Symptoms in women with fibromyalgia after performing physical activity: the role of pain catastrophizing and disease impact.

INTRODUCTION: Walking is an effective treatment for symptoms' management in patients with fibromyalgia. However, despite its benefits, fibromyalgia patients face a variety of obstacles that result in reduced ability to sustain physical exercise. The main goal of the study was to analyze the role of pain catastrophizing and fibromyalgia impact in the relationship between regular walking behavior and pain and fatigue experienced after a laboratory walking test. METHOD: The study has an observational analytical laboratory design. A total of 100 women were contacted by the research team. Seventy-six women diagnosed with fibromyalgia aged 18 years and older (mean age = 55.05, SD = 7.69) participated. RESULTS: Significant correlations were found among regular walking behavior, pain catastrophizing, impact of fibromyalgia, pain intensity after walking, and fatigue intensity after walking. The serial multiple mediation analyses confirmed that pain catastrophizing and impact of fibromyalgia mediated the relationship between regular walking behavior and the level of pain (beta B = 0.044, 95% CI = [0.01-0.012]) and fatigue (beta B = 0.028, 95% CI = [0.01-0.08]) after the laboratory walking test. Also, the participants that walked less regularly experienced more pain and fatigue after the 6-Minute Walk Test. CONCLUSIONS: Considering cognitive variables alongside the impact of fibromyalgia will help understand the inhibitors of engaging in physical activity. Therapeutic walking programs must be tailored to patients with fibromyalgia to reduce pain and fatigue related to physical activity and to promote better functioning and quality of life. Key Points • Regular walking behavior was associated with fibromyalgia impact, pain catastrophizing, and less pain and fatigue after physical activity. • When patients catastrophize pain, they usually interpret physical activity as threatening, which generates more pain and fatigue after doing exercise. • Therapeutic programs should be designed to reduce pain catastrophizing and fibromyalgia impact.

What Does the Psychological Flexibility Model Contribute to the Relationship Between Depression and Disability in Chronic Pain? The Role of Cognitive Fusion and Pain Acceptance.

This study examines the mediator role of cognitive fusion between depressive symptoms, activity avoidance and excessive persistence at different levels of pain acceptance (moderator) among fibromyalgia patients (FM). Using a sample of 231 women, multiple and moderate mediation analyses were conducted with PROCESS. Results showed that depression was positively associated with activity avoidance and excessive persistence. Furthermore, cognitive fusion and pain acceptance were found to mediate the effect of depression in both patterns. Additionally, pain acceptance was found to play a contextual role in cognitive fusion, as a moderator, between depressive symptoms and maladaptive patterns. Specifically, FM patients with high acceptance levels and low levels of depression presented the strongest associations between depression and cognitive fusion. Techniques aimed at reducing cognitive fusion, could be especially beneficial to FM women with high pain acceptance.

Exploring the Preference for Fatigue-avoidance Goals as a Mediator Between Pain Catastrophizing, Functional Impairment, and Walking Behavior in Women With Fibromyalgia.

OBJECTIVES: Along with the symptoms of pain and fatigue, pain catastrophizing and avoidance behaviors are highly prevalent and associated with functional impairment in fibromyalgia (FM) patients. Although pain and fatigue affect patients' quality of life, research has been exclusively focused on how pain affects physical activity and exercise. The aim of this study was to analyze the role of pain catastrophizing and preference for fatigue-avoidance goals in walking behavior and functional impairment in women with FM. MATERIALS AND METHODS: In this cross-sectional study the sample was composed of 76 participants aged 18 years and older (mean age=55.05, SD=7.70). The study evaluated pain catastrophizing, preference for fatigue-avoidance goals, functional impairment, and walking behavior along with sociodemographic variables and clinical data. RESULTS: Pain catastrophizing was associated with preference for fatigue-avoidance goals and this preference was associated with greater functional impairment and less distance walked. Path analysis supported the mediating role of preference for fatigue-avoidance goals in the relationship between pain catastrophizing and walking behavior and between pain catastrophizing and functional impairment. Furthermore, pain catastrophizing predicted greater preference for fatigue-avoidance goals which predicted more problems in functioning and less distance walked. DISCUSSION: The present study may help clarify the connection between the factors that stop individuals with FM from implementing beneficial behaviors such as walking, and thus, allowing for the design of psychological interventions that seek to maintain physical functioning despite experiencing fatigue.

Contextualizing goal preferences in fear-avoidance models. Looking at fatigue as a disabling symptom in fibromyalgia patients.

The fear-avoidance model provides an explanation for the development of chronic pain, including the role of perception (i.e. pain catastrophism) as an explanatory variable. Recent research has shown that the relationship between pain catastrophism and avoidance is influenced in turn by different psychological and contextual variables, highlighting the affective-motivational ones. From this perspective, the Goal Pursuit Questionnaire (GPQ) was developed to measure the preference for hedonic goals (mood-management or pain-avoidance goals) over achievement goals in musculoskeletal pain patients. Recently, the Spanish version of the GPQ in fibromyalgia patients has been validated. Our aim has been to adapt the Spanish version of GPQ from pain to fatigue symptoms and to validate this new questionnaire (GPQ-F) in fibromyalgia. Despite the recognition of fibromyalgia as a complex disorder and the need for a differential study of its symptoms, fatigue, despite its high prevalence and limiting nature, remains the forgotten symptom. We conducted a cross-sectional study with 231 women with fibromyalgia. Previously, we adapted the Spanish GPQ for fatigue symptoms with three sub-studies (group structured interview, self-administration questionnaire and thinking-aloud; n = 15-27 patients). We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Exploratory factor analysis showed two factors: 'Fatigue-avoidance goal' and 'Mood-management goal' (39.3% and 13.9% of explained variance, respectively). The activity avoidance pattern fully mediated the relation between both catastrophizing and fatigue-avoidance goals with fatigue. The study shows initial findings about the usefulness of the GPQ-F as a tool to analyze goal preferences related to fatigue in fibromyalgia. The results supported the mediational role of activity avoidance patterns in the relationship between preference for fatigue-avoidance goals and fatigue.

Cellular strategies against metal exposure and metal localization patterns linked to phosphorus pathways in Ochrobactrum anthropi DE2010.

Cytotoxic, chemical, biochemical, compositional, and morphometric responses were analyzed against heavy metal exposure in Ochrobactrum anthropi DE2010, an heterotrophic bacterium isolated from Ebro Delta microbial mats (Tarragona, NE Spain). Several parameters of effect and exposure were evaluated to determine tolerance to a range of cadmium (Cd), lead (Pb(II)), copper (Cu(II)), chromium (Cr(III)), and zinc (Zn) concentrations. Additionally, removal efficiency, polyphosphate production and metal localization patterns were also analyzed. O. anthropi DE2010 showed high resistance to the tested metals, supporting concentrations of up to 20 mM for Zn and 10 mM for the rest of the elements. The bacterium also demonstrated a high removal capacity of metals-up to 90 % and 40 % for Pb(II) and Cr(III), respectively. Moreover, polyphosphate production was strongly correlated with heavy metal concentration, and three clear cell localization patterns of metals were evidenced using compositional and imaging techniques: (i) extracellular in polyphosphate granules for Cu(II); (ii) in periplasmic space forming crystals with phosphorus for Pb(II); and (iii) intracytoplasmic in polyphosphate inclusions for Pb(II), Cr(III), and Zn. The high resistance and metal sequestration capacity of O. anthropi DE2010 both highlight its great potential for bioremediation strategies, especially in Pb and Cr polluted areas.

Exploring the contextual role of pain severity as a moderator of the relationship between activity patterns and the physical and mental functioning of women with fibromyalgia.

INTRODUCTION: In past years, and mostly due to contextual psychological therapies, it has been argued that particular behavioural patterns may be useful in certain contexts, but not in others. The goal of this study has been to explore whether pain severity is indeed a contextual factor influencing the relationship between two controversial activity patterns, namely pacing and persistence, and functionality in people with fibromyalgia. METHODS: Participants were 231 women diagnosed with fibromyalgia. A multivariate regression was conducted to explore the moderating role of pain severity in the relationship between activity patterns and outcomes (i.e. fibromyalgia impact and depressive symptoms). RESULTS: Excessive persistence (interaction: t = -2.45, p = 0.015) and pain-contingent persistence (interaction: t= -2.13, p = 0.034) were more strongly associated with fibromyalgia impact when people experienced less severe pain. Pacing for pain reduction was only significantly related to depressive symptoms at very severe (M = 10) pain levels (interaction: ß= -0.18, t= -2.73). CONCLUSIONS: The results here reported suggest that the context in which behaviour occurs is relevant when the utility of certain behaviour patterns is considered. The clinical implications of this are clear, as it would justify adapting the recommendations given to patients according to their pain severity status. SIGNIFICANCE: This manuscript shows that some activity patterns (i.e. pacing to conserve energy for valued activities) might be advisable regardless of pain levels. Conversely, some patterns might be especially recommended (i.e. pain-reduction pacing) or inadvisable (i.e. excessive and pain-contingent persistence) depending on pain levels (i.e. severe and mild pain, respectively).

Predicting optimal interventions for clinical depression: Moderators of outcomes in a positive psychological intervention vs. cognitive-behavioral therapy.

Identifying differences in the clinical response to specific interventions is an important challenge in the field of Clinical Psychology. This is especially true in the treatment of depression where many treatments appear to have comparable outcomes. In a controlled trial, we compared a positive psychology group intervention, the Integrative Positive Psychological Intervention for Depression (IPPI-D; n = 62) to a cognitive-behavioral therapy group intervention (CBT; n = 66) for depression. No statistically or clinically-significant differences between the treatments were found, but a slight advantage was observed, on average, for IPPI-D. The aim of the present study was to identify and combine moderators of the differential efficacy of these two psychological interventions for clinical depression. For this purpose, a secondary analysis using the Personalized Advantage Index (PAI) was performed to identify the intervention predicted to produce the better outcome for each patient. Six of the 21 potential moderators were found to predict differential efficacy between the treatments. IPPI-D was predicted to be the optimal treatment for 73% of the sample. Baseline features that characterized these individuals were: mental and physical comorbidity, prior antidepressant medication, higher levels of negative thoughts, and higher personal growth. The 27% who were predicted to achieve better outcomes in CBT than in IPPI-D tended to have these baseline features: no comorbidities, no prior antidepressant medication, lower levels of negative thoughts, and lower personal growth.

CBT and positive psychology interventions for clinical depression promote healthy attentional biases: An eye-tracking study.

BACKGROUND: Although there is a growing interest in the role of attentional biases in depression, there are no studies assessing changes in these biases after psychotherapeutic interventions. METHODS: We used a validated eye-tracking procedure to assess pre-post therapy changes in attentional biases toward emotional information (i.e., happy, sad, and angry faces) when presented with neutral information (i.e., neutral faces). The sample consisted of 75 participants with major depression or dysthymia. Participants were blindly assigned to one of two 10 weekly sessions of group therapy: a cognitive behavior therapy intervention (N = 41) and a positive psychology intervention (N = 34). RESULTS: Both treatments were equally efficacious in improving depressive symptoms (p = .0001, η² = .68). A significant change in attentional performance after therapy was observed irrespective of the intervention modality. Comparison of pre-post attentional measures revealed a significant reduction in the total time of fixations (TTF) looking at negative information (i.e., sad and angry faces) and a significant increase in the TTF looking at positive information (i.e., happy faces)-all p < .02. CONCLUSIONS: Findings reveal for the first time that psychotherapeutic interventions are associated with a significant change in attentional biases as assessed by a direct measure of attention. Furthermore, these changes seem to operate in the same direction typically found in healthy populations (i.e., a bias away from negative information and a parallel bias toward positive information). These findings illustrate the importance of considering attentional biases as clinical markers of depression and suggest the viability of modifying these biases as a potential tool for clinical change.

Pattern of Changes during Treatment: A Comparison between a Positive Psychology Intervention and a Cognitive Behavioral Treatment for Clinical Depression.

Research on psychotherapy has traditionally focused on analyzing changes between the beginning and the end of a treatment. Few studies have addressed the pattern of therapeutic change during treatment. The aim of this study was to examine the pattern of changes in clinical and well-being variables during a cognitive behavioral therapy (CBT) program compared with an integrative positive psychology interventions program for clinical depression IPPI-D. 128 women with a diagnosis of major depression or dysthymia were assigned to the CBT or PPI group. A measure of depressive symptoms (i.e., Beck Depression Inventory) and well-being (i.e., Pemberton Happiness Index) were administered four times: at the beginning and end of the treatment, as well as during treatment (at sessions 4 and 7). Through mixed-model repeated measures ANOVAs, both depressive symptoms (p .08). The percentage of improvement in depressive symptoms in the first treatment period was higher than in the later ones (ps < .005). On the contrary, well-being showed a more gradual improvement (p = .15). These results highlight the importance of assessing the pattern of changes in symptoms and well-being separately.

Comparing the acceptability of a positive psychology intervention versus a cognitive behavioural therapy for clinical depression.

There is growing evidence on the efficacy of positive psychology interventions (PPI) to treat clinical disorders. However, very few studies have addressed their acceptability. The present study aimed to analyse 2 key components of acceptability (i.e., client satisfaction and adherence to treatment) of a new PPI programme, the Integrative Positive Psychological Intervention for Depression (IPPI-D), in comparison to a standard cognitive behavioural therapy (CBT) programme in the treatment of clinical depression. One hundred twenty-eight women with a DSM-IV diagnosis of major depression or dysthymia were allocated to a 10-session IPPI-D or CBT group intervention condition. Results showed that both interventions were highly acceptable for participants. Attendance rates were high, and there were no significant differences between conditions. However, the IPPI-D condition showed significantly higher client satisfaction than the CBT condition. Moreover, acceptability did not differ based on participants' severity of symptoms, regardless of condition. These findings encourage further investigations of the applicability of PPI in clinical settings in order to broaden the range of acceptable and suitable therapies for depressed patients. Key Practitioner Message This study sheds light on the client satisfaction and adherence to a positive intervention. For participants, positive psychology interventions (PPI) may be more satisfactory than CBT as PPI are framed within a positive mental health model and, consequently, may reduce the risk of stigmatization Because acceptability of treatments and preferences may affect the efficacy of treatments, this study provides an excellent opportunity to offer professionals more therapeutic options to tailor treatments to clients' needs and expectations.

Pattern of changes during treatment: a comparison between a positive psychology intervention and a cognitive behavioral treatment for clinical depression

Research on psychotherapy has traditionally focused on analyzing changes between the beginning and the end of a treatment. Few studies have addressed the pattern of therapeutic change during treatment. The aim of this study was to examine the pattern of changes in clinical and well-being variables during a cognitive behavioral therapy (CBT) program compared with an integrative positive psychology interventions program for clinical depression IPPI-D. 128 women with a diagnosis of major depression or dysthymia were assigned to the CBT or PPI group. A measure of depressive symptoms (i.e., Beck Depression Inventory) and well-being (i.e., Pemberton Happiness Index) were administered four times: at the beginning and end of the treatment, as well as during treatment (at sessions 4 and 7). Through mixed-model repeated measures ANOVAs, both depressive symptoms (p < .001, partial η2 = .52) and well-being (p < .001, partial η2 = .29) showed a significant improvement through the four assessment times. No significant interactions between time and treatment modality were found (ps > .08). The percentage of improvement in depressive symptoms in the first treatment period was higher than in the later ones (ps < .005). On the contrary, well-being showed a more gradual improvement (p = .15). These results highlight the importance of assessing the pattern of changes in symptoms and well-being separately (AU)

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The power of extraverts: Testing positive and negative mood regulation / El poder de los extravertidos: Evaluando la regulación de estados de ánimo positivos y negativos

Extraversion is a personality trait which has been systematically related to positive affect and well-being. One of the mechanisms that may account for these positive outcomes is the ability to regulate the responses to positive, as well as negative, moods. Prior research has found that extraverts’ higher positive mood maintenance could explain their higher levels of positive affect. However, research exploring differences between extraverts and introverts in negative mood regulation has yielded mixed results. The aim of the current study was explore the role of different facets of mood regulation displayed by extraverts, ambiverts, and introverts. After been exposed to a sad vs. happy mood induction, participants underwent a mood regulation task. Extraverts and ambiverts exhibited higher positive mood regulation than introverts, but similar mood repair. Thus, this research highlights the importance of positive mood regulation in the psychological functioning of extraverts, and opens new conceptualizations for developing interventions for introverts to improve their positive mood regulation and, hence, overall positive affect and well-being

La extraversión es un rasgo de personalidad que ha sido sistemáticamente relacionado con el afecto positivo y el bienestar. Uno de los mecanismos que puede dar cuenta de estos efectos positivos es la habilidad para responder a los estados de ánimo tanto negativos como positivos. La investigación previa ha encontrado que el mayor mantenimiento de estados de ánimo positivos que logran los extravertidos podría explicar sus niveles elevados de afecto positivo. Sin embargo, las investigaciones que han explorado las diferencias entre extravertidos e introvertidos en cuanto a la regulación del estado de ánimo negativo han dado lugar a resultados mixtos. El objetivo del presente estudio fue explorar el papel de las diferentes facetas de la regulación emocional desplegadas por los extravertidos, ambivertidos e introvertidos. Tras ser inducidos a un estado de ánimo triste o alegre, los participantes fueron sometidos a una tarea de regulación emocional. Los participantes extravertidos y ambivertidos mostraron un nivel de regulación del estado de ánimo positivo mejor que los introvertidos, pero un nivel similar de regulación del estado de ánimo triste. Por tanto, esta investigación destaca la importancia de la regulación de estados de ánimo positivos en el funcionamiento psicológico de los extravertidos, y abre nuevas conceptualizaciones para desarrollar intervenciones en las que los introvertidos puedan mejorar la regulación de sus estados de ánimo positivos y, en consecuencia, mejorar su nivel general de afecto positivo y de bienestar

Adaptación de las "Escalas de afecto positivo y negativo" (PANAS) en una muestra general española / An adaptation of the Positive and Negative Affect Schedules (PANAS) in a Spanish general sample

Las "Escalas de afecto positivo y negativo" (Positive and Negative Affect Schedule, PANAS) han sido ampliamente utilizadas para evaluar el afecto. Este trabajo tiene como objetivo analizar las propiedades psicométricas, estructura e invarianza factorial de una adaptación al español en una muestra general española (N= 1071). El coeficiente alfa de Cronbach fue de 0,92 para la Escala de afecto positivo y de 0,88 para la Escala de afecto negativo. Los análisis factoriales exploratorio y confirmatorio revelaron una estructura bifactorial de las PANAS y los análisis de invarianza factorial confirmaron la invarianza de esta adaptación en función del sexo y la edad. Asimismo, se encontraron correlaciones significativas en diferentes muestras entre las escalas del instrumento y otras medidas de afecto, depresión, ansiedad y bienestar. En conjunto, esta nueva versión de las PANAS supone algunas mejoras relevantes, especialmente en el ajuste de la traducción, y presenta buenas propiedades psicométricas en estas muestras

The Positive and Negative Affect Schedule (PANAS) have been widely used to measure affect. This study aimed to analyze the psychometric properties, structure and factorial invariance of an adaptation to Spanish in a general sample from Spain (N= 1071). Cronbach's alpha was .92 for Positive Affect Scale and .88 for Negative Affect Scale. Exploratory and confirmatory factor analyses revealed a two-factor structure of the PANAS. Factorial invariance analyses confirmed the invariance of this adaptation by sex and age. Furthermore, significant correlations were found in different samples between the scales of the instrument and other measures of affect, depression, anxiety and well-being. Overall, this new version of the PANAS has good psychometric properties in the samples analyzed

Modificación de sesgos cognitivos (MSC) en depresión: una revisión crítica de nuevos procedimientos para el cambio de sesgos cognitivos / Cognitive bias modification (CBM) in depression: a critical review of new procedures to change cognitive biases

Los sesgos cognitivos juegan un papel importante como factores de vulnerabilidad en los trastornos emocionales. Recientemente se han empezado a desarrollar intervenciones para la Modificación de Sesgos Cognitivos (MSC), con el objetivo final de mejorar los síntomas clínicos. Aunque estos procedimientos innovadores se han utilizado más en los problemas de ansiedad, existe una investigación creciente sobre su uso en la depresión. En este trabajo efectuamos una revisión del marco teórico, los procedimientos utilizados y los principales resultados de la MSC en la depresión, en especial en la corrección de sesgos atencionales y de interpretación. Finalmente se analizan las limitaciones conceptuales y metodológicas de estas nuevas intervenciones y se discuten sus implicaciones clínicas, teóricas y aplicadas.

Cognitive biases play an important role as vulnerability factors in emotional disorders. Interventions for Cognitive Bias Modification (CBM) have recently begun to be developed with the ultimate goal of improving clinical symptoms. Although these innovative procedures have been applied mainly in anxiety problems, there is increasing research on the application in depression. This work reviews the theoretical framework, the procedures used, and the main results of CBM in depression, especially in the modification of attention and interpretative bias. Finally the conceptual and methodological limitations of these promising interventions procedures are analyzed as well as the clinical, theoretical and applied implications.

Una aproximación a los valores distintivos del médico / An approach to the distinctive values of the physician

La educación del carácter resulta esencial en la formación del médico. El objetivo de este estudio ha sido evaluar las cualidades del carácter de los futuros médicos y compararlas con las de estudiantes de otras disciplinas. Para ello se hizo uso del sistema de clasificación de las fortalezas y virtudes personales que ha sido ampliamente utilizado en diferentes países y muestras. Tres muestras de estudiantes universitarios participaron en el estudio: Medicina (n = 75); Psicología (n = 71) y Ciencias Económicas y Empresariales (n = 60). Los participantes completaron el instrumento Values in Action Inventory of Strengths (VIA-IS) y la Escala de Afecto Positivo y Negativo (PANAS). Las fortalezas más autoadscritas por los tres grupos fueron la bondad, el amor, la justicia, la gratitud y la honestidad, aunque diferían en el orden de clasificación. Los análisis de covarianza controlando el sexo y las emociones positivas y negativas mostraron que los estudiantes de Medicina presentaban puntuaciones significativamente más altas en perseverancia, perspectiva, prudencia y perdón que los estudiantes de Psicología. Del mismo modo, los estudiantes de Medicina tuvieron puntuaciones significativamente más altas en justicia, humildad, bondad y curiosidad que los estudiantes de Ciencias Económicas y Empresariales. Estos resultados preliminares muestran algunas diferencias significativas en el perfil de fortalezas de los próximos médicos. Se sugieren nuevas posibilidades de investigación y de formación en esta área educativa emergente

Character education is essential in the physician training. The aim of this study was to assess character strengths of Medicine students and compare them to students from different disciplines. For this purpose, the character strengths and virtues classification was used, a model that has been widely used in different countries and samples. Three different samples of university students participated in the study [Medicine (n=75), Psychology (n=71) and Economics (n=60)]. Participants filled out the Values in Action Inventory of Strengths (VIAIS) and the Positive and Negative Affective Questionnaire (PANAS). Kindness, love, fairness, gratitude and honesty were the signature strengths of the three groups, although classification order differed. Covariance analyses controlling for sex and positive and negative emotions showed that Medical students reported significantly higher scores on perseverance, perspective, prudence and forgiveness than Psychology students. Likewise, Medical students had significantly higher scores on fairness, humility, kindness and curiosity than Economics students. These preliminary results show some significant differences in the profile of wouldbe physicians. Possibilities for future research and training in this emerging educational area are suggested

Valores del médico y su carácter: proyecto VADEMECA. Evaluación de los valores del futuro médico / Physician values and character: VADEMECA project. Assesment of the values of the future physician

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