Latent classes of gambling in youths: The role of comorbidity, alexithymia and stressful life events by sex. / Clases latentes de juego problemático en jóvenes: El papel de la comorbilidad, la alexitimia y los acontecimientos vitales estresantes en función del sexo.

Alexithymia is related with propensity towards impulsive behavioral responses, rather than cognitive regulation of stressful events. Youth is a particularly vulnerable time for the confluence of these variables, which may impact the severity of gambling disorders (GD). However, sex differences have hardly been explored. This study aimed, firstly, to explore the frequency of GD among young people, as well as the presence of GD with other comorbid addictions. Secondly, latent classes were examined on the basis of gambling risk and their relationship to other addictive behaviors, alexithymia and stressful life events. Thirdly, we analyzed whether class membership was predicted by sex and age. The sample was composed of 360 participants between the ages of 18 and 35, the majority female. The results obtained revealed that alcohol abuse was the most prevalent addictive behavior both for problem and non-problem gamblers of both sexes. Group membership analyses showed the presence of two latent classes based on gambling risk. One of them was characterized by gambling risk, comorbidity, alexithymia, and stressful life events, and mainly predicted by being male. The other model was characterized by no gambling risk, lower levels of stressful life events and alexithymia, and mainly predicted by being female. This second profile presents a risk of alcohol abuse and compulsive buying. We highlight the need to introduce a gender perspective both in the interpretation of research findings and in the clinical application of treatments. CAST: La comorbilidad, la alexitimia y los acontecimientos vitales estresantes desempeñan un papel importante en la salud mental de los jóvenes. Este estudio ha tenido como objetivo, en primer lugar, explorar la frecuencia del trastorno de juego (TJ) en los jóvenes, así como la presencia del TJ  con otras adicciones comórbidas. En segundo lugar, se pretendía analizar un modelo de perfil basado en el riesgo de juego y su relación con las otras conductas adictivas, la alexitimia y los acontecimientos vitales estresantes. En tercer lugar, se analizó si la pertenencia a cada perfil era predicha por el sexo y la edad. La muestra estaba compuesta por 360 participantes. Los resultados obtenidos revelaron que el abuso de alcohol era la conducta adictiva más prevalente tanto para los jugadores problemáticos como para los no problemáticos de ambos sexos. Los análisis de pertenencia de clase mostraron la presencia de dos modelos de perfil de juego. El primeor de ellos se caracterizaba por el riesgo de juego, la comorbilidad, la alexitimia y los acontecimientos vitales estresantes, y estaba principalmente predicho por la condición sexo-varón. El otro modelo se caracteriza por la ausencia de riesgo de juego, niveles más bajos de acontecimientos vitales estresantes y alexitimia, y se predice principalmente por ser mujer.  En este segundo perfil hay riesgo de abuso de alcohol y de compra compulsiva. Destacamos la necesidad de introducir una perspectiva de género tanto en la interpretación de los resultados de la investigación como en la aplicación clínica de los tratamientos.

La alexitimia se relaciona con la propensión a las respuestas conductuales impulsivas, en lugar de una regulación cognitiva de los acontecimientos estresantes. La juventud es una etapa de especial vulnerabilidad para la confluencia de estas variables, pudiendo repercutir en la severidad del trastorno de juego (TJ). No obstante, las diferencias entre sexos apenas han sido exploradas. Este estudio tuvo como objetivo, en primer lugar, explorar la frecuencia de TJ en los jóvenes, así como la presencia de TJ con otras adicciones comórbidas. En segundo lugar, se examinó el riesgo de juego y su relación con las otras conductas adictivas, la alexitimia y los acontecimientos vitales estresantes. En tercer lugar, se analizó si la pertenencia a una determinada clase latente era predicha por el sexo y la edad. La muestra estaba compuesta por 360 participantes, con edades comprendidas entre los 18 y 35 años, siendo la mayoría mujeres. Los resultados obtenidos revelaron que el abuso de alcohol era la conducta adictiva más prevalente, tanto para los jugadores problemáticos como para los no problemáticos de ambos sexos. Los análisis de pertenencia de grupo mostraron la presencia de dos clases latentes en base al riesgo de juego. El primero de ellos se caracterizaba por el riesgo de juego, la comorbilidad, la alexitimia y los acontecimientos vitales estresantes, y estaba principalmente predicho por la condición sexo-varón. El otro modelo se caracterizaba por la ausencia de riesgo de juego, niveles más bajos de acontecimientos vitales estresantes y alexitimia, y se predice principalmente por la condición sexo-mujer. En este segundo perfil se halló riesgo de abuso de alcohol y de compra compulsiva. Señalamos la necesidad de introducir una perspectiva de género tanto en la interpretación de los resultados de la investigación como en la aplicación clínica de los tratamientos.

The Mediating Effect of Coping Strategies and Emotion Regulation in the Relationship between Impulsivity, Metacognition, and Eating Disorders.

BACKGROUND: Risk factors for eating disorders are multifaceted and complex, so it is crucial to elucidate the role of executive functions, including impulsivity and metacognition, and coping strategies in the severity of eating behaviors. The study aims were threefold: (1) to analyze gender differences in impulsivity, metacognition, coping strategies, emotion regulation, and eating disorders; (2) to examine the correlation between the study variables; and (3) to test the mediating role of coping and emotion-regulation strategies in the relationship between metacognition, impulsivity, and eating disorders. METHODS: A total of 1076 participants (Mage = 21.78, SD = 5.10; 77.7% women) completed a set of questionnaires. Two mediation analyses were conducted to test the mediating role of coping strategies, including emotion regulation, in the relationship between executive functions (i.e., impulsivity and metacognition) and eating disorders. RESULTS: Women displayed higher coping strategies, specifically emotional expression, wishful thinking, and social support, whereas men presented greater social withdrawal. Mediational analyses showed a significant association between impulsivity, metacognition, and eating disorders, whose relationship was partially mediated by coping strategies and mainly by emotion regulation. CONCLUSION: Interventions based on coping strategies and emotion regulation could be a feasible and effective option to deal with eating disorders among the young population.

Latent classes of eating disorders and addictions by sex: Implication of alexithymia and stressful life events in youths.

Introduction: Eating disorders (EDs) and behavioural addictions show common psychological vulnerability factors such as alexithymia and stressful life events (SLE). This study aims, firstly, to explore the prevalence and latent profiles of participants based on their risk of suffering EDs, gambling disorder (GD), alcohol and/or drug abuse, and compulsive buying (CB) by sex. Secondly, it aimed to test whether alexithymia and having experienced SLE are associated with group membership. Methods: The sample was predominantly drawn from university students and social networks. It was composed of 352 young adults between 18 and 35 years old, of whom 77.8% were women and 22.2% men. Results: The results showed that the most prevalent disorders of the sample were alcohol, EDs, CB, drugs and GD, respectively. Moreover, latent class analyses were conducted based on the risk of suffering EDs or addictions by sex. Three main profiles were found: 'Men with addictions', 'Healthy women' and 'Women with EDs'. Finally, differences in SLE and alexithymia levels were tested by latent classes. "Men with addictions" and "Women with EDs" had higher scores on alexithymia and SLE than the group of "Healthy women". However, the group of "Women with EDs" (class 3) reported significantly higher levels of SLE and alexithymia than the other two groups. Discussion and conclusion: In conclusion, we discuss the possibility that some vulnerability factors operate generally and transdiagnostically in EDs and addictive disorders. The identification of clinical phenotypes could complement and deepen prediction, prevention and treatment research in clinical settings. The need to take sex and gender differences into account is reinforced.

Sex-comparative study of gambling disorder regarding alexithymia and symptoms of depression, anxiety and hostility.

BACKGROUND AND AIMS: Alexithymia and psychological symptomatology have been closely associated with gambling disorder (GD). However, sex differences remain underexplored. This study aims, firstly, to explore the differences between groups (GD and no-GD) and sexes (women vs. men) in alexithymia and psychological symptomatology (depression, anxiety and hostility). Secondly, the relationship between alexithymia and psychological symptomatology was analysed by gambling and sex groups. Thirdly, it examines the moderation role of sex and gambling in the relationship between alexithymia and each psychological symptom. METHOD: The sample was composed of 80 people with GD diagnosis and 80 without GD (40 women and 40 men in each group). RESULTS: The results showed that alexithymia is positively related to depression, anxiety and hostility, with significantly higher scores in people with GD. Moderation analyses showed a threefold interaction, in which higher alexithymia was related to higher depression for men with GD but not for GD-women. However, in women with GD, depression levels are higher than in people without GD and tend to be more stable over time, despite the lack of effect of alexithymia. CONCLUSIONS: These results provide evidence indicating that dysfunctional psychological symptomatology affects people with GD to a greater extent than people without GD, but also that the aetiology and effect of underlying vulnerability factors on gambling is different according to sex. The need of prevention and treatment programmes that consider different psychological aspects depending on sex is reinforced.

Mediating Role of Intimate Partner Violence Between Emotional Dependence and Addictive Behaviours in Adolescents.

Objective: Intimate partner violence (IPV) has been related to emotional dependence and addictive disorders. This study aims to provide a global approach to analyse the relationship between these variables and to determine the factors underlying permanence in violent relationships. Methods: It is a non-experimental, cross-sectional correlational design study. Participants had to have at least one dating relationship for at least 1 month to complete the questionnaire, which included the following instruments: emotional dependence scale (DEN), scale of violence in dating relationships (VREP) and impulse control disorders scale (MULTICAGE CAD 4). Results: The sample consisted of 1.533 adolescents, 53.9% were male (n = 826) and 46.1% female (n = 707), between 14 and 18 years. Emotional dependence correlated significantly with received violence (r = 0.37, p < 0.001). Compulsive spending is strongly associated with emotional dependence (r = 0.21, p < 0.001), whereas sex addiction is associated with received violence to a greater extent (r = 0.18, p < 0.001). Received violence mediates on emotional dependence and addictions. Conclusion: IPV is a risk factor for the perpetuation of addictive behaviours. It is advisable to promote affective education for developing resilience and adequate coping.

Longitudinal Changes in Gambling, Buying and Materialism in Adolescents: A Population-Based Study.

Gambling disorder, gambling-related cognitive biases, compulsive buying, and materialistic values lead to impaired functioning in important areas of life. The aims of the present longitudinal study are (1) to evaluate the change produced after one year in those mentioned variables and (2) to examine the gender role in these changes and to analyze the mediational mechanisms among the variables of the study. The sample was composed of 182 adolescents (103 females and 79 males) from secondary education Spanish institutions who completed self-administered questionnaires. Structural equation modeling has been used to explore associations between the different variables. Our results show significant decreases in compulsive buying, materialism, and cognitive biases related to gambling after one year. Gambling disorder severity was directly related to cognitive distortions of gambling and being a man. Compulsive buying was associated with older age and the female gender. Materialism was associated with compulsive buying and the male gender. In conclusion, gambling disorder, gambling-related cognitive biases, compulsive buying, and materialistic values change over time in different ways, according to gender. The understanding of gambling disorder and compulsive buying in adolescents could potentially lead to early prevention and treatment programs for the specific needs of gender and age.

Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual in Adult Patients With Emotional Disorders in the Primary Care Setting (PsicAP Study): Protocol for a Randomized Controlled Trial.

BACKGROUND: Demand for primary care (PC) services in Spain exceeds available resources. Part of this strong demand is due to the high prevalence of emotional disorders (EDs)-anxiety, depression, and somatic symptom disorders-and related comorbidities such as pain or chronic illnesses. EDs are often under- or misdiagnosed by general practitioners (GPs) and, consequently, treatment is frequently inadequate. OBJECTIVE: We aim to compare the short- and long-term effectiveness of group-delivered transdiagnostic cognitive behavioral therapy (TD-CBT) versus treatment as usual (TAU) in the treatment of EDs in the PC setting in Spain. We also aim to compare the effect of these treatments on disability, quality of life, cognitive-emotional factors, and treatment satisfaction. METHODS: Here we present the study design of a two-arm, single-blind, randomized controlled trial (N=1126) to compare TAU to TD-CBT for EDs. TAU will consist primarily of pharmacological treatment and practical advice from the GP while TD-CBT will be administered in seven 90-minute group sessions held over a period ranging from 12 to 14 weeks. Psychological assessments are carried out at baseline (ie, pretreatment); posttreatment; and at 3-, 6-, and 12-month follow-up. The study is conducted in approximately 26 PC centers from the National Health System in Spain. RESULTS: This study was initiated in December 2013 and will remain open to new participants until recruitment and follow-up has been completed. We expect all posttreatment evaluations to be completed by December 2017, and follow-up will end in December 2018. CONCLUSIONS: We expect the TD-CBT group to have better results compared to TAU on all posttreatment measures and that this improvement will be maintained during follow-up. This project could serve as a model for use in other areas or services of the National Health System in Spain and even in other countries. CLINICALTRIAL: International Standard Randomized Controlled Trial Number (ISRCTN): 58437086; http://www.isrctn.com/ISRCTN58437086 (Archived by WebCite at http://www.webcitation.org/6mbYjQSn3).

Activación versus amenaza en la inducción de la reacción de ansiedad / Arousal versus threat when inducing an anxiety reaction

En los últimos años, diversos autores han empleado la hiperventilación voluntaria como método de inducción de activación fisiológica pudiendo llegar a generar una reacción de ansiedad. El propósito de nuestra investigación es analizar experimentalmente las relaciones entre el proceso de activación y la experiencia emocional, centrándonos para ello en la ansiedad y utilizando la hiperventilación como técnica de inducción frente a otra tarea (preparación para hablar en público). Se sometió a prueba la siguiente hipótesis general: la hiperventilación inducirá una reacción de alta activación fisiológica (tasa cardiaca y conductancia de la piel), pero de escasa experiencia ansiosa (valoración subjetiva de los parámetros valencia, intensidad y control), frente a una tarea consistente en preparar una charla, que generará alta activación así como un aumento significativo de la experiencia de ansiedad. La muestra de 89 mujeres se dividió en dos grupos (n= 45 y n= 44), equiparados en distintos parámetros de ansiedad, para realizar en distinto orden y en situación de laboratorio ambas tareas. Los resultados obtenidos confirman la hipótesis principal y ofrecen evidencia en contra de la utilización de la hiperventilación como técnica para generar una experiencia de ansiedad (AU)

Over the past years, several authors have used voluntary hyperventilation as a method for inducing physiological arousal and the experience of anxiety. The purpose of this investigation is to analyze the relationship between the process of arousal and the experience of anxiety. In order to induce anxiety, two tasks were assigned: hyperventilating and preparing a speech. General hypothesis tested: hyperventilation will induce a high level of physiological arousal (heart rate and skin conductance) with a limited experience of anxiety (subjective appraisal of valence, intensity, and control), whereas preparing a speech will generate a high level of arousal and a significant increase in the experience of anxiety. A sample of 89 women was divided into two groups (n= 45 and n= 44). After matching the two groups in various anxiety parameters, both tasks were carried out in a different order by each group in the laboratory. Results obtained confirm the main hypothesis and provide evidence against the use of hyperventilation as a technique for generating anxious experience (AU)

[Arousal versus threat when inducing an anxiety reaction]. / Activación versus amenaza en la inducción de la reacción de ansiedad.

Over the past years, several authors have used voluntary hyperventilation as a method for inducing physiological arousal and the experience of anxiety. The purpose of this investigation is to analyze the relationship between the process of arousal and the experience of anxiety. In order to induce anxiety, two tasks were assigned: hyperventilating and preparing a speech. General hypothesis tested: hyperventilation will induce a high level of physiological arousal (heart rate and skin conductance) with a limited experience of anxiety (subjective appraisal of valence, intensity, and control), whereas preparing a speech will generate a high level of arousal and a significant increase in the experience of anxiety. A sample of 89 women was divided into two groups (n=45 and n=44). After matching the two groups in various anxiety parameters, both tasks were carried out in a different order by each group in the laboratory. Results obtained confirm the main hypothesis and provide evidence against the use of hyperventilation as a technique for generating anxious experience.

PTSD and depression after the Madrid March 11 train bombings.

The March 11, 2004, train bombings in Madrid, Spain, caused the largest loss of life from a single terrorist attack in modern European history. We used a cross-sectional random digit dial survey of Madrid residents to assess the prevalence of posttraumatic stress disorder (PTSD) and major depression in the general population of Madrid 1 to 3 months after the March 11 train bombings. Of respondents 2.3% reported symptoms consistent with PTSD related to the March 11 bombings and 8.0% of respondents reported symptoms consistent with major depression. The prevalence of PTSD was substantially lower, but the prevalence of depression was comparable to estimates reported after the September 11 attacks in Manhattan. The findings suggest that across cities, the magnitude of a terrorist attack may be the primary determinant of the prevalence of PTSD in the general population, but other factors may be responsible for determining the population prevalence of depression.