ter qualidades psicométricas adequadas para ser utilizada em estudantes, em sujeitos da população geral, bem como em populações com psicopatologia depressiva, sendo necessária agora investigação em outras amostras e utilizando estudos de seguimento.

Promoting emotion and behavior regulation in male prison inmates: A secondary data analysis from a randomized controlled trial testing the efficacy of the growing pro-social program

This article describes a secondary data analysis collected from inmates who participated in an independent randomized controlled trial, testing the efficacy of the Growing Pro-Social (GPS) Program. The current study aimed to test the program's ability to increase, on one hand, cognitive reappraisal (adaptive emotion regulation strategy) and, on the other hand, decrease expressive suppression (maladaptive emotion regulation strategy) over time. It was also assessed if the GPS was capable of reducing disciplinary infractions committed by inmates over time. Participants were randomized to the GPS treatment (n = 121) or the control group (n = 133). The Emotion Regulation Questionnaire was completed at baseline, at mid-treatment, at post-treatment and at 12-months' follow-up. Disciplinary infractions were collected from prison records during the 12 months before the beginning of the program, during the GPS's 12-month length and during the 12 months after treatment completion. Treatment effects were analyzed with latent growth curve models. Concerning cognitive reappraisal, while treatment participants showed a significant increase, controls presented a decrease over time. For expressive suppression, the treatment group presented a significant decrease, and the control group showed no change over time. Treatment participants also presented a significant decrease in the number of disciplinary infractions and in the number of days in punishment, while controls showed no change or an increase over time. This study showed the GPS's ability to promote emotion and behavior regulation, which contributes not only to inmate's interpersonal adjustment, but also to a more efficient management of the prison system. (PsycINFO Database Record

How and when immersion and distancing are useful in emotion focused therapy for depression

Objective: The potential benefit or harm of immersion (egocentric perspective) and distancing (observer perspective) on negative experiences are unclear and have not been empirically investigated in therapy. This is a first exploratory study aimed to analyze and compare the perspectives adopted on reflection (immersion and distancing) of negative experiences across therapy and the relationship between them and depressive symptoms in contrasting therapeutic outcomes of emotion-focused therapy (EFT). Method: Three good-outcomes cases and three poor-outcomes cases of EFT, diagnosed with mild to moderate depression at the beginning of therapy, were randomly selected. Immersion and distancing on negative experiences were analyzed using the measure of immersed and distanced speech. The depressive symptoms were assessed by the Beck Depression Inventory-II. Results: Significant differences across sessions were only found in the good-outcome cases which showed a significant decrease of immersion and an increase of distancing, and this evolution pattern was found related to the reduction of symptoms. Moreover, at the beginning of therapy, distancing was higher in the poor-outcome cases rather than in the good-outcome cases. Conclusion: The progressive and significant evolution from higher immersion at the initial phase to higher distancing in the final phase may be helpful in EFT for depression.

Gender differences in inflammatory bowel disease: Explaining body image dissatisfaction

The aim of this study was to examine the role of body image problems in the context of inflammatory bowel disease and to explore gender differences in these associations. A sample of inflammatory bowel disease patients (60 males and 140 females) was collected. Findings from a multi-group analysis show that inflammatory bowel disease symptomatology may impact on body image in both male and female patients through the effect of body-image-related cognitive fusion. Body image difficulties in the context of inflammatory bowel disease should not be a neglected dimension in research aiming at understanding the psychosocial effects of inflammatory bowel disease and by health professionals working with these patients.

The impact of early shame memories in Binge Eating Disorder: The mediator effect of current body image shame and cognitive fusion

This study examined the phenomenology of shame experiences from childhood and adolescence in a sample of women with Binge Eating Disorder. Moreover, a path analysis was investigated testing whether the association between shame-related memories which are traumatic and central to identity, and binge eating symptoms' severity, is mediated by current external shame, body image shame and body image cognitive fusion. Participants in this study were 114 patients, who were assessed through the Eating Disorder Examination and the Shame Experiences Interview, and through self-report measures of external shame, body image shame, body image cognitive fusion and binge eating symptoms. Shame experiences where physical appearance was negatively commented or criticized by others were the most frequently recalled. A path analysis showed a good fit between the hypothesised mediational model and the data. The traumatic and centrality qualities of shame-related memories predicted current external shame, especially body image shame. Current shame feelings were associated with body image cognitive fusion, which, in turn, predicted levels of binge eating symptomatology. Findings support the relevance of addressing early shame-related memories and negative affective and self-evaluative experiences, namely related to body image, in the understanding and management of binge eating.

Positive affect and parasympathetic activity: Evidence for a quadratic relationship between feeling safe and content and heart rate variability

There has been an increased interest in the study of underlying autonomic correlates of emotions. This study tests the hypothesis that high levels of high-frequency heart rate variability (HF HRV) are associated with positive emotions. In addition, we hypothesize that this association will differ according to the type of positive emotion. Also, based on recent findings, we tested the hypothesis that this relationship would be nonlinear. Resting-state HRV was collected and self-report measures of different positive emotions were administered to a sample of 124 volunteers.

RESULTS

Results suggested that there was a quadratic relationship between high-frequency heart rate variability and positive emotions associated with safeness and contentment, but not with positive emotions associated with excitement or lack of arousal. Our data suggests that different positive emotions may be characterized by qualitatively distinct profiles of autonomic activation. Also, given the role of positive emotions in social affiliation, and particularly positive emotions associated with a quiescence motivational state, results are interpreted in light of theoretical accounts that highlight the importance of vagal regulation for social behavior.

The effects of the growing pro-social program on cognitive distortions and early maladaptive schemas over time in male prison inmates: A randomized controlled trial

OBJECTIVE

This randomized controlled trial aimed to assess the efficacy of a structured cognitive-behavioral group program, Growing Pro-Social (GPS), in reducing cognitive distortions and early maladaptive schemas over time in male prison inmates.

METHOD

A total of 254 participants were recruited from nine Portuguese prisons and allocated to receive GPS (n = 121) or treatment as usual (n = 133). Participants were assessed with self-report measures on cognitive distortions and early maladaptive schemas at baseline, during intervention, at post-treatment and at 12 months' follow-up. Assessors were blind to group allocation. Treatment effects were tested with latent growth curve models.

RESULTS

At baseline, no significant differences between conditions were found. Results from latent growth curve models showed that condition was a significant predictor of change observed in all outcome measures over time. When compared with the control group, the treatment group showed a significant increase on adaptive thinking, and a significant decrease of cognitive distortions and early maladaptive schemas over time. Results also showed that treatment effects were maintained over time (12 months after GPS completion). Additionally, participants who completed the program presented higher improvements on cognitive distortions and early maladaptive schemas over time than noncompleters.

CONCLUSION

This study showed that a structured cognitive-behavioral group program can have positive effects on the cognitive functioning of male prison inmates, by reducing cognitive distortions and the prominence of early maladaptive schemas. (PsycINFO Database Record

Developments on committed action: Validity of the CAQ-8 and analysis of committed action's role in depressive symptomatology in breast cancer patients and healthy individuals

Committed action, a process of acceptance and commitment therapy's psychological flexibility model, is considered an understudied construct that currently can only be measured by one instrument, the Committed Action Questionnaire (CAQ-8). This study aims at analysing the psychometric properties of the CAQ-8 in healthy individuals and breast cancer patients. This study also aims to explore the specific meditational role of committed action in the well-established relationship between experiential avoidance and depression symptoms. The healthy sample comprised 294 adults from the general population, and the breast cancer samples comprised 82 participants. Both groups completed the validated self-report measures. CAQ-8's robustness was examined through validity analyses, confirmatory factor analyses, and multigroup analysis. The meditational model was conducted using structural equation modelling. The CAQ-8 presented good internal consistency and construct, convergent, concurrent, and divergent validity in both samples. Further, the CAQ-8 showed incremental validity over a measure of engaged living. Findings also demonstrated measurement invariance between healthy individuals and breast cancer patients. Regarding the conducted meditational model that was also invariant between the two analysed groups, it was demonstrated that part of the effect that experiential avoidance holds on depressive symptomatology is explained by committed action. This study suggests that the CAQ-8 is adequate for use in healthy and cancer populations. Moreover, it provides novel, empirical support regarding the links between committed action, experiential avoidance, and depressed mood, being also the first investigation to particularly study committed action in a cancer population. Implications for theory and practice are discussed.