What Is Considered Healthy Eating? An Exploratory Study among College Students of Nutrition and Food Science.

In modern industrialized societies, the focus on healthy eating has increased significantly across multiple sectors, including the media, public policy, expert opinion, and public awareness. The aim of this research was to explore the perceptions of healthy eating and the barriers to adopting a healthy diet among undergraduate students in Human Nutrition and Dietetics (HND) and Food Science and Technology (FST) degrees in Spain. An exploratory and descriptive cross-sectional study was conducted using a qualitative and quantitative methodology and convenience sampling. Two focus groups and a questionnaire were utilized (300 participants from all academic years completed the survey). Differences in definitions of healthy eating and perceived barriers were found between genders and students at different stages of training (p < 0.05). In their understanding of healthy eating, the students placed importance on balance, variety, moderation, and individual factors. Although students considered it easy to follow a healthy diet, family's eating habits, time availability, and emotional states were found to be the main barriers to the implementation of healthy practices. The obtained data supports the need to critically address perceptions of healthy eating throughout the training of nutrition and food science professionals. The insights obtained on the perceived barriers highlight the importance of considering both individual and environmental factors.

Perceptions of Food among College Students in the Field of Food Science: A Food Sustainability Approach.

The complex concept of food sustainability has become crucial in all spheres of life. Dietitians, food scientists, and technologists are in a unique position to promote sustainability in food systems. However, the perceptions of food sustainability among food science professionals and college students are under-researched, particularly in Spain. The aim of this study was therefore to analyze perceptions related to food and to food sustainability in a sample of Human Nutrition and Dietetics (HND) and Food Science and Technology (FST) students in Barcelona (Spain). An exploratory and descriptive cross-sectional study was carried out using qualitative and quantitative methodology and convenience sampling. Two focus groups and an online questionnaire were conducted (300 participants completed the survey, 151 from HND and 149 from FST). Although the students expressed concern about food sustainability, their dietary choices were primarily associated with or influenced by taste/pleasure and health/nutrition. The issue of sustainability seemed more internalized by women than men, whereas the generalized conception of a sustainable diet was essentially based on environmental aspects, with socioeconomic dimensions largely overlooked. The concept of sustainability should be promoted among food science students in all its multidimensionality, and actions need to be implemented that bring sustainability closer to students' social practices, which should be incorporated into all university education and that is taught by professors duly trained in the subject.

The effect of two cognitive therapies on subjective wellbeing of individuals with depression: results from a randomised controlled trial.

BACKGROUND: Despite the burden associated to depression, current standards of care are still limited in scope and effectiveness. In addition, therapy outcomes have frequently focused solely on symptoms, leaving patients' wellbeing relatively unaddressed. AIMS: The objective of this study was to test whether two cognitive therapies increased subjective wellbeing in a sample of adults diagnosed with a depressive disorder, additionally assessing the relationship between this growth and decreases in both depression severity and psychological distress. METHODS: Data from 116 participants from a randomised controlled trial comparing the efficacy of cognitive behavioural therapy and dilemma-focused therapy were analysed. Multilevel linear models were employed, together with correlational analyses. RESULTS: Results showed that both interventions significantly improved wellbeing with moderate to large effect sizes, while no significant differences were found between treatments. In turn, the increase in wellbeing was significantly associated to improvements in depression severity and psychological distress. CONCLUSIONS: This study sheds light on the complex relationship between happiness and depression, supporting their conceptualisation as related yet independent human experiences, and strengthening subjective wellbeing as a useful outcome for psychological research. Psychotherapy is presented as an effective intervention to enhance wellbeing, even among individuals with severe depressive symptoms.

Knowledge and perceptions of food sustainability in a Spanish university population.

In 2015, the United Nations adopted the 2030 Agenda for Sustainable Development, with 17 Sustainable Development Goals (SDGs) at its core. Besides tackling climate change and the fight to reduce inequality, the SDG number 12 is specifically focused to develop strategies toward food sustainability. The aim of this study, aligned with SDG number 12, was to analyze the level of knowledge and perceptions of food sustainability in a university community from Spain. A descriptive cross-sectional study, based on an online questionnaire, was carried out between July and November 2021 with convenience sampling. The survey included 28 items and was distributed among students, teachers, researchers and administrative staff from a Spanish university. A total of 1,220 participants completed the survey. 70.4% of the respondents heard about the environmental impact of food and more than 50% were aware of the existence of the SDGs. The different aspects related to diet that concerned them the most were food waste, plastic usage, and environmental impact. They reported that a sustainable diet should be mainly based on local and seasonal products and with a low environmental impact as well as no or the minimum food waste. When asked if they were following a sustainable diet, 77% answered affirmatively. Moreover, the food groups more involved in a sustainable diet should be vegetables and fruits, olive oil, legumes, and whole grains. Regarding food waste, 60% of the surveyed population claimed to generate it at home, with the use of leftovers and planning shopping and meals being some of the most important domestic actions to avoid it. Further initiatives must be implemented to increase the level of knowledge as well as to raise the awareness on the importance to translate it into individual and collective actions that allow a shift toward more sustainable practices.

Evaluation and perceptions of a nursing discharge plan among nurses from different healthcare settings in Spain.

PURPOSE: The exchange of information between different healthcare settings through a nursing discharge plan is essential for safe care. However, the factors contributing to achieving the most efficient exchange have not been well studied. This study aimed to evaluate and explore the perceptions of a nursing discharge plan from the perspective of nurses in different healthcare settings. METHODS: A mixed methods approach comprising a specifically designed ad hoc questionnaire (n = 437) and a focus group session (n = 8). FINDINGS: Overall, 66.1% out of 437 nurses, and especially those working in nursing homes, were satisfied with the nursing discharge plan. Lack of time to complete the report and poor information about both nursing diagnoses and patients' social assessment were identified as problem areas. Some proposals emerged from the focus group: providing sufficient time for its completion, giving the nursing discharge plan a more flexible structure permitting more open-ended responses, requiring more information to be provided about the social and psychological situation of the patients, training nurses to use standardized language to avoid possible misinterpretations, and getting nurses from the different health care settings to work together in designing continuity of care plans. Elderly and low-income patients are found to need greater attention when filling out nursing discharge plans. CONCLUSIONS: The study has revealed key aspects that need to be improved and some recommendations in implementing the nursing discharge plan in our health area. These include that there should be more time provided to complete the NDP, and also specific details regarding the format, structure, content of the information that is communicated, and the prioritization of the patient profile.

Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial / Terapias Cognitivo-Conductual y de Constructos Personales para la depresión en mujeres con fibromialgia: un estudio controlado aleatorizado

ResumenAntecedentes/Objetivo: La fibromialgia es un trastorno de dolor crónico que los síntomas depresivos agravan. El objetivo de este estudio es probar la eficacia de la Terapia de Cons-tructos Personales (TCP), aproximación que enfatiza las características identitarias y los significados personales como foco de la intervención, para el tratamiento de síntomas de-presivos en mujeres con fibromialgia. Método: Comparamos la TCP con la Terapia Cognitivo-Conductual (TCC) en un ensayo multicéntrico paralelo aleatorizado. Mujeres con fibromial-gia y síntomas depresivos (n = 106) fueron aleatorizadas a TCC (n = 55) o TCP (n = 51), en formato individual y modular para ajustarse a las necesidades de las pacientes. Los datos se analizaron usando modelos lineales de efectos mixtos. Resultados: Ambas condiciones redu-jeron significativamente los síntomas depresivos sin encontrarse diferencias significativas después del tratamiento (β= -0,47, t = -0,49, p = 0,63) ni en el seguimiento (β= -1,12, t = -1,09, p = 0,28). Resultados similares se encontraron para la ansiedad, el impacto de la fi-bromialgia, la distribución del cambio clínicamente significativo para los síntomas depresi-vos y el dolor. Conclusiones: la TCP y TCC parecerían ser igualmente efectivas para el trata-miento de los síntomas depresivos, postulando la TCP como una alternativa de tratamiento.

AbstractBackground/Objective:Fibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia. Method: We compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (n = 106) were randomly allocated to CBT (n = 55) or PCT (n = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models. Results: Participants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (β= -0.47, t = -0.49, p = .63) and at follow-up (β= -1.12, t = -1.09, p = .28). Results were similar between groups for anxiety, fibromyalgia’s impact, and the distribution of clinically significant changes in depressive symptoms and pain. Conclusions: PCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.

Cognitive-Behavioral and Personal Construct Therapies for Depression in Women with Fibromyalgia: A Randomized Controlled Trial.

Background/Objective: Fibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia. Method: We compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms (n = 106) were randomly allocated to CBT (n = 55) or PCT (n = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models. Results: Participants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (ß = -0.47, t = -0.49, p = .63) and at follow-up (ß = -1.12, t = -1.09, p = .28). Results were similar between conditions for anxiety, fibromyalgia's impact, and the distribution of clinically significant changes in depressive symptoms and pain. Conclusions: PCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment.

Antecedentes/Objetivo: La fibromialgia es un trastorno de dolor crónico que los síntomas depresivos agravan. El objetivo del estudio es probar la eficacia de la Terapia de Constructos Personales (TCP), aproximación que enfatiza las características identitarias y los significados personales como foco de la intervención, para el tratamiento de síntomas depresivos en mujeres con fibromialgia. Método: Comparamos la TCP con la Terapia Cognitivo-Conductual (TCC) en un ensayo multicéntrico paralelo aleatorizado. Mujeres con fibromialgia y síntomas depresivos (n = 106) fueron aleatorizadas a TCC (n = 55) o TCP (n = 51), en formato individual y modular para ajustarse a las necesidades de las pacientes. Los datos se analizaron usando modelos lineales de efectos mixtos. Resultados: Ambas condiciones redujeron significativamente los síntomas depresivos sin encontrarse diferencias significativas después del tratamiento (ß = -0,47, t = -0,49, p = 0,63) ni en el seguimiento (ß = -1,12, t = -1,09, p = 0,28). Resultados similares se encontraron para la ansiedad, el impacto de la fibromialgia, la distribución del cambio clínicamente significativo para los síntomas depresivos y el dolor. Conclusiones: La TCP y la TCC parecerían ser igualmente efectivas para el tratamiento de los síntomas depresivos, postulando la TCP como una alternativa de tratamiento.

Vocabulary Abilities and Parents' Emotional Regulation Predict Emotional Regulation in School-Age Children but Not Adolescents With and Without Developmental Language Disorder.

A comprehensive approach, including social and emotional affectations, has been recently proposed as an important framework to understand Developmental Language Disorder (DLD). There is an increasing considerable interest in knowing how language and emotion are related, and as far as we know, the role of the emotional regulation (ER) of parents of children with and without DLD, and their impact on their children's ER is still unknown. The main aims of this study are to advance our knowledge of ER in school-age children and adolescents with and without DLD, to analyze the predictive value of expressive and receptive vocabulary on ER in school-age children and adolescents, and to explore parental ER and their effect on their children's and adolescents' ER. To cover all objectives, we carried out three studies. In the first and second study, expressive and receptive vocabulary were assessed in wave 1, and ER (Emotional Regulation Checklist -ERC- for children and Emotion Regulation Scale -DERS- for adolescents) was assessed in wave 2, 4 years later. Participants in the first study consisted of two groups of school-aged children (13 had DLD and 20 were typically developing children -TD). Participants in the second study consisted of two groups of adolescents (16 had DLD and 16 were TD adolescents). In the third study, the ER of 65 of the parents of the children and adolescents from study 1 were assessed during wave 2 via self-reporting the DERS questionnaire. Results showed no significant differences in ER between DLD and TD groups neither in middle childhood nor in adolescence. Concerning vocabulary and ER, expressive language predicted ER in school-age children but not in adolescents. Finally, parental ER explained their school-age children's ER, but this was not the case in adolescents. In conclusion, the present data indicated that expressive vocabulary has a fundamental role in ER, at least during primary school years, and adds new evidence of the impact of parents' ER upon their children's ER, encouraging educators and speech language pathologists to include parents' assessments in holistic evaluations and interventions for children with language and ER difficulties.

Semantic priming and schizotypal personality: reassessing the link between thought disorder and enhanced spreading of semantic activation.

The term schizotypy refers to a group of stable personality traits with attributes similar to symptoms of schizophrenia, usually classified in terms of positive, negative or cognitive disorganization symptoms. The observation of increased spreading of semantic activation in individuals with schizotypal traits has led to the hypothesis that thought disorder, one of the characteristics of cognitive disorganization, stems from semantic disturbances. Nevertheless, it is still not clear under which specific circumstances (i.e., automatic or controlled processing, direct or indirect semantic relation) schizotypy affects semantic priming or whether it does affect it at all. We conducted two semantic priming studies with volunteers varying in schizotypy, one with directly related prime-target pairs and another with indirectly related pairs. Our participants completed a lexical decision task with related and unrelated pairs presented at short (250 ms) and long (750 ms) stimulus onset asynchronies (SOAs). Then, they responded to the brief versions of the Schizotypal Personality Questionnaire and the Oxford-Liverpool Inventory of Feelings and Experiences, both of which include measures of cognitive disorganization. Bayesian mixed-effects models indicated expected effects of SOA and semantic relatedness, as well as an interaction between relatedness and directness (greater priming effects for directly related pairs). Even though our analyses demonstrated good sensitivity, we observed no influence of cognitive disorganization over semantic priming. Our study provides no compelling evidence that schizotypal symptoms, specifically those associated with the cognitive disorganization dimension, are rooted in an increased spreading of semantic activation in priming tasks.

Positive Schizotypy Increases the Acceptance of Unpresented Materials in False Memory Tasks in Non-clinical Individuals.

Enhanced spreading of semantic activation has been hypothesized to underlie some of the most significant symptoms of schizotypal personality, like thought disorder, odd speech, delusion, or magical thinking. We applied the Deese/Roediger-McDermott false memory task to the study of semantic activation in a group of 123 non-clinical individuals varying in the three dimensions of schizotypal personality: positive, negative and disorganized schizotypy. In the study phase, we presented them with lists composed of words semantically associated to unpresented critical words. Then, they responded to a recognition questionnaire including previously presented words and critical unpresented lures, as well as weakly related and unrelated unpresented lures. Participants rated their confidence in recognizing each word. They also filled in a standardized schizotypal personality questionnaire. Confirming the false memory effect, recognition ratings provided in response to critical words were higher than those produced for both weakly related and unrelated items. Crucially, scores in the positive dimension increased recognition percentages and confidence ratings for weakly related and unrelated lures. This study indicates that high levels of positive schizotypy might influence the tendency to accept false memories of unrelated unpresented material.

Personal Construct Therapy vs Cognitive Behavioral Therapy in the Treatment of Depression in Women with Fibromyalgia: Study Protocol for a Multicenter Randomized Controlled Trial.

Background: Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia. METHODS AND ANALYSIS: This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3-5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02711020.

Cognitive rigidity in patients with depression and fibromyalgia.

BACKGROUND/OBJECTIVE: The comorbidity of depression and fibromyalgia chronic syndrome has been well documented in the literature; however, the cognitive structure of these patients has not been assessed. Previous results reported variability in cognitive rigidity in depressive patients, the key for this might be the presence of chronic physical pain such as fibromyalgia. The present study explores and compares the cognitive rigidity and differentiation, between patients with depression with and without fibromyalgia syndrome. METHOD: Thirty one patients with depression and fibromyalgia were matched, considering age, sex and number of depressive episodes, with 31 patients with depression but without fibromyalgia diagnosis. Cognitive rigidity and differentiation were measured with the repertory grid technique. RESULTS: The results indicated that depressed patients with fibromyalgia presented higher levels of depressive symptoms, greater cognitive rigidity and lower cognitive differentiation than those without fibromyalgia. CONCLUSIONS: The results might inform future treatments to address the cognitive structure of these patients.

ANTECEDENTES/OBJETIVO: La comorbilidad de la depresión y la fibromialgia ha sido bien documentada en la literatura. Sin embargo, la estructura cognitiva de estos pacientes no ha sido evaluada. Estudios previos muestran variabilidad en medidas de rigidez cognitiva en pacientes con depresión. Los síndromes físicos crónicos podrían ser una variable clave para explicar esta variabilidad presente en estudios previos. El presente estudio explora y compara la rigidez y la diferenciación cognitiva entre paciente con depresión que tienen y aquellos que no tienen fibromialgia. MÉTODO: Treinta y un pacientes con depresión y fibromialgia fueron emparejados, considerando edad, sexo y números de episodios depresivos con 31 pacientes con depresión, pero sin diagnóstico de fibromialgia. RESULTADOS: Los resultados indican que los pacientes que presentan depresión y fibromialgia evidencian niveles más altos de síntomas depresivos, mayor rigidez cognitiva y menor diferenciación cognitiva que los pacientes sin fibromialgia. CONCLUSIONES: Estos resultados podrían ser considerados al momento de crear tratamientos ajustados a la estructura cognitiva de estos pacientes.

Cognitive rigidity in patients with depression and fibromyalgia / Rigidez cognitiva en pacientes con depresión y fibromialgia

Background/Objective: The comorbidity of depression and fibromyalgia chronic syndrome has been well documented in the literature; however, the cognitive structure of these patients has not been assessed. Previous results reported variability in cognitive rigidity in depressive patients, the key for this might be the presence of chronic physical pain such as fibromyalgia. The present study explores and compares the cognitive rigidity and differentiation, between patients with depression with and without fibromyalgia syndrome. Method: Thirty one patients with depression and fibromyalgia were matched, considering age, sex and number of depressive episodes, with 31 patients with depression but without fibromyalgia diagnosis. Cognitive rigidity and differentiation were measured with the repertory grid technique. Results: The results indicated that depressed patients with fibromyalgia presented higher levels of depressive symptoms, greater cognitive rigidity and lower cognitive differentiation than those without fibromyalgia. Conclusions: The results might inform future treatments to address the cognitive structure of these patients

Antecedentes/Objetivo: La comorbilidad de la depresión y la fibromialgia ha sido bien documentada en la literatura. Sin embargo, la estructura cognitiva de estos pacientes no ha sido evaluada. Estudios previos muestran variabilidad en medidas de rigidez cognitiva en pacientes con depresión. Los síndromes físicos crónicos podrían ser una variable clave para explicar esta variabilidad presente en estudios previos. El presente estudio explora y compara la rigidez y la diferenciación cognitiva entre paciente con depresión que tienen y aquellos que no tienen fibromialgia. Método: Treinta y un pacientes con depresión y fibromialgia fueron emparejados, considerando edad, sexo y números de episodios depresivos con 31 pacientes con depresión, pero sin diagnóstico de fibromialgia. Resultados: Los resultados indican que los pacientes que presentan depresión y fibromialgia evidencian niveles más altos de síntomas depresivos, mayor rigidez cognitiva y menor diferenciación cognitiva que los pacientes sin fibromialgia. Conclusiones: Estos resultados podrían ser considerados al momento de crear tratamientos ajustados a la estructura cognitiva de estos pacientes

Schizotypal personality and semantic functioning: Revisiting category fluency effects in a subclinical sample.

Semantic disturbances have been proposed as a possible cause of formal thought disorder in schizophrenia. Fluency tasks, in which volunteers are asked to produce as many exemplars as they can for a given category during one minute, are usually applied to the assessment of semantic processing. However, studies associating fluency and proneness to psychosis have provided conflicting results so it is not clear whether these disturbances can be identified at subclinical stages. We conducted two experiments. In the first one, 71 volunteers completed written category fluency tasks with four semantic categories (animals, fruits, clothing and vehicles). In the second experiment, 77 new participants completed oral category and phonological fluency tasks (words starting with f, t, p and c). In both experiments, we assessed schizotypal personality and vocabulary size. Schizotypal traits were not reliably associated with either productivity or originality of the responses in any experiment. In contrast, vocabulary size significantly predicted the participants' scores in all the tasks. Along with results of other recent studies, our data cast doubt on the reliability of previous observations pointing out an association between schizotypy and lexical-semantic disturbances, at least in relation to productivity and originality in fluency tests.

One-year follow-up of a randomized trial with a dilemma-focused intervention for depression: Exploring an alternative to problem-oriented strategies.

BACKGROUND: Cognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a non-counteractive approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT. METHOD: A total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects. FINDINGS: According to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22). INTERPRETATION: Although using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression. TRIAL REGISTRATION: ClinicalTrials.gov; ID: NCT01542957.

A DILEMMA-FOCUSED INTERVENTION FOR DEPRESSION: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL WITH A 3-MONTH FOLLOW-UP.

BACKGROUND: Since long ago it has been asserted that internal conflicts are relevant to the understanding and treatment of mental disorders, but little research has been conducted to support the claim. The aim of this study was to test the differential efficacy of group cognitive behavioral therapy (CBT) plus an intervention focused on the dilemma(s) detected for each patient versus group individual CBT plus individual CBT for treating depression. A comparative controlled trial with a 3-month follow-up was conducted. METHODS: One hundred twenty-eight adults meeting criteria for MDD and/or dysthymia, presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct, assessed by the repertory grid technique) and who had completed seven sessions of group CBT were randomly assigned to eight sessions of individual manualized CBT or dilemma-focused therapy (DFT). The Beck Depression Inventory-II was administered at baseline, at the end of therapy and after 3 months' follow-up. RESULTS: Multilevel mixed effects modeling yielded no significant differences between CBT and DFT with the intention-to-treat sample. Equivalent effect sizes, remission, and response rates were found with completers as well. In combination with group CBT, both individual CBT and DFT significantly reduced depressive symptoms. CONCLUSIONS: Both conditions obtained comparable results to those in the literature. Thus, the superiority of the adjunctive DFT was not demonstrated. Working with dilemmas can be seen as a promising additional target in the psychotherapy of depression, but further research is still required.

Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial.

BACKGROUND: Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence.Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression. DESIGN: A therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions). METHOD: Participants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used. DISCUSSION: We expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression. TRIAL REGISTRATION: ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

Increased familiarity of intellectual deficits in early-onset schizophrenia spectrum disorders.

OBJECTIVES: Early-onset schizophrenia is considered to be neurobiologically similar to adult-onset forms, although it represents a more severe expression of the disorder. In the present study, we explored putative larger familial vulnerability of intellectual impairments in early-onset schizophrenia spectrum disorders (EOS) when compared to adult-onset (AOS) families. METHODS: A sample of 340 subjects including schizophrenia spectrum disorder patients, their first degree relatives and age-matched healthy controls was assessed on intelligence quotient (IQ). We used linear regression analysis and intraclass correlation coefficients (ICC) to explore familial aggregation of IQ across age at onset groups. RESULTS: The relationship between IQ level of patients and their first-degree relatives showed positive linear association (ß = 0.43, P < 0.01). High significant familial aggregation was found for intelligence quotient in EOS families (ICC = 0.618, P < 0.01), while AOS families responded to lower estimates (ICC = 0.204, P = 0.26; between ICC comparison z = 1.993, P < 0.05). CONCLUSIONS: High aggregation of intellectual performance in the EOS group suggests larger familial vulnerability in early-onset forms of the disease when cognitive functions are considered. Within a continuum of psychopathology in schizophrenia spectrum disorders, specific genetic effects are discussed for distinct onset forms that might be in line with a neurodevelopmental model of the disease.

Childhood abuse, the BDNF-Val66Met polymorphism and adult psychotic-like experiences.

BACKGROUND: The well-established relationship between childhood adversity and psychosis is likely to involve other factors such as genetic variants that can help us to understand why not everyone exposed to adverse events develops psychotic symptoms later in life. AIMS: We investigated the influence of childhood abuse and neglect on positive and negative psychotic-like experiences in adulthood and the potential moderating effect of the BDNF-Val66Met polymorphism. METHOD: Psychotic-like experiences and childhood adversity were assessed in 533 individuals from the general population. RESULTS: Childhood abuse showed a strong independent effect on the positive dimension of psychotic-like experiences (ß = 0.16, s.e. = 0.05, P = 0.002). Furthermore, this association was moderated by the BDNF-Val66Met polymorphism (ß = 0.27, s.e. = 0.10, P = 0.004). CONCLUSIONS: Individuals exposed to childhood abuse are more likely to report positive psychotic-like experiences. Met carriers reported more positive psychotic-like experiences when exposed to childhood abuse than did individuals carrying the Val/Val genotype. Therefore, the observed gene-environment interaction effect may be partially responsible for individual variation in response to childhood abuse.

The catechol-O-methyl transferase Val158Met polymorphism and experience of reward in the flow of daily life.

Genetic moderation of experience of reward in response to environmental stimuli is relevant for the study of many psychiatric disorders. Experience of reward, however, is difficult to capture, as it involves small fluctuations in affect in response to small events in the flow of daily life. This study examined a momentary assessment reward phenotype in relation to the catechol-O-methyl transferase (COMT) Val(158)Met polymorphism. A total of 351 participants from a twin study participated in an Experience Sampling Method procedure to collect daily life experiences concerning events, event appraisals, and affect. Reward experience was operationalized, as the effect of event appraisal on positive affect (PA). Associations between COMT Val(158)Met genotype and event appraisal on the one hand and PA on the other were examined using multilevel random regression analysis. Ability to experience reward increased with the number of 'Met' alleles of the subject, and this differential effect of genotype was greater for events that were experienced as more pleasant. The effect size of genotypic moderation was quite large: subjects with the Val/Val genotype generated almost similar amounts of PA from a 'very pleasant event' as Met/Met subjects did from a 'bit pleasant event'. Genetic variation with functional impact on cortical dopamine tone has a strong influence on reward experience in the flow of daily life. Genetic moderation of ecological measures of reward experience is hypothesized to be of major relevance to the development of various behavioral disorders, including depression and addiction.