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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.

The presence of meaning in life (PML) and the search for meaning in life (SML) are crucial when facing difficult times. Although several theoretical frameworks have tried to explain the dynamics of meaning in life during adversity, empirical evidence about interactions among both constructs using longitudinal designs is scarce. This study examined the trajectories of both PML and SML during the COVID-19 lockdown period in Spain. In total, 220 adults fulfilled an online survey during two periods: a strict and a relaxed lockdown period. Latent growth models showed that both PML and SML declined slightly during the strict lockdown, but they reached a plateau during the relaxed lockdown. Results also showed that age and having a partner predicted higher PML and lower SML at baseline, whereas being male predicted higher scores on PML. PML and SML were negatively associated at baseline, higher SML at baseline was related to a steeper decreasing PML slope during the strict lockdown, and the PML and SML slopes in the relaxed lockdown period were negatively related. This study contributes to better understanding longitudinal fluctuations of meaning in life in situations of adversity.

COVID-19 pandemic-related confinement may be a fruitful opportunity to use individual resources to deal with it or experience psychological functioning changes. This study aimed to analyze the evolution of different psychological variables during the first coronavirus wave to identify the different psychological response clusters, as well as to keep a follow-up on the changes among these clusters. The sample included 459 Spanish residents (77.8% female, Mage = 35.21 years, SDage = 13.00). Participants completed several online self-reported questionnaires to assess positive functioning variables (MLQ, Steger et al. in J Loss Trauma 13(6):511–527, 2006. 10.1080/15325020802173660; GQ-6, McCullough et al. in J Person Soc Psychol 82:112–127, 2002. 10.1037/0022-3514.82.1.112; CD-RISC, Campbell-Sills and Stein in J Traum Stress 20(6):1019–1028, 2007. 10.1002/jts.20271; CLS-H, Chiesi et al. in BMC Psychol 8(1):1–9, 2020. 10.1186/s40359-020-0386-9; SWLS; Diener et al. in J Person Assess, 49(1), 71–75, 1985), emotional distress (PHQ-2, Kroenke et al. in Med Care 41(11):1284–1292, 2003. 10.1097/01.MLR.0000093487.78664.3C; GAD-2, Kroenke et al. in Ann Internal Med 146(5):317–325, 2007. 10.7326/0003-4819-146-5-200703060-00004; PANAS, Watson et al. in J Person Soc Psychol 47:1063–1070, 1988; Perceived Stress, ad hoc), and post-traumatic growth (PTGI-SF; Cann et al. in Anxiety Stress Coping 23(2):127–137, 2010. 10.1080/10615800903094273), four times throughout the 3 months of the confinement. Linear mixed models showed that the scores on positive functioning variables worsened from the beginning of the confinement, while emotional distress and personal strength improved by the end of the state of alarm. Clustering analyses revealed four different patterns of psychological response: “Survival”, “Resurgent”, “Resilient”, and “Thriving” individuals. Four different profiles were identified during mandatory confinement and most participants remained in the same cluster. The “Resilient” cluster gathered the largest number of individuals (30–37%). We conclude that both the heterogeneity of psychological profiles and analysis of positive functioning variables, emotional distress, and post-traumatic growth must be considered to better understand the response to prolonged adverse situations. Supplementary Information The online version contains supplementary material available at 10.1007/s10902-021-00469-z.

‘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: Data from primary health care in Spain show a high prevalence of the major depressive disorder. Blended treatment (combination of face-to-face and online components) seems to be a very promising tool for the optimization and dissemination of psychological treatments in a cost-effective form. Although there is growing data that confirm the advantages of blended therapies, few studies have analyzed their application in regular clinical practice. The objective of the present paper is to describe the protocol for a clinical study aimed at exploring the clinical and cost-effectiveness of a blended cognitive behavioral therapy (b-CBT) for depression, compared to treatment as usual (TAU) in a primary health care setting.Methods: A two-arm randomised controlled non-inferiority trial will be carried out, with repeated measures (baseline, 3 months, 6 months, and 12 months) under two conditions: b-CBT and TAU. The b-CBT program will consist in three face-to-face sessions and eight online sessions. The TAU is defined as the routine care delivered by the general practitioner for the treatment of depression in primary care. The primary outcome is a symptomatic change of depressive symptoms on the patient-health questionnaire (PHQ-9). Other secondary outcomes will be considered (e.g., quality of life, treatment preference). All participants must be 18 years of age or older and meet the diagnostic criteria for major depressive disorder according to the Diagnostic and Statistical Manual of Mental disorders 4th edition. 156 participants will be recruited (78 per arm).Discussion: It is expected that b-CBT is clinically non-inferior when compared to TAU. This is the first study in Spain to use a b-CBT format in primary and specialized care, and this format could be an efficacious and cost-effective therapeutic strategy for the treatment of depression.Trial registration: ClinicalTrials.gov NCT02361684. Registered on 8 January 2015. Currently recruiting participants.

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

The aim of this study is to evaluate the role of the type of interface device in the efficacy of a serious game that teaches emotional regulation (ER) strategies in a non-clinical sample of adolescents. We conducted a between-participants experiment in which participants (N = 61) played a frustration induction game, and then an ER game (a breathing strategy game), using one of three types of devices (computer, smartphone, and RGB-D camera). Frustration mood and perceived arousal were the main variables measured. Results revealed a significant interaction between moment (pre-induction phase, post-induction phase, and regulation phase) and the type of interface device used in the frustration mood scores. In participants who used the computer and smartphone, frustration increased after the induction phase and decreased after the regulation phase. However, for participants who used the RGB-D camera, frustration decreased significantly after the induction phase, and this change was maintained after the regulation phase. Changes in arousal were similar with the three devices. This study highlights that the type of interface device (and specifically, the participation of the body) is a crucial variable in the efficacy of serious games affecting users emotional experience., This work was supported by the Ministerio de Educacion y Ciencia (Spain), Project Game Teen (TIN2010-20187), and partially by Ministerio de Economia y Competitividad (Spain) under grants "PROMOSAM" (PSI2014-56303-REDT), "BODYTA" (Plan Nacional I + D + I 2013-2016 PSI2014-51928-R), and CIBEROBN, an initiative of ISCIII (ISC III CB06 03/0052).

Greater emotion regulation when observing a physically similar avatar.Greater frustration induction when observing a physically similar avatar.Greater physical identification with physically similar avatar.Significant change in brain when observing a physically similar avatar. The aim of this study is to evaluate the influence of the physical similarity of avatars with the user on emotion regulation strategy training. In this study twenty-four teenagers observed an avatar (either physically similar to the participant or neutral) that gets frustrated with his/her computer, after which he/she applies an emotion regulation strategy (slow breathing). The intensity of the emotional induction and regulation processes was measured using questionnaires and electroencephalogram data. The results show that observing an avatar that is physically similar to the participant has a significantly greater impact on emotional valence and arousal in participants and also induces emotional states that are significantly more intense than when observing a neutral avatar. The results seem to indicate significantly greater activation of specific brain regions that are related to these processes and greater identification with the avatar in terms of both subjective and objective measures in participants that observed an avatar that was physically similar to them. However, there were no significant differences in the sense of presence or the appeal (i.e., satisfaction) to participants regarding the virtual environment. The use of avatars in mental health applications is relatively new and its specific influence is still unknown. We consider this study to be a first step forward in better understanding the use of avatars in mental health applications for youth. This research brings new guidelines to the design of different types of applications in this field in order to achieve greater behavioral changes in youth.

[EN] We all use more or less adapted strategies to confront adverse emotional situations in our lives without being psychologically affected. Emotional Regulation (ER) strategies that we use determine the way in which we feel, express and behave. Moreover, ER strategies are particularly important in adolescents, a population in the age when the deficits of ER strategies can be linked to the appearance of numerous mental health disorders such as depression or anxiety, or disruptive behaviors. Thus, the early detection of dysfunctional ER strategies and the training in adaptive ER strategies will help us to prevent the future occurrence of possible behavioral and psychosocial disorders. In this paper, we present the GAMETEEN SYSTEM (GT-System), a novel instrument based on Virtual Reality and serious games for the assessment and training of ER strategies in adolescent population. The results of our preliminary evaluation suggest that this system is effective in training and evaluating emotional regulation strategies in the adolescent population.