Overvaluation of weight and shape in obesity: a comparative study between people with and without binge eating disorder.

Introduction: The overvaluation of weight and shape is a diagnostic criterion in eating disorders, except in binge eating disorder (BED), where it has received less attention. This aspect is also not usually analyzed in people with overweight or obesity without an eating disorder. This research aims to identify the indicators of symptomatology, as well as those of self-construction and cognitive structure, that are associated with overvaluation in obesity, either alone or in conjunction with BED. Method: A sample of 102 overweight or obese participants was accessed. The sample was divided into four groups: one without overvaluation or BED (n = 33); a second with overvaluation and without BED (n = 21); a third with BED, but without overvaluation (n = 15), and a fourth with BED and overvaluation (n = 33). The groups completed instruments regarding eating symptomatology, anxiety, depression, and stress. In addition, they were administered the Repertory Grid Technique, a semi-structured interview to evaluate the cognitive structure involved in the construal of the self and others. Results: The factors of overvaluation and the presence of BED independently explained eating symptomatology, and the latter also showed a tendency to influence anxiety, depression, and stress. In terms of cognitive structure, weight polarization was explained by overvaluation, while BED was associated with a high presence of cognitive conflicts. In self-construction, BED was the factor that explained the differences, particularly in Self-Ideal discrepancy. Discussion: The results highlight the importance of overvaluation in obesity, even in the absence of BED. Its evaluation and treatment are recommended. Furthermore, in the case of BED, it is also advisable to evaluate the overvaluation of weight and shape since it can be a severity specifier.

Dyadic effects of interpersonal perception on the quality of couple relationships: Idealization and accuracy matter.

Interpersonal perceptions have an impact on the quality of couple relationships but we want to examine the putative moderating role of gender considering personal meanings as the target of perception. We employed the Couple's Grid to measure interpersonal perception based on personal constructs and the Actor-Partner Interdependence Model (pooled regression) to analyze the mutual effects of partners' observations. We explore the dyadic effects of seven variables of interpersonal perception on relationship quality in a sample of 26 Spanish opposite-sex couples. Idealization of the partner was associated with one's own and partner's relationship quality (actor and partner effects), while being accurate in the perception of the partner's self-image was positively related to men's relationship quality but negatively related to women's (actor effects). The findings stimulate the existing debate regarding the benefits of being accurate or biased in a relationship and the need to take into account gender differences for guiding therapeutic interventions.

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

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

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

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

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

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

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

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

Does virtual reality increase the efficacy of psychotherapy for young adults with mild-to-moderate depression? A study protocol for a multicenter randomized clinical trial.

BACKGROUND: The improvement of psychological treatments for depression in young adults is a pressing issue highlighted in the literature. Its relevance is determined not only because young adults are underrepresented in research, but also to prevent chronic severe mental health disorders later in life. Engagement is considered a key factor for a good therapeutic outcome, especially among young patients. In this sense, virtual reality could be particularly suited to engage young adults in the therapy process. This project aims to improve the psychological treatment of mild-to-moderate depression in young adults by testing out the efficacy of virtual reality-enhanced personal construct therapy (PCT-VR), as compared to personal construct therapy alone (PCT) and to the reference standard cognitive behavioral therapy (CBT). In contrast to CBT, PCT neither educates patients about depression nor gives them directions on the changes to be made in their dysfunctional behaviors or cognitions. Rather, PCT explores the coherence (or conflicts) of thoughts and behaviors with respect to the person's sense of identity and focuses on meaning-making processes. METHODS: The efficacy of this innovative intervention (PCT-VR) will be compared to PCT and to CBT in a randomized clinical trial. The study includes an appraisal of therapists' adherence and independent assessments to preserve internal validity. The Beck Depression Inventory-II is the primary outcome measure for calculating both statistical and clinical significance, but other outcomes will also be assessed (e.g., functioning, well-being, anxiety, stress) at pre- and post-therapy and at 6-month follow-up. The trial will be conducted in a naturalistic context, mostly at the usual health care center of each patient. A sample of 225 participants is targeted to reach enough statistical power to accomplish the goals of the study. DISCUSSION: We expect that providing evidence for PCT-VR will widen the repertoire of evidence-based technology-based psychotherapeutic interventions for young adults and contribute to the prevention of deteriorating courses of the disorder. TRIAL REGISTRATION: ClinicalTrials.gov NCT04321525 . Registered on 18 February 2020.

Effectiveness of integrated treatment for eating disorders in Spain: protocol for a multicentre, naturalistic, observational study.

INTRODUCTION: Eating disorders (EDs) are complex pathologies which require equally complex treatment strategies. These strategies should be multidisciplinary, personalised interventions, performed in appropriate settings along a healthcare continuum from inpatient to community care. Personalisation, and the complexity of levels of care and interventions make evaluation of treatments difficult. The present study aims to measure the effectiveness of a complex treatment programme for EDs which includes hospitalisation, day hospital and outpatient settings. Our purpose is to assess the complete therapeutic process of each patient through all these levels of care, capturing the multiplicity of trajectories that a programme of these characteristics involves. METHODS AND ANALYSIS: This protocol describes a multicentre, naturalistic, observational study. All patients starting between November 2017 and October 2020 in a healthcare network for EDs in Spain are being invited to participate. The first phase of intensive change monitoring to November 2020 is followed by lower intensity follow-up until October 2025. In the first phase progress of all participants is assessed every 3 weeks using specific measures for ED and the Clinical Outcomes Routine Evaluation system, a family of instruments specifically designed to measure change in psychotherapy. In the second phase data collection will happen quarterly. Both cross-sectional and longitudinal analyses will be conducted, with a special focus on patterns and predictors of change studied through multilevel linear models. ETHICS AND DISSEMINATION: The study has been approved by the Research Bioethics Committee of the University of Barcelona (no. IRB00003099) and the ethical committee of ITA Mental Health, the organisation to which all participating centres belong. Dissemination will be in papers for peer-reviewed research journals and to clinicians working with ED. TRIAL REGISTRATION NUMBER: NCT04127214.

Cognitive Conflict in Borderline Personality Disorder: A Study Protocol.

Borderline personality disorder (BPD) represents a severe mental condition that is usually characterized by distressing identity disturbances. Although most prevailing explanatory models and psychotherapy approaches consider and intervene on self-concept, they seem not to recognize or explore idiosyncratic cognitive conflicts that patients may experience. These conflicts, which have been conceptualized as "implicative dilemmas" and "dilemmatic constructs" by personal construct theorists, could be considered as key elements of the explanatory model for BPD to provide a better understanding of this disorder and possibly enhance the effectiveness of contemporary psychotherapeutic approaches. The current study (Identifier: NCT04498104) aims to examine the characteristics of the interpersonal cognitive system of a group of patients diagnosed with BPD, using the repertory grid technique, and to compare them with those of a community sample. We will test if BPD participants are more affected by cognitive conflicts than controls. Additionally, we will gauge the association between cognitive conflicts and symptom severity as well as their predictive capacity of treatment outcome. The obtained results will be a necessary step to determine if cognitive conflicts have a substantial role on the explanation of BPD. It could also help to consider the development of a conflict resolution intervention module for this disorder.

Placing Cognitive Rigidity in Interpersonal Context in Psychosis: Relationship With Low Cognitive Reserve and High Self-Certainty.

Introduction: People with psychosis show impairments in cognitive flexibility, a phenomenon that is still poorly understood. In this study, we tested if there were differences in cognitive and metacognitive processes related to rigidity in patients with psychosis. We compared individuals with dichotomous interpersonal thinking and those with flexible interpersonal thinking. Methods: We performed a secondary analysis using two groups with psychosis, one with low levels of dichotomous interpersonal thinking (n = 42) and the other with high levels of dichotomous interpersonal thinking (n = 43). The patients were classified by splitting interpersonal dichotomous thinking (measured using the repertory grid technique) to the median. The groups were administered a sociodemographic questionnaire, a semi-structured interview to assess psychotic symptoms [Positive and Negative Syndrome Scale (PANSS)], a self-report of cognitive insight [Beck Cognitive Insight Scale (BCIS)], neurocognitive tasks [Wisconsin Card Sorting Test (WCST) and Wechsler Adult Intelligence Scale (WAIS)], and the repertory grid technique. We used a logistic regression model to test which factors best differentiate the two groups. Results: The group with high dichotomous interpersonal thinking had earlier age at onset of the psychotic disorder, higher self-certainty, impaired executive functioning, affected abstract thinking, and lower estimated cognitive reserve than the group with flexible thinking. According to the logistic regression model, estimated cognitive reserve and self-certainty were the variables that better differentiated between the two groups. Conclusion: Cognitive rigidity may be a generalized bias that affects not only neurocognitive and metacognitive processes but also the sense of self and significant others. Patients with more dichotomous interpersonal thinking might benefit from interventions that target this cognitive bias on an integrative way and that is adapted to their general level of cognitive abilities.