Using Immersive Virtual Reality Distraction to Reduce Fear and Anxiety before Surgery.

Presurgical anxiety is very common and is often treated with sedatives. Minimizing or avoiding sedation reduces the risk of sedation-related adverse events. Reducing sedation can increase early cognitive recovery and reduce time to discharge after surgery. The current case study is the first to explore the use of interactive eye-tracked VR as a nonpharmacologic anxiolytic customized for physically immobilized presurgery patients. Method: A 44-year-old female patient presenting for gallbladder surgery participated. Using a within-subject repeated measures design (treatment order randomized), the participant received no VR during one portion of her preoperative wait and interactive eye-tracked virtual reality during an equivalent portion of time in the presurgery room. After each condition (no VR vs. VR), the participant provided subjective 0-10 ratings and state-trait short form Y anxiety measures of the amount of anxiety and fear she experienced during that condition. Results: As predicted, compared to treatment as usual (no VR), the patient reported having 67% lower presurgical anxiety during VR. She also experienced "strong fear" (8 out of 10) during no VR vs. "no fear" (0 out of 10) during VR. She reported a strong sense of presence during VR and zero nausea. She liked VR, she had fun during VR, and she recommended VR to future patients during pre-op. Interactive VR distraction with eye tracking was an effective nonpharmacologic technique for reducing anticipatory fear and anxiety prior to surgery. The results add to existing evidence that supports the use of VR in perioperative settings. VR technology has recently become affordable and more user friendly, increasing the potential for widespread dissemination into medical practice. Although case studies are scientifically inconclusive by nature, they help identify new directions for future larger, carefully controlled studies. VR sedation is a promising non-drug fear and anxiety management technique meriting further investigation.

Assessment of Acceptability and Initial Effectiveness of a Unified Protocol Prevention Program to Train Emotional Regulation Skills in Female Nursing Professionals during the COVID-19 Pandemic.

Healthcare professionals, especially women, have shown increases in anxious-depressive symptoms as a consequence of the COVID-19 pandemic. The aim of this pilot study was to evaluate the acceptability and preliminary effectiveness of a Unified Protocol (UP) prevention program to provide emotional regulation skills to cope with stressful situations. The sample consisted of 27 nursing professionals (100% women; mean age: 45.67; SD = 7.71) working in a Spanish public hospital during COVID-19, who were randomized to an immediate treatment group (ITG, n = 13) or to a delayed treatment group (DTG, n = 14, which served as the waiting list control group and received the program 5 weeks after the ITG had received it). The program consisted of five-weekly, two-hour, UP-based group sessions. Variables related to emotional symptomatology, emotional regulation, personality, burnout, and perceived quality of life were evaluated at the following time points: pre- and post-intervention and at 1-, 3-, and 6-month follow-ups. Statistically significant between-group differences showed lower emotional exhaustion and personal accomplishment in favor of the ITG after the intervention. Regarding the effect over time for all participants who received the UP (n = 27), statistically significant reductions were observed in neuroticism, personal accomplishment, and subjective distress caused by traumatic events (-0.23 ≤ d ≤ -0.73). A statistically significant interaction "Time*Condition" was found in anxiety, with increases in the DTG. Participants showed high satisfaction with the UP. These findings show good acceptability and preliminary effectiveness of the UP to reduce the emotional impact of the pandemic in female nursing workers.

Ecological momentary intervention to enhance emotion regulation in healthcare workers via smartphone: a randomized controlled trial protocol.

BACKGROUND: CUIDA-TE is an APP that offers transdiagnostic cognitive behavioral therapy focused on enhancing emotion regulation. As a novelty, it incorporates ecological momentary interventions (EMI), which can provide psychological support in real time, when suffering arises. The main goal of the study is to evaluate the efficacy of CUIDA-TE to improve emotion regulation in healthcare workers, a population that has been particularly emotionally impacted by the COVID-19 pandemic. METHODS: In this three-arm, randomized controlled trial (RCT) the study sample will be composed of a minimum of 174 healthcare workers. They will be randomly assigned to a 2-month EMI group (CUIDA-TE APP, n ≥ 58), a 2-month ecological momentary assessment (EMA) only group (MONITOR EMOCIONAL APP, n ≥ 58), or a wait-list control group (no daily monitoring nor intervention, n ≥ 58). CUIDA-TE will provide EMI if EMA reveals emotional problems, poor sleep quality/quantity, burnout, stress, or low perceived self-efficacy when regulating emotions. Depression will be the primary outcome. Secondary outcomes will include emotion regulation, quality of life, and resilience. Treatment acceptance and usability will also be measured. Primary and secondary outcomes will be obtained at pre- and post-intervention measurements, and at the 3-month follow-up for all groups. DISCUSSION: To our knowledge, this is the first RCT that evaluates the efficacy of an APP-based EMI to improve emotion regulation skills in healthcare workers. This type of intervention might ultimately help disseminate treatments and reach a larger number of individuals than traditional face-to-face individual therapies. TRIAL REGISTRATION: ClinicalTrial.gov : NCT04958941 Registered 7 Jun 2021. STUDY STATUS: Participant recruitment has not started.

Preventing Emotional Dysregulation: Acceptability and Preliminary Effectiveness of a DBT Skills Training Program for Adolescents in the Spanish School System.

Emotional dysregulation is a key factor in the development and maintenance of multiple disabling mental disorders through a person's lifespan. Therefore, there is an urgent need to prevent emotional dysregulation as early as possible. The main aim of this study was to evaluate the acceptability and preliminary effectiveness of an adapted Dialectical Behavior Therapy Skills Training program for Emotional Problem Solving in Adolescents (DBT STEPS-A) during secondary school. The sample included 93 adolescents (mean age = 12.78; SD = 0.54; and 53% female) studying in their 2nd year of secondary school in a public center in Catalonia (Spain). Measures of acceptability, difficulties of emotional regulation, mental health problems, and life satisfaction were completed before and after participation in the DBT STEPS-A program during one academic year. The majority of students rated the program as useful (64%) and enjoyed the classes (62%) and 48% of them reported practicing the newly learned skills. Statistically significant improvements were revealed in some emotional regulation-related variables, namely the number of peer problems (p = 0.003; d = 0.52) and prosocial behaviors (p < 0.001; d = -0.82). Although non-significant, the scores in the remaining outcomes indicated a general positive trend in emotional dysregulation, mental health, and life satisfaction. The adapted DBT STEPS-A was very well-accepted and helped overcome some emotional regulation difficulties in Spanish adolescents.

Unifi ed Protocol in a Group Format for Improving Specifi c Symptoms of Emotional Disorders in the Spanish Public Health System / Protocolo Unifi cado en Formato Grupal Para la Mejora de losSíntomas de los Trastornos Emocionales en el Sistema de Salud Público

Background: The Unifi ed Protocol (UP) for the transdiagnostic treatment of emotional disorders (EDs) has demonstrated its effi cacy in improvingdimensions shared by EDs, but there is insuffi cient evidence regarding thespecifi c symptoms of each ED. The main objective of the study was toevaluate the effi cacy of the UP applied in a group format compared withindividual Treatment as Usual (TAU), in improving specifi c ED symptoms.Methods: The study sample (n=243) was a subset of participants of arandomized controlled trial conducted in the Spanish public health system.Specifi c symptoms assessed from pre-treatment to the six-month follow-upwere: depressive, agoraphobic, generalized anxiety, panic, and obsessivecompulsive symptoms. Personality dimensions and quality of life werealso measured. Results: There were statistically signifi cant changes afterthe UP in all the study variables (0.44 = d = 1.35). Changes in depressivesymptoms, obsessive-compulsive disorder, and perceived quality of lifewere superior in the UP. Conclusions: The results support the effi cacyof group UP for improving both transdiagnostic dimensions and specifi cED symptoms, as well as quality of life, through the public health-caresystem.

Antecedentes: el Protocolo Unifi cado (PU) para el tratamiento transdiagnóstico de los trastornos emocionales (TEs) ha demostradoefi cacia en la mejora de las dimensiones compartidas por los TEs, perono hay sufi ciente evidencia respecto a los síntomas específi cos de cadauno de los TEs. El objetivo principal de este estudio fue evaluar la efi caciadel PU aplicado en formato grupal, en comparación con un Tratamiento Habitual (TH) individual, para mejorar los síntomas específi cos de losTEs. Método: la muestra del estudio (n=243) fueron un subgrupo departicipantes de un ensayo controlado aleatorizado en el sistema desalud público español. Los síntomas evaluados antes y hasta los 6 mesesde seguimiento fueron: depresión, agorafobia, ansiedad generalizada,pánico y obsesivo-compulsivo. También se midieron dimensiones de lapersonalidad y la calidad de vida. Resultados: se produjeron cambiosestadísticamente signifi cativos tras el PU en todas las variables (0.44 =d = 1.35). Los cambios en síntomas de depresión, trastorno obsesivocompulsivo y calidad de vida fueron superiores en el PU. Conclusiones: los resultados apoyan la efi cacia del PU en grupo para mejorar tanto lasdimensiones transdiagnósticas, como los síntomas específi cos de los TEs,así como la calidad de vida en nuestro sistema público de salud.

Spanish-Speaking Therapists Increasingly Switch to Telepsychology During COVID-19: Networked Virtual Reality May Be Next.

Background: Social distancing restrictions imposed due to the Novel Coronavirus 2019 (COVID-19) pandemic resulted in a rapid shift in the delivery of psychological interventions from in-person to telehealth. Much of the research on this transition has been conducted with English-speaking mental health providers, leaving a gap in understanding related to how this shift has impacted Spanish-speaking treatment providers. Methods: Fifty non-U.S. Spanish-speaking therapists completed a survey related to their use of telecommunication modalities; client population characteristics; professional, ethical, and legal/regulatory issues; and telehealth training and practice. Participants completed the survey at one time point and retrospectively described their use of telehealth both pre-pandemic and during the pandemic. Results: Most of the 50 Spanish-speaking therapists surveyed reported using telepsychology 58% before COVID-19 versus 84% during the COVID-19 pandemic (χ2 = 5.76, p < 0.05). Compared with pre-pandemic, the number of hours therapists spent using telepsychology per week increased significantly for early adopter therapists (those who began using telehealth before the pandemic began) (Z = -3.18, p = 0.001) and also for late adopter therapists who only began using telehealth during the pandemic (Z = -3.74, p < 0.001). Many therapists reported equity issues. Most participants also reported ethical and regulatory concerns regarding security/confidentiality or Health Insurance Porability and Accountability Act. Conclusions: The rapid adoption of technology to deliver therapy during COVID-19 has spurred growing pains for Spanish-speaking therapists and their underserved clients, and more research is needed to better understand and improve the therapists' adoption of these technologies with diverse patient populations.

Implementation, efficacy and cost effectiveness of the unified protocol in a blended format for the transdiagnostic treatment of emotional disorders: a study protocol for a multicentre, randomised, superiority controlled trial in the Spanish National Health System.

INTRODUCTION: Emotional disorders (EDs) have become the most prevalent psychological disorders in the general population, which has boosted the economic burden associated with their management. Approximately half of the individuals do not receive adequate treatment. Consequently, finding solutions to deliver cost-effective treatments for EDs has become a key goal of today's clinical psychology. Blended treatments, a combination of face-to-face and online interventions, have emerged as a potential solution to the previous. The Unified Protocol for the Transdiagnostic Treatment of EDs (UP) might serve this purpose, as it can be applied to a variety of disorders simultaneously and its manualised format makes it suitable for blended interventions. METHODS AND ANALYSIS: The study is a multicentre, randomised, superiority, clinical trial. Participants will be 310 individuals with a diagnosis of an ED. They will be randomised to a treatment as usual (individual cognitive behavioural therapy) or a UP condition in a blended format (face-to-face individual UP +online, app-based UP). Primary outcomes will be ED diagnostic criteria and depression and anxiety symptoms. Cost efficiency of the intervention, app usability, as well as opinion and confidence in the treatment will also be evaluated. Assessment points will include baseline and 3 months, 6 months and 12 months after UP treatment. ETHICS AND DISSEMINATION: The study has received approvals by the Ethics Research Committee of Navarra, Castellón, Euskadi, Castilla y León, Extremadura, Lleida and Aragón. The study is currently under an approval process by the Ethics Research Committees of all the remaining collaborating centres. Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings. TRIAL REGISTRATION NUMBER: NCT04304911.

Estudio preliminar sobre la eficacia de la Terapia dialéctico-comportamental en personas diagnosticadas de trastorno límite de la personalidad y bulimia nerviosa / Preliminary efficacy of dialectical behavior therapy in people diagnosed with borderline personality disorder and bulimia nervosa

El trastorno límite de la personalidad (TLP) constituye uno de los cuadros psicopatológicos más complejos y difíciles de abordar. Uno de los programas de tratamiento que ha demostrado eficacia empírica es la Terapia dialéctico-comportamental (Dialectical Behavior Therapy, DBT). El TLP aparece a menudo como condición comórbida en los trastornos de la conducta alimentaria (TCA) y suele ser indicativo de un peor pronóstico. El objetivo del presente trabajo es ofrecer datos de la eficacia preliminar de la DBT con la presentación de dos casos diagnosticados de TLP y bulimia nerviosa tras ser tratados durante un año. Los resultados de este estudio indican una disminución de las conductas desadaptativas de regulación del afecto, abuso de tóxicos, conductas autolesivas, sintomatología depresiva (BDI-II) y comer emocional (EES), número de ingresos hospitalarios, puntuaciones menores en la escala de interferencia y gravedad valorada por el clínico y un aumento en la escala de evaluación de la actividad global (Eje V, DSM-IV-TR) de las pacientes. Estos datos preliminares confirman la posible eficacia de la DBT para tratar pacientes con TLP grave y TCA (AU)

The borderline personality disorder (BPD) is very complex psychopathologically and one of the psychological problems most difficult to treat. One of the treatment programs that has demonstrated to be effective empirically is Dialectical Behavior Therapy (DBT). BPD is often encountered as a comorbid condition in eating disorders what is usually a factor of worse prognosis. The aim of the present study is to offer preliminary evidence of the efficacy of DBT in two cases with a diagnosis of BPD and bulimia nervosa after one year of treatment. The results of this study showed decreases in desadaptative behaviours to regulate affect, substance abuse, self-mutilation behaviors, depressive symptoms (BDI-II), emotional eating (EES), number of hospitalizations, lower scores in global impairment and severity rated by the clinician, and higher scores in global assessment of functioning (Axis V, DSM-IV-TR). These preliminary data showed the possible efficacy of DBT to treat patients with severe BPD and eating disorders