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An 18-item Portuguese-language version of the CompACT scale has recently been proposed for the Portuguese population. This study aims at conducting the first Confirmatory Factor Analysis of the Portuguese CompACT in participants from two different samples (community adults and women in the post-partum period; total N = 1090). Given that the CompACT had yet to be subjected to gender invariance testing, the present study also presents an invariance analysis between male and female community participants. The measurement invariance of the Portuguese CompACT between community and post-partum women was also examined. The current study additionally explored the scale’s relationships with theoretically relevant outcomes associated in the literature with psychological flexibility. Results showed that the three-factor correlated model of the Portuguese CompACT was an adequate fit for the data taken from the complete sample, with most items presenting statistically and practically significant loading values. The Portuguese CompACT presented acceptable to good internal consistencies for all factors - Openness to Experience (OE), Behavioral Awareness (BA), and Valued Action (VA). Full measurement invariance was found, with results further indicating that community women presented lower scores in BA than community men, and that women in the post-partum period scored higher than community women in BA and VA, and lower in OE. The three subscales of the Portuguese CompACT, that underpin the overarching construct of psychological flexibility, demonstrated different patterns of association from one another with various aspects of individual functioning. Although those associations were in the expected directions with flexibility being associated with lower distress, some forms of psychological flexibility assessed by the CompACT were not significantly associated with measures of positive affect or resilience. This result underscores the difficulty of measuring psychological flexibility as a single construct, as it comprises a number of sub-component processes. Further implications of findings are discussed.

This study aimed to examine the role of decentering and committed action as mediators of the link of external and internal shame with psychological health, in people with a chronic disease diagnosis (n = 223) and without chronic disease (n = 230). Participants with chronic disease presented higher levels of both external and internal shame. Path analysis results showed that these variables seem to be negatively linked to psychological health and that their effects on this outcome seem to be reduced by the mechanisms of decentering and committed action. The tested model explained 56% of psychological health's variance and was invariant across groups. This study emphasizes the importance of taking a decentered stance towards internal experiences and behaving accordingly to one's personal values on psychosocial functioning, independently of disease status. These results may have particular relevance to individuals with high levels of shame.

The aim of this longitudinal study was to examine changes in COVID-19 and illness-related perceptions, gastrointestinal symptoms, coping, catastrophising, psychological distress, and QoL during the COVID-19 pandemic. A total of 831 adults with a gastrointestinal condition completed an online questionnaire at baseline (May—October 2020). Of those, 270 (32.5%) participants (85.2% female, mean age = 47.3 years) provided follow-up data (March—May 2021). Repeated-measures multiple analysis of variance and a cross-lagged panel model were used to test the study hypotheses. Gastrointestinal symptoms and COVID-19 perceptions at follow-up were strongly predicted by their baseline values, while illness perceptions were predicted by baseline gastrointestinal symptoms. Cross-lagged relationships indicated a reciprocal relationship between gastrointestinal symptoms and psychological distress. Moreover, gastrointestinal symptoms had substantial predictive utility, strongly predicting future gastrointestinal symptoms, and to a lesser extent, more negative illness perceptions, greater psychological distress, and greater use of adaptive coping strategies across time.

Acceptance and Commitment Therapy (ACT) has been widely tested for chronic pain, with demonstrated efficacy. Nevertheless, although there is meta-analytical evidence on the efficacy of face-to-face ACT, no reviews have been performed on online ACT in this population. The aim of this meta-analysis is to determine the efficacy of online ACT for adults with chronic pain, when compared with controls. PubMed, PsycINFO, CENTRAL, and Web of Knowledge were searched for randomized controlled trials (RCTs) of online-delivered ACT for chronic pain. Effects were analyzed at post-treatment and follow-up, by calculating standardized mean differences. Online-delivered ACT was generally favored over controls (5 RCTs, N = 746). At post-treatment, medium effects for pain interference and pain acceptance, and small effects for depression, mindfulness, and psychological flexibility were found. A medium effect for pain interference and acceptance, and small effects for pain intensity, depression, anxiety, mindfulness, and psychological flexibility were found at follow-up. ACT-related effects for pain interference, pain intensity, mindfulness, and anxiety increased from post-treatment to follow-up. Nevertheless, the current findings also highlight the need for more methodologically robust RCTs. Future trials should compare online ACT with active treatments, and use measurement methods with low bias. Perspective This is the first meta-analytical review on the efficacy of online ACT for people with chronic pain. It comprises 5 RCTs that compared online ACT with active and/or inactive controls. Online ACT was more efficacious than controls regarding pain interference, pain intensity, depression, anxiety, mindfulness, and psychological flexibility.

This study aimed to investigate the associations between the different abuse types, and gastrointestinal (GI) and extraintestinal symptom severity in irritable bowel syndrome (IBS), and possible mediators of these relationships.We assessed sexual and physical abuse in childhood and adulthood with the Drossman and Leserman abuse questionnaire, whereas GI and extraintestinal symptoms were assessed with the Gastrointestinal Symptom Rating Scale and the Symptom Check List-90 Revised. General linear models with bootstrapping tested the mediating role of depressive symptoms, anxiety symptoms, and GI-specific anxiety and rectal pain threshold. A path model analysis testing all relationships simultaneously was also performed.Among our 186 patients with IBS, an overall history of abuse (i.e., at least one type) was found in 37%. The effects of child and adult sexual abuse on GI symptom severity were fully mediated by GI-specific anxiety and rectal pain threshold (F = 21.540, R2 = 0.43, and F = 22.330, R2 = 0.44, respectively; p.001 for both). The effect of adult sexual abuse and child physical abuse on extraintestinal symptom severity was fully mediated by GI-specific anxiety, depressive symptoms, and rectal pain threshold, whereas the effect of child sexual abuse was partially mediated (F = 14.992, R2 = 0.28; F = 15.065, R2 = 0.30; and F = 18.037, R2 = 0.32, respectively; p.001 for all). When analyzed in a single path model, child sexual abuse and adult physical abuse only had a direct effect on extraintestinal symptom severity, whereas child physical abuse had an indirect effect through depressive symptoms.Abuse is associated with increased GI and extraintestinal symptom severity in IBS. These associations are mediated by levels of GI-specific anxiety, depressive symptoms, and rectal sensitivity.

This study aimed to explore the association between perceived isolation and symptoms of distress in people with GI disorders at the time of the pandemic; and to examine factors which moderate this relationship. This online cross-sectional survey was advertised in May–September 2020 via patient organisations and associated social media. Overall, 831 people (82% female, mean age 49 years) from 27 countries participated. A significant relationship between social isolation and psychological distress was noted (r = .525, p

A robust scale capable of assessing illness-related experiential avoidance (EA) in any given medical condition is currency lacking. Further, there is no available measure that assesses EA related to illness behaviours, i.e., actions and/or reactions in relation to feeling unwell that have the purpose of defining one’s state of health and obtaining physical or emotional relief from perceived or actual illness. This study intends to fill this significant gap by presenting the development and psychometric test of a measure of EA related to illness behaviour, the Illness Behaviour Avoidance Scale (IBAS). A total of 370 Portuguese adults with chronic illness participated in the study. The structure and validity of the IBAS was tested through an Exploratory Factor Analysis (EFA; n = 185), a Confirmatory Factor Analysis (CFA; n = 185), and reliability analyses. The IBAS presented a 7-item unifactorial structure, with good global (CMIN/DF = 2.08; CFI = 0.97; TLI = 0.94; SRMR = 0.04; RMSEA = 0.08, p = 0.139) and local adjustments (SRWs 0.56–0.73; SMCs 0.31–0.53). It also presented a good internal consistency (with αs = 0.82), and construct and discriminant validity. The IBAS appears to be a significant improvement from the use of previous EA measures in illness contexts. This scale can provide a measurement of whether the behavioural response to any given condition is a manifestation of EA.

Although several studies have reported the impact of fears relating to coronavirus-19 on several chronic illnesses, there are few studies focused on gastrointestinal conditions. Therefore, the aim of this study was to compare the fear of coronavirus-19 in patients with inflammatory bowel disease to other gastrointestinal conditions and how the fear of COVID-19 manifests across different demographical backgrounds among inflammatory bowel disease respondents.Participants with gastrointestinal conditions (age ≥ 18) were recruited from 27 countries. Demographic, clinical, and psychosocial information was collected. An adapted scale for inflammatory bowel disease patients measuring the fear of coronavirus-19 and gastrointestinal-specific fear of coronavirus-19 was used.In 831 participants (312 inflammatory bowel disease), only significant increases in gastrointestinal-fear of coronavirus-19 were found in between inflammatory bowel disease and other gastrointestinal conditions (mean [standard deviation]: 13.5 [5.5] vs 10.9 [5.0], P.01). Among inflammatory bowel disease respondents, persons on sick leave had significantly more fear of coronavirus-19 than those employed (median [IQR], 31.0 [28.5-39.5] vs 26.0 [20.0-33.0], P = .035) and significantly more gastrointestinal-fear of coronavirus-19 compared to the employed (18.0 [14.5-22.0] vs 13.0 [9.0-17.0], P = .033) or respondents outside of the labor market (12.0 [7.0-16.0], P = .022). Persons living in a rural setting had significantly more fear of coronavirus-19 compared to persons living in regional setting (29.5 [22.0-37.8] vs 25.0 [20.0-31.3], P = .007) and gastrointestinal-fear of coronavirus-19 (15.0 [11.0-19.8] vs 12.0 [9.0-16.0], P = .02).Respondents with inflammatory bowel disease are more afraid of coronavirus-19 regarding their disease; especially, persons on sick leave or persons living in a rural setting. This should be taken into consideration to personalize the support that health care providers can offer in mitigating fear related to coronavirus-19.

BACKGROUND: Irritable bowel syndrome patients report reduced disease-specific quality of life (IBSQOL). Factors of potential relevance for QOL include gastrointestinal (GI), psychological, and somatic symptoms, demographics, and GI motor and sensory abnormalities. OBJECTIVE: The aim of our study was to evaluate the relative importance of these factors on the different IBSQOL dimensions. METHODS: We included irritable bowel syndrome (IBS) patients who completed validated questionnaires to assess QOL, stool form and frequency, GI symptom severity, psychological distress, GI-specific anxiety, sense of coherence, and overall somatic symptom severity. Patients also underwent tests for oroanal transit time and rectal sensitivity. The nine dimensions of IBSQOL and their average (overall IBSQOL) were used as outcome variables, and factors associated with these were assessed using general linear models. RESULTS: We included 314 IBS patients (74% female, mean age 36.3 ± 12.2 years). Higher stool frequency, GI and overall somatic symptom severity, psychological distress, and GI-specific anxiety were independently associated with reduced overall IBSQOL, with the model explaining 60% of the variance (p

In paramagnetic metalloproteins, longitudinal relaxation rates of 13C′ and 13Cα nuclei can be measured using 13C detected experiments and converted into electron spin-nuclear spin distance restraints, also known as Paramagnetic Relaxation Enhancement (PRE) restraints. 13C are less sensitive to paramagnetism than 1H nuclei, therefore, 13C based PREs constitute an additional, non-redundant, structural information. We will discuss the complementarity of 13C PRE restraints with 1H PRE restraints in the case of the High Potential Iron Sulfur Protein (HiPIP) PioC, for which the NMR structure of PioC has been already solved by a combination of classical and paramagnetism-based restraints. We will show here that 13C R1 values can be measured also at very short distances from the paramagnetic center and that the obtained set of 13C based restraints can be added to 1H PREs and to other classical and paramagnetism based NMR restraints to improve quality and quantity of the NMR information.

The aim of this study was to develop and validate the Athletes’ Perceptions of the Coach-related Critical Attitudes Scale (APoCCAS), using three independent samples of Portuguese adult athletes. In the first stage, the items were developed to assess athletes’ perceptions of coach-related critical attitudes and the items’ factorial structure were explored via a principal components analysis. In a second stage, the findings of Principal Components Analysis were confirmed and cross-validated using confirmatory factor analysis with two independent samples of athletes. The development of a pool of items resulted in a 10-item with a unifactorial structure. This scale presented high internal consistency, adequate convergent validity, and presented a negative association with self-reassurance and positive associations with self-criticism, anxiety, and depressive symptoms. The APoCCAS demonstrated to be a short and reliable measure of the athletes’ perceptions regarding coach-related critical attitudes and seems to be useful for practice and research fields in clinical sport psychology. By highlighting the associations between the athletes’ perception of coach-related critical attitudes and mental health indicators, this study could create a space to alert coaches towards the effect of their attitudes on athletes’ mental health.

The enhancement of nuclear relaxation rates due to the interaction with a paramagnetic center (known as Paramagnetic Relaxation Enhancement) is a powerful source of structural and dynamics information, widely used in structural biology. However, many signals affected by the hyperfine interaction relax faster than the evolution periods of common NMR experiments and therefore they are broadened beyond detection. This gives rise to a so-called blind sphere around the paramagnetic center, which is a major limitation in the use of PREs. Reducing the blind sphere is extremely important in paramagnetic metalloproteins. The identification, characterization, and proper structural restraining of the first coordination sphere of the metal ion(s) and its immediate neighboring regions is key to understand their biological function. The novel HSQC scheme we propose here, that we termed R2-weighted, HSQC-AP, achieves this aim by detecting signals that escaped detection in a conventional HSQC experiment and provides fully reliable R2 values in the range of 1H R2 rates ca. 50–400 s−1. Independently on the type of paramagnetic center and on the size of the molecule, this experiment decreases the radius of the blind sphere and increases the number of detectable PREs. Here, we report the validation of this approach for the case of PioC, a small protein containing a high potential 4Fe-4S cluster in the reduced [Fe4S4]2+ form. The blind sphere was contracted to a minimal extent, enabling the measurement of R2 rates for the cluster coordinating residues.

CFQ-CI was previously developed and preliminarily validated in a study with a single online-recruited inflammatory bowel disease (IBD) sample. The current study presents a further validation of CFQ-CI in four different samples of patients with chronic health conditions: a sample of 82 women with breast cancer, an online-recruited mixed sample of 100 people with cancer, a sample of 69 people with IBD, and an online-recruited mixed chronic illness sample of 93 participants. Confirmatory Factor Analyses, multi-group, reliability, and differences analyses were conducted. Results indicated that the scale is a robust unidimensional 7-item measure of chronic illness-related cognitive-fusion, with excellent reliability and structural validity across the four studied samples and in both paper-pencil- and online-based collection methods. Measurement invariance was not established across the samples, suggesting that CFQ-CI does not appear tofunction equivalently across different illness diagnoses. This study confirms CFQ-CI as a robust, adequate, and simple measure of chronic illness-related cognitive fusion that can be used in different behavioural medicine research and clinical contexts. As the scale does not seem to present measurement invariance, comparing scores between different illness groups is not recommended.

Major life events have been positively associated with depression symptoms. Although psychological flexibility has been associated with adaptive coping skills and negatively linked with depression ...

Objective In accordance to ACT theory, psychological inflexibility may influence the well-known link between learned helplessness and depression symptomatology. This exploratory preliminary study aims to analyse whether psychological flexibility moderates the relationship between these variables. Methods A community sample of 84 Portuguese participants (30 men and 54 women), with a mean age of 33.98 (SD = 11.05), completed the LHS, CompACT, and DASS-21. The moderating effect of psychological flexibility on the relationship between learned helplessness and depression symptomatology was calculated using the PROCESS computation macro. Results The interaction term between learned helplessness and psychological flexibility was significant (b = −0.01, SE = 0.00, p Discussion Higher psychological flexibility seems to be protective for depression symptomatology, in particular for those individuals who experience higher levels of learned helplessness. Individuals who are most likely to struggle with learned helplessness are potentially those who could benefit the most of an intervention targeting psychological flexibility as a way to ameliorate depressive symptomatology. Future studies with larger and clinical samples are required to confirm these preliminary findings.

Although there is some evidence on the efficacy of mindfulness-based interventions in improving health and psychological outcomes in women with breast cancer, further research is needed to understand these findings’ clinical significance. Furthermore, Acceptance and Commitment Therapy (ACT) intervention studies on breast cancer are scarce, and no compassion-based intervention has been tested for cancer patients. Given the complementarity and compatibility of mindfulness practice, ACT, and Compassion Focused Therapy, the current study combined these approaches to develop an integrative intervention specifically adapted to cancer patients, the Mind programme. Participants were recruited at the Radiotherapy Service of the Coimbra University Hospital (CHUC) and were assigned to one of two groups: the experimental group (Treatment As Usual + Mind Programme (8 weekly sessions and homework assignments) – n = 15) and the control group (Treatment As Usual – n = 17). There was a 100% retention on the experimental group, during the intervention. The effect size for psychological health (g = 0.79) was particularly noteworthy, suggesting that the intervention presented benefits that are comparable to mindfulness only-based interventions. The experimental group also improved on physical health (g = 0.16), quality of social relationships (g = 0.42), depression symptoms (g = −0.42), and stress (g = −0.32). Participants reported it was important for them to take part in the programme, and that it improved the way they deal with difficulties. Results indicate that the Mind programme may be a useful complement to the medical treatment of breast cancer and support the combination of acceptance, mindfulness, and compassion-based components in this context. Having an accessible and integrative psychological programme for people with cancer may significantly help improving quality of life and mental health in this population. Further implications are discussed.

BackgroundThis pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates.MethodsSeventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform’s usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention from a practitioner’s point of view.ResultsThis study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format.ConclusionThis study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed.

O presente artigo objetiva analisar a extradição à luz dos princípios de cooperação jurídica internacional previstos no Novo Código de Processo Civil. Para tanto, inicialmente, faz-se necessária a abordagem do conceito de extradição, vislumbrada como medida de cooperação internacional, bem como as exigências legais da Lei 13.445/2017 (Lei de Migração). Aliás, a abordagem da lei de migração é de suma importância por ter revogado o Estatuto do Estrangeiro, até então norma responsável por ditar as regras a serem observadas nos casos em concreto sobre a extradição. Na verdade, muito antes da abordagem do assunto principal, mister analisar os requisitos legais da nova lei que aborda a extradição, uma vez que sua análise é primordial para a chegada do tema sobre princípios, que são bases primordiais de análise de qualquer decisão sobre extradição. Em seguida, o artigo enumera os princípios próprios da cooperação internacional previstos no Novo Código de Processo Civil, diretamente ligados ao instituto da extradição, e também os compara ao Código Modelo de Cooperação Interjurisdicional para Ibero- -América, proposto como norte de adequação dos Estados-Membros quando o assunto é cooperação internacional, como o próprio nome diz. Por fim, o artigo estabelece um paralelo entre os princípios diretrizes da Lei de Migração, vislumbrando-se tudo isso em um caso em concreto, utilizando o método lógico-dedutivo.

Objetivo: O presente estudo teve como objetivo testar o potencial efeito mediador da autocompaixão e da ação comprometida na relação entre vergonha e sintomatologia depressiva, em pessoas sem e com diagnóstico de doença física crónica. Adicionalmente, foram exploradas as diferenças em relação a essas variáveis entre os dois grupos. Métodos: A amostra foi constituída por 453 participantes (223 com e 230 sem diagnóstico de doença física crónica), os quais responderam numa plataforma online a um protocolo de medidas de autorrelato de vergonha, autocompaixão, ação comprometida e sintomas depressivos. Resultados: Os participantes com diagnóstico de doença crónica apresentaram níveis significativamente (p < 0,05) superiores de vergonha e sintomatologia depressiva, e níveis inferiores de ação comprometida, comparativamente aos participantes sem doença física crónica. Contudo, não foram encontradas diferenças significativas entre os dois grupos relativamente às competências autocompassivas. As análises de correlação revelaram que a vergonha se associa negativamente à autocompaixão e ação comprometida e positivamente á sintomatologia depressiva, tanto no grupo sem como no grupo com diagnóstico de doença física crónica. Os resultados da path analysis indicaram que sentimentos de vergonha têm um impacto significativo, explicando 41% da variância da sintomatologia depressiva, parcialmente via menores níveis de autocompaixão e de ação comprometida. Os resultados da análise multigrupos demonstraram que o modelo testado é plausível nos dois grupos em estudo. Conclusões: Este estudo parece fornecer importantes contributos para a compreensão do impacto protetor das competências autocompassivas e da adoção de ações comprometidas para a saúde mental, tanto para pessoas sem como com diagnóstico de doença física crónica. De facto, os resultados sugerem que estes processos de regulação emocional são importantes mecanismos mediadores da relação entre vergonha e sintomas depressivos. Finalmente, estes dados parecem suportar o desenvolvimento de abordagens mais eficazes para a promoção da saúde psicológica para pessoas sem e com doença crónica.

Irritable Bowel Syndrome (IBS) negatively influences mental and physical quality of life (QoL), but factors that explain this impact are still unclear. Increasing evidence has associated IBS severity, psychological distress, somatic symptoms, and gastrointestinal (GI)-specific anxiety with QoL in IBS. The aim of this study is to further explore these associations and to analyze potential mediating factors.A total of 1017 IBS patients (69.3% female, mean age 40.6 years) who completed a QoL measure (SF-36) were included in this study. A proportion of these participants (N = 183; 72.7% female, mean age 41.7), who additionally completed psychological distress, somatic symptoms, and GI-specific anxiety measures, was included in the mediation analysis. This analysis was conducted via structural equation modelling to identify factors of importance for generic QoL, using a cross-sectional design.IBS patients reported lower QoL than what is observed in the general population, in particular regarding role limitations caused by health and emotional functioning, vitality, and social functioning. Female patients scored lower than male patients on most QoL dimensions. The effects of IBS severity on mental and physical QoL were mediated by GI-specific anxiety. In addition to GI-specific anxiety, depressive symptoms were also of importance for mental QoL, and somatic symptom severity for physical QoL.QoL is reduced in patients with IBS and GI-specific anxiety, depressive symptoms, and somatic complaints are particularly important for this outcome. Future trials should test the efficacy of psychological interventions specifically targeting these factors in improving QoL in IBS.

Objectives Evidence shows that Acceptance and Commitment Therapy (ACT) is an empirically supported psychological approach for chronic pain (CP) management. Although self-compassion is not explicitly a target of ACT, it seems to be one mechanism of change in ACT for CP. However, research is lacking on the benefits of including explicit self-compassionate exercises in ACT for CP. The current study pilot tested a Compassionate ACT 8-session group program (COMP.ACT; n=9), as well as an ACT-only 8-session group program (ACT; n=7), in a sample of women with CP. Methods The current study follows a quasi-experimental design, and conducts Reliable and Significant Change analyses comparing pre- to post-intervention scores of self-report measures. Results No differences were found between conditions at baseline, nor between completers and drop-outs. Although preliminary, results showed COMP.ACT led to greater clinical improvements in depression and anxiety, while ACT led to greater improvements in stress and uncompassionate self-responding. Reliable and Significant Change analysis showed that some participants improved significantly (in psychopathological symptoms, valued living and uncompassionate self-responding) in both conditions, while the majority did not change significantly. Conclusions More research is needed to conclude whether explicit self-compassion exercises are useful in ACT for CP. Limitations and implications are further discussed.

The aim of this cross-sectional study was to use an extended common sense model (CSM) to evaluate the impact of fear of COVID-19 on quality of life (QoL) in an international inflammatory bowel disease cohort. An online study involving 319 adults (75% female, mean (SD) 14.06 (15.57) years of symptoms) completed the Gastrointestinal Symptom Rating Scale, Brief Illness Perceptions Questionnaire, Fear of Contracting COVID-19 Scale, Brief-COPE, Depression, Anxiety and Stress Scale, and the EUROHIS-QOL. The extended CSM had an excellent fit (χ

Considering that self-criticism is an important process in the development and maintenance of depression, and taking into account the stigma associated with inflammatory bowel disease (IBD), the present study aimed to analyse whether self-criticism exacerbates the relationships of depression symptoms with IBD symptomatology and chronic illness-related shame. The sample included 53 ambulatory IBD patients (66% females) with ages from 18 to 65. Moderation analyses were conducted using structural equation modelling. Self-criticism exacerbated the associations of depression with IBD symptoms (b = 0.01; standard error [SE] = 0.00; Z = 3.73; P < .001) and illness shame (b = 0.02; SE = 0.01; Z = 2.40; P = .016). For the same level of IBD symptomatology or chronic illness-related shame, those individuals who present more feelings of inadequacy towards the self, experience more symptoms of depression. This exacerbation effect is stronger when IBD symptomatology and chronic illness-related shame are more intense. A high self-critical IBD patient may view the illness and/or symptomatology as a flaw or error that should be self-corrected. Physicians and other health professionals should be attentive to these pathological mechanisms and should attempt to alleviate them. It may be beneficial to refer high self-critical patients to psychological care.

An extensive body of research has showed the impact of major life events on depressive symptoms. However, the underlying psychological processes that contribute to this association are still unclear. The present study aims to explore the mediating role of external shame and fears of receiving compassion on the associations of the number of major life events and their appraisals by the individual with depressive symptoms. Participants were 400 Portuguese-speaking adults from the general population (121 men and 279 women) with ages between 18 and 65 years, that completed self-report measures. Correlation analysis showed significant and positive associations between the number of major life events that occurred in the previous year and the positive and negative appraisal of such events, external shame, fears of receiving compassion, and depressive symptoms. Path analysis revealed that external shame and fears of receiving compassion fully mediated the effects of number of life events on depressive symptoms. Furthermore, results showed a direct effect of negative appraisal of major life events on depressive symptoms. This study sheds light on the psychological processes that may underlie the relationship between the cumulative number of major life events and depressive symptoms. Specifically, it suggests that the occurrence of major life events can impact on depressive symptoms when associated with feelings of shame and fears of receiving compassion from others.

This study aimed to explore, through structural equation modelling, experiential avoidance and committed action’s effects on the association between anxiety and psychological quality of life and whether this relationship presents significant differences across a sample of 115 college students with chronic illness and a sample of 232 students without illness. Students with chronic illness presented higher levels of anxiety and experiential avoidance and lower levels of quality of life. The association between anxiety and psychological quality of life was partially explained by experiential avoidance and committed action. This path model was shown to be invariant between the two groups of students.

This study aims to (a) explore individual differences in women with chronic pain (CP) in regard to pain intensity, functional impairment, cognitive fusion, and depressive symptoms and (b) longitudinally test whether cognitive fusion is a significant predictor of depression symptoms, while controlling for pain intensity and functional impairment, over a 12-month period. This study follows a longitudinal design and was conducted in a sample of 86 women with CP who responded to an online battery of questionnaires in three equally spaced assessment moments. In order to explore the growth trajectory of variables of interest, latent growth curve models were examined. Also, correlation analyses were conducted between demographic and illness-related variables and depressive symptoms, as well as between all variables in all assessment moments. Cognitive fusion and functional impairment (but not pain intensity) were significantly associated with baseline levels of depressive symptoms. Cognitive fusion significantly predicted the growth trajectory of depressive symptoms, whereas pain intensity and functional impairment did not. No demographic (age, marital status, education, socio-economic) nor illness-related variables (number of CP diagnoses, duration of CP, taking medication) were associated with depressive symptoms at any point. These results suggest that the trajectory of depressive symptoms in women with CP is not predicted by the intensity of pain nor pain-related functional impairment, but rather by the tendency to get entangled with internal experiences (e.g., thoughts, emotions, and physical sensations), which may or may not be related to pain-specific contents. Clinical implications are discussed.

Research has questioned whether it is feasible to assess psychosocial variables through web-based recruitment methods. Previous literature on IBD focused exclusively on testing differences on psychosocial scores and did not test the invariance between types of recruitment on the relationships between variables. The aim of the present study is thus to analyse structural invariance between internet-recruited and hospital-recruited groups of IBD patients on a mediation model with theoretical basis on previous studies (experiential avoidance as possible mediator of the association between IBD symptomatology and psychopathology). The internet sample included 137 IBD patients recruited through a patients association, and the hospital sample comprised 66 IBD patients. Structural equation modelling was used; a multiple-group comparison was conducted to examine model invariance between samples. Although the internet sample presented higher levels of experiential avoidance and psychopathological symptoms compared to the hospital sample, the relationships between these variables were invariant across groups. Experiential avoidance partially mediated the impact of IBD symptomatology on levels of stress, anxiety, and depression symptoms in a similar way for online respondents and hospital-recruited patients. This is a new finding that argues for the validity of web-based research methods.

Metalloproteins play key roles across biology, and knowledge of their structure is essential to understand their physiological role. For those metalloproteins containing paramagnetic states, the enhanced relaxation caused by the unpaired electrons often makes signal detection unfeasible near the metal center, precluding adequate structural characterization right where it is more biochemically relevant. Here, we report a protein structure determination by NMR where two different sets of restraints, one containing Nuclear Overhauser Enhancements (NOEs) and another containing Paramagnetic Relaxation Enhancements (PREs), are used separately and eventually together. The protein PioC from Rhodopseudomonas palustris TIE-1 is a High Potential Iron-Sulfur Protein (HiPIP) where the [4Fe-4S] cluster is paramagnetic in both oxidation states at room temperature providing the source of PREs used as alternative distance restraints. Comparison of the family of structures obtained using NOEs only, PREs only, and the combination of both reveals that the pairwise root-mean-square deviation (RMSD) between them is similar and comparable with the precision within each family. This demonstrates that, under favorable conditions in terms of protein size and paramagnetic effects, PREs can efficiently complement and eventually replace NOEs for the structural characterization of small paramagnetic metalloproteins and de novo-designed metalloproteins by NMR. DATABASES: The 20 conformers with the lowest target function constituting the final family obtained using the full set of NMR restraints were deposited to the Protein Data Bank (PDB ID: 6XYV). The 20 conformers with the lowest target function obtained using NOEs only (PDB ID: 7A58) and PREs only (PDB ID: 7A4L) were also deposited to the Protein Data Bank. The chemical shift assignments were deposited to the BMRB (code 34487).

Health applications have increasingly been used to improve physical, mental and social well-being. Chronic pain (CP) is defined as pain that lasts for a period of three months and causes sporadic or constant discomfort. In Portugal, the treatments for this type of pain are almost exclusively pharmacological and with known limited effects. Endowing patients with self-management skills, will help them cope with pain in a more effective way. Psychological treatments (e.g. mindfulness-based interventions) may play a relevant role here, because they intervene on a cognitive, emotional and behavioural level, which in turn helps the chronic pain patient to deal with pain-related disorders and suffering. The current availability of connected and powerful smartphones and tablets creates an opportunity to propose alternative pain management solutions that may be used immediately when pain appears, which has been the argument that favoured the pharmacological solutions. For this we propose a mobile application that guides patients on the mindfulness practice and to self-manage the sensed pain. Learning to gradually adequate pain management may have several advantages such as: reduced the number of consultation visits and consequent waiting lists; increased cost-effectiveness; self-management of chronic pain at the patient’s pace and according to their needs; extend access to the treatment to patients that reside in low density regions. Being an alternative to traditional treatment, the proposed treatment will be under the guidance of qualified health professionals that will supervise treatment sessions and perform the required assessments. By promoting patients’ self-management, the control and monitoring of the chronic pain condition is expected to improve greatly, which in turn may prevent the aggravation of the clinical condition. This research and the mobile application are being developed in a collaboration between the Centre for Research in Neuropsychology and Cognitive Behavioral Intervention of the University of Coimbra and the Institute of Systems and Robotics.

Nuclear magnetic resonance (NMR) spectroscopy is a key technique for the structural and functional characterization of biological molecules. This chapter introduces the reader to the basics of the technique and progresses to specific features that originate from the presence of metals and their unpaired electrons in the molecules to be analyzed. This is done in a gradual fashion to accompany the demands of characterizing increasingly complex molecules. A few strategies to illustrate how paramagnetic molecules can be studied experimentally are presented. The description of NMR spectroscopy made here is targeted towards students or researchers unfamiliar with NMR and interested in the applications of the technique relevant for biomolecular work involving metalloproteins or interactions between proteins and metal ions.

Literature has emphasized the significant role of social acceptance and connectedness in well-being and the benefits of cultivating a positive body image in the prevention and treatment of body and eating-related difficulties. The current study aims to examine whether strategies of self-reassurance and body-image appreciation mediate the association of feelings of social safeness and acceptance with the “core” dimensions of body and eating-related psychopathology (restraint, eating concern, weight concern, and shape concern), while controlling the effects of body mass index (BMI). Participants were 309 Portuguese women, aged between 18 and 50 years that completed self-report measures. Results from the performed path analysis revealed that self-reassurance and body-image appreciation mediated the impact of feelings of social safeness and acceptance on eating psychopathology-related dimensions. Results seem to suggest that women who perceive the self as acceptable and desirable tend to adopt self-reassurance strategies. These strategies in turn seem to predict a protective and caring relationship with one’s own body and decreased severity of eating psychopathology symptoms. This path model explained 22%, 27%, 51%, and 47% of restraint, eating concern, weight concern, and shape concern, respectively, and showed an excellent model fit. Our findings appear to offer significant insights in the field of body and eating-related psychopathology and seem to support the pertinence of creating intervention programs for women from the general community with body and eating-related difficulties that encourage the adoption of self-reassurance strategies and promote a positive and respectful relationship with one’s own body image. Level of evidence V, cross-sectional descriptive study.

The current study tested a path model examining the impact of fears of compassion in the adoption of disordered eating and whether social safeness and body shame would mediate this relationship. Participants were 645 women (aged between 18 and 55) from the general community, who completed an online survey. Results indicated that fears of compassion were negatively associated with one’s ability to feel secure and safe within close relationships, and positively linked with higher levels of body shame and disordered eating. The tested model accounted for 62% of the variance of disordered eating. Path analyses results revealed that the three dimensions of fears of compassion impacted on disordered eating. Particularly, fear of expressing compassion for others presented a direct impact on disordered eating. Moreover, fears of self-compassion and fears of receiving compassion from others partially impacted on disordered eating attitudes and behaviours, through the mechanisms of social safeness and body image-focused shame. These findings suggested that women who present higher levels of fear of self-compassion and of receiving signs of affection and compassion from others tend to feel more insecure in their social group, which seem explain body shame and the engagement in disordered eating behaviours. This study highlights the pathogenic impact of fears of compassion on body image and eating attitudes and behaviours. The current data seem to offer relevant insights for research and clinical practice, by supporting the relevance of developing compassionate abilities and attitudes to target body image and eating-related difficulties.

Body compassion is a new construct which incorporates two multidimensional concepts: body image and self-compassion. Self-compassion has been revealed as a protective mechanism against body image and eating-related-related disturbances, including eating disorders. However, the study of this compassionate competence specifically focused on the domain of the body is still largely unexplored. This study aims to test whether body compassion moderate the impact of external shame on body image shame and disordered eating, in a sample of 354 women from the Portuguese general population. Correlation analyses showed that body compassion was negatively associated with experiences of shame and disordered eating. Path analysis results demonstrated the existence of a moderator effect of body compassion on the relationship between general feelings of shame and both body image shame and related behaviours, and disordered eating symptomatology. In fact, results suggested that body compassion buffered the impact of general feelings of shame on these psychopathological indices, with the tested model accounting for 46% and 39% of the variance of body image shame and disordered eating, respectively. This study contributes to a better understanding of the role of body compassion in body image and eating difficulties. Body compassion seems to be an important protector of these difficulties in women by buffering the effects of general shame on body image shame and related body concealment behaviours, as well as disordered eating. The findings from this study thus appear to offer important research and clinical implications, supporting the relevance of promoting body compassion in prevention and treatment programs for body image difficulties and disordered eating.

This study explores the impact of illness-related shame on the quality of social relationships and psychological health in chronic patients. We aimed to examine the roles of fear of receiving compassion from others and experiential avoidance as potential mediators of this relationship. Although some studies have demonstrated the negative impact of chronic illness-related shame on psychological functioning, the mechanisms that may underlie this link remain understudied. The sample was comprised by 115 college students, which had been diagnosed with at least 1 chronic illness. Participants completed self-report measures on an online platform. This study's design was cross-sectional. A path analysis was conducted using structural equation modelling. Results showed that the impact of illness-related shame on both psychological health (R2 = .45) and the quality of social relationships (R2 = .33) was fully accounted by fear of compassion from others and experiential avoidance. This model revealed an excellent fit. Fear of receiving compassion from others was the main mediator of the illness-related shame link with the quality of social relationships (β = -.22). The main mediator of the association between shame-related chronic illness and psychological health was experiential avoidance (β = -.21).This study shed light on possible psychological mechanisms linking feelings of shame associated with having a chronic condition and impaired social relationships and mental health. On one hand, resisting feelings of compassion and care from others and, on the other hand, avoiding difficult internal experiences and situations that might trigger them seem to underlie the impact of shame on psychological and social functioning in chronic patients.

Objective To date, research with people with inflammatory bowel disease (IBD) has only examined how self-compassion is linked with stress, and have exclusively used cross-sectional designs. This study aims to examine the associations of self-compassion with depressive symptoms, anxiety, and stress in people with IBD over time. Methods Participants were 155 adults with IBD who completed the SCS and the DASS-21 at two different times, spaced 9 months apart. The study design is longitudinal: three separate hierarchical regression models were conducted to examine whether self-compassion at baseline predicted depressive symptoms, anxiety, and stress measured at follow-up, while controlling for the effects of baseline IBD symptomatology and the respective outcome. Results Participants who had IBD for a longer period of time presented higher levels of self-compassion. Self-compassion at baseline predicted lower follow-up levels of depressive symptoms (β = −0.17, p = 0.015), anxiety (β = −0.15, p = 0.032), and stress (β = −0.26, p = 0.001), even in the presence of baseline levels of IBD symptomatology and the outcome. Isolation (as opposed to common humanity) was the most relevant self-compassion component for explaining higher depression levels, while the mindfulness component was important for explaining lower anxiety and stress. Conclusions This study is the first to demonstrate the prospective effects of self-compassion on mental health indicators in IBD. Given these findings, and previous evidence on the high comorbidity of depression and anxiety and frequent self-report of illness shame and self-criticism in this population, compassion-based interventions may be particularly beneficial for improving well-being in people with IBD.

Objective This study thus aims to test differences between patients with inflammatory bowel disease (IBD) regarding IBD symptomatology, cognitive fusion, and psychological and physical health, as well as to explore whether the maladaptive emotion regulation process of cognitive fusion longitudinally impacts on the baseline and evolution of these outcomes over a period of 18 months. Design and methods Participants include 116 IBD patients with a mean age of 36.76 (SD = 11.39) of both genders (69.83% females) that completed the self-report measures of interest in three different times, equally spaced 9 months apart, over a period of 18 months. Latent growth curve models were conducted using structural equation modelling to estimate the growth trajectory of the variables in study. Results Inflammatory bowel disease symptomatology and cognitive fusion's levels were negatively associated with psychological health and physical health's baseline levels. Furthermore, IBD symptomatology did not influence the growth of psychological health, while cognitive fusion did (β = .30, p = .007). The same result was found for physical health (β = .26, p = .024). These findings indicate that individuals with higher levels of cognitive fusion present lower levels of psychological health and physical health that tend to further decrease over the time through the effects of this maladaptive emotion regulation process. Conclusions This study implies that it is of crucial importance to include psychotherapeutic interventions in the health care of patients with IBD. If successful, these interventions could represent decreases in the cost of IBD treatment and in the use of drugs with adverse side effects, in addition to improving patients’ mental health and quality of life. Further implications for clinical and research work are discussed. Statement of contribution What is already known on this subject? Research has demonstrated the impact of emotion regulation on both physical and mental health. Nevertheless, the longitudinal effects of the specific emotion regulation process of cognitive fusion on physical and psychological health have never been explored. Additionally, no study has yet examined the causal role of emotion regulation in evolution of physical health in inflammatory bowel disease (IBD). What does this study add? Cognitive fusion longitudinally impacted on IBD patients’ physical and mental health. These variables were measured over a period of 18 months. Treatment for IBD should include interventions aiming to diminish maladaptive emotion regulation.

This study presents the Inflexible Eating Questionnaire (IEQ), which measures the inflexible adherence to subjective eating rules. The scale's structure and psychometric properties were examined in distinct samples from the general population comprising both men and women. IEQ presented an 11-item one-dimensional structure, revealed high internal consistency, construct and temporal stability, and discriminated eating psychopathology cases from non-cases. The IEQ presented significant associations with dietary restraint, eating psychopathology, body image inflexibility, general psychopathology symptoms, and decreased intuitive eating. IEQ was a significant moderator on the association between dietary restraint and eating psychopathology symptoms. Findings suggested that the IEQ is a valid and useful instrument with potential implications for research on psychological inflexibility in disordered eating.

Feelings of social safeness and connectedness have been associated with adaptive emotion regulation processes and well-being indicators. Further, literature has demonstrated that interpersonal experiences play an important role in the etiology and maintenance of body and eating psychopathology. However, the study of the role of social variables and emotion regulation processes in the engagement in inflexible eating rules and eating psychopathology is still in its early stages. The current study aims to fill some gaps within the literature and explore the mediator role of body appreciation and inflexible eating rules in the link between social safeness and disordered eating. Participants were 253 women, aged between 18 and 50 years old, who completed a series of online self-report measures. Results from the tested path analysis model showed that social safeness holds a significant effect on eating psychopathology, through the mechanisms of body appreciation and inflexible eating rules. Also, results suggested that women who present higher levels of social safeness tend to present a more positive and respectful attitude towards their body and decreased adoption of inflexible eating rules, which seem to explain lower levels of disordered eating behaviours. These findings seem to present empirical support for the development of intervention programs that promote a positive, affectionate and healthy relationship with one's body image, in order to prevent the inflexible adherence to eating rules and disordered eating behaviours.