Characteristics of RCTs focusing on health promotion in community samples: a scoping review protocol based on the d-CoSPICO framework.

INTRODUCTION: Developing the capabilities of individuals, groups and communities to enhance their health has received a great deal of attention in the literature. One essential source of results is evidence-based intervention programmes, which often involve a number of different variables. This paper describes a methodology for carrying out a scoping review that maps available evidence on randomised controlled trials focusing on health promotion intervention programmes. METHODS AND ANALYSIS: The scoping review protocol follows the general Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Joanna Briggs Institute guidelines. It also incorporates some modifications to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review flowchart and complements its methodological framework. This new format, called documents, Concept, Studies, Participants, Interventions, Comparator, and Outcomes (d-CoSPICO), guides the review sequence, which is represented in a flowchart. The search will focus on different sources of information using formal (searches in thematic -PubPsych, ERIC, MedLine, PsychINFO- and multidisciplinary databases -Academic Search Ultimate, Core Collection Web of Science, Scopus and ProQuest-, repositories and other websites), informal (contact with researchers), and retrospective (previous reviews on this topic) strategies to identify relevant publications until 2021, including grey literature. Coding, identification, selection, and data extraction will be carried out following the generation of a database in which each retrieved record's content (abstract and/or full text) can be analysed. The review is expected to be completed in 2023. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. The d-CoSPICO framework and the results will be disseminated through (a) peer-reviewed publications; (b) presentations at scientific dissemination events and (c) training activities for applying this protocol.

Relationship among Self-Efficacy Expectations, Locus of Control, and Attributions in Bariatric Patients.

Background: Bariatric surgery is the most effective method for achieving accelerated weight loss. However, in the short- and medium-term, between 20% and 40% of patients regain a significant percentage of the weight lost. Cognitive and attitudinal psychological variables contribute to explaining weight regain. The aim of this study was to analyze differences in self-efficacy, locus of control, and attributions among bariatric patients, in accordance with weight maintenance or weight regain. Methods: Participants were classified according to weight regain (≥15% weight regain) and weight maintenance (<15% weight regain). A receiver operating characteristic (ROC) curve analysis was employed to assess the diagnostic value of the locus of control for weight loss and to establish a cutoff point to differentiate those who maintained weight loss from those who regained more than 15% of the weight lost. Results: Those who maintained weight loss showed a statistically higher locus of control ratio than those who regained weight. The locus of control ratio was associated with a lower risk of weight regain (odds ratio 0.760, p = 0.018). Using the area under the ROC curve (AUC), the locus of control significantly identified those who maintained weight (AUC = 0.761; p = 0.001). The maximum combination of sensitivity and specificity was shown at the cutoff point of 39. Qualitative results show a difference in the type of attributions and expectations according to current weight maintenance or weight regain status. Conclusion: Participants' self-efficacy expectations, locus of control, and attributions change in accordance with the outcome achieved in terms of weight regain or weight maintenance.

Fuzzy Cognitive Maps as a Tool for Identifying Cognitive Conflicts That Hinder the Adoption of Healthy Habits.

Implementing healthy lifestyle habits can take a great effort and sticking to such prescriptions is complicated. Failure rates amongst people seeking to adopt a healthier diet are estimated to be around 80%. Exploring the network of meanings that an individual associates with adopting habits such as healthy eating, maintaining the correct weight, and practising physical exercise can reveal the inconsistencies, obstacles, or psychological conflicts that hinder change and target-achievement. Fuzzy cognitive maps (FCM) can be of great utility in this task as they allow us to explore the structure of the personal meaning system of an individual as well as determine any obstacles and simulate hypothetical scenarios that project its future evolution. This can help to identify the foci of cognitive conflicts that hinder the adoption of healthy habits and establish more effective personalised intervention programmes that make it easier to maintain these habits.

Intervención grupal desde un enfoque sensoriomotriz para reducir la intensidad del dolor crónico / Group intervention from a sensorimotor approach to reduce the intensity of chronic pain

Objetivo: Determinar la eficacia de una intervención (Time In) para reducir el dolor y mejorar los síntomas psicológicos en personas con dolor crónico. Diseño: Ensayo clínico aleatorizado con grupo control y con 3 mediciones realizadas a lo largo de 3 meses. Emplazamiento: Granada. Participantes: Un total de 40 mujeres mayores de 18 años con una historia de dolor crónico (más de 6 meses de duración). La captación fue en la Asociación de Fibromialgia de Granada (AGRAFIM). Intervenciones: Time In es un trabajo sensoriomotriz que combina procedimientos biomecánicos fisioterapéuticos y estrategias psicológicas. Se planificó una sesión semanal de 3h de duración y el total del programa se desarrolló durante 5 semanas seguidas. Mediciones principals: Variables dependientes: puntuaciones de las escalas Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) y Clinical Outcome in Routine Evaluation (CORE-OM). Variables independientes: información sociodemográfica, historial clínico y grupo de intervención o control. Resultados: Se observaron diferencias significativas entre grupo control y grupo intervención de gran parte de las escalas utilizadas en las mediciones postintervención y seguimiento. Así pues, se obtuvieron puntuaciones medias significativamente inferiores en la intensidad, interferencia y zonas de dolor, calidad de vida, síntomas psicológicos y cambio de comportamiento. Se observaron resultados similares en las puntuaciones de d Cohen "muy importantes" en la intensidad del dolor (d = -1,01, d = -0,97) y la interferencia del dolor (d = -0,85, d = 0,74), con un porcentaje de mejoría del 21 al 30%. Conclusiones. La intervención Time In reduce el dolor y mejora los síntomas psicológicos en pacientes con fibromialgia, lo que redunda en una mejor calidad de vida

Objective: To assess the effectiveness, on people with chronic pain, of an intervention (Time In) designed to reduce pain and to improve psychological symptoms. Design: A randomized clinical trial with a control group, taking three measurements over three months. Setting: Granada, Spain. Participants: A sample of 40 women aged 18 or older with a history (over 6 months) of chronic pain. The recruitment was in the Fibromyalgia Association of Granada, Spain (AGRAFIM). Interventions: Time In is a sensorimotor intervention that combines biomechanical physiotherapeutic procedures and psychological strategies. A weekly session of 3h was planned and the total of the program was developed during five weeks. Main measurements: Independent variables: sociodemographic information, clinical history and Time In intervention. Dependent variables: Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) and Clinical Outcome in Routine Evaluation (CORE-OM). Results: Significant differences were observed between control group and intervention group of most of the scales used in postintervention and follow up measurements. Thus, significantly lower mean scores were obtained in intensity, interference and areas of pain, quality of life, psychological symptoms and behavioural change. Similar results were observed on d Cohen scores. They were 'very important' on intensity of pain (d = -1.01, d = -0.97) and interference of pain (d = -0.85, d = -0.74), with an improvement percentage from 21% to 30%. Conclusions: Time In intervention reduces pain and improves psychological symptoms in patients with fibromyalgia; this results in a better quality of life

[Group intervention from a sensorimotor approach to reduce the intensity of chronic pain]. / Intervención grupal desde un enfoque sensoriomotriz para reducir la intensidad del dolor crónico.

OBJECTIVE: To assess the effectiveness, on people with chronic pain, of an intervention (Time In) designed to reduce pain and to improve psychological symptoms. DESIGN: A randomized clinical trial with a control group, taking three measurements over three months. SETTING: Granada, Spain. PARTICIPANTS: A sample of 40 women aged 18 or older with a history (over 6 months) of chronic pain. The recruitment was in the Fibromyalgia Association of Granada, Spain (AGRAFIM). INTERVENTIONS: Time In is a sensorimotor intervention that combines biomechanical physiotherapeutic procedures and psychological strategies. A weekly session of 3h was planned and the total of the program was developed during five weeks. MAIN MEASUREMENTS: Independent variables: sociodemographic information, clinical history and Time In intervention. Dependent variables: Brief Pain Inventory (BPI-S), Short-Form Health Survey (SF-12), Symptom Check List-90-R (SCL-90-R) and Clinical Outcome in Routine Evaluation (CORE-OM). RESULTS: Significant differences were observed between control group and intervention group of most of the scales used in postintervention and follow up measurements. Thus, significantly lower mean scores were obtained in intensity, interference and areas of pain, quality of life, psychological symptoms and behavioural change. Similar results were observed on d Cohen scores. They were 'very important' on intensity of pain (d=-1.01, d=-0.97) and interference of pain (d=-0.85, d=-0.74), with an improvement percentage from 21% to 30%. CONCLUSIONS: Time In intervention reduces pain and improves psychological symptoms in patients with fibromyalgia; this results in a better quality of life.

A review of cognitive conflicts research: a meta-analytic study of prevalence and relation to symptoms.

Recent research has highlighted the role of implicative dilemmas in a variety of clinical conditions. These dilemmas are a type of cognitive conflict, in which different aspects of the self are countered in such a way that a desired change in a personal dimension (eg, symptom improvement) may be hindered by the need of personal coherence in another dimension. The aim of this study was to summarize, using a meta-analytical approach, the evidence relating to the presence and the level of this conflict, as well as its relationship with well-being, in various clinical samples. A systematic review using multiple electronic databases found that out of 37 articles assessed for eligibility, nine fulfilled the inclusion criteria for meta-analysis. Random effects model was applied when computing mean effect sizes and testing for heterogeneity level. Statistically significant associations were observed between the clinical status and the presence of dilemmas, as well as level of conflict across several clinical conditions. Likewise, the level of conflict was associated with symptom severity. Results highlighted the clinical relevance and the transdiagnostic nature of implicative dilemmas.

Cognitive conflicts in major depression: between desired change and personal coherence.

OBJECTIVES: The notion of intrapsychic conflict has been present in psychopathology for more than a century within different theoretical orientations. However, internal conflicts have not received enough empirical attention, nor has their importance in depression been fully elaborated. This study is based on the notion of cognitive conflict, understood as implicative dilemma (ID), and on a new way of identifying these conflicts by means of the Repertory Grid Technique. Our aim was to explore the relevance of cognitive conflicts among depressive patients. DESIGN: Comparison between persons with a diagnosis of major depressive disorder and community controls. METHODS: A total of 161 patients with major depression and 110 non-depressed participants were assessed for presence of IDs and level of symptom severity. The content of these cognitive conflicts was also analysed. RESULTS: Repertory grid analysis indicated conflict (presence of ID/s) in a greater proportion of depressive patients than in controls. Taking only those grids with conflict, the average number of IDs per person was higher in the depression group. In addition, participants with cognitive conflicts displayed higher symptom severity. Within the clinical sample, patients with IDs presented lower levels of global functioning and a more frequent history of suicide attempts. CONCLUSIONS: Cognitive conflicts were more prevalent in depressive patients and were associated with clinical severity. Conflict assessment at pre-therapy could aid in treatment planning to fit patient characteristics.

Viewing Cognitive Conflicts as Dilemmas: Implications for Mental Health.

The idea that internal conflicts play a significant role in mental health has been extensively addressed in various psychological traditions, including personal construct theory. In the context of the latter, several measures of conflict have been operationalized using the Repertory Grid Technique (RGT). All of them capture the notion that change, although desirable from the viewpoint of a given set of constructs, becomes undesirable from the perspective of other constructs. The goal of this study is to explore the presence of cognitive conflicts in a clinical sample (n = 284) and compare it to a control sample (n = 322). It is also meant to clarify which among the different types of conflict studied provides a greater clinical value and to investigate its relationship to symptom severity (SCL-90-R). Of the types of cognitive conflict studied, implicative dilemmas were the only ones to discriminate between clinical and nonclinical samples. These dilemmas were found in 34% of the nonclinical sample and in 53% of the clinical sample. Participants with implicative dilemmas showed higher symptom severity, and those from the clinical sample displayed a higher frequency of dilemmas than those from the nonclinical sample.

The Multi-Center Dilemma Project: an investigation on the role of cognitive conflicts in health.

The Multi-Center Dilemma Project is a collaborative research endeavour aimed at determining the role of dilemmas--a kind of cognitive conflict, detected by using an adaptation of Kelly's Repertory Grid Technique--in a variety of clinical conditions. Implicative dilemmas appear in one third of the non-clinical group (n = 321) and in about half of the clinical group (n = 286), the latter having a proportion of dilemmas that doubles that of the non-clinical sample. Within the clinical group, we studied 87 subjects, after completing a psychotherapy process, and found that therapy helps to dissolve those dilemmas. We also studied, independently, a group of subjects diagnosed with social phobia (n = 13) and a group diagnosed with irritable bowel syndrome (n = 13) in comparison to non-clinical groups. In both health related problems, dilemmas seem to be quite relevant. Altogether, these studies, though preliminary (and with a small group size in some cases), yield a promising perspective to the unexplored area of the role of cognitive conflicts as an issue to consider when trying to understand some clinical conditions, as well as a focus to be dealt with in psychotherapy when dilemmas are identified.