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Clara Paz,1 Mari Aguilera,2 Marta Salla,3 Victoria Compañ,3 Joan C Medina,3,4 Arturo Bados,3 Eugeni García-Grau,3 Antoni Castel,5 José Cañete Crespillo,6 Adrián Montesano,7 Leticia Medeiros-Ferreira,8 Guillem Feixas3,4 1School of Psychology, Universidad de Las Américas, Quito, Ecuador; 2Department of Cognition, Development and Educational Psychology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain; 3Department of Clinical Psychology and Psychobiology, Faculty of Psychology, Universitat de Barcelona, Barcelona, Spain; 4The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain; 5Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; 6Department of Psychiatry, Hospital de Mataró, Mataró, Spain; 7Faculty of Psychology and Educational Sciences, Universitat Oberta de Catalunya, Barcelona, Spain; 8Nou Barris Nord Adult Mental Health Centre, Barcelona, SpainCorrespondence: Clara Paz Jose Queri y Av, De Los Granados, Quito EC170125, EcuadorTel +593 2 3981000 ext. 2518Email clara.paz@udla.edu.ecBackground: Fibromyalgia (FM) is a debilitating syndrome, more prevalent in women, which is aggravated by the presence of depressive symptoms. In the last decade, cognitive behavioral therapy (CBT) has demonstrated to reduce such depressive symptoms and pain in these patients, but there are still a considerable number of them who do not respond to interventions. The complexity of the disorder requires the consideration of the unique psychological characteristics of each patient to attain good outcomes. One approach that could accomplish this goal might be personal construct therapy (PCT), an idiographic approach that considers identity features and interpersonal meanings as their main target of intervention. Then, the aim of the study is to test the efficacy of PCT as compared to a well-established treatment in the reduction of depressive symptoms in women with fibromyalgia.Methods and Analysis: This is a multicenter randomized controlled trial. In each condition participants will attend up to eighteen 1-hr weekly therapy sessions and up to three 1-hr booster sessions during the following 3– 5 months after the end of treatment. The depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) will be the primary outcome measure and it will be assessed at baseline, at the end of therapy, and at 6-month follow-up. Other secondary measures will be applied following the same schedule. Participants will be 18- to 70-years-old women with a diagnosis of FM, presenting depressive symptoms evinced by scores above seven in depression items of the HADS-D. Intention-to-treat and complete case analyses will be performed for the main statistical tests. Linear mixed models will be used to analyze and to compare the treatment effects of both conditions.Trial Registration: ClinicalTrials.gov: NCT02711020.Keywords: psychotherapy, pain, repertory grid technique, study protocol, CBT, personal construct therapy

Antoni Grau,1,2 Ernesto Magallón-Neri,3,4 Gustavo Faus,1,2 Guillem Feixas3,41ITA Mental Health Specialist, Madrid, Spain; 2ITA Foundation, Barcelona, Spain; 3Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain; 4Institute of Neurosciences, University of Barcelona, Barcelona, SpainIntroduction: Several studies have noted the potentially negative effect of eating disorders (ED) on cognitive performance.Objective: To compare the impact of the duration of abnormal eating behaviors on cognitive performance in a sample of people with short- and long-term eating disorders and in two control groups matched for age.Method: The neuropsychological performance of 82 women diagnosed with an eating disorder were compared with two control groups from the community of 66 healthy women. Time of duration of the disorder was less than two years in half of the clinical sample, and more than 10 years in the other half. The following instruments were used to measure neuropsychological performance: the Matrix Test, the Stroop task, the Trail-Making Test, the Tower of London Test, the Posner Spatial Task, the Rey’s Complex Figure, the Wechsler Vocabulary Test, and the Hayling Completion Test.Results: It showed that persons with long-term ED presented more impaired neuropsychological profiles, but not in all areas. In contrast, the short-term ED group presented similar profiles to the control groups.Discussion: This study highlights the positive association between cognitive impairment and time of evolution of ED, above all in perceptual measures and non-verbal memory. Considering the effect of the evolution of ED cognitive performance (especially in long-term patients) may further our understanding of the development of the disorder and the factors that may favor its persistence.Keywords: eating disorder, cognitive impairment, long-duration ED

Adrián Montesano,1 María Angeles López-González,2 Luis Angel Saúl,2 Guillem Feixas1 1Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Barcelona, 2Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, National Distance Education University, Madrid, Spain Abstract: Recent research has highlighted the role of implicative dilemmas in a variety of clinical conditions. These dilemmas are a type of cognitive conflict, in which different aspects of the self are countered in such a way that a desired change in a personal dimension (eg, symptom improvement) may be hindered by the need of personal coherence in another dimension. The aim of this study was to summarize, using a meta-analytical approach, the evidence relating to the presence and the level of this conflict, as well as its relationship with well-being, in various clinical samples. A systematic review using multiple electronic databases found that out of 37 articles assessed for eligibility, nine fulfilled the inclusion criteria for meta-analysis. Random effects model was applied when computing mean effect sizes and testing for heterogeneity level. Statistically significant associations were observed between the clinical status and the presence of dilemmas, as well as level of conflict across several clinical conditions. Likewise, the level of conflict was associated with symptom severity. Results highlighted the clinical relevance and the transdiagnostic nature of implicative dilemmas. Keywords: implicative dilemmas, cognitive conflicts, intrapersonal conflicts, meta-analysis

Introduction: A constructivist view of the cognitive system contemplates the possibility of meaning conflicts or dilemmas involving self-identity. Patients' contradictions between verbal discourse and actual behaviors (e.g., agreeing with the therapist to carry on an action and then not doing it), or between behaviors (e.g., to dismiss a romantic partner and then initiating sex with her or him) are seen as manifestations of an internal conflict or dilemma. These internal conflicts, which can be detected using the Repertory Grid technique, are found to be common in patients of different conditions but especially for those with a diagnosis of depression (67% of the cases; Feixas et al, 2014). Objectives: To study the efficacy of a dilemma-focused intervention (DFI; Feixas & Compañ, 2016) tackle these conflicts in the therapy process rather than counteracting negative thoughts, as in cognitive-behavioural therapy (CBT). Methods: An RCT was conducted combining group and individual therapy formats. 128 patients participated in eight sessions of group CBT and were then randomised to eight sessions of either individual CBT or DFT. Results: No differences were found between treatment conditions neither at the end of therapy or at follow up (Feixas et al, 2016; 2018). Depressive symptoms decreased in a significant way and with a big effect size (d = 1.37 for the 106 completers). Conclusions: Psychotherapy can have a significant impact on depressive symptoms no matter whether using traditional CBT techniques or assisting patients in identifying their internal conflicts and finding a way to resolve them (DFI). [ABSTRACT FROM AUTHOR]

Introduction: A negative self-concept has been established as one of the key psychological features of depression. However, several studies have shown that a particular kind of cognitive conflict, implicative dilemma, is highly prevalent in depression. Objectives: This study aimed to gauge the relative significance of both aspects, self-negativity and cognitive conflict, for depression. Methods: A cross-sectional study compared 161 patients with major depression with 110 controls. They were assessed to measure negative self-construing (self-ideal discrepancy) and conflicts (implicative dilemmas) with the repertory grid technique, and also symptom severity. Results: At least one implicative dilemma was found for 68.3% of patients with depression, compared to 34.5% of controls (p < .01; phi = .33). As expected, the self-ideal distance was also much higher for the group with depression (M = .47; SD = .15) than for controls (M = .25; SD = .10; d = 1.8). Both cognitive conflict and self-ideal discrepancy entered in the regressionmodel created to predict depressive symptoms. 99%of participants of the clinical group had at least a positive view (coincidence between "self now" and "ideal self"). Conclusions: Negative self-views proved to be a characteristic of people with depression. However, our results show that depression is better characterized by a pattern of mixed positive and negative self-descriptions with a high rate of conflict between them. Therefore, in addition to self-negativity, we need to consider internal conflict (e.g., implicative dilemmas) as a factor to complement our understanding and treatment strategy for depression. [ABSTRACT FROM AUTHOR]

Introduction: Substance abuse among medical professionals is common and can lead to malpractice. The study of identity conflicts developed by the Psychology of Personal Constructs could explain part of this problem. Objectives: This study aims to describe the medical professionals who abuse substances in terms of their personal construing process and other associated psychological measures. Methods: Thirty medical professionals suffering from a substance use disorder hospitalized in a clinic specialized in their treatment were recruited for this study. The Repertory Grid, Beck's Depression Inventory, State-Trait Anxiety Inventory, and Maslach Burnout Inventory were used for assessment. Results: More than half of the participants presented cognitive conflicts (implicative dilemmas) and this group scored higher on trait anxiety and burnout than medical professionals without such conflicts. No statistically significant differences were found between those with implicative dilemmas and those without in terms of depression symptoms or state of anxiety. Logistic regression analysis showed that the presence of cognitive conflicts was best predicted by burnout. Distance between the "ideal self" and "actual self" elements, and cognitive complexity were the best predictors of belonging to the clinical sample or to a randomly matched community sample. Content analysis of the constructs revealed an overrepresentation of constructs referring to values and interests in the clinical sample. Conclusions: Overall, our findings support previous research with regards to psychological factors associated with the development of substance abuse and identity problems among medical professionals. The presence of implicative dilemmas and self-esteem problems can help us better understand these problems. [ABSTRACT FROM AUTHOR]

Introduction: Eating Disorders (ED) are complex and costly for patients, families, and society. Treatments of different types have shown some effectiveness for many sufferers with ED but are still far from satisfactory. Controlled efficacy studies provide evidence with internal validity but the external validity of complex treatment services is compromised. The ITA Model of Integrated Treatment of Eating Disorders (ITAMITED) combines outpatient, inpatient and day hospital adapted to every patient's needs. Objectives: To evaluate the changes occurred in patients with EDs after the ITAMITED service on the bases of a recently implemented routine outcome assessment system. Methods: A cohort of 324 ED patients who entered the ITAMITED service between November of 2017 and October of 2018 was routinely assessed with the Clinical Outcomes in Routine Evaluation (CORE) system and measures specific for EDs (e.g., EAT). Data analysis included details from the patients' health records such as diagnosis, BMI, previous treatments, and chronicity. Results: Changes in CORE yielded large effect sizes for both inpatient and outpatient treatment modalities, and moderate for day hospital care (figure 1). Effect sizes for EAT (figure 2) were big for inpatient treatment and day hospital and moderate for outpatient treatment. Conclusions: Overall, ITAMITED succeeded in improving EDs patients, especially in the inpatient facility. Day hospital care proved more effective for specific ED symptoms than for general functioning and well-being, while the inverse pattern was found for those in outpatient treatment. The effects of many more variables need to be brought into the equation to explain more detailed outcomes. [ABSTRACT FROM AUTHOR]

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.

Objective: The use of ulipristal acetate (UPA) was indicated for the treatment of uterine fibroids. Following UPA suspension in March 2020, some patients presented worsening and required surgery. We aimed to identify patients at high-risk for undergoing surgery after UPA suspension., Methods: We evaluated 85 women receiving intermittent UPA treatment until March 2020. Following UPA suspension, patients received other medical treatments or surgery. The clinico-pathological features were recoded and a quality of life health survey was completed by patients at the time of UPA suspension and at 6-months thereafter., Results: After the suspension of UPA, 17 of the 85 patients receiving intermittent UPA (20%) required surgery, and 68 (80%) required other medical treatments. Patients who underwent surgery were younger and had greater fibroid volume., Conclusions: In our series, 20% of clinically stable patients receiving intermittent UPA required surgery following UPA suspension. These women should be considered for future medical strategies.

Introduction: Eating disorders (EDs) are complex pathologies which require equally complex treatment strategies. These strategies should be multidisciplinary, personalised interventions, performed in appropriate settings along a healthcare continuum from inpatient to community care. Personalisation, and the complexity of levels of care and interventions make evaluation of treatments difficult. The present study aims to measure the effectiveness of a complex treatment programme for EDs which includes hospitalisation, day hospital and outpatient settings. Our purpose is to assess the complete therapeutic process of each patient through all these levels of care, capturing the multiplicity of trajectories that a programme of these characteristics involves., Methods and Analysis: This protocol describes a multicentre, naturalistic, observational study. All patients starting between November 2017 and October 2020 in a healthcare network for EDs in Spain are being invited to participate. The first phase of intensive change monitoring to November 2020 is followed by lower intensity follow-up until October 2025. In the first phase progress of all participants is assessed every 3 weeks using specific measures for ED and the Clinical Outcomes Routine Evaluation system, a family of instruments specifically designed to measure change in psychotherapy. In the second phase data collection will happen quarterly. Both cross-sectional and longitudinal analyses will be conducted, with a special focus on patterns and predictors of change studied through multilevel linear models., Ethics and Dissemination: The study has been approved by the Research Bioethics Committee of the University of Barcelona (no. IRB00003099) and the ethical committee of ITA Mental Health, the organisation to which all participating centres belong. Dissemination will be in papers for peer-reviewed research journals and to clinicians working with ED., Trial Registration Number: NCT04127214., Competing Interests: Competing interests: AGT is the Clinical Director at ITA Mental Health, the network financing the study and in which it is being conducted. ITA was motivated to explore the effectiveness and any differential effectiveness of the treatment programme by centre, hence, funded data collection within ITA and also funded an external organisation, University of Barcelona, to deliver scientific advice in the design and implementation of data collection, to ensure database integrity, and to ensure independent analysis. The data collection has generated a pseudonymised dataset which is held by UB and CE. ITA Mental Health and the University of Barcelona (team led by GF) have established a contract for this collaboration (ref. FBG309562). GF is the Principal Investigator of the research group involved in this contract., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Borderline personality disorder (BPD) represents a severe mental condition that is usually characterized by distressing identity disturbances. Although most prevailing explanatory models and psychotherapy approaches consider and intervene on self-concept, they seem not to recognize or explore idiosyncratic cognitive conflicts that patients may experience. These conflicts, which have been conceptualized as "implicative dilemmas" and "dilemmatic constructs" by personal construct theorists, could be considered as key elements of the explanatory model for BPD to provide a better understanding of this disorder and possibly enhance the effectiveness of contemporary psychotherapeutic approaches. The current study (Identifier: NCT04498104) aims to examine the characteristics of the interpersonal cognitive system of a group of patients diagnosed with BPD, using the repertory grid technique, and to compare them with those of a community sample. We will test if BPD participants are more affected by cognitive conflicts than controls. Additionally, we will gauge the association between cognitive conflicts and symptom severity as well as their predictive capacity of treatment outcome. The obtained results will be a necessary step to determine if cognitive conflicts have a substantial role on the explanation of BPD. It could also help to consider the development of a conflict resolution intervention module for this disorder.