Savoring the present: The reciprocal influence between positive emotions and positive emotion regulation in everyday life.

A growing body of research has investigated the regulation of negative emotions in ecological settings, but little is known about the mechanisms underlying positive emotion regulation in everyday life. Although some evidence suggests that adopting positive strategies is beneficial for emotional well-being, the literature is inconsistent about the effects of positive emotions on subsequent regulatory processes. In the present study, we adopted a two-week ecological momentary assessment to explore the association between positive emotions and positive emotion regulation in daily life. According to our results, the less individuals felt positive emotions at one point, the more they tended to enhance their use of positive strategies from this time to the next, which in turn resulted in subsequent higher levels of positive emotions. This prototype of positive regulation can be seen as a highly adaptive mechanism that makes it possible to compensate for a lack of positive emotions by enhancing the deployment of positive strategies. The theoretical and clinical implications of these findings are discussed.

Predictors of Adherence in Three Low-Intensity Intervention Programs Applied by ICTs for Depression in Primary Care.

Depression is one of the most common disorders in psychiatric and primary care settings, and is associated with disability, loss in quality of life, and economic costs. Internet-based psychological interventions have been shown to be effective in depression treatment but present problems with a low degree of adherence. The main aim of this study is to analyze the adherence predictors in three low-intensity interventions programs applied by Information and Communication Technologies (ICTs) for depression. A multi-center, randomized, controlled clinical trial was conducted with 164 participants with depression, who were allocated to: Healthy Lifestyle Program, Positive Affect Promotion Program or Mindfulness Program. Sociodemographic characteristics, Patient Health Questionnaire-9, Visual Analog Scale, Short Form Health Survey, Positive and Negative Affect Schedule, Five Facets Mindfulness Questionnaire, Pemberton Happiness Index and Treatment Expectancy Questionnaire were used to study adherence. Results showed that positive affect resulted in a predictor variable for Healthy Lifestyle Program and Positive Affect Promotion Program. Perceived health was also a negative adherence predictor for the Positive Affect Promotion Program. Our findings demonstrate that there are differences in clinical variables between treatment completers and non-completers and we provide adherence predictors in two intervention groups. Although new additional predictors have been examined, further research is essential in order to improve tailored interventions and increase adherence treatment.

Efficacy of Three Low-Intensity, Internet-Based Psychological Interventions for the Treatment of Depression in Primary Care: Randomized Controlled Trial.

BACKGROUND: Primary care is a major access point for the initial treatment of depression, but the management of these patients is far from optimal. The lack of time in primary care is one of the major difficulties for the delivery of evidence-based psychotherapy. During the last decade, research has focused on the development of brief psychotherapy and cost-effective internet-based interventions mostly based on cognitive behavioral therapy (CBT). Very little research has focused on alternative methods of treatment for depression using CBT. Thus, there is a need for research into other therapeutic approaches. OBJECTIVE: This study aimed to assess the effectiveness of 3 low-intensity, internet-based psychological interventions (healthy lifestyle psychoeducational program [HLP], focused program on positive affect promotion [PAPP], and brief intervention based on mindfulness [MP]) compared with a control condition (improved treatment as usual [iTAU]). METHODS: A multicenter, 4-arm, parallel randomized controlled trial was conducted between March 2015 and March 2016, with a follow-up of 12 months. In total, 221 adults with mild or moderate major depression were recruited in primary care settings from 3 Spanish regions. Patients were randomly distributed to iTAU (n=57), HLP (n=54), PAPP (n=56), and MP (n=54). All patients received iTAU from their general practitioners. The main outcome was the Spanish version of the Patient Health Questionnaire-9 (PHQ-9) from pretreatment (time 1) to posttreatment (time 2) and up to 6 (time 3) and 12 (time 4) months' follow-up. Secondary outcomes included the visual analog scale of the EuroQol, the Short-Form Health Survey (SF-12), the Positive and Negative Affect Schedule (PANAS), and the Pemberton Happiness Index (PHI). We conducted regression models to estimate outcome differences along study stages. RESULTS: A moderate decrease was detected in PHQ-9 scores from HLP (ß=-3.05; P=.01) and MP (ß=-3.00; P=.01) compared with iTAU at posttreatment. There were significant differences between all intervention groups and iTAU in physical SF-12 scores at 6 months after treatment. Regarding well-being, MP and PAPP reported better PHI results than iTAU at 6 months post treatment. PAPP intervention significantly decreased PANAS negative affect scores compared with iTAU 12 months after treatment. CONCLUSIONS: The low-intensity, internet-based psychological interventions (HLP and MP) for the treatment of depression in primary care are more effective than iTAU at posttreatment. Moreover, all low-intensity psychological interventions are also effective in improving medium- and long-term quality of life. PAPP is effective for improving health-related quality of life, negative affect, and well-being in patients with depression. Nevertheless, it is important to examine possible reasons that could be implicated for PAPP not being effective in reducing depressive symptomatology; in addition, more research is still needed to assess the cost-effectiveness analysis of these interventions. TRIAL REGISTRATION: ISRCTN Registry ISRCTN82388279; http://www.isrctn.com/ISRCTN82388279. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12888-015-0475-0.

Interventions of computerized psychotherapies for depression in Primary Care in Spain.

Currently, depression is a global health problem recognized by the WHO. The prevalence of this pathology in Primary Care is estimated at 19.5% worldwide, and 20.2% in Spain. In addition, the current intervention policies and protocols involve significant costs, both personal and economic, for people suffering from this disorder, as well as for society in general. On the other hand, the relapse rates after pharmacological interventions that are currently applied and the lack of effective specialized attention in mental health services reflect the need to develop new therapeutic strategies that are more accessible and profitable. Therefore, one of the proposals that are being investigated in different parts of the world is the design and evaluation of therapeutic protocols applied through Information and Communication Technologies, especially through the Internet and computer programs. The objective of this work was to present the current situation in Spain regarding the use of these interventions for the treatment of depression in Primary Care. The main conclusion is that although there is scientific evidence on the effectiveness of these programs, there are still important barriers that hinder their application in the public system, and also the need to develop implementation studies that facilitate the transition from research to clinical practice.

Analysis of the efficacy of an internet-based self-administered intervention ("Living Better") to promote healthy habits in a population with obesity and hypertension: An exploratory randomized controlled trial.

INTRODUCTION: Changes in unhealthy lifestyles are key elements in the prevention and treatment of obesity and hypertension. Internet-based programs offer great potential for the implementation of evidence-based interventions focused on promoting healthy habits. We evaluate the efficacy of an Internet-based self-administered program ("Living Better") that addresses people diagnosed as being overweight or having type I obesity and hypertension. METHODS: The sample was composed of a total of 106 participants (age Mean = 53; 59 males) from a public hospital in Spain, diagnosed as being overweight or having type I obesity and hypertension and randomized into two groups-the intervention group (IG; Internet-based intervention) and the control group (CG; usual medical treatment). The intervention used cognitive-behavioral strategies and psychoeducation to promote healthy habits. Anthropometric data (i.e., Body Mass Index -BMI-, waist circumference, and hip circumference) and lifestyle/psychological data (i.e., quality of life, physical activity, eating styles, motivation, mood, and self-efficacy) were assessed before and after the intervention, and at 6 and 12-month follow-ups. RESULTS: Significant differences were observed between the IG and the CG in anthropometrical variables after intervention (i.e., BMI and waist circumference), external eating style, and anxiety and stress scores (p < 0.05). Follow-up data showed that changes were maintained in BMI, waist and hip circumference, and external eating in the IG. After receiving the Internet-based treatment, the CG also improved its clinical condition. DISCUSSION: This study demonstrates that the Internet is a viable alternative for the delivery and dissemination of interventions focused on promoting healthy habits, and a totally self-administered intervention can produce long-term positive results.

The Power of Visualization: Back to the Future for Pain Management in Fibromyalgia Syndrome.

OBJECTIVE: Previous studies have demonstrated the effects of positive psychological factors on pain adjustment. Specifically, optimism has been linked to better physical functioning and less psychological distress. Until recently, these beneficial effects have mostly been examined in correlational studies or laboratory settings. The aim of this study was to test the efficacy of the Best Possible Self intervention using information and communication technologies with fibromyalgia patients. METHODS: Seventy-one patients were randomly allocated to the Best Possible Self intervention or a Daily Activities control condition. The Best Possible Self intervention used an interactive multimedia system with the support of an Internet platform to practice the guided imagery exercise online. RESULTS: Intent-to-treat analyses showed that, compared with the control condition, Best Possible Self patients showed significant improvements in depression, positive affect, and self-efficacy at postintervention. Moreover, at three-month follow-up, patients who received the intervention improved their optimism and negative affect significantly more than participants in the control condition. CONCLUSIONS: This study shows how a technology-supported intervention aimed at augmenting positive affect and promoting positive functioning works in the case of fibromyalgia, expanding the intervention's efficacy data in clinical populations and adding knowledge about the role that positive psychological factors play in pain experience. Moreover, it demonstrates the specific effects of the Best Possible Self intervention in order to incorporate this exercise in pain treatment protocols.

Efficacy of low-intensity psychological intervention applied by ICTs for the treatment of depression in primary care: a controlled trial.

BACKGROUND: Depression is one of the most common disorders in Psychiatric and Primary Care settings and is associated with significant disability and economic costs. Low-intensity psychological interventions applied by Information and Communication Technologies (ICTs) could be an efficacious and cost-effective therapeutic option for the treatment of depression. The aim of this study is to assess 3 low-intensity psychological interventions applied by ICTs (healthy lifestyle, positive affect and mindfulness) in Primary Care; significant efficacy for depression treatment has previously showed in specialized clinical settings by those interventions, but ICTs were not used. METHOD: Multicenter controlled randomized clinical trial in 4 parallel groups. Interventions have been designed and on-line device adaptation has been carried out. Subsequently, the randomized controlled clinical trial will be conducted. A sample of N = 240 mild and moderate depressed patients will be recruited and assessed in Primary Care settings. Patients will be randomly assigned to a) healthy lifestyle psychoeducational program + improved primary care usual treatment (ITAU), b) focused program on positive affect promotion + ITAU c) mindfulness + ITAU or d) ITAU. The intervention format will be one face to face session and four ICTs on-line modules. Patients will be diagnosed with MINI psychiatric interview. Main outcome will be PHQ-9 score. They will be also assessed by SF-12 Health Survey, Client Service Receipt Inventory, EuroQoL-5D questionnaire, Positive and Negative Affect Scale, Five Facet Mindfulness Questionnaire and the Pemberton Happiness Index. Patients will be assessed at baseline, post, 6 and 12 post-treatment months. An intention to treat and per protocol analysis will be performed. DISCUSSION: Low-intensity psychological interventions applied by Information and Communication Technologies have been not used before in Spain and could be an efficacious and cost-effective therapeutic option for depression treatment. The strength of the study is that it is the first multicenter controlled randomized clinical trial of three low intensity and self-guided interventions applied by ICTs (healthy lifestyle psychoeducational program; focused program on positive affect promotion and brief intervention based on mindfulness) in Primary Care settings. TRIAL REGISTRATION: Current Controlled Trials ISRCTN82388279 . Registered 16 April 2014.

La realidad virtual en las intervenciones psicológicas con pacientes oncológicos / No disponible

El objetivo de este trabajo es presentar las principales aportaciones de la Realidad Virtual (RV) en el tratamiento psicológico con pacientes oncológicos, y describir un programa de intervención que utiliza esta tecnología para promover bienestar emocional en pacientes hospitalizados. La RV se presenta como una prometedora herramienta de apoyo al paciente oncológico. Diversos estudios plantean su utilidad para hacer algunos tratamientos médicos más tolerables, para reducir los niveles de distrés y dolor, así como promover mayores niveles de emociones positivas. Se ha empleado principalmente con pacientes ambulatorios, existiendo una menor proporción de propuestas dirigidas al período de hospitalización. La intervención que ha desarrollado nuestro grupo aborda esta condición desde un foco también poco explorado: la promoción de bienestar. Esta intervención se compone de 4 sesiones (módulos de distracción y reminiscencia) implementadas individualmente en la habitación del paciente. Antes y después de cada sesión se evaluó el estado emocional (escalas visuales), la percepción de paso del tiempo (en minutos), de cambio en el estado de ánimo y de satisfacción con el procedimiento. Los resultados iniciales señalan incrementos en las emociones positivas después de cada sesión, existiendo cambios significativos en la primera y tercera sesión. Además, la mayoría de pacientes informó que su estado de ánimo había mejorado después de las sesiones. A partir de estos hallazgos se observa que los entornos virtuales y las tecnologías de la información y la comunicación muestran utilidad no sólo para disminuir el malestar sino también para promover bienestar emocional, especialmente durante períodos de tratamiento y hospitalización (AU)

The purpose of the present study is to review the main contributions of Virtual Reality (VR) to the field of psychological treatment with cancer patients, and to describe an intervention that uses this technology to promote emotional well-being on inpatients. VR appears as a promising tool for supporting psychological treatments in cancer patients. Several studies explore its utility for promoting more tolerable medical treatments, lowering the level of distress and pain, as well as increasing positive emotions. VR has been mainly used with outpatients, with a minor proportion of proposals oriented to the hospitalization period. The intervention developed by our group addresses this issue from a focus not very much explored: the promotion of well-being. This intervention is composed of 4 sessions (distraction and reminiscence modules) implemented individually in the patients’ room. Emotional state (visual analog scales), perceived time duration (minutes), perception of mood change and satisfaction with the procedure were assessed before and after sessions. Preliminary results showed an increase in positive emotions after each session, being these changes significant in the first and third session. Besides, most patients perceived themselves in a better mood after the sessions. Virtual environments and information and communication technologies could be useful not only to diminish discomfort but also to promote emotional well-being, especially during medical procedures and hospitalization (AU)

Virtual reality in the treatment of fibromyalgia: a pilot study.

The aim of this article is to present preliminary data on the effectiveness of virtual reality (VR) as an adjunct to cognitive behavioral therapy (CBT) in the treatment of fibromyalgia (FM). The sample comprised six women diagnosed with FM according to the American College of Rheumatology guidelines (1990). The treatment program consisted of 10 sessions of group CBT with the support of an adaptive virtual environment containing a specific content for developing relaxation and mindfulness skills. Patients were assessed at pretreatment, post-treatment, and at a 6-month follow-up for the following outcome variables: functional status related to pain, depression, a negative and positive affect, and coping skills. The results showed the long-term benefits of significantly reduced pain and depression and an increased positive affect and use of healthy coping strategies. This is the first study showing a preliminary utility of VR in treating FM.

A positive psychological intervention using virtual reality for patients with advanced cancer in a hospital setting: a pilot study to assess feasibility.

PURPOSE: This study presents data on the feasibility and possible benefits of a psychological intervention that uses virtual reality to induce positive emotions on adult hospitalized patients with metastatic cancer. The patient's satisfaction and perceived utility was also examined. METHOD: The sample was composed of 19 patients (53 % men, aged from 29 to 85 years old; x = 60.9; standard deviation = 14.54). The intervention consisted of four 30-min sessions during 1 week in which patients navigated through virtual environments designed to induce joy or relaxation. Mood was assessed before and after each session using the Visual Analog Scale. Patient satisfaction was assessed after each session and at the end of the intervention. Qualitative data were also collected with open-ended questions. RESULTS: There were no major difficulties with the use of devices, and any difficulties that did arise were solved through practice. There were adequate levels of pleasantness and perceived utility of the proposed intervention. The main perceived benefits were distraction, entertainment, and promotion of relaxation states. Regarding mood changes, an increase in positive emotions and a decrease in negative emotions were also detected. CONCLUSIONS: The intervention was positively assessed and rated as minimally uncomfortable. Future actions are discussed as well as the need to implement brief interventions that take into account the patients' medical state and physical discomfort level, especially with those in the advanced stages of disease.

Presence and emotions in virtual environments: the influence of stereoscopy.

This study investigates how stereoscopy (the illusion of depth and 3D imaging) affects the sense of presence and the intensity of the positive mood that users feel in virtual environments (VEs). A between-group design was used, and 40 volunteers were randomly assigned to one of two experimental conditions (stereoscopy vs. no stereoscopy) and to one of two emotional VEs (relaxation or joy). The participants' emotions were assessed before and after the VR experience. Presence was measured with two postexperiment questionnaires (ITC-SOPI and SUS). Results show that there were no differences between stereoscopic and monoscopic presentations in VEs (neither subjective sense of presence nor emotional reactions). Practical and theoretical implications of these findings are discussed herein.

Internet-based telehealth system for the treatment of agoraphobia.

In this work that is being validated within the VEPSY project, we present a system that allows the patient to continue a psychological virtual reality treatment from his or her home PC as complementary therapy. In the consulting room, we have been using virtual therapy for panic disorder and agoraphobia treatment to expose the patient to several situations. For the complementary therapy, a structured treatment via the Internet has been prepared, which consists of several parts: an assessment protocol; a structured treatment protocol organized in several blocks (such as psychoeducation and exposure); and an outcome protocol. The same situations as in the consulting room have been selected for the exposure, but each of them has been divided into several virtual environments with specific characteristics that limit its difficulty level. The stimuli that are used at each level are controlled automatically by the system. The information of the patient is stored in a database, which is placed in a remote server using XML format and used to control which stages of the treatment he or she can access. The psychologist can limit the evolution of the patient. The virtual environments are installed in the patient's PC, and they are implemented with a mechanism that ensures that they can only be run when the patient connects to the web. The user should not have any special virtual reality hardware at home, so head rotations have been simulated with the navigation system.