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Background: Action mechanisms of therapeutic alliance in stepped and digital interventions remain unclear., Aims: (a) To compare the development of therapeutic alliance between psychosocial treatment as usual (PTAU) and a stepped digital intervention designed to prevent distress in cancer patients; (b) to analyse the level of agreement between patients' and therapists' therapeutic alliance ratings; and (c) to explore variables associated with therapeutic alliance in the digital intervention., Method: A multicentre randomised controlled trial with 184 newly diagnosed breast cancer women was conducted. Patients were assigned to digital intervention or PTAU. Therapeutic alliance was assessed at 3, 6 and 12 months after inclusion using the working alliance inventory for patients and therapists. Age, usability (system usability scale), satisfaction (visual analogue scale), type and amount of patient-therapist communication were analysed as associated variables., Results: Patients and therapists established high therapeutic alliance in the digital intervention, although significantly lower compared with PTAU. The development of patients' therapeutic alliance did not differ between interventions, unlike that of the therapists. No agreement was found between patients' and therapists' therapeutic alliance ratings. Patients' therapeutic alliance was associated with usability and satisfaction with app, whereas therapists' therapeutic alliance was associated with satisfaction with monitoring platform., Conclusions: A stepped digital intervention for cancer patients could develop and maintain strong therapeutic alliance. Neither the type nor amount of communication affected patients' therapeutic alliance, suggesting that flexible and available digital communication fosters a sense of care and connection. The association between usability and satisfaction with digital tools highlights their importance as key therapeutic alliance components in digital settings.

Based on the repertory grid technique, we developed Explore Your Meanings (EYME), a digital platform that helps patients explore identity values and internal conflicts using virtual reality (VR). EYME was part of a research project treating depression in young adults, including 10 weekly, 1-h sessions aimed at changing personal constructs-cognitive schemas that shape how individuals interpret reality. We present the case of Mary, a 21-year-old woman diagnosed with persistent major depressive disorder and social phobia. Early sessions with EYME revealed key implicit dilemmas in Mary's worldview, such as feeling that she had to be selfish (an undesired personal characteristic) to become smarter and more self-confident (desired pole). As Mary visualized these constructs in VR, she began to recognize her identity conflicts and strengths, ultimately helping her to improve her negative self-image. Interventions focused on reframing these constructs, particularly around "intelligence" and introducing "emotional intelligence," which helped Mary adopt a more nuanced view of herself. A key session involved a two-chair dialog between her "critical" and "emotional" selves, facilitating the integration of polarized aspects of her personality. In subsequent sessions, EYME reinforced these changes, with Mary reinterpreting behaviors like being "selective" as protective rather than negative. By the end of therapy, she no longer met the criteria for depression or social phobia, and her psychological distress had normalized., (© 2025 Wiley Periodicals LLC.)

Virtual environments like online videogames offer increasingly more people the opportunity to socialize purely within the digital plane. These interactions, often done through customizable avatars, have brought about the concept of the "virtual-self," understood as the multiple identities that can be expressed in virtual environments. This can take many forms and fulfill different psychological roles, from portraying the individual's ideal-self to allowing them to explore what it feels like to be someone completely different. In this study, we used a constructivist perspective to put forward a typology of the different ways in which players construe their virtual identities in online videogames. We administered the repertory grid technique to 202 online videogame players to measure their perceived discrepancies between their actual-self (how they see themselves), ideal-self (how they wish to be), and virtual-self (how they see their main character in a game of their choice). After conducting a cluster analysis, we found three main patterns of virtual-self construal. The projection-type, where players with a high actual-ideal discrepancy created a virtual character resembling their ideal-self; the exploration-type, where players with a lower actual-ideal discrepancy tended to create a character that was different from both their actual and ideal selves; and the proximal-type, where players created characters that were similar to their actual-self. This typology can be a useful resource for any videogame research that wishes to include an identity perspective, as well as in the diagnosis and treatment of internet gaming disorder.

Introduction: The overvaluation of weight and shape is a diagnostic criterion in eating disorders, except in binge eating disorder (BED), where it has received less attention. This aspect is also not usually analyzed in people with overweight or obesity without an eating disorder. This research aims to identify the indicators of symptomatology, as well as those of self-construction and cognitive structure, that are associated with overvaluation in obesity, either alone or in conjunction with BED., Method: A sample of 102 overweight or obese participants was accessed. The sample was divided into four groups: one without overvaluation or BED ( n  = 33); a second with overvaluation and without BED ( n  = 21); a third with BED, but without overvaluation ( n  = 15), and a fourth with BED and overvaluation ( n  = 33). The groups completed instruments regarding eating symptomatology, anxiety, depression, and stress. In addition, they were administered the Repertory Grid Technique, a semi-structured interview to evaluate the cognitive structure involved in the construal of the self and others., Results: The factors of overvaluation and the presence of BED independently explained eating symptomatology, and the latter also showed a tendency to influence anxiety, depression, and stress. In terms of cognitive structure, weight polarization was explained by overvaluation, while BED was associated with a high presence of cognitive conflicts. In self-construction, BED was the factor that explained the differences, particularly in Self-Ideal discrepancy., Discussion: The results highlight the importance of overvaluation in obesity, even in the absence of BED. Its evaluation and treatment are recommended. Furthermore, in the case of BED, it is also advisable to evaluate the overvaluation of weight and shape since it can be a severity specifier., Competing Interests: AG was employed by ITA Salud Mental, Clariane. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Escandón-Nagel, Peró-Cebollero, Grau, Soriano and Feixas.)

There has been increasing interest in the study of new pathogenic mechanisms in endometriosis (END), including the coagulation/fibrinolysis system and its link with inflammation and tissue remodeling. It has been suggested that END patients, especially with deep-infiltrating (DE) forms, could present a hypercoagulable state revealing higher levels of proinflammatory and procoagulant markers, such as total circulating microparticles (cMPs) and cMP-TF (tissue factor), released by cells in response to damage, activation, or apoptosis. However, no previous study has assessed the effect of END hormonal treatments on cMP and cMP-TF levels. Therefore, the aim of this study was to evaluate the impact of these treatments on cMP and cMP-TF levels in DE patients. Three groups were compared: DE patients receiving a continuous combined oral contraceptive regimen (CCOCR) (n = 41), DE patients without CCOCR (n = 45), and a control group (n = 43). cMP and cMP-TF levels were evaluated in platelet-free plasma. A significant decrease in the total cMP levels was found in the DE group with CCOCR versus the group without CCOCR, reflecting a higher chronic inflammatory status in DE patients that decreased with the treatment. cMP-TF levels were higher in DE patients receiving CCOCR versus those not receiving CCOCR, suggesting that treatments containing estrogens play a predominant role in suppressing the inhibitory pathway of TF.

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

Interpersonal perceptions have an impact on the quality of couple relationships but we want to examine the putative moderating role of gender considering personal meanings as the target of perception. We employed the Couple's Grid to measure interpersonal perception based on personal constructs and the Actor-Partner Interdependence Model (pooled regression) to analyze the mutual effects of partners' observations. We explore the dyadic effects of seven variables of interpersonal perception on relationship quality in a sample of 26 Spanish opposite-sex couples. Idealization of the partner was associated with one's own and partner's relationship quality (actor and partner effects), while being accurate in the perception of the partner's self-image was positively related to men's relationship quality but negatively related to women's (actor effects). The findings stimulate the existing debate regarding the benefits of being accurate or biased in a relationship and the need to take into account gender differences for guiding therapeutic interventions., (© 2023 The Authors. Journal of Marital and Family Therapy published by Wiley Periodicals LLC on behalf of American Association for Marriage and Family Therapy.)

Background: Vaccination can have an impact on menstruation, and this impact may be more notable in women with inflammatory gynecological pathologies such as endometriosis., Objectives: We aimed to investigate the impact of mRNA-based SARS-CoV-2 vaccines on menstrual cycle-related symptoms in women with endometriosis and assess the effect of hormonal therapy on potential SARS-CoV-2 vaccination-induced menstrual changes., Design: A total of 848 women who received at least two doses of mRNA-based COVID-19 vaccines were prospectively recruited: 407 with endometriosis (endometriosis group) and 441 healthy controls (non-endometriosis group)., Methods: Data regarding demographics, clinical characteristics, hormonal treatment, and menstrual-associated symptoms in the first and second cycle after vaccination were collected through an online survey., Results: A similar percentage of patients in both the endometriosis and the non-endometriosis group self-reported menstrual-associated changes the first (52.6% versus 48.8%, respectively) and second cycle after vaccination (29.0% versus 28.1%, respectively). Although the total symptoms recorded were not different between the two groups, several specific symptoms were statistically more frequent in the endometriosis group. These were pain disorders and fatigue in the first cycle after vaccination and pain disorders, menstrual headache and fatigue in the second cycle after vaccination. Bleeding frequency/regularity disorders were found to be more frequent in the non-endometriosis group in the first cycle after vaccination. Patients under hormonal treatment reported fewer changes in menstrual symptoms in the first and second cycle after vaccination compared with those not receiving this treatment. Similarly, patients in the endometriosis group receiving hormonal treatment reported fewer changes in menstrual-associated symptoms compared with those not following any hormonal treatment in the first and second menstrual cycle after the last vaccination., Conclusion: Women with endometriosis immunized with mRNA-based SARS-CoV-2 vaccines did not perceive greater worsening or new menstrual-associated symptoms after complete COVID-19 vaccination compared with healthy controls. Hormonal treatment may have a protective effect against worsened or new menstrual symptoms induced by COVID-19 vaccination.

Background/objective: Fibromyalgia is a chronic pain syndrome that depressive symptoms can aggravate. The aim of the present study was to test the efficacy of Personal Construct Therapy (PCT), an approach that emphasizes identity features and interpersonal meanings as the focus of the treatment of depressive symptoms, in women with fibromyalgia., Method: We compared PCT with Cognitive Behavioral Therapy (CBT) in a multicenter parallel randomized trial. Women with fibromyalgia and depressive symptoms ( n  = 106) were randomly allocated to CBT ( n  = 55) or PCT ( n  = 51) in individual and modular formats to adjust to their needs. Analysis was by linear mixed-effects models., Results: Participants in both conditions had significantly reduced depressive symptoms, and we found no significant difference when comparing groups both post-treatment (β = -0.47, t  = -0.49, p  = .63) and at follow-up (β = -1.12, t  = -1.09, p  = .28). Results were similar between conditions for anxiety, fibromyalgia's impact, and the distribution of clinically significant changes in depressive symptoms and pain., Conclusions: PCT and CBT seem to be equally effective in the treatment of depressive symptoms, making PCT a viable alternative treatment., (© 2022 The Author(s).)

Background: Endometriosis is a debilitating chronic inflammatory disease. The current SARS-COV2 pandemic has had an impact on the management of these patients. Tele-health care has been a relevant tool. The aim of this study was to analyze the impact of the SARS-COV2 pandemic on the perceived clinical health status and the type of care received in patients with endometriosis. Materials and Methods: We evaluated 945 premenopausal women treated at the Hospital Clinic of Barcelona between October 1 and December 31, 2020. Five hundred forty-nine women had endometriosis, and 396 had other benign gynecological diseases. An online health survey was sent to these patients. Clinicopathological features data were recorded. Results: Compared to patients with other benign gynecological diseases, a higher proportion of patients with endometriosis reported worsening of their symptoms (148/549, 27% vs. 85/396, 21.5%) and concern about their disease (515/549, 93.8% vs. 342/396, 86.4%), and more frequently received tele-health care (73.8% vs. 54.0%) during the pandemic. Patients with endometriosis and "significant" pelvic pain reported more concern and worsening than patients without "significant" pelvic pain, and evaluated the assistance received poorly. Multivariate analysis showed pelvic pain, limitation in usual activity, and sadness as risk factors of perception of disease worsening. Awaiting surgery and the feeling of sadness were risk factors of concern. Conclusions: Patients with endometriosis, and especially patients with "significant" pelvic pain, reported greater concern and the perception of worsening during the SARS-COV2 pandemic. Tele-health is a useful tool in patients with endometriosis, and face-to-face visit should be considered in those reporting "significant" pelvic pain. Clinical Trial Registration Number: HCB 1202011497.