Effectiveness of two video-based multicomponent treatments for fibromyalgia: The added value of cognitive restructuring and mindfulness in a three-arm randomised controlled trial.

BACKGROUND/OBJECTIVES: The aim of this study was to examine the effectiveness of two video-based multicomponent programs (FIBROWALK) and the Multicomponent Physiotherapy Program (MPP) for patients with fibromyalgia (FM) compared to treatment-as-usual (TAU) only. We posit that FIBROWALK, due to inclusion of specific psychological ingredients (cognitive restructuring and mindfulness), can produce additional clinical benefits when compared to TAU or MPP alone. METHODS: A total of 330 patients with FM were recruited and randomly allocated (1:1:1) to TAU only, TAU + FIBROWALK, or TAU + MPP. FIBROWALK and MPP consisted of weekly videos on pain neuroscience education, therapeutic exercise and self-management patient education, but only the FIBROWALK intervention provided cognitive restructuring and mindfulness. Both programs were structurally equivalent. Between-group differences in functional impairment, pain, kinesiophobia, anxious-depressive symptoms and physical functioning were evaluated at post-treatment following Intention-To-Treat and complete-case approaches. RESULTS: Compared to TAU only, individuals in the FIBROWALK arm showed larger improvements in all clinical outcomes; similarly, participants in the MPP program also showed greater improvements in functional impairment, perceived pain, kinesiophobia, depressive symptoms compared to TAU only. The FIBROWALK intervention showed superior effects in improving pain, anxiety and depressive symptoms and physical functioning compared to MPP. CONCLUSIONS: This RCT supports the short-term effectiveness of the video-based multicomponent programs FIBROWALK and MPP for FM and provides evidence that cognitive-behavioural and mindfulness-based techniques can be clinically useful in the context of physiotherapeutic multicomponent treatment programs. TRIAL REGISTRATION NUMBER: NCT04571528.

Effectiveness of Acceptance and Commitment Therapy (ACT) in Professional Dementia Caregivers Burnout.

OBJECTIVES: To implement and assess the efficacy of a 6-week Acceptance and Commitment Therapy intervention to reduce anxiety and burnout in healthcare professionals working with dementia, and to increase their psychological flexibility and life satisfaction. METHODS: A total of 105 workers from the CSSV Ricard Fortuny Hospital were randomly assigned to an intervention group (Acceptance and Commitment Therapy) or a wait list control group. Psychological Flexibility (AAQ-II), Life Satisfaction (SWLS), Anxiety (STAI-T), and Burnout (MBI) were measured before and after the intervention. Follow-up data were collected 3 months and 12 months post-intervention. Split-plot analyses were performed following intention to treat approach. RESULTS: No significant differences were found in baseline outcome measures. No time effects were found in wait list control group in any variable. In the intervention group, pre-post comparison showed a significant decrease in levels of MBI emotional exhaustion (p = .001) and anxiety (p < .001), and an increase in life satisfaction levels (p < .001) and MBI personal accomplishment (p < .001). These results were maintained at the 3- and 12-month follow-up periods. No significant intervention effects were observed in pre-post flexibility scores; however, data suggest slight progressive increase in flexibility at follow-up. CONCLUSIONS: Acceptance and Commitment Therapy showed positive effects in healthcare professionals working with dementia by reducing anxiety and burnout. CLINICAL IMPLICATIONS: The implementation of Acceptance and Commitment Therapy could help to increase the psychological well-being of healthcare professionals working with dementia.

Effects of a Mindfulness Program for University Students / Los efectos de un programa de mindfulness en estudiantes universitarios

The aim of this study was to determine the effectiveness of a brief and flexible mindfulness program in reducing anxiety and increasing mindful awareness in psychology university students. The sample consisted of 72 psychology students who participated in four different studies. The first was a quasi-experimental study and the remaining three studies were randomized controlled trials (RCT). A mindfulness program was applied to intervention groups. Anxiety (STAI-T) and mindful awareness (FFMQ) were assessed before and immediately after the intervention. Anxiety was reduced and mindful awareness increased in the intervention groups (p < .05). In the three RCTs the magnitude of change (between groups) showed a moderate increase in mindful awareness in one study (d = 0.68) and a large increase in the remaining two (d = 1.32, 1.01), and as regards anxiety, large changes were observed in the three studies (d = 0.80, 1.04, 0.81). As a conclusion, this mindfulness program proved to be effective in reducing anxiety and increasing mindful awareness

El objetivo de este estudio es determinar la eficacia de un programa de mindfulness breve y flexible para reducir la ansiedad y aumentar la conciencia plena en los estudiantes universitarios de psicología. La muestra comprende 72 estudiantes de psicología que participaron en cuatro estudios diferentes. El primero fue cuasi-experimental y los tres restantes fueron ensayos controlados aleatorizados (en inglés, RCT). Se aplicó un programa de mindfulness a los grupos de intervención. La ansiedad (STAI-T) y la conciencia plena (FFMQ) se evaluaron antes e inmediatamente después de la intervención. Se redujo la ansiedad y se incrementó la conciencia plena en los grupos de intervención (p <. 05). En los tres RCT la magnitud del cambio (entre grupos) mostró un aumento moderado de la conciencia plena en un estudio (d = 0.68) y un gran aumento de los dos restantes (d = 1.32, 1.01) y en lo que respecta a la ansiedad se observaron grandes cambios en los tres estudios (d = 0.80, 1.04, 0.81). Como conclusión, este programa de mindfulness demostró su eficacia en la reducción de la ansiedad y el aumento de la conciencia plena

[Psychological flexibility, burnout and job satisfaction in dementia care workers]. / Flexibilidad psicológica, burnout y satisfacción vital en profesionales que trabajan con personas afectadas de demencia.

INTRODUCTION: The clinical complexity of dementia, its physical burden, and the potential assaults associated with psychological and behavioral symptoms, could put healthcare workers working with dementia at high risk of burnout. Certain attitudes toward dementia and certain coping styles may be a protective factor against the stress experienced by these workers. On the other hand, it has been shown that a coping style based on psychological flexibility can prevent the development of burnout in the workplace. The present study analyzes the relationship between levels of burnout, psychological flexibility, attitudes towards dementia and life satisfaction in a sample of healthcare workers who work with people affected by dementia. METHODS: A sample of 105 healthcare workers from the Ricard Fortuny Social Hospital was recruited (day hospital, hospitalization unit, and nursing home), and psychological flexibility (AAQII), burnout levels (MBI), life satisfaction (SWL), anxiety (STAI-R), and attitudes towards dementia (EAD) were assessed. RESULTS: Psychological inflexiblility showed a positive relationship with 2 dimensions of burnout (emotional exhaustion [r=.342, P<.01]; depersonalization [r=.328, P<.01]), and with anxiety (r=.723, P<.01), and also showed a negative relation with life satisfaction (r=-.485, P<.01) and affect attitude (r=-.209); p<.05). It was also found a negative relation between rejection attitude with emotional exhaustion (r=-.328, P<.01) and with depersonalization (r=-.328; P<.01). CONCLUSIONS: Those participants with greater psychological flexibility, in addition to feel more satisfaction with life, were found to be less likely to feel emotionally exhausted, to depersonalize patients with dementia, and felt more affection for them. On the other hand, no relationship was found between Burnout levels and the cognitive dimension of Attitudes towards dementia (the worker's knowledge of dementia). The results have significant implications regarding the type of training that is given to healthcare workers who work with people affected by dementia. Psychoeducational interventions promoting the psychological flexibility could help to reduce the risk of burnout in healthcare workers who work with dementia.

Los siete secretos mágicos de la efectividad terapéutica / The seven magic secrets of therapeutic effectiveness

Parecería que el avance de la Psicología nos debería aumentar la confianza respecto a nuestras prácticas, sin embargo la proliferación de técnicas, protocolos, enfoques, ... nos genera, más bien, una sensación de confusión; la duda sobre si quizás estamos en la opción correcta o nos estamos equivocando de paradigma terapéutico. Los metanálisis y revisiones sistemáticas procuran poner orden intentando averiguar qué terapias psicológicas son más efectivas. Sin embargo, los resultados no son concluyentes y más bien parecen indicar que ningún enfoque psicológico predomina sobre otro. Ante esta situación la pregunta que emerge es: ¿qué factores comparten las distintas técnicas que las convierte en eficaces? Son muchas las categorizaciones sobre factores comunes. En este artículo desvelaremos los 7 secretos mágicos (factores comunes) que consideramos clave para explicar la efectividad terapéutica. Esta clasificación no tiene ninguna pretensión más que provocar la reflexión

It would seem that the advancement of psychology should increase our confidence in our practices, however the proliferation of techniques, protocols, approaches, etc. gives us instead a sense of confusion. We have doubts as to whether we are in the correct therapeutic paradigm or not. Meta-analysis and systematic reviews attempt to create order, trying to determine which psychological therapies are most effective. Unfortunately, the results are inconclusive and seem to indicate that no one psychological approach prevails over the others. The question that emerges is: what factors do the different techniques share that make them effective? There are many categorizations concerning common factors. In this article we unveil the seven magic secrets (common factors) that we consider key in explaining therapeutic effectiveness. This classification has no claim other than to provoke reflection

Catastrophizing, state anxiety, anger, and depressive symptoms do not correlate with disability when variations of trait anxiety are taken into account. a study of chronic low back pain patients treated in Spanish pain units [NCT00360802].

OBJECTIVES: To assess the influence of pain severity, catastrophizing, anger, anxiety, and depression on nonspecific low back pain (LBP)-related disability in Spanish patients with chronic LBP. Study Design. Cross-sectional correlation between psychological variables and disability. Methods. One hundred twenty-three patients treated for chronic LBP in pain units within nine Spanish National Health Service Hospitals, in eight cities, were included in this study. Intensity of LBP and pain referred to the leg, disability, catastrophizing, anger, state anxiety, trait anxiety, and depression were assessed through previously validated questionnaires. The association of disability with these variables, as well as gender, age, academic level, work status, and use of antidepressants, was analyzed through linear regression models. RESULTS: Correlations between LBP, referred pain, disability, catastrophizing, anger, state anxiety, trait anxiety, and depression were significant, except for the ones between anger and LBP and between anger and referred pain. The multivariate regression model showed that when variations of trait anxiety were taken into account, the association of the other psychological variables with disability was no longer significant. The final model explained 49% of the variability of disability. Standardized coefficients were 0.452 for trait anxiety, 0.362 for intensity of LBP, 0.253 for failed back surgery, and -0.140 for higher academic level. CONCLUSION: Among Spanish chronic LBP patients treated at pain units, the correlation of catastrophizing, state anxiety, anger, and depression with disability ceases to be significant when variations of trait anxiety are taken into account. Further studies with LBP patients should determine whether anxiety trait mediates the effects of the other variables, explore its prognostic value, and assess the therapeutic effect of reducing it.

Terapias Psicológicas para el Tratamiento del Dolor Crónico / Psychological Therapies to Treat Chronic Pain

A pesar de que existe abundante literatura que muestra la efectividad del tratamiento cognitivo-conductual del dolor crónico, en nuestro país, se carecía de un manual del mismo. Por este motivo, diseñamos un protocolo donde se describen las diferentes técnicas de dicha terapia. En el presente artículo, realizamos una detallada descripción del mismo. Antes de adentrarnos en la terapia cognitivo-conductual, presentamos una revisión de las principales terapias psicológicas que se emplean en el tratamiento del dolor crónico (AU)

Although there is abundant literature showing the effectiveness of cognitivebehavioral treatment of chronic pain, in our country, there was no manual for it. For this reason, we designed a protocol that describes the various techniques of this therapy. In this article, we conducted a detailed description. Before dealing with cognitive-behavioral therapy, we present a review of the main psychological therapies used in the treatment of chronicpai (AU)

Study protocol of effectiveness of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial.

BACKGROUND: Non-specific low back pain is a common cause for consultation with the general practitioner, generating increased health and social costs. This study will analyse the effectiveness of a multidisciplinary intervention to reduce disability, severity of pain, anxiety and depression, to improve quality of life and to reduce the incidence of chronic low back pain in the working population with non-specific low back pain, compared to usual clinical care. METHODS/DESIGN: A Cluster randomised clinical trial will be conducted in 38 Primary Health Care Centres located in Barcelona, Spain and its surrounding areas. The centres are randomly allocated to the multidisciplinary intervention or to usual clinical care. Patients between 18 and 65 years old (n = 932; 466 per arm) and with a diagnostic of a non-specific sub-acute low back pain are included. Patients in the intervention group are receiving the recommendations of clinical practice guidelines, in addition to a biopsychosocial multidisciplinary intervention consisting of group educational sessions lasting a total of 10 hours. The main outcome is change in the score in the Roland Morris disability questionnaire at three months after onset of pain. Other outcomes are severity of pain, quality of life, duration of current non-specific low back pain episode, work sick leave and duration, Fear Avoidance Beliefs and Goldberg Questionnaires. Outcomes will be assessed at baseline, 3, 6 and 12 months. Analysis will be by intention to treat. The intervention effect will be assessed through the standard error of measurement and the effect-size. Responsiveness of each scale will be evaluated by standardised response mean and receiver-operating characteristic method. Recovery according to the patient will be used as an external criterion. A multilevel regression will be performed on repeated measures. The time until the current episode of low back pain takes to subside will be analysed by Cox regression. DISCUSSION: We hope to provide evidence of the effectiveness of the proposed biopsychosocial multidisciplinary intervention in avoiding the chronification of low back pain, and to reduce the duration of non-specific low back pain episodes. If the intervention is effective, it could be applied to Primary Health Care Centres. TRIAL REGISTRATION: ISRCTN21392091.