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Published online: 07 Jun 2020, Portugal is one of the European countries that implemented early protective measures in the context of the COVID-19 pandemic. Portugal declared a state of emergency on 18 March, and a set of regional and national preventive public health measures was progressively implemented. Studies on the psychological impact of pandemics show evidence of the negative impact on mental health. Of particular concern are individuals with previous fragility (e.g. personal, family or occupational) and those undergoing life transitions. In this paper, we present a telephone-based psychological crisis intervention that was implemented to provide brief, appropriate, and timely psychological help. This intervention follows standard models of crisis intervention and is structured in five phases and five different intervention modules to take into account the impact of the pandemic on the mental health of specific risk groups. With these support services, we hope to help our community better cope with the immediate impact of the pandemic and to contribute to preventing serious mental health problems in the medium and long term., This study was partially conducted at the Psychology Research Centre (PSI/01662), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/01662/2019), through the national funds (PIDDAC). We acknowledge Associação de Psicologia da Universidade do Minho (APsi-UMinho) and APsiUMinho collaborators for supporting the telephone-based psychological crisis intervention: Ana Daniela Silva, Ana Isabel Gonçalves, Ana Rita Pereira, Andreia Milhazes, Ângela Ferreira, Alexandra Vieira, Célia Sampaio, Carina Magalhães, Cátia Braga, Delfina Fernandes, Dulce Lopes, Dulce Pinto, Inês Castro, Inês Marques, Gabriela Santana, Joana Andrade, Joana Coutinho, Joana Guimarães, Joana Soares, Joana Teixeira, Joana Torres, João Batista, João Tiago Oliveira, Mariana Leite, Marta Sousa, Patrícia Mendes, Sara Lima, Soraia Mesquita, Teresa Castanho. We would like to thanks P5 and affiliated Psychologists: Liliana Amorim, and Inês Fernandes. We gratefully acknowledge OutSystems for the financial support through OutSystems COVID-19 Community Response Program.

APOLO-Teens is a Facebook-based psychological intervention aiming to optimize hospital treatment for adolescents with overweight/obesity. The present qualitative study aims to explore (1) how adolescents experienced participation in APOLO-Teens and (2) how parents perceived adolescents' participation. Sixteen adolescent–parent dyads were interviewed by telephone using semistructured guides. An inductive approach of thematic analysis was used to analyze data by two independent codifiers. The consensus was used to resolve differences in coding/themes, and two independent auditors reviewed the codes and the themes proposed. We identified four themes from adolescents' interviews, namely, expectations, perception of outcomes, participation in the intervention, and sharing of acquired knowledge. From parents' interviews, we identified five themes: expectations for son/daughter participation, perception of adolescents' outcomes, son/daughter participation, parental role, and use of social networks in intervention programs for adolescents. Both elements of the dyad indicated that adolescents' participation in APOLO-Teens contributed to favorable outcomes, further highlighting the use of online interventions to complement the hospital treatment of adolescents with overweight/obesity. Future studies should address the viewpoints of adolescents and parents in the design of Facebook-based interventions, namely, to implement tailored, shorter, less time-demanding interventions that favor engagement between participants and parental involvement., Foundation for Science and Technology, Grant/Award Numbers: 2020.01538.CEECIND, 2020.07384.BD, PTDC/PSI-GER/28209/2017, SFRH/BD/146470/2019

Worry is a phenomenon that is present in multiple psychopathologies. Given the widely accepted transdiagnostic role that worry plays in psychopathology, reliable measures for this construct are pivotal for clinical practice. The Penn State Worry Questionnaire (PSWQ) is one of the most widely used and established measures of worry in both clinical and non-clinical populations and it is accepted as a highly reliable measure. The present study aimed to examine the factor structure and psychometric properties of the PSWQ for the Portuguese population. The total sample consisted of 428 participants, 256 from the community, and 172 from the clinical population. Confirmatory factor analysis supported a model of one factor with a method factor containing the negatively worded items., This study was conducted at the Psychology Research Centre (PSI/01662), School of Psychology, University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/01662/2019), through national funds (PIDDAC). Dr. Oliveira was also supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education, through national funds, within the scope of the Transitory Disposition of Decree No. 57/2016, of 29 August, amended by Law No. 57/2017 of 19 July. Dr. Machado was supported, in part, by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653); and by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (POCI-01-0145-FEDER-028145).

Sudden gains (SG) are large and rapid symptom improvements experienced by clients that are related to positive effects on the outcome. However, little is known about why SGs happen or what are the mechanisms that underlie them. Ambivalence towards change is a client's variable related to outcome that has not been previously studied in the context of SGs. The main purpose of this study was to explore the role of ambivalence in the context of SGs. The sample consisted of 68 outpatients suffering from depression and/or anxiety disorders. The clients were treated using a manualized treatment for emotional disorders at an outpatient university-based clinic. SGs were detected with the Outcome Questionnaire 10.2. A 20.6% of the participants experienced a SG, occurring more frequently in session eight. The SG group presented lower levels of ambivalence and psychological symptoms at the end of the treatment when compared with non-SGs. Multilevel analysis suggested that the trajectory of ambivalence tends to be steeper in the SG group. The results suggest that SGs are associated with ambivalence and reinforce the idea that ambivalence resolution is closely related to treatment success., This study was conducted at the Psychology Research Centre (PSI/01662), School of Psychology, University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (UID/PSI/01662/2019), through national funds (PIDDAC). Dr. Oliveira was also supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education, through national funds, within the scope of the Transitory Disposition of Decree No. 57/2016, of 29 August, amended by Law No. 57/2017 of 19 July. Dr. Machado was supported, in part, by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653); and by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education (POCI-01-0145-FEDER-028145).

Although the Therapeutic Communities (TCs) have been considered a useful drug addiction treatment resource, much remains to be understood about the process of change in this treatment. The TC residents’ perspectives on their change can contribute towards an understanding of this process of change. This study aims to describe residents’ perspectives on change through each of the three treatment phases. We used a longitudinal and prospective research design with 25 residents from the three treatment phases. All residents filled in the Helpful Aspects of Therapy sheet after their weekly therapies; those who ended the treatment phase were interviewed using the Change Interview. A total of 427 documents were analyzed using grounded theory data procedures. According to residents’ views, the study results suggest that their agency was the core factor in the change, while treatment tasks and healing relationships established the context for change. During each phase, contextual factors acquired particular features, with the common factor being conduciveness to action by the residents themselves. Such agency enabled the residents to appropriate treatment resources across three phases. By the end of the treatment, residents had made major changes to the way in which they relate to themselves and others and could envisage a new life in which drugs had no place. Based on the results of the study, we suggest that clinicians should monitor and support the agency of the residents. We also propose that further studies focus on residents’ perspectives about the events that limited their mobilization for change as agents., Psychology Research Centre (UID/PSI/01662/2013), University of Minho, and supported by the Portuguese Foundation for Science and Technology and the Portuguese Ministry of Science, Technology and Higher Education through national funds and co-financed by FEDER through COMPETE2020 under the PT2020 Partnership Agreement (POCI-01-0145-FEDER-007653), info:eu-repo/semantics/publishedVersion

This article explores the role of ambivalence in grief therapy within a narrative framework. From this perspective, change starts with the occurrence of innovative moments, which can be nullified by reaffirmation of the problematic self-narrative as a sign of ambivalence. This study analyzed ambivalence in six complicated grief cases using the “Return to the Problem Coding System.” Markers of ambivalence emerged in all cases, with a decreasing profile in cases with greater symptomatic improvement, suggesting an association between clinical change and ambivalence evolution in therapy. Addressing ambivalence may bring to light important aspects of client’s selfreconstruction after a major loss., Portuguese Foundation for Science and Technology, through the Grant PTDC/PSI-PCL/121525/2010 (Ambivalence and Unsuccessful Psychotherapy,2012–2015) and the PhD Grant SFRH/BD/48607/2008

With the present study we aimed to analyze the relationship between infants' behavior and their visual evoked-potential (VEPs) response. Specifically, we want to verify differences regarding the VEP response in sleeping and awake infants and if an association between VEP components, in both groups, with neurobehavioral outcome could be identified. To do so, thirty-two full-term and healthy infants, approximately 1-month of age, were assessed through a VEP unpatterned flashlight stimuli paradigm, offered in two different intensities, and were assessed using a neurobehavioral scale. However, only 18 infants have both assessments, and therefore, these is the total included in both analysis. Infants displayed a mature neurobehavioral outcome, expected for their age. We observed that P2 and N3 components were present in both sleeping and awake infants. Differences between intensities were found regarding the P2 amplitude, but only in awake infants. Regression analysis showed that N3 amplitude predicted an adequate social interactive and internal regulatory behavior in infants who were awake during the stimuli presentation. Taking into account that social orientation and regulatory behaviors are fundamental keys for social-like behavior in 1-month-old infants, this study provides an important approach for assessing physiological biomarkers (VEPs) and its relation with social behavior, very early in postnatal development. Moreover, we evidence the importance of the infant's state when studying differences regarding visual threshold processing and its association with behavioral outcome., We wouldlike to thank the families andinfants whoparticipated in this study. Also, we would like to thank Pedro Hispano Hospital, particularly to Dr. J. Lopes dos Santos, for all the kindness throughout the time that we were there for the data collection process. We thank to Maria de Góis-Eanes for all the help and knowledge entailed throughout this study. Furthermore, we thank Associac¸ ão Viver a Ciência for the Simbiontes prize in 2013. This work was supported by Fundac¸ ão Bial (grant number 42/08) and financed by Fundac¸ ão para a Ciência e Tecnologia (FCT) under a PhD grant (reference SFRH/BD/68263/2010).

Sex differences between men and women in social anxiety are largely unexplored. This study sought to shed some light on this topic. We administered self-report measures of social anxiety to community samples of 17,672 women and 13,440 men from 16 Latin American countries, Spain and Portugal, as well as to a clinical sample of 601 patients diagnosed with social anxiety disorder. Small but significant differences were found between men and women in the general degree of social anxiety and self-reported fears of interactions with the opposite sex, criticism and embarrassment, and speaking in public-talking to people in authority. These results point to small, but meaningful differences between men and women in social anxiety. Implications of these results for the self-report measurement of social anxiety in men and women are discussed.

Several studies have proposed that self-narrative transformation occurs through the elaboration of “Innovative Moments” (IMs), which are alternative experiences to the problematic self-narrative. This study aimed to analyze the emergence of IMs among 6 complicated grief women undergoing grief therapy according to the meaning reconstruction approach and to examine associations of IMs to the severity of grief symptomatology, assessed by the “Inventory of Complicated Grief.” Eighty-three sessions were analyzed using the “Innovative Moments Coding System” (IMCS). A generalized linear model analysis (GLM) showed a significant association between the emergence of IMs and the interaction between time and symptomatic improvement, indicating a higher rate of IM production over time in cases with better clinical outcomes. These results reinforce IMs' relevance in studying narrative change among cases with distinct clinical progressions.

Much has been written about the situations most often feared by persons with social phobia, and several self-report measures are frequently used to assess such feared situations. However, it is not clear whether the situations feared by persons with social phobia form unidimensional or multidimensional factors. If these situations are multidimensional, reliance on a total score of feared situations would not reflect important differences between those dimensions. This research examined the multidimensional nature and multicultural validity of a newly developed instrument (the Social Anxiety Questionnaire for Adults [SAQ-A]) in two studies with a total of 539 patients diagnosed with social phobia and 15,753 nonpatients from 20 different countries. The structure (five clear and solid factors) and psychometric properties of the final instrument (the SAQ-A30) support the multidimensional nature of social anxiety and provide a new perspective in the assessment of social phobia.

The relationship between war exposure and PTSD has been largely investigated but the impact of the combat experience on physical health has only recently merited attention. The authors investigated the relationship between war exposure, psychological and physical health among 350 Portuguese colonial war veterans. The role of current PTSD symptoms as a mediator of these relationships was also investigated. The results showed that 39% of the veterans met criteria for current PTSD diagnosis and psychological distress was present in half of the sample. Pain, fatigue and sleep problems were the most reported physical symptoms and mental health and gastro-intestinal problems, the most reported illnesses. Combat exposure variables were significant predictors of current health. The results indicated that veterans with higher exposure to war trauma maintained higher current levels of psychological distress and presented more physical health problems and physical symptoms than those less exposed. Mediation analyses showed that current PTSD was a full mediator of the relationship between war exposure and physical health outcomes., The authors wish to thank the Fundação para a Ciência e Tecnologia, grant POCTI (POCTI/ESP/39515/2000), for financing this project. The authors are also grateful for the collaboration of the Associação Portuguesa de Veteranos de Guerra and their aid with the data collection.

Emergency service workers continuously face situations where they are in charge of the lives of others, and this can be a risk factor for their mental health. This study aims to determine the psychological impact of exposure to current death and physical injury events in the context of motor vehicle accidents among emergency personnel and which variables better predict posttraumatic stress disorder. Participants were National Institute of Medical Emergency workers (nurses and medical doctors; n= 59) in the north of Portugal. They filled out a trauma exposure and posttraumatic stress disorder scale (PTSD), a scale that assesses distress (General Health Questionnaire 12), a peritraumatic dissociation scale (Peritraumatic Dissociative Experiences Questionnaire) and a coping scale (Ways of Coping Questionnaire). Participants reported high exposure to events evaluated as traumatic, but low prevalence of PTSD. When the relation between exposure, time in emergency, sex, distress symptoms, peritraumatic dissociation, and PTSD symptoms was examined, peritraumatic dissociation and distress were the only predictors of PTSD symptoms, but beyond their contribution direct coping explains PTSD variance. In conclusion, taking into account the contribution of distress and peritraumatic dissociation to predict psychopathological symptoms, and the contribution of coping to lower PTSD scores, education and training should help the professionals deal with these reactions and improve coping, and organizations should support professionals in the most disturbing situations.

Objectives: This study evaluated the development of the therapeutic alliance and the emergence of alliance ruptures, in a sample of patients with different diagnosis and different therapeutic outcome. Design: We examined the longitudinal data of 38 therapeutic dyads receiving cognitive-behavioural therapy, including dropouts as well as successful and unsuccessful cases. The sample included cases with Axis I and Axis II disorders. Method: At the end of each session, patients evaluated the alliance using the Working Alliance Inventory (WAI). Six judges trained in the observation of alliance rupture markers with an observational system of ruptures, rated 201 videotaped sessions. Longitudinal statistical models were applied to the data. Results: We found that the pattern of alliance development of successful cases was different from the unsuccessful and dropouts cases. In addition on average, patients with personality disorders began therapy with a lower WAI score that decreased over time, whereas patients with Axis-I disorders began therapy with a higher WAI score that increased over time

This paper explores the development of therapeutic collaboration in Person-Centered Therapy (PCT). It presents a good outcome case - "Mary" - selected from York I Depression Study, treated with PCT. The study examined how therapist and client worked together throughout the therapy, using the Therapeutic Collaboration Coding System (TCCS). The TCCS assumes that effective therapeutic collaboration occurs within the client's therapeutic zone of proximal development (TZPD), defined as the distance between the actual and the potential client's developmental level. It consists of a transcript-based method by which therapist's interventions and client's responses are analyzed on a moment-to moment basis. Two independent trained judges coded 15 sessions of this case, using the TCCS. Results showed that the therapeutic dyad worked most of the time within the client's TZPD, thus suggesting a collaborative pattern throughout the therapy process. In addition, the results showed that the client proactively interacted with the therapist, moving forward in her TZPD., (undefined)

This study compared two methods of detecting ruptures in therapy sessions, a procedure based on a self-report measure, the Working Alliance Inventory (WAI), and an observational Rupture Resolution Rating System (3RS). We anticipated that the 3RS would detect more ruptures than the WAI. We examined the longitudinal data of 38 patient-therapist dyads in a cognitive-behavioral therapy condition. The sample included cases that did not complete treatment (dropped cases) as well as good-outcome and poor-outcome cases. At the end of each session, patients completed the WAI self-report questionnaire. Six judges were trained to observe and detect the occurrence of ruptures, and then rated 201 videotaped sessions. Longitudinal statistical models were applied to the data retrieved from the WAI questionnaires completed by patients. We found discrepancies in the ability of the two methods to detect rupture events with the observational 3RS detecting more ruptures than the WAI. Thus, the use of observational systems for the detection of alliance ruptures is crucial for effectively assessing the quality of the therapeutic alliance over the course of treatment. Furthermore, observational systems proven to detect ruptures can be used to improve clinical practice and training of new clinicians., (undefined)

Several studies have suggested that the process of narrative change in psychotherapy occurs through the emergence and expansion of moments of novelty, known as innovative moments (IMs), that allow changes in the problematic self-narrative responsible for the client’s suffering. However, as these IMs challenge typical (and problematic) ways of acting, feeling, and thinking, they may also generate discrepancy or uncertainty. Clients may reduce uncertainty by returning to the problematic self-narrative immediately after the emergence of an IM, thus ensuring the homeostasis of the previous meaning system. This cyclical movement is a form of ambivalence, which can maintain problematic stability across therapy and lead to therapeutic failure. In this study, we identified return to the problem markers (RPMs), which are empirical indicators of the ambivalence process, for all IMs in two cases of constructivist grief psychotherapy. Both cases evidenced a high percentage of IMs with RPMs, and the evolution of IMs and RPMs along treatment was significantly correlated. We suggest that stability of the ambivalence process in grief psychotherapy may represent a form of self-protection from the anxiety or guilt of releasing pain as a disconnection from the deceased.

Aim: We explored therapists’ and clients’ experiences of alliance rupture events for the first 15 sessions of each of eight cases; therapists were each paired with one client who had a personality disorder. Method: All sessions were videotaped and rated with the Rupture Resolution Rating System. Approximately 1 week after a rupture, clients and therapists were individually interviewed about the causes of the rupture, how the rupture evolved, the impact of the rupture on the therapeutic process, and experiences during the event. The interviews were analyzed by five judges using consensual qualitative research (CQR; Hill, 2011). Results: Typically, rupture events involved a repetition of a previous rupture event, the rupture emerged when the client was not prepared to respond to the therapist’s intervention, both therapists and clients felt confused and ambivalent, and confrontation events activated intense and negative feelings. We discuss the implications for practice, training, and research., Fundação para a Ciência e a Tecnologia