Estudio piloto sobre la eficacia de un tratamiento transdiagnóstico para trastornos emocionales en Atención Primaria / A Pilot Study of the Effectiveness of a Transdiagnostic Treatment for Emotional Disorders in Primary Care

Este estudio tuvo como objetivo evaluar y determinar la eficacia de un tratamiento transdiagnóstico breve en formato grupal para personas con trastornos emocionales leves y moderados y establecer correlaciones entre los cambios tras el tratamiento en las diferentes variables. Para ello, se usó un diseño experimental de grupo único (n=11) con medidas pre-post. Los participantes fueron evaluados antes y después de la intervención con las siguientes medidas: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B y CERQ-18. Se encontró que la terapia transdiagnóstica breve fue efectiva para reducir los síntomas depresivos (p =.005), síntomas ansiosos (p =.011) y preocupación (p = .020) con tamaños del efecto alto. Además, se encontraron correlaciones significativas positivas entre los cambios de las variables de síntomas depresivos y preocupación y entre los cambios en síntomas ansiosos y rumiación. Se concluyó que los tratamientos transdiagnóticos breves pueden ser una opción a tener en cuenta para los pacientes con trastornos emocionales leves y moderados en atención primaria debido a su eficacia en algunos síntomas y sus características. (AU)

This study aimed to evaluate and determine the efficacy of a brief transdiagnostic treatment in group format for people with mild and moderate emotional disorders, and to establish correlations between the changes after treatment in the different variables. We use a single experimental group (n=11) design with pre-post measures. Participants were assessed pre- and post-intervention with the following measures: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B, and CERQ-18. Brief transdiagnostic therapy was found to be effective in reducing depressive symptoms (p =.005), anxious symptoms (p=.011), and worry (p=.020) with high/moderate effect sizes. In addition, significant positive correlations were found between changes in depressive symptoms and worry variables, and between changes in anxious symptoms and rumination. In conclusion, brief transdiagnostic treatments can be a treatment to consider for patients with mild and moderate emotional disorders in primary care due to their efficacy in some symptoms and their characteristics. (AU)

Estudio piloto sobre la eficacia de un tratamiento transdiagnóstico para trastornos emocionales en Atención Primaria / A Pilot Study of the Effectiveness of a Transdiagnostic Treatment for Emotional Disorders in Primary Care

Este estudio tuvo como objetivo evaluar y determinar la eficacia de un tratamiento transdiagnóstico breve en formato grupal para personas con trastornos emocionales leves y moderados y establecer correlaciones entre los cambios tras el tratamiento en las diferentes variables. Para ello, se usó un diseño experimental de grupo único (n=11) con medidas pre-post. Los participantes fueron evaluados antes y después de la intervención con las siguientes medidas: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B y CERQ-18. Se encontró que la terapia transdiagnóstica breve fue efectiva para reducir los síntomas depresivos (p =.005), síntomas ansiosos (p =.011) y preocupación (p = .020) con tamaños del efecto alto. Además, se encontraron correlaciones significativas positivas entre los cambios de las variables de síntomas depresivos y preocupación y entre los cambios en síntomas ansiosos y rumiación. Se concluyó que los tratamientos transdiagnóticos breves pueden ser una opción a tener en cuenta para los pacientes con trastornos emocionales leves y moderados en atención primaria debido a su eficacia en algunos síntomas y sus características. (AU)

This study aimed to evaluate and determine the efficacy of a brief transdiagnostic treatment in group format for people with mild and moderate emotional disorders, and to establish correlations between the changes after treatment in the different variables. We use a single experimental group (n=11) design with pre-post measures. Participants were assessed pre- and post-intervention with the following measures: PHQ-15, PHQ-9, GAD-7, PSQW-A, RRS-B, and CERQ-18. Brief transdiagnostic therapy was found to be effective in reducing depressive symptoms (p =.005), anxious symptoms (p=.011), and worry (p=.020) with high/moderate effect sizes. In addition, significant positive correlations were found between changes in depressive symptoms and worry variables, and between changes in anxious symptoms and rumination. In conclusion, brief transdiagnostic treatments can be a treatment to consider for patients with mild and moderate emotional disorders in primary care due to their efficacy in some symptoms and their characteristics. (AU)

Risk Factors Associated with Gambling on Loot Boxes.

BACKGROUND: Loot boxes (LBs) are virtual objects that players open without knowing the value of the item they will obtain. Because of their features, studies have explored their association with gambling, finding commonalities. However, risk factors have been overlooked. This study examined risk factors associated with gambling as applied to LBs (gambling in the past year, having family/friends who use LBs/gamble, trait impulsivity, and sensation-seeking). METHOD: 253 participants (82.2% men) with a mean age of 28 years ( SD = 12.11)­in three groups: gamblers ( n = 89), LB purchasers ( n = 63), and free-LB openers ( n = 101)­completed a self-report. RESULTS: Having family/friends who used LBs was related to increased engagement in opening LBs at no cost. However, having gambled in the past year or having family/friends who used LBs or who gambled was not associated with increased purchasing. Gamblers, LB purchasers, and LB openers scored equally highly on impulsivity and sensation-seeking. Because some gamblers used LBs, and LB purchasers also opened free-LBs, further analyses were performed to control for the effects of overlapping groups. Loot boxers had higher scores in sensation-seeking than gamblers. CONCLUSIONS: The results can contribute to the development of prevention and intervention strategies for LB users.

Variables Associated with Emotional Symptom Severity in Primary Care Patients: The Usefulness of a Logistic Regression Equation to Help Clinical Assessment and Treatment Decisions.

The aim of this study is to contribute to the evidence regarding variables related to emotional symptom severity and to use them to exemplify the potential usefulness of logistic regression for clinical assessment at primary care, where most of these disorders are treated. Cross-sectional data related to depression and anxiety symptoms, sociodemographic characteristics, quality of life (QoL), and emotion-regulation processes were collected from 1,704 primary care patients. Correlation and analysis of variance (ANOVA) tests were conducted to identify those variables associated with both depression and anxiety. Participants were then divided into severe and nonsevere emotional symptoms, and binomial logistic regression was used to identify the variables that contributed the most to classify the severity. The final adjusted model included psychological QoL (p < .001, odds ratio [OR] = .426, 95% CI [.318, .569]), negative metacognitions (p < .001, OR = 1.083, 95% CI [1.045, 1.122]), physical QoL (p < .001, OR = .870, 95% CI [.841, .900]), brooding rumination (p < .001, OR = 1.087, 95% CI [1.042, 1.133]), worry (p < .001, OR = 1.047, 95% CI [1.025, 1.070]), and employment status (p = .022, OR [.397, 2.039]) as independent variables, ρ2 = .326, area under the curve (AUC) = .857. Moreover, rumination and psychological QoL emerged as the best predictors to form a simplified equation to determine the emotional symptom severity (ρ2 = .259, AUC = .822). The use of statistical models like this could accelerate the assessment and treatment-decision process, depending less on the subjective point of view of clinicians and optimizing health care resources.

Variables Associated with Emotional Symptom Severity in Primary Care Patients: The Usefulness of a Logistic Regression Equation to Help Clinical Assessment and Treatment Decisions

The aim of this study is to contribute to the evidence regarding variables related to emotional symptom severity and to use them to exemplify the potential usefulness of logistic regression for clinical assessment at primary care, where most of these disorders are treated. Cross-sectional data related to depression and anxiety symptoms, sociodemographic characteristics, quality of life (QoL), and emotion-regulation processes were collected from 1,704 primary care patients. Correlation and analysis of variance (ANOVA) tests were conducted to identify those variables associated with both depression and anxiety. Participants were then divided into severe and nonsevere emotional symptoms, and binomial logistic regression was used to identify the variables that contributed the most to classify the severity. The final adjusted model included psychological QoL (p < .001, odds ratio [OR] = .426, 95% CI [.318, .569]), negative metacognitions (p < .001, OR = 1.083, 95% CI [1.045, 1.122]), physical QoL (p < .001, OR = .870, 95% CI [.841, .900]), brooding rumination (p < .001, OR = 1.087, 95% CI [1.042, 1.133]), worry (p < .001, OR = 1.047, 95% CI [1.025, 1.070]), and employment status (p = .022, OR [.397, 2.039]) as independent variables, ρ2 = .326, area under the curve (AUC) = .857. Moreover, rumination and psychological QoL emerged as the best predictors to form a simplified equation to determine the emotional symptom severity (ρ2 = .259, AUC = .822). The use of statistical models like this could accelerate the assessment and treatment-decision process, depending less on the subjective point of view of clinicians and optimizing health care resources. (AU)

Cost-effectiveness of transdiagnostic group cognitive behavioural therapy versus group relaxation therapy for emotional disorders in primary care (PsicAP-Costs2): Protocol for a multicentre randomised controlled trial.

Several randomised controlled trials (RCT) have demonstrated the superiority of transdiagnostic group cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) for emotional disorders in primary care. To date, however, no RCTs have been conducted to compare TD-CBT to another active intervention in this setting. Our aim is to conduct a single-blind RCT to compare group TD-CBT plus TAU to progressive muscle relaxation (PMR) plus TAU in adults (age 18 to 65 years) with a suspected emotional disorder. We expect that TD-CBT + TAU will be more cost-effective than TAU + PMR, and that these gains will be maintained at the 12-month follow-up. Seven therapy sessions (1.5 hours each) will be offered over a 24-week period. The study will be carried out at four primary care centres in Cantabria, Spain. The study will take a societal perspective. Psychological assessments will be made at three time points: baseline, post-treatment, and at 12-months. The following variables will be evaluated: clinical symptoms (anxiety, depression, and/or somatic); functioning; quality of life (QoL); cognitive-emotional factors (rumination, worry, attentional and interpretative biases, emotion regulation and meta-cognitive beliefs); and satisfaction with treatment. Data on health service use, medications, and sick days will be obtained from electronic medical records. Primary outcome measures will include: incremental cost-effectiveness ratios (ICER) and incremental cost-utility ratios (ICURs). Secondary outcome measures will include: clinical symptoms, QoL, functioning, and treatment satisfaction. Bootstrap sampling will be used to assess uncertainty of the results. Secondary moderation and mediation analyses will be conducted. Two questionnaires will be administered at sessions 1, 4, and 7 to assess therapeutic alliance and group satisfaction. If this trial is successful, widespread application of this cost-effective treatment could greatly improve access to psychological treatment for emotional disorders in the context of increasing demand for mental healthcare in primary care. Trial registration: ClinicalTrials.gov: Cost-effectiveness of a Transdiagnostic Psychological Treatment for Emotional Disorders in Primary Care (PsicAP). NCT05314920.

Cognitive processes associated with emotional disorders: implications for efficient psychological treatments.

BACKGROUND: Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments. AIMS: To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments. METHODS: We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses. RESULTS: Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied. CONCLUSIONS: For "pure" disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.

Psychological Effects of Professional Exposure to Trauma and Human Suffering: Systematic Review and Meta-Analysis.

Over the past decades, a growing interest has emerged toward understanding the impact that the exposure to human suffering produces in mental health professionals, leading to the identification of three constructs: vicarious traumatization (VT), compassion fatigue (CF), and secondary trauma (ST). However, little is known about how these conditions affect psychologists. A systematic review and a meta-analysis were conducted to examine the evidence about the effects of occupational exposure to trauma and suffering in studies that included psychologists among their samples. Fifty-two studies were included comprising 10,233 participants. Overall, the results showed that most professionals did not experience relevant distress due to their work, yet some of them developed clinically significant symptoms (i.e., PTSD). However, solid conclusions could not be drawn due to the numerous methodological difficulties found in this research field (i.e., group heterogeneity, lack of comparison groups, and conceptual overlap). Thus, it is necessary to further investigate this topic with scientific rigor to understand these stressors and develop evidence-based interventions.

El consumo de loot boxes como una nueva forma de azar en los videojuegos / Loot boxes use as a new form of gambling within video games

Las loot boxes son cajas dentro de los videojuegos que los usuarios pagan por abrir y obtener, al azar, un objeto cuyo valor inicialmente desconocen. Tanto la población adolescente como la adulta tiene fácil acceso a ellas, y se han relacionado con el juego de azar. El objetivo de este estudio fue examinar el consumo de loot boxes y explorar si se asociaba con culpabilidad, pérdida de control y malestar. Para ello, 475 participantes (266 adolescentes y 209 adultos) respondieron a un cuestionario ex profeso de elaboración propia. Los resultados mostraron que son los adolescentes los que más dinero invierten en cajas botín. Este gasto se ve aumentado cuando se anuncia nuevo contenido en las plataformas multimedia online (entre ellas, Twitch, YouTube). Además, no obtener los ítems que desean, lo cual es frecuente por su aleatoriedad, predice mayores niveles de culpabilidad y malestar, mientras que su obtención predice la posterior pérdida de control. Así, el 45,5% de los participantes refirieron culpabilidad tras la compra, el 50% malestar y el 17% pérdida de control. En síntesis, las loot boxes están cada vez más presentes en los entornos virtuales de los adolescentes y adultos, y dadas las consecuencias psicológicas y emocionales que parecen tener, es necesario seguir abordando esta problemática en futuras investigaciones en aras de prevenir y apoyar a la población vulnerable. (AU)

Loot boxes are items within video games which players pay to open and, ultimately, to randomly obtain an object whose value is initially unknown. Being easily accessible for both teenagers and adults, loot boxes have been associated with gambling. The purpose of this study was to explore the use of loot boxes and to analyze whether it is associated with guilt, loss of control, and emotional distress. To this end, 475 participants (266 adolescents and 209 adults) were surveyed on their habits regarding loot boxes and gaming. The results showed that teenagers invest more money in loot boxes than adults. This expenditure increases when a new item is announced on online platforms (Twitch, YouTube). Additionally, not obtaining the coveted items, which is common due to loot box randomness, predicts greater levels of guilt and emotional distress, while obtaining them predicts subsequent loss of control. Thus, 45.5% reported guilt over purchasing, 50% distress and 17% loss of control. Summarizing, loot boxes are increasingly present in video games, and owing to their psycho-emotional outcomes, it is necessary for future research to address this matter in order to develop prevention strategies and to provide support to vulnerable populations. (AU)

Risk Factors Associated with Gambling on Loot Boxes / Factores de Riesgo Asociados al Juego de Azar en Cajas Botín

Background: Loot boxes (LBs) are virtual objects that players open without knowing the value of the item they will obtain. Because of their features, studies have explored their association with gambling, finding commonalities. However, risk factors have been overlooked. This study examined risk factors associated with gambling as applied to LBs (gambling in the past year, having family/friends who use LBs/gamble, trait impulsivity, and sensation-seeking). Method: 253 participants (82.2% men) with a mean age of 28 years (SD = 12.11)—in three groups: gamblers (n = 89), LB purchasers (n = 63), and free-LB openers (n = 101)—completed a self-report. Results: Having family/friends who used LBs was related to increased engagement in opening LBs at no cost. However, having gambled in the past year or having family/friends who used LBs or who gambled was not associated with increased purchasing. Gamblers, LB purchasers, and LB openers scored equally highly on impulsivity and sensation-seeking. Because some gamblers used LBs, and LB purchasers also opened free-LBs, further analyses were performed to control for the effects of overlapping groups. Loot boxers had higher scores in sensation-seeking than gamblers. Conclusions: The results can contribute to the development of prevention and intervention strategies for LB users.(AU)

Antecedentes: Las loot boxes (LBs) son objetos virtuales que se abren desconociendo el valor del artículo que contienen. Aunque se han relacionado con el juego de azar, sus factores de riesgo apenas han sido explorados. Este estudio examina los factores de riesgo del juego de azar en LBs (jugar a juegos de azar, tener familiares/amigos que usan LBs/juegan a juegos de azar, impulsividad-rasgo y búsqueda de sensaciones). Método: 253 participantes (M = 28, DT = 12.11, 82.2% hombres), distribuidos en tres grupos: jugadores de azar (n = 89), compradores de LBs (n = 63) y abridores de LBs gratuitas (n = 101), completaron un autoinforme. Resultados: Tener familiares/amigos que usaban LBs se relacionaba con la apertura gratuita, pero jugar a juegos de azar o tener familiares/amigos que usaban LBs/jugaron a juegos de azar no se relacionaba con la compra. Los tres grupos puntuaron igual en impulsividad y búsqueda de sensaciones. Tras controlar el solapamiento (algunos jugadores de azar usaban LBs, y los compradores de LBs abrían LBs gratuitas), los loot boxers puntuaron más alto en búsqueda de sensaciones que los jugadores de azar. Conclusiones: Conocer las comunalidades entre LBs y juegos de azar puede contribuir a su prevención e intervención.(AU)

Effectiveness of the Unified Barlow Protocol (UP) and neuropsychological treatment in cancer survivors for cognitive impairments: study protocol for a randomized controlled trial.

BACKGROUND: Cancer survivors frequently develop cognitive impairment, which negatively affects their quality of life and emotional well-being. This study compares the effectiveness of a well-established treatment (neuropsychological treatment) with the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) to reduce these cognitive deficits and evaluate the effect of both treatments on anxiety-depressive symptoms and the quality of life of cancer survivors. METHODS: A three-arm, randomized superiority clinical trial with a pre-post and repeated follow-up measures intergroup design using a 1:1:1 allocation ratio will be performed. One hundred and twenty-three cancer survivors with mild to moderate cognitive impairment will be randomly assigned to one of the study interventions: a cognitive rehabilitation intervention group, an intervention group with UP intervention, or a control group on the waiting list. The primary outcome is to observe a significant improvement in cognitive function in both intervention groups and a significant decrease in emotional impairments in comparison with the waitlist group. Improvements in anxiety, depression, and quality of life are also expected as secondary outcomes. These results will be maintained at 6 months of follow-up. DISCUSSION: The aim of this trial is to test the efficacy of the UP intervention in reducing cognitive deficits in breast cancer survivors. The results of this trial may be useful in reducing the presence of cognitive problems in cancer survivors and improving their emotional state and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT05289258. Registered 12 March 2022, v01.

Efficacy of a Combined Acceptance and Commitment Intervention to Improve Psychological Flexibility and Associated Symptoms in Cancer Patients: Study Protocol for a Randomized Controlled Trial.

Psychological flexibility is a key concept of acceptation and commitment therapy (ACT). This factor has been linked with psychological wellbeing and associated factors, such as quality of life, in cancer patients. These and other positive results of acceptation and commitment therapy in cancer patients found in previous research could be enhanced by using mhealth tools. A three-arm randomized superiority clinical trial, with a pre-post-follow-up repeated measures intergroup design with a 1:1:1 allocation ratio is proposed. A hundred and twenty cancer patients will be randomly assigned to one of the following interventions: (1) face-to-face ACT + mobile application (app), (2) face-to-face ACT, and (3) Waitlist control group. The primary expected outcome is to observe significant improvements in psychological flexibility acceptance and action questionnaire- II (AAQ-II) in the face-to-face ACT + app group, after comparing baseline and post-treatment scores, and the scores will remain stable in the two assessment points, 3 and 6 months after the intervention. Secondary expected outcomes are significant increasing scores in quality of life (EORTC QLQ C-30) and post-traumatic-growth (PTGI-SF), and significant decreasing scores in anxiety and depression (HADS), insomnia (ISI) and fatigue (BFI) at the same assessment points. Also, it is expected that the scores of this group will be higher than the scores of the face-to-face ACT group and the waitlist control group. This study aims to assess the efficacy of a combined intervention (face-to face ACT + app) for psychological flexibility and associated symptoms in cancer patients. The results of this protocol may help to consider the use of acceptation and commitment therapy and mhealth applications in cancer settings as a valid therapeutic choice. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT05126823].

Cost-effectiveness and cost-utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP-Costs): a multicentre randomized controlled trial protocol.

BACKGROUND: Emotional disorders are common, and they have become more prevalent since the COVID-19 pandemic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetuate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive-behavioural therapy (tCBT) as a cost-effective alternative. However, it is not suitable for everyone; in some cases, one-on-one sessions may be more effective. The objective of the present study is to compare, in cost-benefit terms, group and individual tCBT with the treatment usually administered in Spanish primary care (TAU). METHODS: A randomized, controlled, multicentre, and single-blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calculate incremental cost-effectiveness and cost-utility ratios. DISCUSSION: This trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped-care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021).

Effectiveness of brief group transdiagnostic therapy for emotional disorders in primary care: A randomized controlled trial identifying predictors of outcome.

AbstractBrief transdiagnostic psychotherapy is a possible approach for emotional disorders in primary care. The objective of the present randomized controlled trial was to determine its effectiveness compared with the treatment as usual based on pharmacological interventions in patients with mild/moderate symptoms. In addition, emotional regulation strategies and cognitive factors were studied as potential predictors. Participants (N = 105) were assigned to brief group therapy based on the Unified Protocol (n = 53) or treatment as usual (n = 52). They were assessed before and after the interventions. Mean differences and stepwise regression analyses were performed. Brief group transdiagnostic psychotherapy was more effective than medication in reducing all clinical symptoms (p = .007 for generalized anxiety; p = .000 for somatization; p = .000 for panic disorder; and p = .041 for depression) and in modifying emotional regulation strategies and cognitive processes (p = .000 for cognitive reappraisal, expressive suppression, worry, rumination, and metacognition) with moderate/high effect sizes. Besides, it was found that these variables acted as predictors of the therapeutic change. It is concluded that brief therapies could be an accurate treatment for mild/moderate emotional disorders in primary care due to their cost-effective characteristics.

Psychological and Non-Pharmacologic Treatments for Pain in Cancer Patients: A Systematic Review and Meta-Analysis.

CONTEXT: Pain is the most fearful symptom in cancer. Although there is a relationship between psychosocial variables and oncologic pain, psychological and non-pharmacological treatments for pain management in cancer patients are not very widespread. OBJECTIVES: To analyze the efficacy of psychological and non-pharmacological treatments for reducing pain in cancer patients. METHODS: We performed a systematic review following the PRISMA protocol. In January 2021, data were extracted from PubMed, Web of Science and Scopus, including randomised controlled trials (RCT) published in the last five years (from 28 January, 2015 to December 15, 2020), in the English language and whose sample was patients with cancer pain. The database search used the following keywords: cancer, cancer-related pain, psychological intervention, non-pharmacologic intervention. The Cochrane risk of bias assess ment for randomised trials (RoB 2) was used for quality appraisal. RESULTS: After the inclusion and exclusion criteria were applied, ten papers were fully screened. The evidence suggested that the most effective interventions to reduce cancer pain were mindfulness-based cognitive therapy, guided imagery and progressive muscle relaxation and emotional and symptom focused engagement (EASE). Music therapy and brief cognitive behavioral strategies (CBS) require more research, while coping skills training and yoga did not show positive effects. Overall, we obtained a moderate size effect (d = 0.642, 95% CI: 0.125-1.158) favourable to psychological and non-pharmacologic treatments at post-treatment, which increased at follow-up (k = 5, d = 0.826, 95% CI: 0.141-1.511). CONCLUSION: This study provides insight into psychological interventions which might be applied and contribute to cancer-related pain reduction in adults. Although the results are not completely consistent, they may shed light on psychology applications in the oncology environment.

Loot boxes use as a new form of gambling within video games. / El consumo de loot boxes como una nueva forma de azar en los videojuegos.

Loot boxes are items within video games which players pay to open and, ultimately, to randomly obtain an object whose value is initially unknown. Being easily accessible for both teenagers and adults, loot boxes have been associated with gambling. The purpose of this study was to explore the use of loot boxes and to analyze whether it is associated with guilt, loss of control, and emotional distress. To this end, 475 participants (266 adolescents and 209 adults) were surveyed on their habits regarding loot boxes and gaming. The results showed that teenagers invest more money in loot boxes than adults. This expenditure increases when a new item is announced on online platforms (Twitch, YouTube). Additionally, not obtaining the coveted items, which is common due to loot box randomness, predicts greater levels of guilt and emotional distress, while obtaining them predicts subsequent loss of control. Thus, 45.5% reported guilt over purchasing, 50% distress and 17% loss of control. Summarizing, loot boxes are increasingly present in video games, and owing to their psycho-emotional outcomes, it is necessary for future research to address this matter in order to develop prevention strategies and to provide support to vulnerable populations.

Las loot boxes son cajas dentro de los videojuegos que los usuarios pagan por abrir y obtener, al azar, un objeto cuyo valor inicialmente desconocen. Tanto la población adolescente como la adulta tiene fácil acceso a ellas, y se han relacionado con el juego de azar. El objetivo de este estudio fue examinar el consumo de loot boxes y explorar si se asociaba con culpabilidad, pérdida de control y malestar. Para ello, 475 participantes (266 adolescentes y 209 adultos) respondieron a un cuestionario ex profeso de elaboración propia. Los resultados mostraron que son los adolescentes los que más dinero invierten en cajas botín. Este gasto se ve aumentado cuando se anuncia nuevo contenido en las plataformas multimedia online (entre ellas, Twitch, YouTube). Además, no obtener los ítems que desean, lo cual es frecuente por su aleatoriedad, predice mayores niveles de culpabilidad y malestar, mientras que su obtención predice la posterior pérdida de control. Así, el 45,5% de los participantes refirieron culpabilidad tras la compra, el 50% malestar y el 17% pérdida de control. En síntesis, las loot boxes están cada vez más presentes en los entornos virtuales de los adolescentes y adultos, y dadas las consecuencias psicológicas y emocionales que parecen tener, es necesario seguir abordando esta problemática en futuras investigaciones en aras de prevenir y apoyar a la población vulnerable.

Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial / Tratamientos psicológicos breves para trastornos emocionales en Atención Primaria y Especializada: un ensayo clínico aleatorizado

Background/Objective Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. Method: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. Results: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. Conclusions: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems. (AU)

Antecedentes/Objetivo: Las psicoterapias breves son un posible tratamiento para los trastornos emocionales. Nuestro propósito fue determinar su eficacia en los trastornos emocionales leves/moderados en comparación con el tratamiento habitual basado en intervenciones farmacológicas. Método: Este estudio fue un ensayo clínico aleatorizado simple ciego con diseño paralelo de tres grupos. Los pacientes (N = 102) fueron asignados a psicoterapia breve individual (n = 34), psicoterapia breve grupal (n = 34) o tratamiento habitual (n = 34). Los participantes fueron evaluados antes y después del tratamiento con los siguientes instrumentos: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18 y SCID. Se realizaron análisis por protocolo y por intención de tratar. Resultados: Las psicoterapias breves fueron más efectivas que el tratamiento habitual para la reducción de síntomas y diagnósticos de los trastornos emocionales. El tratamiento habitual solo fue efectivo en reducir los síntomas depresivos. Conclusiones: Las psicoterapias breves pueden ser el tratamiento de elección para los trastornos emocionales leves/moderados y podrían implementarse en los sistemas de salud. (AU)

Brief psychological treatments for emotional disorders in Primary and Specialized Care: A randomized controlled trial.

Background/Objective Brief transdiagnostic psychotherapies are a possible treatment for emotional disorders. We aimed to determine their efficacy on mild/moderate emotional disorders compared with treatment as usual (TAU) based on pharmacological interventions. Method: This study was a single-blinded randomized controlled trial with parallel design of three groups. Patients (N = 102) were assigned to brief individual psychotherapy (n = 34), brief group psychotherapy (n = 34) or TAU (n = 34). Participants were assessed before and after the interventions with the following measures: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18, and SCID. We conducted per protocol and intention-to-treat analyses. Results: Brief psychotherapies were more effective than TAU for the reduction of emotional disorders symptoms and diagnoses with moderate/high effect sizes. TAU was only effective in reducing depressive symptoms. Conclusions: Brief transdiagnostic psychotherapies might be the treatment of choice for mild/moderate emotional disorders and they seem suitable to be implemented within health care systems.

Antecedentes/Objetivo: Las psicoterapias breves son un posible tratamiento para los trastornos emocionales. Nuestro propósito fue determinar su eficacia en los trastornos emocionales leves/moderados en comparación con el tratamiento habitual basado en intervenciones farmacológicas. Método: Este estudio fue un ensayo clínico aleatorizado simple ciego con diseño paralelo de tres grupos. Los pacientes (N = 102) fueron asignados a psicoterapia breve individual (n = 34), psicoterapia breve grupal (n = 34) o tratamiento habitual (n = 34). Los participantes fueron evaluados antes y después del tratamiento con los siguientes instrumentos: PHQ-15, PHQ-9, PHQ-PD, GAD-7, STAI, BDI-II, BSI-18 y SCID. Se realizaron análisis por protocolo y por intención de tratar. Resultados: Las psicoterapias breves fueron más efectivas que el tratamiento habitual para la reducción de síntomas y diagnósticos de los trastornos emocionales. El tratamiento habitual solo fue efectivo en reducir los síntomas depresivos. Conclusiones: Las psicoterapias breves pueden ser el tratamiento de elección para los trastornos emocionales leves/moderados y podrían implementarse en los sistemas de salud.

Psychological, educational, and alternative interventions for reducing fear of childbirth in pregnant women: A systematic review.

OBJECTIVE: This review aims to identify non-medical interventions that may reduce the fear of childbirth, directly or indirectly (through its factors). METHODS: This review followed the PRISMA guidance and a rigorous protocol that was registered in PROSPERO. Searches were done in ProQuest, the International Clinical Trials Registry Platform, and Google Scholar. All RCTs published in the last 5 years, in English or Spanish, regarding women with a low-risk pregnancy and without mental disorders were included. RESULTS: From 5147 articles found, only 69 were full-text assessed. Finally, 18 studies were included suggesting that prenatal education, psychoeducation, and counseling might be effective, whereas cognitive-behavioral therapy and some alternative therapies require more research. The results of relaxation techniques were contradictory. Results also suggest that social support and exposure (through education) might have an important role in the efficacy of interventions. CONCLUSIONS: More appropriately randomized and blinded trials are necessary that use a prespecified definition of fear of childbirth and comprehensive measurement tools specific for pregnant women.