Randomized controlled trial of an Acceptance and Commitment Therapy and compassion-based group intervention for persons with inflammatory bowel disease: the LIFEwithIBD intervention.

Objectives: This study tested the acceptability and efficacy of an Acceptance and Commitment Therapy and compassion-based intervention (LIFEwithIBD) in people with IBD through a two-arm RCT. Methods: Participants were recruited at the Gastroenterology Department of the Coimbra University Hospital between June and September 2019. Of the 355 patients screened, those who accepted to participate were randomly assigned to one of two conditions: experimental group (LIFEwithIBD; n = 25) or control group (waitlist; n = 29). Participants completed self-report measures at baseline (T0), post-intervention (T1), and 3-month (T2) and 12-month (T3) follow-ups. Intervention acceptability was assessed. Efficacy was examined using intent-to-treat ANCOVA at post-intervention after adjusting for baseline values of depressive, anxiety, and stress symptoms (primary outcomes). Linear mixed models for all longitudinal outcomes were also analysed. Inflammatory and disease biomarkers were determined at T0 and T3. Results: Acceptability results revealed a high level of satisfaction and perceived usefulness regarding the intervention. Both groups experienced a significant decrease in stress symptoms and IBD symptom perception at T1. No significant differences were observed at follow-up for the primary outcomes. The experimental group reported significantly lower Crohn's disease Symptom severity at T2 than the control group. Post-hoc analyses designed to mitigate floor effects revealed substantial treatment effects for the experimental group regarding anxiety symptoms. No significant differences were observed in clinical biomarkers from T0 to T3. Conclusion: The LIFEwithIBD intervention shows promising, although preliminary, benefits for managing disease activity and reducing anxiety symptoms in IBD patients with high severity of psychological distress.Clinical trial registration: https://www.clinicaltrials.gov/ct2/show/NCT03840707, identifier NCT03840707.

Improvements in Compassion and Fears of Compassion throughout the COVID-19 Pandemic: A Multinational Study.

During large-scale disasters, social support, caring behaviours, and compassion are shown to protect against poor mental health outcomes. This multi-national study aimed to assess the fluctuations in compassion over time during the COVID-19 pandemic. Respondents (Time 1 n = 4156, Time 2 n = 980, Time 3 n = 825) from 23 countries completed online self-report questionnaires measuring the flows of compassion (i.e., Compassionate Engagement and Action Scales) and fears of compassion toward self and others and from others (i.e., Fears of Compassion Scales) and mental health at three time-points during a 10-month period. The results for the flows of compassion showed that self-compassion increased at Time 3. Compassion for others increased at Time 2 and 3 for the general population, but in contrast, it decreased in health professionals, possibly linked to burnout. Compassion from others did not change in Time 2, but it did increase significantly in Time 3. For fears of compassion, fears of self-compassion reduced over time, fears of compassion for others showed more variation, reducing for the general public but increasing for health professionals, whilst fears of compassion from others did not change over time. Health professionals, those with compassion training, older adults, and women showed greater flows of compassion and lower fears of compassion compared with the general population, those without compassion training, younger adults, and men. These findings highlight that, in a period of shared suffering, people from multiple countries and nationalities show a cumulative improvement in compassion and reduction in fears of compassion, suggesting that, when there is intense suffering, people become more compassionate to self and others and less afraid of, and resistant to, compassion.

Corrigendum: The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease.

[This corrects the article DOI: 10.3389/fpsyt.2021.699367.].

Corrigendum: The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease.

[This corrects the article DOI: 10.3389/fpsyt.2021.699367.].

Compassion Protects Mental Health and Social Safeness During the COVID-19 Pandemic Across 21 Countries.

Objectives: The COVID-19 pandemic is having an unprecedented detrimental impact on mental health in people around the world. It is important therefore to explore factors that may buffer or accentuate the risk of mental health problems in this context. Given that compassion has numerous benefits for mental health, emotion regulation, and social relationships, this study examines the buffering effects of different flows of compassion (for self, for others, from others) against the impact of perceived threat of COVID-19 on depression, anxiety, and stress, and social safeness. Methods: The study was conducted in a sample of 4057 adult participants from the general community population, collected across 21 countries from Europe, Middle East, North America, South America, Asia, and Oceania. Participants completed self-report measures of perceived threat of COVID-19, compassion (for self, for others, from others), depression, anxiety, stress, and social safeness. Results: Perceived threat of COVID-19 was associated with higher scores in depression, anxiety, and stress, and lower scores in social safeness. Self-compassion and compassion from others were associated with lower psychological distress and higher social safeness. Compassion for others was associated with lower depressive symptoms. Self-compassion moderated the relationship between perceived threat of COVID-19 on depression, anxiety, and stress, whereas compassion from others moderated the effects of fears of contracting COVID-19 on social safeness. These effects were consistent across all countries. Conclusions: Our findings highlight the universal protective role of compassion, in particular self-compassion and compassion from others, in promoting resilience by buffering against the harmful effects of the COVID-19 pandemic on mental health and social safeness. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-021-01822-2.

The role of social connection on the experience of COVID-19 related post-traumatic growth and stress.

BACKGROUND: Historically social connection has been an important way through which humans have coped with large-scale threatening events. In the context of the COVID-19 pandemic, lockdowns have deprived people of major sources of social support and coping, with others representing threats. Hence, a major stressor during the pandemic has been a sense of social disconnection and loneliness. This study explores how people's experience of compassion and feeling socially safe and connected, in contrast to feeling socially disconnected, lonely and fearful of compassion, effects the impact of perceived threat of COVID-19 on post-traumatic growth and post-traumatic stress. METHODS: Adult participants from the general population (N = 4057) across 21 countries worldwide, completed self-report measures of social connection (compassion for self, from others, for others; social safeness), social disconnection (fears of compassion for self, from others, for others; loneliness), perceived threat of COVID-19, post-traumatic growth and traumatic stress. RESULTS: Perceived threat of COVID-19 predicted increased post-traumatic growth and traumatic stress. Social connection (compassion and social safeness) predicted higher post-traumatic growth and traumatic stress, whereas social disconnection (fears of compassion and loneliness) predicted increased traumatic symptoms only. Social connection heightened the impact of perceived threat of COVID-19 on post-traumatic growth, while social disconnection weakened this impact. Social disconnection magnified the impact of the perceived threat of COVID-19 on traumatic stress. These effects were consistent across all countries. CONCLUSIONS: Social connection is key to how people adapt and cope with the worldwide COVID-19 crisis and may facilitate post-traumatic growth in the context of the threat experienced during the pandemic. In contrast, social disconnection increases vulnerability to develop post-traumatic stress in this threatening context. Public health and Government organizations could implement interventions to foster compassion and feelings of social safeness and reduce experiences of social disconnection, thus promoting growth, resilience and mental wellbeing during and following the pandemic.

The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease.

Background: There is ample evidence of the high mental health burden caused by Inflammatory Bowel Disease (IBD). Several constructs such as experiential avoidance, cognitive fusion, shame, and self-criticism have recently emerged as potential intervention targets to improve mental health in IBD. Psychotherapeutic models such as Acceptance and Commitment Therapy and compassion-based interventions are known to target these constructs. In this protocol, we aim to describe a two-arm Randomized Controlled Trial (RCT) testing the efficacy of an ACT and compassion-focused intervention named Living with Intention, Fullness, and Engagement with Inflammatory Bowel Disease (LIFEwithIBD) intervention + Treatment As Usual (TAU) vs. TAU in improving psychological distress, quality of life, work and social functioning, IBD symptom perception, illness-related shame, psychological flexibility, self-compassion, disease activity, inflammation biomarkers, and gut microbiota diversity. Methods: This trial is registered at ClinicalTrials.gov (Identifier: NCT03840707, date assigned 13/02/2019). The LIFEwithIBD intervention is an adaptation to the IBD population of the Mind programme for people with cancer, an acceptance, mindfulness, and compassion-based intervention designed to be delivered in a group format. The LIFEwithIBD intervention's structure and topics are presented in this protocol. Participants were recruited at the Gastroenterology Service of the Coimbra University Hospital between June and September 2019. Of the 355 patients screened, 61 participants were selected, randomly assigned to one of two conditions [experimental group (LIFEwithIBD + TAU) or control group (TAU)] and completed the baseline assessment. Outcome measurement took place at baseline, post-intervention, 3- and 12-month follow-ups. Discussion: Results from this RCT will support future studies testing the LIFEwithIBD intervention or other acceptance and/or compassion-based interventions for IBD.

Fears of compassion magnify the harmful effects of threat of COVID-19 on mental health and social safeness across 21 countries.

BACKGROUND: The COVID-19 pandemic is a massive global health crisis with damaging consequences to mental health and social relationships. Exploring factors that may heighten or buffer the risk of mental health problems in this context is thus critical. Whilst compassion may be a protective factor, in contrast fears of compassion increase vulnerability to psychosocial distress and may amplify the impact of the pandemic on mental health. This study explores the magnifying effects of fears of compassion on the impact of perceived threat of COVID-19 on depression, anxiety and stress, and social safeness. METHODS: Adult participants from the general population (N = 4057) were recruited across 21 countries worldwide, and completed self-report measures of perceived threat of COVID-19, fears of compassion (for self, from others, for others), depression, anxiety, stress and social safeness. RESULTS: Perceived threat of COVID-19 predicted increased depression, anxiety and stress. The three flows of fears of compassion predicted higher levels of depression, anxiety and stress and lower social safeness. All fears of compassion moderated (heightened) the impact of perceived threat of COVID-19 on psychological distress. Only fears of compassion from others moderated the effects of likelihood of contracting COVID-19 on social safeness. These effects were consistent across all countries. CONCLUSIONS: Fears of compassion have a universal magnifying effect on the damaging impact of the COVID-19 pandemic on mental health and social safeness. Compassion focused interventions and communications could be implemented to reduce resistances to compassion and promote mental wellbeing during and following the pandemic.

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

OBJECTIVES: Although the Ruminative Responses Scale is one of the most widely used measures of rumination, its two-factor structure remains controversial. Taking this into account, we aimed to test the RRS-10 two-factor invariance (Brazilian version) between different samples of women and to study its internal consistency and convergent validity. METHODS: A sample of 321 women (general population, n = 106; college students, n = 115; and medical population of patients with overweight and obesity, n = 100) participated in the study. The two-factor structure of RRS-10 was assessed by CFA and multigroup analysis using Mplus software. Internal consistency was assessed by Cronbach's alpha and the convergent validity by Pearson correlations. RESULTS: The two-factor structure of RRS-10 showed a good fit, factorial invariance across three samples, good internal consistency, and adequate convergent validity. Brooding and Reflection subscales were both positively correlated with psychological inflexibility, cognitive fusion, anxiety, depression, and stress symptoms, although Brooding presented significantly stronger associations with these variables than Reflection. CONCLUSIONS: This study provides further discussion and evidence regarding the RRS-10 two-factor structure, as well as a valid version of RRS-10 to use in Brazil in order to reliably assess rumination in medical and research settings. PRACTITIONER POINTS: This is the first study to test and confirm the RRS two-factor structure invariance across groups. RRS-10 two-dimensionality was confirmed in medical and non-medical samples of women. Brooding subscale showed significantly stronger relationships with psychopathology and experiential avoidance than Reflection. The study provides evidence that RRS can be used as a valid and sound measure to accurately assess the clinically relevant dimensions of rumination simultaneously across distinct groups.

Cuestionario de asertividad centrado en el estilo de vida (CACEV) en pacientes con síndrome metabólico: desarrollo y validación / The Lifestyle Related Assertiveness Questionnaire (LRAQ) in patients with metabolic syndrome: Development and validation

El objetivo de este trabajo es presentar las propiedades psicométricas del "Cuestionario de asertividad centrado en el estilo de vida" (CACEV) con una muestra de pacientes con síndrome metabólico. La muestra total fue de 136 sujetos de los que 79 terminaron el estudio (48 del grupo de tratamiento y 31 del grupo control), con seguimientos de 6 y 18 meses. Se han incluido los datos sociodemográficos, antropométricos, fisiológicos y bioquímicos de los participantes, aparte de las puntuaciones en el CACEV y en el "Inventario de asertividad" (IA). Los resultados del análisis factorial exploratorio del CACEV han revelado una estructura de tres factores: Expresar la preferencia por el ejercicio y la alimentación saludable, Decir que no al consumo de alimentos poco saludables y Decir que no a actividades obstaculizadoras del ejercicio físico. La consistencia interna (alfa= 0,925), la fiabilidad test-retest y la sensibilidad al cambio fueron adecuadas. Las propiedades psicométricas del CACEV indican que es un cuestionario válido y fiable para evaluar la asertividad centrada en el estilo de vida en personas con síndrome metabólica

The aim of this paper is to present the psychometric properties of the Lifestyle-Related Assertiveness Questionnaire (CACEV) in a sample of patients with metabolic syndrome. The total sample was 136 subjects, of whom 79 completed the study (48 from the treatment group and 31 from the control group), with follow-up at 6 and 18 months. Socio-demographic, anthropometric, physiological and biochemical data of the participants have been included, as well as the CACEV and the Assertiveness Inventory (AI) scores. The results of the exploratory factor analysis of CACEV have revealed a 3-factor structure: Expressing preference for exercise and healthy eating, Saying no to unhealthy food consumption and Saying no to activities that interfere with physical exercise. The internal consistency (alfa = .925), test-retest reliability and sensitivity to change were adequate. From the psychometric properties found in the CACEV, we can conclude that it is a valid and reliable questionnaire to evaluate lifestyle-related assertiveness in people with metabolic syndrome

Body-Image Acceptance and Action Questionnaire: Its deleterious influence on binge eating and psychometric validation / Body-Image Acceptance and Action Questionnaire: su nociva influencia en la ingesta compulsiva y validación psicométrica

Background/Objectives: This study aimed to explore the psychometric properties of BI-AAQ (Body-Image Acceptance and Action Questionnaire) and the body image psychological flexibility role as a mediator in a pervasive path towards binge eating in Brazilian samples. Method: This cross-sectional study was conducted in clinical (overweight or obese women currently in treatment for weight loss; n= 330) and non-clinical (general population; n= 682) groups of women. Results: BI-AAQ has one-factor structure, excellent internal consistency, ability to detect differences between groups and measurement invariance across samples. It was also negatively associated with self-compassion and positively associated with binge eating severity, drive for thinness and self-criticism. Conclusions: This study provides data confirming the robust psychometric properties of BI-AAQ in qualitatively different samples. Furthermore, an additional study conducted in a clinical sample of women with overweight or obesity revealed that body image psychological inflexibility has emerged as a partial and significant mediator of the effect of self-criticism and drive for thinness on binge eating severity (AU)

Antecedentes/Objetivo: Este estudio tuvo como objetivo explorar las propiedades psicométricas del BI-AAQ (Body-Image Acceptance and Action Questionnaire) y el papel mediador de la inflexibilidad psicológica relacionada con la imagen corporal en una trayectoria nociva hacia la ingesta compulsiva en muestras brasileñas. Método: Este estudio transversal se llevó a cabo en grupos clínicos (mujeres con sobrepeso u obesidad actualmente en tratamiento para la pérdida de peso; n= 330) y no clínicos (grupo de población general; n= 682) de mujeres. Resultados: BI-AAQ presenta la estructura de un factor, excelente consistencia interna, capacidad para detectar diferencias entre grupos e invariancia de medida entre diferentes muestras. Sus puntuaciones se asociaron negativamente con la autocompasión y positivamente con la severidad de la compulsión alimentaria, búsqueda de la delgadez y autocrítica. Conclusiones: Este estudio proporcionó datos que confirman que el BI-AAQ tiene propiedades psicométricas sólidas en muestras cualitativamente diferentes. Además, un estudio adicional efectuado en una muestra clínica de mujeres con sobrepeso u obesidad reveló que la inflexibilidad psicológica relacionada con la imagen corporal emergió como mediadora parcial y significativa del efecto de la autocrítica y de la búsqueda de la delgadez sobre la severidad de la compulsión alimentaria (AU)

Cognitive Fusion Questionnaire-Body Image: Psychometric Properties and Its Incremental Power in the Prediction of Binge Eating Severity.

Given the clinical usefulness of the CFQ-BI (Cognitive Fusion Questionnaire-Body Image; the only existing measure to assess the body-image-related cognitive fusion), the present study aimed to confirm its one-factor structure, to verify its measurement invariance between clinical and non-clinical samples, to analyze its internal consistency and sensitivity to detect differences between samples, as well as to explore the incremental and convergent validities of the CFQ-BI scores in Brazilian samples.  This was a cross-sectional study, which was conducted in clinical (women with overweight or obesity in treatment for weight loss) and non-clinical samples (women from the general population). The one-factor structure was confirmed showing factorial measurement invariance across clinical and non-clinical samples. The CFQ-BI scores presented an excellent internal consistency, were able to discriminate clinical and non-clinical samples, and were positively associated with binge eating severity, general cognitive fusion, and psychological inflexibility. Furthermore, body-image-related cognitive fusion scores (CFQ-BI) presented incremental validity over a general measure of cognitive fusion in the prediction of binge eating symptoms. This study demonstrated that CFQ-BI is a short scale with reliable and robust scores in Brazilian samples, presenting incremental and convergent validities, measurement invariance, and sensitivity to detect differences between clinical and non-clinical groups of women, enabling comparative studies between them.

Body-Image Acceptance and Action Questionnaire: Its deleterious influence on binge eating and psychometric validation.

Background/Objectives: This study aimed to explore the psychometric properties of BI-AAQ (Body-Image Acceptance and Action Questionnaire) and the body image psychological flexibility role as a mediator in a pervasive path towards binge eating in Brazilian samples. Method: This cross-sectional study was conducted in clinical (overweight or obese women currently in treatment for weight loss; n= 330) and non-clinical (general population; n= 682) groups of women. Results: BI-AAQ has one-factor structure, excellent internal consistency, ability to detect differences between groups and measurement invariance across samples. It was also negatively associated with self-compassion and positively associated with binge eating severity, drive for thinness and self-criticism. Conclusions: This study provides data confirming the robust psychometric properties of BI-AAQ in qualitatively different samples. Furthermore, an additional study conducted in a clinical sample of women with overweight or obesity revealed that body image psychological inflexibility has emerged as a partial and significant mediator of the effect of self-criticism and drive for thinness on binge eating severity.

Antecedentes/Objetivo: Este estudio tuvo como objetivo explorar las propiedades psicométricas del BI-AAQ (Body-Image Acceptance and Action Questionnaire) y el papel mediador de la inflexibilidad psicológica relacionada con la imagen corporal en una trayectoria nociva hacia la ingesta compulsiva en muestras brasileñas. Método: Este estudio transversal se llevó a cabo en grupos clínicos (mujeres con sobrepeso u obesidad actualmente en tratamiento para la pérdida de peso; n= 330) y no clínicos (grupo de población general; n= 682) de mujeres. Resultados: BI-AAQ presenta la estructura de un factor, excelente consistencia interna, capacidad para detectar diferencias entre grupos e invariancia de medida entre diferentes muestras. Sus puntuaciones se asociaron negativamente con la autocompasión y positivamente con la severidad de la compulsión alimentaria, búsqueda de la delgadez y autocrítica. Conclusiones: Este estudio proporcionó datos que confirman que el BI-AAQ tiene propiedades psicométricas sólidas en muestras cualitativamente diferentes. Además, un estudio adicional efectuado en una muestra clínica de mujeres con sobrepeso u obesidad reveló que la inflexibilidad psicológica relacionada con la imagen corporal emergió como mediadora parcial y significativa del efecto de la autocrítica y de la búsqueda de la delgadez sobre la severidad de la compulsión alimentaria.

Tratamento Cognitivo-Comportamental sinérgico de dependência química, bulimia nervosa e transtorno bipolar / Synergistic Cognitive Behavioural Treatment of chemical dependency, bulimia nervosa and bipolar disorder

Diversos autores julgam que o tratamento integrado/sinérgico dos pacientes com comorbidades psiquiátricas apresenta melhores resultados que a abordagem paralela ou sequencial. O presente trabalho visa apresentar um caso clinico de tratamento cognitivo-comportamental sinérgico de dependência química (de álcool e maconha), transtorno de humor bipolar e bulimia nervosa. Este estudo trata-se de uma pesquisa qualitativa, do tipo estudo de caso. No total, foram realizadas 10 sessões de TCC, com freqüência semanal e duração de 50 minutos e seis atendimentos psiquiátricos concomitantes, com freqüência quinzenal. Ao final dos atendimentos a paciente aderiu ao tratamento farmacológico, diminuiu os comportamentos bulímicos, seu humor ficou eutímico e a fissura para o uso de álcool diminuiu. O tratamento descrito combinou a Entrevista Motivacional, Prevenção à Recaída, aconselhamento nutricional, farmacoterapia e Terapia Cognitivo-Comportamental para dependência química, bulimia e transtorno de humor bipolar. Conclui-se que o tratamento sinérgico foi útil para a prevenção da recaída do álcool e redução do consumo de maconha, além de lidar com os sintomas e prejuízos decorrentes dos transtornos de humor e alimentar (AU).

Several authors think that the integrated/synergistic treatment in patients with psychiatric comorbidities presents better results than a sequential or parallel approach. This paper aims to present a case study of synergistic cognitive behavioral treatment of chemical dependency (alcohol and marijuana), bipolar disorder and bulimia nervosa. This is a qualitative research (case study). In total, 10 sessions of CBT were conducted with weekly frequency and 50 minutes of duration and six concurrent psychiatric sessions with fortnightly frequency. At the end of this treatment the patient adhered to pharmacological prescriptions, decreased bulimic behaviors, her mood was euthymic and her craving for alcohol also decreased. The described treatment combined Motivational Interviewing, Relapse Prevention, nutrition counseling, pharmacotherapy and Cognitive Behavioral Therapy for addiction, bulimia and bipolar disorder. It was concluded that the synergistic treatment was useful to prevent alcohol relapse, to decrease cannabis use, and to deal with both the symptoms and the damages caused by bipolar and eating disorders (AU).

Tratamento cognitivo-comportamental sinérgico de dependência química, bulimia nervosa e transtorno bipolar / Synergistic cognitive behavioural treatment of chemical dependency, bulimia nervosa and bipolar disorder

Diversos autores julgam que o tratamento integrado/sinérgico dos pacientes com comorbidades psiquiátricas apresenta melhores resultados que a abordagem paralela ou sequencial. O presente trabalho visa apresentar um caso clinico de tratamento cognitivo-comportamental sinérgico de dependência química (de álcool e maconha), transtorno de humor bipolar e bulimia nervosa. Este estudo trata-se de uma pesquisa qualitativa, do tipo estudo de caso. No total, foram realizadas 10 sessões de TCC, com freqüência semanal e duração de 50 minutos e seis atendimentos psiquiátricos concomitantes, com freqüência quinzenal. Ao final dos atendimentos a paciente aderiu ao tratamento farmacológico, diminuiu os comportamentos bulímicos, seu humor ficou eutímico e a fissura para o uso de álcool diminuiu. O tratamento descrito combinou a Entrevista Motivacional, Prevenção à Recaída, aconselhamento nutricional, farmacoterapia e Terapia Cognitivo-Comportamental para dependência química, bulimia e transtorno de humor bipolar. Conclui-se que o tratamento sinérgico foi útil para a prevenção da recaída do álcool e redução do consumo de maconha, além de lidar com os sintomas e prejuízos decorrentes dos transtornos de humor e alimentar.

Several authors think that the integrated/synergistic treatment in patients with psychiatric comorbidities presents better results than a sequential or parallel approach. This paper aims to present a case study of synergistic cognitive behavioral treatment of chemical dependency (alcohol and marijuana), bipolar disorder and bulimia nervosa. This is a qualitative research (case study). In total, 10 sessions of CBT were conducted with weekly frequency and 50 minutes of duration and six concurrent psychiatric sessions with fortnightly frequency. At the end of this treatment the patient adhered to pharmacological prescriptions, decreased bulimic behaviors, her mood was euthymic and her craving for alcohol also decreased. The described treatment combined Motivational Interviewing, Relapse Prevention, nutrition counseling, pharmacotherapy and Cognitive Behavioral Therapy for addiction, bulimia and bipolar disorder. It was concluded that the synergistic treatment was useful to prevent alcohol relapse, to decrease cannabis use, and to deal with both the symptoms and the damages caused by bipolar and eating disorders.

Induction and comparison of craving for tobacco, marijuana and crack

Abstract Background The literature findings report that use of multiple substances can produce adverse clinical and behavioral effects, which may affect craving and the results of drug treatment. Also, the understanding of craving construct and its interaction in the use of smoked substances is underexplored. Objectives To induce and compare craving for tobacco, marijuana and crack-cocaine on hospitalized dependents whose drug of choice is crack-cocaine. Methods Quasi-experimental study with a convenience sample consisting of 210 males divided into 3 equal groups (Group-1: craving induced by crack; Group-2: craving induced by tobacco; and Group-3: craving induced by marijuana). All participants met ICD-10 dependence criteria for cocaine/crack, marijuana and tobacco, were aged between 18 and 65 and had used these substances for at least one year. Photos were used to induce craving and self-report instruments to evaluate possible alterations. Results This study showed that craving for tobacco was more intense than for marijuana and crack, when the groups were compared by VAS. Using specific scales, both craving for tobacco and craving for marijuana were more intense than craving for crack. Discussion These results would imply interventions at the initial stages of abstinence with cognitive-behavioural techniques and pharmacotherapy in order to reduce craving.

Perfil clínico e cognitivo de usuários de crack internados / Clinical and cognitive profile of hospitalized crack users

Trata-se de estudo transversal que objetivou avaliar: consumo de crack (entrevista semi-estruturada), funcionamento adaptativo (relativo às amizades, trabalho e família), psicopatológico (Adult Self-Report) e funções cognitivas (Screening Cognitivo do WAIS-III) de usuários de crack internados. Dos 84 participantes (90,5% homens), 53,6% fez uso diário de crack no último ano, com consumo médio usual de 1,54 gramas (DP=0,53; Mín.=0,5; Máx.=2,5). Houve grande prevalência de classificação na faixa clínica nos problemas internalizantes (77,4%), externalizantes (77,4%), funcionamento adaptativo (variando de 84,6 a 97,6%) e de comportamentos transgressores (70,3% comportamentos de quebra de regras e 59,6% comportamentos anti-sociais). As funções cognitivas encontraram-se preservadas (médio inferior/médio/médio superior) na grande maioria (>75%) dos entrevistados, com pior desempenho no subteste Vocabulário (22,6% classificação inferior).(AU)

The aim of this cross-sectional study was to assess the use of crack cocaine (semi-structured interview), adaptive functioning (concerning friends, work, and family), psychopathological functioning (Adult Self-Report) and cognitive functions (WAIS-III) among hospitalized crack cocaine users. From the 84 respondents (90.5% male), 53.6% used crack cocaine on a daily basis in the previous year, with an usual average consumption of 1.54 grams (SD=.53; Min.=.5; Max.=2.5). There was a large prevalence of internalizing (77.4%) and externalizing (77.4%) problems, adaptive functioning (84.6 to 97.6%) and wrongful behavior (70.3% of rule-breaking behavior and 59.6% of antisocial behavior). Cognitive functions were preserved (low average/average/high average) in most respondents (>75%), with worse performance on the Vocabulary subtest (22.6% in the low average range).(AU)

Perfil clínico e cognitivo de usuários de crack internados / Clinical and cognitive profile of hospitalized crack users

Trata-se de estudo transversal que objetivou avaliar: consumo de crack (entrevista semi-estruturada), funcionamento adaptativo (relativo às amizades, trabalho e família), psicopatológico (Adult Self-Report) e funções cognitivas (Screening Cognitivo do WAIS-III) de usuários de crack internados. Dos 84 participantes (90,5% homens), 53,6% fez uso diário de crack no último ano, com consumo médio usual de 1,54 gramas (DP=0,53; Mín.=0,5; Máx.=2,5). Houve grande prevalência de classificação na faixa clínica nos problemas internalizantes (77,4%), externalizantes (77,4%), funcionamento adaptativo (variando de 84,6 a 97,6%) e de comportamentos transgressores (70,3% comportamentos de quebra de regras e 59,6% comportamentos anti-sociais). As funções cognitivas encontraram-se preservadas (médio inferior/médio/médio superior) na grande maioria (>75%) dos entrevistados, com pior desempenho no subteste Vocabulário (22,6% classificação inferior).

The aim of this cross-sectional study was to assess the use of crack cocaine (semi-structured interview), adaptive functioning (concerning friends, work, and family), psychopathological functioning (Adult Self-Report) and cognitive functions (WAIS-III) among hospitalized crack cocaine users. From the 84 respondents (90.5% male), 53.6% used crack cocaine on a daily basis in the previous year, with an usual average consumption of 1.54 grams (SD=.53; Min.=.5; Max.=2.5). There was a large prevalence of internalizing (77.4%) and externalizing (77.4%) problems, adaptive functioning (84.6 to 97.6%) and wrongful behavior (70.3% of rule-breaking behavior and 59.6% of antisocial behavior). Cognitive functions were preserved (low average/average/high average) in most respondents (>75%), with worse performance on the Vocabulary subtest (22.6% in the low average range).

Variação na frequência cardíaca e intensidade do craving durante a exposição a estímulo em dependentes de crack / Variation in heart rate and intensity of craving during exposure tostimulus in crack dependents

Introdução: O presente trabalho avaliou a variação do craving e da frequência cardíaca durante a exposição à estímulo em dependente de crack. Método: Estudo experimental com amostra aleatória composta por dependentes de crack internados. Os sujeitos foram divididos em grupo experimental (n=30) para quem eram apresentadas fotografias de uso de crack e grupo controle (n=30) para quem eram apresentadas fotografias neutras. Durante a exposição foi controlada: frequência cardíaca, craving e confiança. Resultados: Observou-se que o estímulo exerceu um efeito significativo sobre a variabilidade do craving (p=0,006) e da frequência cardíaca (p=0,008), não ocorrendo este fenômeno frente à confiança (p=0,983). O craving teve Variação na frequência cardíaca e intensidade do craving durante a exposição a estímulo em dependentes de crack. correlação positiva com a frequência cardíaca (r=0,347; p<0,05) no grupo experimental. Conclusões: O craving e a frequência cardíaca foram alterados quando o sujeito exposto à estímulos associados ao uso da substância, o que fundamenta a utilização da frequência cardíaca como instrumento auxiliar na avaliação do craving.(AU)

Introduction: This study evaluated the variation of craving and heart rate during exposure in hospitalized crack dependents. Method: Experimental study that had random sample of crack addicts admitted. The subjects were divided into an experimental group (n=30) to whom were presented crack related photographs and the control group (n=30) who saw landscapes (neutral) photos. During the exposure time heart rate, craving and trust were controlled. Results: It was observed that the experimental stimulus has had a significant effect on the variability of craving (p=0,006) and heart rate (p=0,008), this phenomenon did not occur for trust (p=0,983). The correlation between craving and heart rate was significant and of low intensity (r = 0.347; p<0.05) in the experimental group. Conclusion: The craving and heart rate were changed when the subjects was exposed to drug addiction related stimuli. These data underpin the use of the heart rate to evaluate craving.(AU)

Fatores protetivos e de risco para o uso de crack e danos decorrentes de sua utilização: revisão de literatura / Protective and risk factors for the use of crack and damages from its use: review of literature

INTRODUÇÃO: Este estudo objetivou revisar pesquisas que relatam danos decorrentes do uso de crack e possíveis fatores protetivos ou de risco para o uso. MÉTODO: Foram realizadas buscas no PsycInfo, PubMed e LILACS. Os descritores utilizados foram: (Crack Cocaine) AND (Street Drugs OR Population Characteristics OR Epidemiology). RESULTADOS: A facilidade de acesso do crack, uso frequente de cocaína injetável, cristais de metanfetamina, envolvimento em comércio sexual e variedade de drogas utilizadas nos últimos seis meses foram considerados fatores de risco para o uso. Não usuários de crack percebem o condicionamento vicário, informações fornecidas pela família e o medo de morrer como fatores protetivos para o uso da droga. O uso de crack pode causar danos físicos, problemas psiquiátricos, neurocognitivos e prejuízos sociais. CONCLUSÃO: O uso de crack está associado a danos físicos, mentas e sociais. Fatores protetivos e de risco devem ser considerados na elaboração de políticas públicas de saúde.(AU)

BACKGROUND: The aim of this paper was to review studies that describe the damage caused by crack and the possible protective or risk factors for this use. METHOD: The PsycInfo, PubMed and LILACS databases were searched using the following terms: (Crack Cocaine) AND (Street Drugs OR Population Characteristics OR Epidemiology). RESULTS: The easy access to crack, the frequent use of injectable cocaine, crystal methamphetamine, the involvement in sex trade, and the variety of drugs used in the past six months were regarded as risk factors for drug use. For crack non-users, vicarious conditioning, information given by the family and fear of death were protective factors for drug use. The use of crack can cause physical damage, psychiatric and neurocognitive problems and social impairment. CONCLUSION: The use of crack is associated with physical, mental and social damage. Protective and risk factors must be contemplated in the design of public health policies.(AU)