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The study aimed to analyze the longitudinal change in mental health during the third wave of COVID-19 infections in Spain. Negative (e.g., emotional distress) and positive (e.g., positive functioning variables) outcomes were analyzed. Protective factors (e.g., resilience) as predictors of psychological adjustment (i.e., positive mental health, openness to the future, and low burden due to COVID-19) after ten months of the pandemic were also examined. The sample consisted of 164 participants, and self-reported questionnaires were administered at the beginning of the lockdown (March 2020), at the end of the lockdown (June 2020), and during the third wave (January 2021). Linear mixed models showed that individuals’ emotional distress increased, and positive functioning variables (i.e., meaning in life, gratitude, resilience, and life satisfaction) decreased over time, but an increase was observed in some dimensions of posttraumatic growth. Regression analyses showed that resilience scores at all three data collection time points were significant predictors of positive mental health, openness to the future, and burden during the third wave. Mediation analyses showed that positive mental health and openness to the future were mediators of the effect of resilience on burden. The prolonged situation of the COVID-19 crisis had an important impact on positive and negative mental health. However, resilience may help to build up resources that can act as a buffer against adverse psychological effects.

The prevalence of mental disorders continues to increase, especially with the advent of the COVID-19 pandemic. Although we have evidence-based psychological treatments to address these conditions, most people encounter some barriers to receiving this help (e.g., stigma, geographical or time limitations). Digital mental health interventions (e.g., Internet-based interventions, smartphone apps, mixed realities -virtual and augmented reality) provide an opportunity to improve accessibility to these treatments. This article summarizes the main contributions of the different types of digital mental health solutions. It analyzes their limitations (e.g., drop-out rates, lack of engagement, lack of personalization, lack of cultural adaptations) and showcases the latest sophisticated and innovative technological advances under the umbrella of precision medicine (e.g., digital phenotyping, chatbots, or conversational agents). Finally, future challenges related to the need for real world implementation of these interventions, the use of predictive methodology, and hybrid models of care in clinical practice, among others, are discussed.

‘Living Better’, a self-administered web-based intervention, designed to facilitate lifestyle changes, has already shown positive short and medium-term health benefits in patients with an obesity-hypertension phenotype. The objectives of this study were: (1) to examine the long-term (3-year) evolution of a group of hypertensive overweight or obese patients who had already followed the ‘Living Better’ program; (2) to analyse the effects of completing this program a second time (reintervention) during the COVID-19 pandemic. A quasi-experimental uncontrolled design was used. We recruited 29 individuals from the 105 who had participated in our first study. We assessed and compared their systolic and diastolic blood pressure (SBP and DBP, respectively), Body Mass Index (BMI), eating behavior, and physical activity levels (METs-min/week) at Time 0 (follow-up 12 months after the first intervention), Time 1 (before the reintervention), and Time 2 (post-reintervention). Our results showed significant improvements between Time 1 and Time 2 in terms of SBP [−4.7 (−8.7 to −0.7); P=.017], DBP [−3.5 (−6.2 to −0.8); P=.009], BMI [−0.7 (−1.0 to −0.4); PP=.012], external eating [−1.1 (−2.1 to −0.1); P=.039], and physical activity levels (Time 1: 2308±2266; Time 2: 3203±3314; P=.030, Z=-2,17). Statistical analysis showed no significant differences in SPB, DBP, BMI, and eating behavior between Time 0 and Time 1 (P>.24). Implementation of the ‘Living Better’ program maintained some positive long-term (3-year) health benefits in patients with an obesity-hypertension phenotype. Moreover, a reintervention with this same program during the ongoing COVID-19 pandemic produced significant improvements in blood pressure, BMI, eating behavior, and physical activity levels beyond the 3-year follow-up.Trial Registration: ClinicalTrials.gov NCT04571450; https://clinicaltrials.gov/ct2/show/NCT04571450; First Posted: 01/10/2020.

Recently, the prevalence of childhood obesity has increased alar- mingly. Interventions combining eating habits, physical activity (PA), behavioral components, and family support have been shown to be effective, although variables such as self-efficacy beliefs and motivation seem to be important in achieving stable changes. Information and communication technologies (ICTs) can provide additional resources to traditional treatments. The objective is to analyze the efficacy of two treatments: a cognitive and behavioral treatment (CBT) focused on the promotion of healthy eating and PA habits, and this CBT intervention supported by a web platform (ETIOBE). Forty-seven obese children were randomized to these two conditions. Anthropometrical measures were evaluated before and after treatment and at follow-up. Self-efficacy and motivation ques- tionnaires werefilled out in thefirst and last intervention sessions. Mixed ANOVAs were performed for all variables. Simple mediation analyses were conducted to test whether the effect of condition on the post-intervention anthropometrical variable scores were mediated by self-efficacy. Results revealed that both treatments produced an improvement in the anthropometrical variables. CBT-E participants showed more PA self-efficacy as the treatment pro- gressed and lower BMIz, lower fat mass, and higher lean mass. These results suggest that ICT help to improve the effects of child- hood obesity interventions.

Background: Therapeutic alliance (TA) between the patient and therapist has been related to positive therapeutic outcomes. Because Internet-based interventions are increasingly being implemented, a tool is needed to measure the TA with Internet-based self-guided programs. The Working Alliance Inventory for online interventions (WAI-TECH-SF) was adapted based on the WAI Short Form (Hatcher &amp, Gillaspy, 2006). The objectives of this study were: (1) to analyse the psychometric properties of the WAI-TECH-SF, (2) to explore the differences in the WAI-TECH-SF scores according to different categories of the sample, and (3) to analyse whether the WAI-TECH-SF can predict therapeutic outcomes and satisfaction with the treatment. Methods: 193 patients diagnosed with depression were included and received blended Cognitive-Behavioural Therapy. Measures of preferences, satisfaction, and credibility about the treatment, TA with the online program, depressive symptoms, and satisfaction with the treatment were administered. Results: An exploratory factor analysis revealed a one-dimensional structure with adequate internal consistency. Linear regression analyses showed that the WAI-TECH-SF predicted changes in depressive symptoms and satisfaction with the treatment. Conclusions: WAI-TECH-SF is a reliable questionnaire to assess the TA between the patient and the online program, which is associated with positive therapeutic outcomes and satisfaction with the treatment.

Background: A large number of low-intensity Internet-based interventions (IBIs) for the treatment of depression have emerged in Primary Care, most of them focused on decreasing negative emotions. However, recent studies have highlighted the importance of addressing positive affect (PA) as well. This study is a secondary analysis of a randomized control trial. We examine the role of an IBI focused on promoting PA in patients with depression in Primary Care (PC). The specific objectives were to explore the profile of the patients who benefit the most and to analyze the change mechanisms that predict a significantly greater improvement in positive functioning measures. Methods: 56 patients were included. Measures of depression, affect, well-being, health-related quality of life, and health status were administered. Results: Participants who benefited the most were those who had lower incomes and education levels and worse mental health scores and well-being at baseline (7.9%&ndash, 39.5% of explained variance). Improvements in depression severity and PA were significant predictors of long-term change in well-being, F (3,55) = 17.78, p &lt, 0.001, R2 = 47.8%. Conclusions: This study highlights the importance of implementing IBIs in PC and the relevance of PA as a key target in Major Depressive Disorder treatment.

espanolEl concepto de regulacion emocional (RE) se refiere a la habilidad para percibir, asimilar, comprender y regular las propias emociones. Pese a que la RE se entiende como un proceso eminentemente adaptativo, los esfuerzos por modificar los estados emocionales pueden ser ineficaces e incluso contraproducentes, y formar parte de la vulnerabilidad y sintomatologia de diversos trastornos mentales. Muchas investigaciones han senalado la adolescencia como el periodo de desarrollo mas importante para la adquisicion de esta habilidad. Dada su importancia, es esencial contar con buenos instrumentos de evaluacion. El objetivo del presente estudio es determinar las propiedades psicometricas del “Cuestionario de Regulacion Emocional” (ERQ-CA) en adolescentes espanoles. Para ello, 399 participantes (178 hombres y 221 mujeres), con una media de edad de 15.27 cumplimentaron los cuestionarios ERQ-CA y el de “Dificultades en la Regulacion Emocional” (DERS). Posteriormente, se realizo el analisis factorial exploratorio, consistencia interna y validez convergente. Los resultados revelaron que el analisis factorial mostro una estructura de dos factores, la consistencia interna para las subescalas del ERQ-CA mostro niveles muy bajos en comparacion con valores obtenidos con adultos y en cuanto a la validez convergente, apenas hubo correlacion entre ambos instrumentos. El ERQ-CA muestra niveles bajos de fiabilidad en poblacion adolescente espanola, por lo que se necesita mas investigacion para confirmar la conveniencia o no de su uso en esta poblacion. EnglishPsychometric validation of the emotional regulation questionnaire (ERQ-CA) in adolescent population. The concept of emotion regulation (ER) refers to the ability to perceive, assimilate, understand, and regulate emotions. Although ER is an eminently adaptive process, efforts to modify emotional states can be ineffective and even counterproductive and be part of the vulnerability and the symptoms of various mental disorders. Many research has pointed to adolescence as the most important developmental period for the acquisition of this skill. Given its importance, it is essential to have good assessment tools. The aim of this study was to determinate the psychometric properties of the “Emotion Regulation Questionnaire” (ERQ-CA) in Spanish adolescents. For this, 399 participants (178 boys and 221 girls) with a mean age of 15.27 completed the questionnaires ERQCA and “Difficulties in Emotion Regulation Scale” (DERS). Subsequently, the exploratory factor analysis, internal consistency and convergent validity analysis was performed. The results revealed that the factorial analysis showed a two-factor structure, the internal consistency for the subscales was not acceptable compared to values obtained in validations with adults and as for the convergent validity, correlation between the two instruments was small. The ERQ-CA shows low levels of reliability in adolescent population. For this reason, more research is needed to confirm the use of the questionnaire in this population.

Self-critical rumination is a negative and repetitive self-thinking process related to different disorders and negative psychological outcomes such as emotion dysregulation. The objectives of this study are twofold: (a) to examine the factor structure of the Spanish version of the Self-Critical Rumination Scale (SCRS), providing further evidence on its construct validity, and (b), to explore the mediator role of self-critical rumination between emotion dysregulation and psychopathology. A sample of 431 Spanish participants were recruited and completed online questionnaires. Confirmatory factor analysis, mediation analysis, and Pearson's correlations were conducted. A single factor structure was confirmed, and the SCRS showed good psychometric properties (Cronbach's alpha was 0.911). Significant correlations were found between the SCRS and related constructs (self-criticism, self-compassion, difficulties in emotion regulation, and psychopathology). Mediation analysis indicated that self-critical rumination plays a mediator role between emotion dysregulation and psychopathology. These results provide further evidence of the construct validity of the SCRS and extend our understanding of the mechanisms that underlie the relationship between emotion dysregulation and psychopathology. These findings have key clinical implications suggesting that ruminative self-criticism could be potentially considered a transdiagnostic factor and a relevant target in the therapeutic process.

BACKGROUND Given the rise of internet-based treatments as an effective therapeutic tool for psychological disorders, it is necessary to carry out research that examines clients’ experiences with this type of intervention. The qualitative methodology has been found to be useful for analyzing clients’ perceptions in terms of facilitators and barriers, acceptability, and negative effects of internet-based treatments. However, a lack of integration of these primary studies has prevented their findings from being applied to new research and in clinical practice. OBJECTIVE The objective of this paper is to describe the protocol for a metasynthesis of qualitative studies exploring the experiences of clients who underwent an internet-based treatment. METHODS Elliot and Timulak’s metasynthesis approach will be used to review and synthesize qualitative studies related to client experiences in terms of the barriers and facilitators they perceived when undergoing internet-based treatment. For each search string, the features in the Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) tool will be considered. Electronic databases (PubMed, PsycINFO, and Web of Science) will be searched. Two independent reviewers will analyze the material in order to determine whether the eligibility criteria are fulfilled. Findings will make it possible to create a hierarchy of domains in terms of their relevance across all the primary studies. The data obtained from primary studies will be cross-analyzed using descriptive and interpretative procedures. RESULTS The search strategy is currently being conducted. First results are expected to be submitted for publication in 2019. CONCLUSIONS We will develop conceptual framework of the barriers and facilitators perceived by clients and propose their implications and recommendations for clinical practice, research, and training. CLINICALTRIAL PROSPERO CRD42018079894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79894 (Archived by WebCite at http://www.webcitation.org/73C6OtlS7). INTERNATIONAL REGISTERED REPOR PRR1-10.2196/9722