Chronic pain and depression are frequently comorbid conditions associated with significant health care and social costs. This study examined the cost-utility and cost-effectiveness of videoconference-based group forms of Acceptance and Commitment Therapy (ACT) and Behavioral Activation Therapy for Depression (BATD), as a complement to treatment-as-usual (TAU), for patients with chronic low back pain (CLBP) plus depressive symptoms, compared to TAU alone. A trial-based economic evaluation (n = 234) was conducted from a governmental and health care perspective with a time horizon of 12 months. Primary outcomes were the Brief Pain Inventory-Interference Scale (BPI-IS) and Quality Adjusted Life Year. Compared to TAU, ACT achieved a significant reduction in total costs (d = .47), and BATD achieved significant reductions in indirect (d = .61) and total costs (d = .63). Significant improvements in BPI-IS (d = .73 and d = .66, respectively) and Quality Adjusted Life Year scores (d = .46 and d = .28, respectively) were found in ACT and BATD compared to TAU. No significant differences in costs and outcomes were found between ACT and BATD. In the intention-to-treat analyses, from the governmental and health care perspective, no significant differences in cost reduction and incremental effects were identified in the comparison between ACT, BATD, and TAU. However, in the complete case analysis, significant incremental effects of ACT (∆BPI-IS = -1.57 and -1.39, respectively) and BATD (∆BPI-IS = -1.08 and -1.04, respectively) compared with TAU were observed. In the per-protocol analysis, only the significant incremental effects of ACT (∆BPI-IS = -1.68 and -1.43, respectively) compared to TAU were detected. In conclusion, ACT and BATD might be efficient options in the management of CLBP plus comorbid depression symptoms as compared to usual care. However, no clear difference was found in the comparison between the 2 active therapies regarding cost-effectiveness or cost-utility. PERSPECTIVE: The economic evaluation of psychological therapies for the management of complex conditions can be used in decision-making and resource allocation. This study provides evidence that ACT and BATD are more effective and involve a greater reduction in costs than usual care in the management of CLBP plus comorbid depressive symptoms. TRIAL NUMBER: NCT04140838.

ObjectiveChronic pain frequently co-occurs with clinically relevant psychological distress. A systematic review was conducted to identify the efficacy of cognitive behavioral therapy-based interventions for patients with these comorbid conditions.MethodsThe systematic search was carried out in Medline, PsycINFO, Web of Science, and Scopus up to March 18th, 2023. Four reviewers independently conducted screenings, extraction, and quality assessment.ResultsTwelve randomized controlled trials and one non-randomized controlled trial involving 1,661 participants that examined the efficacy of Cognitive Behavioral Therapy (nine studies), Mindfulness-based Interventions (three studies), Acceptance and Commitment Therapy (one study), and Behavioral Activation Therapy for Depression (one study) were included. Compared to treatment as usual, six out of eight studies of traditional Cognitive Behavioral Therapy reported significant differences in the reduction of depressive symptoms at post-treatment (d from 1.31 to 0.18) and four out of six at follow-up (d from 0.75 to 0.26); similarly, five out of six reported significant differences in the reduction of anxiety symptoms at post-treatment (d from 1.08 to 0.19) and three out of four at follow-up (d from 1.07 to 0.27). Overall, no significant differences between traditional Cognitive Behavioral Therapy and treatment as usual were reported at post-treatment and follow-up in the studies exploring pain intensity and pain catastrophizing.ConclusionThe available evidence suggests that traditional Cognitive Behavioral Therapy may produce significant benefits for the improvement of depression, anxiety, and quality of life, but not for pain intensity and pain catastrophizing. More evidence is needed to determine the effects of MBI, ACT, and BATD.Systematic review registrationPROSPERO, CRD42021219921.

PURPOSE:To explore the experiences of patients with chronic low back pain (CLBP) plus comorbid depressive symptoms who received a remote synchronous videoconference group form of Acceptance and Commitment Therapy (ACT) or Behavioral Activation Treatment for Depression (BATD). METHODS:A qualitative study (IMPACT-Q) was nested within a randomized controlled trial (RCT) designed to assess the efficacy and the cost-utility/cost-effectiveness of two therapies in the management of CLBP and depression. Fifty-five patients with CLBP plus depression were selected from the RCT. Twelve focus group sessions, each approximately 60-90 min long, were audio-recorded, transcribed verbatim, and analyzed by six coders through a thematic analysis (deductive and inductive) based on a descriptive phenomenological approach. RESULTS:Patients perceived behavioral, affective, and cognitive improvements after completing group sessions. Overall, psychotherapy was perceived as a safe and non-judgmental place to express emotions and feel understood. The main barriers reported were lack of human contact and loss of social interaction. In contrast, ease of access, flexibility in the ability to connect from anywhere, avoidance of the need to travel, and savings in time and money were key facilitators to increase attendance and adherence to therapy. CONCLUSION:This study provided support for the acceptability of videoconference-delivered ACT or BATD in patients with CLBP plus comorbid depressive symptoms.

This study examined the efficacy of adding a remote, synchronous, group, videoconferencebased form of acceptance and commitment therapy (ACT) or behavioral activation therapy for depression (BATD) to treatment-as-usual (TAU) in 234 patients with chronic low back pain (CLBP) plus comorbid depressive symptoms. Participants were randomly assigned to ACT, BATD, or TAU. Compared to TAU, ACT produced a significant reduction in pain interference at posttreatment (d = .64) and at follow-up (d = .73). BATD was only superior to TAU at follow-up (d = .66). A significant reduction in pain catastrophizing was reported by patients assigned to ACT and BATD at posttreatment (d = .45 and d = .59, respectively) and at follow-up (d = .59, in both) compared to TAU. Stress was significantly reduced at posttreatment by ACT in comparison to TAU (d = .69). No significant between-group differences were found in depressive or anxiety symptoms. Clinically relevant number needed to treat (NNT) values for reduction in pain interference were obtained at posttreatment (ACT vs TAU = 4) and at follow-up (ACT vs TAU = 3; BATD vs TAU = 5). In both active therapies, improvements in pain interference at follow-up were significantly related to improvements at posttreatment in psychological flexibility. These findings suggest that new forms of cognitive-behavioral therapy are clinically useful in improving pain interference and pain catastrophizing. Further research on evidence-based change processes is required to understand the therapeutic needs of patients with chronic pain and comorbid conditions.Trial number: NCT04140838.Perspective: Group videoconference-based ACT and BATD showed greater efficacy than TAU for reducing pain interference and pain catastrophizing in patients with CLBP plus clinically relevant depression. Psychological flexibility appeared to be the main contributor to treatment effects for both ACT and BATD.(c) 2023 The Author(s). Published by Elsevier Inc. on behalf of the American Pain Society

This systematic review aimed to investigate immune-inflammatory and hypothalamic-pituitary-adrenal (HPA) axis biomarkers in individuals with non-specific low back pain (NSLBP) compared to healthy control. The search was performed in five databases until 4 November 2021. Two reviewers independently conducted screenings, data extraction, risk of bias, and methodological quality assessment of 14 unique studies. All studies reported the source of the fluid analyzed: nine studies used serum, two used plasma, one used serum and plasma, and two studies used salivary cortisol. We found preliminary and limited evidence (only one study for each biomarker) of increased levels in growth differentiation factor 15 (GDF-15), interleukin-23 (IL-23), transforming growth factor–beta (TGF-β), and soluble tumor necrosis factor receptor 1 (sTNF-R1) in NSLBP. Inconsistent and limited evidence was identified for interleukin-10 (IL-10). Although C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor–alpha (TNF-α) levels appear to increase in NSLBP, only one study per each biomarker reported statistically significant differences. Interleukin-1 beta (IL-1β), interleukin-17 (IL-17), interferon gamma (IFN-γ), and high-sensitivity CRP (hsCRP) showed no significant differences. Regarding cortisol, one study showed a significant increase and another a significant decrease. More robust evidence between GDF-15, IL-23, TGF-β, and sTNF-R1 with NSLBP is needed. Moreover, contrary to the findings reported in previous studies, when comparing results exclusively with healthy control, insufficient robust evidence for IL-6, TNF-α, and CRP was found in NSLBP. In addition, cortisol response (HPA-related biomarker) showed a dysregulated functioning in NSLBP, with incongruent evidence regarding its directionality. Therefore, our effort is to find adjusted evidence to conclude which immune-inflammatory and HPA axis biomarkers are altered in NSLBP and how much their levels are affected. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020176153 , identifier CRD42020176153.

The aim of this study was to evaluate the influence of primary and secondary appraisal, and of coping strategies, on daily stress, taking into account any possible effect of the big five personality traits. Over 10 days, a cohort of 122 people filled out an on-line diary in which they recorded the most important stressful event each day, their primary and secondary appraisal of this, and how they coped with it. The results indicate that negative affect is influenced by a high degree of primary appraisal, limited secondary appraisal and a high rate of refusal, with no significant influence of personality traits. Positive affect is mainly influenced by a lower extent of primary appraisal, more secondary appraisal, and by a low rate of refusal and of social support seeking. Moreover, a low level of neuroticism was a predictor of greater positive affect. These data are discussed, highlighting the importance of a situational assessment of stressful episodes at each moment to not only understand the effects of stress on health but also, to develop effective interventions. El objetivo de este estudio fue evaluar la influencia de la evaluación primaria, secundaria y de las estrategias de afrontamiento sobre el estrés diario, teniendo en cuenta cualquier posible efecto de los cinco grandes rasgos de personalidad. Durante 10 días, una cohorte de 122 personas llenó un diario en línea en el que registraron el evento estresante más importante de cada día, su evaluación primaria y secundaria y cómo lo afrontaron. Los resultados indican que el afecto negativo está influido por una evaluación primaria alta, una evaluación secundaria limitada y una alta tasa de rechazo, sin influencia significativa de los rasgos de personalidad. El afecto positivo está influido principalmente por un menor grado de valoración primaria, una evaluación secundaria alta, por una baja tasa de rechazo y de búsqueda de apoyo social. Además, un nivel bajo de neuroticismo fue el mejor predictor del afecto positivo. Se discuten estos datos, destacando la importancia de una evaluación situacional de episodios estresantes en cada momento para no sólo comprender los efectos del estrés en la salud sino también, para desarrollar intervenciones efectivas.

The objective of this study was to assess the choice of coping strategies in relation to daily stress, taking into account the influence of the primary and secondary appraisals and the Big Five traits of personality. Over 10 days, a cohort of 122 individuals filled out an online diary in which they recorded the most important stressful event each day, their primary and secondary appraisal of this, and how they chose to cope with it. The results indicate that problem-focused coping depends on a strong primary and secondary appraisal, and on extraversion, whereas emotion-focused coping depends on a strong secondary appraisal and on extraversion. Social support seeking depends on strong primary and secondary appraisal, and on extraversion, openness and neuroticism. Refusal to seek support is associated with a strong primary appraisal, a weak secondary appraisal and a low level of conscientiousness. The conclusions are that momentary appraisals have a stronger predictive capacity than the personality traits, and that different coping strategies are not mutually incompatible.

The objective was to review the methods used to assess daily stress, focusing on the types records used, as well as the methods used to describe daily stressors, the ways to operationally define stress, and the different research approaches. A search for quantitative research articles published between January 2008 and December 2017 was carried out on indexed entries of four electronic databases. Of the 254 publications found in the search after duplicates were removed, eft 57 articles were selected to analyse. A large diversity of recording methods was detected, a single daily record for a week being the most frequently used. The different ways to operationalize stress highlight the different implicit definitions of stress: the number or intensity of stressful event refers to stress as an external factor, negative feelings refer to the individual's responses, and reactivity or pile-up are related to the process by which stress develops over time. Such variation suggests that stress is not a precise concept that can be assessed by a single measure, stress is rather a generic label for the complex process of adaptation to specific situations. The first one is that it can be concluded that stress is a process that explains the short- and long-term effects of exposure to stressors on health and wellbeing through a complex chain of mediators and moderators. The second point is that although it is known that the changes produced in stressful situations are adaptive at first, studies of the negative side of stress prevail. And the third point is that the studies analysed were not reduced to the analysis of the stress process or of any particular aspect of stress but rather, the evaluation of daily stress served to study other processes with marked social and affective components.

Dada la escasez de instrumentos que midan la valoracion cognitiva siguiendo el modelo de estres transaccional de Lazarus y Folkman (1984) e identificando claramente tanto la evaluacion primaria como la secundaria con todos los componentes propuestos por el modelo de estres. El presente estudio pretende validar y traducir al espanol el cuestionario Primary Appraisal Secondary Appraisal (PASA) de Gaab et al. (2004). Asi pues, se realiza la traduccion del instrumento al espanol y se incorpora la escala de dano/perdida que no consta en la version original. Asimismo, se adaptan los items para poder aplicar el instrumento tanto en situaciones anticipatorias de estres como en situaciones pasadas recientes. Se pasa la nueva version del instrumento a una muestra de 397 participantes, considerando los dos tipos de situaciones y se analizan los datos a partir de dos analisis factoriales, uno exploratorio y otro confirmatorio que proponen la solucion de 5 dimensiones, relacionadas con las escalas de la Evaluacion Cognitiva: 3 escalas de Evaluacion Primaria (Amenaza, Reto y Perdida) y 2 de Evaluacion Secundaria (Autoeficacia y Expectativa de Control). Se obtienen indices de fiabilidad de a = 0.674 a=0.765. Se concluye que la nueva version del instrumento en version espanola y con la incorporacion de la escala de dano/perdida presenta propiedades psicometricas adecuadas para su uso.

BACKGROUND:During their workday, nurses face a variety of stressors that are dealt with using different coping strategies. One criticism of the contextual models of work stress is that they fail to focus on individual responses like coping with stress. Neverthless, little is know about the momentary determinants of coping in nurses.OBJECTIVES:To identify the momentary predictors of problem-focused approaching coping and emotion-focused approaching coping, as well as those for seeking social support and refusal coping strategies, during the working day in nurses.DESIGN:This study uses descriptive, correlational, two-level design with repeated measures.SETTINGS:Wards of two University hospitals.PARTICIPANTS:A random cohort of 113 nurses was studied.METHODS:An ecological momentary assessment was made of demand, control, effort, reward, nursing task, coping, mood and fatigue, and of coping style by questionnaire. Multilevel two-level statistical analyses were performed in order to identify both within person and between person relationships.RESULTS:Different momentary types of coping were associated with different tasks. The problem-focused coping could be explained by the direct care and medication tasks, demand, planning coping style, mood, and negatively by acceptation coping style. Emotion-focused coping could be explained by documentation and medication tasks (negatively), mood, demand, distraction, and disengagement coping styles. Seeking social support coping could be explained by the task of communication, mood, fatigue (negatively), and seeking emotional support as a coping style. Refusal coping could be explained by mood, and the coping style of focusing and venting emotions. Refusal coping is not specific to any task.CONCLUSIONS:The choice of the coping strategy depends on the task, of their appraisal and on the different styles of coping.

Introduction The IMPACT study focuses on chronic low back pain (CLBP) and depression symptoms, a prevalent and complex problem that represents a challenge for health professionals. Acceptance and Commitment Therapy (ACT) and Brief Behavioural Activation Treatment for Depression (BATD) are effective treatments for patients with persistent pain and depression, respectively. The objectives of this 12 month, multicentre, randomised, controlled trial (RCT) are (i) to examine the efficacy and cost-utility of adding a group-based form of ACT or BATD to treatment-as-usual (TAU) for patients with CLBP and moderate to severe levels of depressive symptoms; (ii) identify pre–post differences in levels of some physiological variables and (iii) analyse the role of polymorphisms in the FKBP5 gene, psychological process measures and physiological variables as mediators or moderators of long-term clinical changes.Methods and analysis Participants will be 225 patients with CLBP and moderate to severe depression symptoms recruited at Parc Sanitari Sant Joan de Déu (St. Boi de Llobregat, Spain) and Hospital del Mar (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs TAU+ACT versus TAU+BATD. A comprehensive assessment to collect clinical variables and costs will be conducted pretreatment, post-treatment and at 12 months follow-up, being pain interference the primary outcome measure. The following physiological variables will be considered at pretreatment and post-treatment assessments in 50% of the sample: immune-inflammatory markers, hair cortisol and cortisone, serum cortisol, corticosteroid-binding globulin and vitamin D. Polymorphisms in the FKBP5 gene (rs3800373, rs9296158, rs1360780, rs9470080 and rs4713916) will be analysed at baseline assessment. Moreover, we will include mobile-technology-based ecological momentary assessment, through the Pain Monitor app, to track ongoing clinical status during ACT and BATD treatments. Linear mixed-effects models using restricted maximum likelihood, and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed.Ethics and dissemination This study has been approved by the Ethics Committee of the Fundació Sant Joan de Déu and Hospital del Mar. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities.Trial registration number NCT04140838

As self-reports of affect are limited in several regards, an indirect measure of affect, the Implicit Positive and Negative Affect Test (IPANAT; Quirin, Kazén, & Kuhl, 2009) has previously been developed and adapted to more than 10 languages (Quirin et al., 2018), showing adequate reliability and validity. Based on a sample of 242 Spanish adults (111 males), we evaluate a trimmed 18 items version of the IPANAT (IPANAT-18). Item reductive procedures consisted in a random selection of the stimuli words used in the IPANAT. Psychometric properties of the IPANAT-18 were evaluated via Confirmatory Factor Analysis. In addition, correlational analyses were used to determine the relationship between the brief and the full version of the IPANAT, and with explicit measures of affect. We replicated a two-factors structure of positive affect versus negative affect and found a good fit for the IPANAT-18 model (CFI = 1; TLI = 1; RMSEA = .00; SRMR = .03). Reliability was adequate (implicit PA, α = .86; implicit NA, α = .77) and the pattern of relationships with explicit affect measures were congruent and consistent with previous findings. Differences between the mean scores of implicit affect assessed with 18 items or 36 items were statistically non-significant, and showed strong correlations (PA, r = .92, p < .01; NA, r = .88, p < .01). In sum, the IPANAT-18 showed satisfactory psychometric properties and constitutes a useful tool for economically measuring affective processes such as in experimental and economical multiple assessment (e.g., daily diary) settings.

BACKGROUND:Self-report measures of affective states (i.e., explicit measure) underlie a variety of cognitive biasing factors. Therefore, measures for the indirect assessment of affect (i.e., implicit) have previously been developed, such as the Implicit Positive and Negative Affect Test. The IPANAT asks participants to make judgments about the degree to which artificial non-sense words sound like affective states, and has demonstrated good reliability and validity. METHODS:We created a Spanish version of this test (IPANAT-SPAIN). After adapting artificial words to Spanish language, based on preliminary studies, the IPANAT-SPAIN was administered to a representative sample of N = 468 adults from Spain (225 men). Competing models of its latent structure were evaluated using confirmatory factor analysis. To assess convergent validity, we correlated the IPANAT-SPAIN with explicit measures of affect. RESULTS:The best-fitting model consisted of two factors corresponding to positive implicit affect (PA) and negative implicit affect (NA). Reliability of the IPANAT-SPAIN was a = .94 for PA, and a = .88 for NA. The pattern of relationships between the IPANAT-SPAIN and explicit affect measures were consistent with previous findings. CONCLUSIONS:The results indicate that the Spanish adaptation of the IPANAT has satisfactory psychometric properties.

Background and aims: The purpose of the present study is to investigate the influence of each perceived emotional intelligence dimension on coping strategies in the face of daily stress. Material and methods: The sample was comprised of 50 people aged 18 to 25 years. PEI was assessed through the TMMS-24 that evaluates three dimensions: emotional attention, emotional clarity and emotional repair. A momentary ecological assessment was carried out in which the daily stressors were recorded with the DISE; the affective state with the PANAS; and the coping with the daily stress using the MoCope scale. The assessment lasted four days. Four types of coping were evaluated: Problem-focused coping, seeking social support, acceptance of emotions, and rejection. The design was quasi-experimental with repeated measures. The data were analysed by multiple regressions. Results: The results showed that: a) People with high emotional attention used more acceptance of emotions and seeking social support; b) people with high emotional clarity used more problem-focused coping and acceptance of emotions but less rejection; and c) people with high emotional repair used more problem-focused coping and seeking social support but less rejection. Conclusions: These results support the hypothesis that PEI strengthens emotional well-being because it promotes adaptive coping ability of daily stress. (C) 2019 Sociedad Espanola para el Estudio de la Ansiedad y el Estres - SEAS. Published by Elsevier Espana, S.L.U. All rights reserved.

Risk perception among climbers is a factor that can contribute to injury prevention. The purpose of this study was to analyze how expert climbers make judgments about potential risks to their safety. Specifically, we studied how climbers combine the available information on environmental conditions and personal resources in order to arrive at risk judgments. Sixteen distinct scenarios were presented to 134 climbers, and their risk perception related to each situation was recorded. Findings revealed that all variables were highly relevant for determining risk perception. When all variables were present at the same time, confidence was found to minimize the perception of risks caused by environmental conditions, such as difficult climbing. We conclude that an understanding of how expert climbers combine relevant information in order to judge risk can offer ways for them to take more effective preventive measures against injuries, specifically to identify hazards and their combined effects.

The categorical approach of personality disorders (PD) has giv-en way to a dimensional paradigm. Within this, the Five-factor model (FFM) proposes theoretical hypotheses describing personality pathologies and PD empirical prototypes based on the DSM (DSM-PD). Moreover, a methodology to score DSM-PD using the NEO PI-R facets was devel-oped. In this ex post-facto study FFM-PD count norms were developed using data from the NEO PI-R Spanish adaptation. Furthermore, the di-agnostic agreement with the IPDE and validity of FFM-PD counts was analyzed in a clinical (n = 222) and non-clinical sample (n = 742). Based on NEO PI-R scores, we presented Spanish FFM-PD normative data. FFM-PD benchmarks were highly likely to be exceeded if subjects were classi-fied as a subclinical case in the DSM-PD. Convergent correlations of FFM-PD counts with their equivalent subclinical cases of DSM-PD were statistically significant and outperformed any divergent correlation as well as the average divergent correlations in all FFM-PD. The use of a count technique based on NEO PI-R facets and Spanish FFM-PD normative data facilitate PD understanding and interpretation in various applied psy-chology fields.

BACKGROUND:Work-related stress is a prevalent condition in the nursing profession, and its influence may vary according to changeable individual and situational factors. It is, therefore, important to investigate the real-time momentary changes in these factors and their relationship to emotional exhaustion experienced by nurses.OBJECTIVES:We aim to analyse how their perceptions of demand, control, effort and reward change according to the task performed through real-time assessment and interact with the emotional exhaustion level of ward nurses.DESIGN:The research design was longitudinal.METHOD:A three-level hierarchical model with a repeated measures design was used to assess the momentary self-reports of 96 hospital ward nurses, completed using a smartphone programmed with random alarms.RESULTS:Findings show that demand, effort, and control appraisals depend on the task performed. The task appraised as most demanding, effortful, and controllable was direct care. Reward appraisal depends on the task performed and personal variables, i.e. emotional exhaustion. The situations perceived as more rewarding were rest and direct care. Momentary hedonic tone can be explained by the task performed, demand, reward, emotional exhaustion and by the interaction between emotional exhaustion and demand appraisal. Momentary fatigue can be explained by the task performed, demand, reward, and the emotional exhaustion.CONCLUSIONS:This study highlights the importance of using momentary measures to understand complex and changeable inter-relationships. While also clarifying the targets of intervention programmes aimed at preventing burnout within the nursing profession.

Presentamos una experiencia de ApS en la que, siguiendo la metodologia ABP, los estudiantes disenan proyectos para responder a necesidades reales presentadas por entidades que trabajan en ambitos de la salud, la educacion y la intervencion social. Profesorado y entidades seleccionan los proyectos mas adecuados, realistas e innovadores, cuyos autores pueden llevarlos a cabo en un entorno real con el apoyo de las entidades y reconocimiento academico de la Universidad durante el curso siguiente.