Study protocol for a three-arm randomized controlled trial investigating the effectiveness, cost-utility, and physiological effects of a fully self-guided digital Acceptance and Commitment Therapy for Spanish patients with fibromyalgia.

Objective: Fibromyalgia (FM) is a prevalent pain syndrome with significant healthcare and societal costs. The aim of the SMART-FM-SP study is to determine the effectiveness, cost-utility, and physiological effects in patients with FM of a digital intervention (STANZA®) currently marketed in the United States, which delivers smartphone-based, fully self-guided Acceptance and Commitment Therapy (Digital ACT) for treating FM-related symptoms. Methods: A single-site, parallel-group, superiority, randomized controlled trial (RCT) will be conducted, including a total of 360 adults diagnosed with FM. Individuals will be randomly allocated (1:1:1) to treatment as usual (TAU), to TAU plus 12 weeks of treatment with Digital ACT, or to TAU plus 12 weeks of treatment with digital symptom tracking (i.e. FibroST). Participants will be assessed at baseline, post-treatment, and 6-month follow-up. An intention-to-treat analysis using linear mixed models will be computed to analyze the effects of Digital ACT on functional impairment (primary outcome), as measured by the Fibromyalgia Impact Questionnaire Revised at 6 months from the inception of the treatment. Secondary outcomes include impression of change, symptoms of distress, pain catastrophising, quality of life, cost-utility, and selected biomarkers (cortisol and cortisone, immune-inflammatory markers, and FKBP5 gene polymorphisms). The role of ACT-related processes of change will be tested with path analyses. Conclusions: This study is the first RCT that tests Digital ACT for Spanish patients with FM. Results will be important not only for patients and clinicians, but also for policy makers by examining the cost-utility of the app in a public healthcare context.

Combining mindfulness and cognitive training in children with attention deficit hyperactivity disorder: study protocol of a pilot randomized controlled trial (the NeuroMind study).

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) has a global mean prevalence of 5%. Cognitive Training (CT) and Mindfulness-Based Interventions (MBIs) have shown promising results in managing ADHD symptoms, but they are not its Treatment-As-Usual (TAU). The NeuroMind Study aims to evaluate the preliminary effectiveness and feasibility of three interventions: Mindfulness for Health (M4H), CT using the NeuronUP® platform (CT), and a combination of both, Mindfulness Cognitive Training (MCT). There is empirical evidence supporting the effectiveness of the M4H and NeuronUP® platform; however, this study explores for the first time the effectiveness of MCT and CT, as well as the integration of M4H into TAU. The objectives of this 5-month Randomized Controlled Trial (RCT) are: (1) To analyze the preliminary effectiveness and feasibility of M4H, CT or a combination of both (MCT) added to TAU for children with ADHD; (2) To evaluate the role of psychological process variables (mindfulness and emotional regulation) as mediators of 5-month follow-up clinical outcomes; (3) To preliminarily explore whether specific sociodemographic and clinical characteristics can predict the short-and medium-term clinical response to the specific treatments. Methods and analysis: Participants will be 120 children (7 to 12 years) with ADHD recruited at Child and Adolescent Mental Health Service (CAMHS) Sant Joan de Déu Terres de Lleida (Spain) randomly allocated to one of the four study arms: TAU vs. TAU + CT vs. TAU + M4H vs. TAU + MCT. An assessment to collect ADHD symptoms, Executive Functions (EF), comorbid symptoms and global functioning will be conducted pre-intervention, post-intervention (2 months after baseline) and at the 5-month follow-up. Linear mixed models and mediational models will be computed. Discussion: If the preliminary effectiveness and feasibility of the MCT are demonstrated, this study could be a preliminary basis to do a full RCT with a larger sample to definitively validate the intervention. The MCT could be applied in clinical practice if it is definitively validated.Clinical trial registration:ClinicalTrials.gov, identifier, NCT05937347. https://clinicaltrials.gov/study/NCT05937347?locStr=Spain&country=Spain&cond=ADHD&intr=Mindfulness&rank=1.

The Association between exposure to COVID-19, internalizing symptoms, and Dispositional Mindfulness in Adolescents: a longitudinal pre- and during-pandemic study.

This study examined the association between contact with COVID-19 and internalizing symptoms in Spanish adolescents, and the moderation and mediation roles of dispositional mindfulness. Adolescents (N = 383; 58% female; Mage = 15.62, SD = 1.32) completed measures of dispositional mindfulness (MAAS-A) and internalizing symptoms (DASS-21), other stressors different from COVID-19, and contact with COVID-19 twice, in October 2019 and 2020. Three profiles emerged according to their contact with COVID-19: (1) little/no contact, (2) knowing someone close (outside home) who was infected, hospitalized, or died, and (3) being or someone at home being infected and/or hospitalized. Compared to little/no contact, both contact profiles predicted dispositional mindfulness and anxiety; and profile 2 predicted stress. Dispositional mindfulness mediated the association between both contact profiles and depression and stress. This study suggests that contact with COVID-19 predicts increased internalizing symptoms in adolescents, which could be partially explained by the decrease in mindfulness levels.

Emotion dysregulation and mindfulness in non-suicidal self-injury.

This study examined the association between mindfulness and engagement in non-suicidal self-injury (ENSSI) and whether emotion dysregulation explains this association. A secondary objective was to explore the difference between participants who engaged in a suicide attempt and those who only engaged in non-suicidal self-injury. A sample of 201 psychiatric patients (62.7% female; age range: 18-71 years old) participated in the study. The path analysis indicated that trait mindfulness was negatively associated with all emotion dysregulation dimensions and that one of these dimensions, impulse control difficulty, was associated with higher ENSSI. Moreover, impulse control difficulty was associated with increased odds of having attempted suicide. These findings suggest that mindfulness is a relevant construct to ENSSI with and without a suicide attempt. Future studies should investigate mindfulness-based interventions for ENSSI and the role played by the capacity to control impulses when experiencing negative emotions.

Comparing emotional working memory in adolescents and young adults with and without depressive symptoms: developmental and psychopathological differences.

Depressive symptoms are associated with working memory impairments. Yet, comparative studies examining working memory across the developmental spectrum in depressed and non depressed cohorts are lacking. This study examined emotional working memory in 74 adolescents (mean age = 14; 21 with depressive symptoms) and 92 adults (mean age = 22; 36 with depressive symptoms). Participants completed two versions of an emotional face n-back task, and either paid attention to the valence of the emotion or the gender. Both tasks were completed at low load (0-back) and high load (2-back). In the high load condition, healthy adolescents showed a bias towards positive faces, both speeding up reaction times (RTs) when emotion was task relevant but slowing RTs when they were task irrelevant. This interaction was neither significant in adolescents with depressive symptoms nor in young adults. Depressive symptoms did not influence RTs in low load. The results indicate that adolescents with depressive symptoms might lack the bias towards positive affective material at high load WM task present in healthy adolescents.

The Association Between Dispositional Mindfulness and Need Threat Following Ostracism in Spanish Adolescents: The Moderating Role of Age.

BACKGROUND: Ostracism -being ignored and excluded- entails risks for adolescent mental health. Less is known about the factors that are negatively associated with the adverse consequences of ostracism. This study explored the association between dispositional mindfulness and need threat following social exclusion using the Cyberball paradigm. Sex and age were included as moderators of the relationship between dispositional mindfulness and need threat. Additionally, the factor structure of the Need Threat Scale (NTS) was analyzed in Spanish adolescents. METHOD: Participants (N = 750, 52.4% female; mean age = 14.51) completed a mindfulness questionnaire, were ostracized in the Cyberball game, and reported their need threat during this game. RESULTS: Dispositional mindfulness was negatively associated with need threat only in older adolescents (>15 years old). Although girls reported higher levels of need threat than boys, sex did not moderate the association between mindfulness and need threat. CONCLUSIONS: This research suggests that dispositional mindfulness is only associated with NTS in older adolescents and girls are more vulnerable to the negative consequence of ostracism.

The Association Between Dispositional Mindfulness and Need Threat Following Ostracism in Spanish Adolescents: The Moderating Role of Age / La Asociación Entre el Rasgo de Mindfulness y la Amenaza Percibida tras el Ostracismo en Adolescentes Españoles: el papel Moderador de la Edad

Background: Ostracism –being ignored and excluded– entails risksfor adolescent mental health. Less is known about the factors that arenegatively associated with the adverse consequences of ostracism. Thisstudy explored the association between dispositional mindfulness and needthreat following social exclusion using the Cyberball paradigm. Sex andage were included as moderators of the relationship between dispositionalmindfulness and need threat. Additionally, the factor structure of the Need Threat Scale (NTS) was analyzed in Spanish adolescents. Method: Participants (N = 750, 52.4% female; mean age = 14.51) completeda mindfulness questionnaire, were ostracized in the Cyberball game,and reported their need threat during this game. Results: Dispositionalmindfulness was negatively associated with need threat only in olderadolescents (>15 years old). Although girls reported higher levels of needthreat than boys, sex did not moderate the association between mindfulnessand need threat. Conclusions: This research suggests that dispositionalmindfulness is only associated with NTS in older adolescents and girls aremore vulnerable to the negative consequence of ostracism

Antecedentes: el ostracismo –ser ignorado y excluido– conllevariesgos para la salud mental de los adolescentes. Se sabe menos sobre losfactores que se asocian negativamente con las consecuencias adversas delostracismo. Este estudio exploró la asociación entre el rasgo de mindfulness y la amenaza percibida tras una situación de exclusión social utilizando elparadigma experimental Cyberball. Se incluyeron el sexo y la edad comomoderadores de la relación entre el rasgo de mindfulness y la amenazapercibida. Adicionalmente, se analizó la estructura del cuestionario de Amenaza Percibida (NTS) en adolescentes españoles. Método: losparticipantes (N = 750, 52,4% chicas; edad media = 14,51) completaron uncuestionario de mindfulness, fueron excluidos en el Cyberball e indicaronla amenaza percibida tras el juego. Resultados: el rasgo de mindfulness seasoció negativamente con la amenaza percibida solo en los adolescentesmás mayores (>15años). Aunque las chicas reportaron mayores niveles deamenaza percibida, el sexo no moderó la asociación entre mindfulness yamenaza percibida. Conclusiones: esta investigación sugiere que el rasgode mindfulness solo se asocia con la amenaza percibida en los adolescentesmayores y que las chicas son más vulnerables a las consecuencias negativadel ostracismo

Longitudinal Associations between Internalizing Symptoms, Dispositional Mindfulness, Rumination and Impulsivity in Adolescents.

Mindfulness has been associated with fewer negative mental health symptoms during adolescence, but fewer studies have examined longitudinal associations between mindfulness and symptoms in conjunction with two vulnerability factors for psychopathology with mindfulness: rumination and impulsivity. This study examined longitudinal associations between internalizing symptoms (depression, anxiety, stress), mindfulness, rumination, and impulsivity over a one-year period among 352 Spanish adolescents (57.4% girls; M = 14.47, SD = 1.34). Participants completed self-reported measures of symptoms, mindfulness, rumination, and impulsivity at two time points. Mindfulness negatively predicted stress and depressive symptoms, and a bidirectional negative association was found between mindfulness and impulsivity. Impulsivity positively predicted stress, and anxiety positively predicted depressive symptoms, stress, and rumination. This study highlights the importance of mindfulness as a protective factor and impulsivity and anxiety as risk factors for internalizing symptoms throughout adolescence. These findings build on previous studies that examined longitudinal associations between mindfulness and symptoms by including rumination and impulsivity's roles.

A spanish adaptation of the mindfulness in parenting questionnaire / Adaptación de la versión española del cuestionario de mindfulness en la crianza

BACKGROUND: The Mindfulness in Parenting Questionnaire (MIPQ) is a self-report instrument to measure how much parents practice mindful parenting. The main aim of this study was to analyze the psychometric properties of the Spanish version of the MIPQ. METHOD: A total of 271 parents of adolescents completed the MIPQ along with questionnaires about their mindfulness trait, parenting style, and their children's resilience and symptoms of depression. Their adolescent children completed questionnaires about their own depressive symptoms, their perception of their parents' parenting style, and their perceived stress. RESULTS: Factor analyses suggested a two-factor structure corresponding to Being in the Moment with the Child and Mindful Discipline. Moreover, the MIPQ showed good internal consistency and was related to parent's dispositional mindfulness and positive parenting as well as to adolescents' resilience and (negatively) to their depressive symptoms. CONCLUSION: The Spanish version of the MIPQ exhibits good psychometric properties and is an easily applicable test for the assessment of mindful parenting

ANTECEDENTES: el Cuestionario Mindfulness in Parenting (MIPQ) es un instrumento de autoinforme para medir la crianza consciente entre las madres y los padres. El objetivo de este estudio fue analizar las propiedades psicométricas de la versión española del MIPQ. MÉTODO: participaron en el estudio 271 madres y padres de adolescentes que respondieron el MIPQ junto con cuestionarios sobre su rasgo de atención plena, su estilo de crianza y la resiliencia y síntomas de depresión de sus hijos/as. Sus hijos/as adolescentes respondieron cuestionarios sobre sus propios síntomas depresivos, su percepción sobre el estilo de crianza de sus padres y madres y su estrés percibido. RESULTADOS: los análisis factoriales sugirieron una estructura de dos factores correspondientes a Estar en el Momento con el Niño/a y Disciplina Consciente. Además, el MIPQ mostró una buena consistencia interna y se relacionó con el rasgo de atención plena de los padres y madres y la crianza positiva, y con la resiliencia y los síntomas depresivos (negativamente) de los y las adolescentes. CONCLUSIÓN: la versión española del MIPQ presenta buenas propiedades psicométricas y es una prueba fácilmente aplicable para la evaluación de la crianza consciente

A Spanish adaptation of the mindfulness in parenting questionnaire.

BACKGROUND: The Mindfulness in Parenting Questionnaire (MIPQ) is a self-report instrument to measure how much parents practice mindful parenting. The main aim of this study was to analyze the psychometric properties of the Spanish version of the MIPQ. METHOD: A total of 271 parents of adolescents completed the MIPQ along with questionnaires about their mindfulness trait, parenting style, and their children's resilience and symptoms of depression. Their adolescent children completed questionnaires about their own depressive symptoms, their perception of their parents' parenting style, and their perceived stress. RESULTS: Factor analyses suggested a two-factor structure corresponding to Being in the Moment with the Child and Mindful Discipline. Moreover, the MIPQ showed good internal consistency and was related to parent's dispositional mindfulness and positive parenting as well as to adolescents' resilience and (negatively) to their depressive symptoms. CONCLUSION: The Spanish version of the MIPQ exhibits good psychometric properties and is an easily applicable test for the assessment of mindful parenting.

The Effect of an Intervention Teaching Adolescents that People can Change on Depressive Symptoms, Cognitive Schemas, and Hypothalamic-Pituitary-Adrenal Axis Hormones.

Interest is increasing in developing universal interventions to prevent depression in adolescents that are brief enough to be scaled up. The aim of this study was to test the effects on depressive symptoms, cognitive schemas, and Hypothalamic-Pituitary-Adrenal Axis Hormones of an intervention focused on teaching an element of an incremental theory of personality, namely, the belief that people can change. We also examined whether grade level moderated the effects of the intervention. A double-blind, randomized, controlled trial was conducted with 867 Spanish adolescent participants (51.9% boys, Grades 8-10) randomly assigned to an incremental theory intervention (n = 456) or an educational control intervention (n = 411). The adolescents completed measures of depressive symptoms and negative cognitive schemas at pretest, at 6-month follow-up, and at 12-month follow-up. A subsample of 503 adolescents provided salivary samples for cortisol and DHEA-S testing. In 8th grade, adolescents who received the incremental theory intervention displayed a greater decrease in depressive symptoms and cognitive schemas and a lower increase in DHEA-S. Moreover, in adolescents who received the intervention, the rate of adolescents with high depression scores decreased by almost 18% whereas in the control group, the rate increased by 37%. Surprisingly, the effects of the intervention were in the opposite direction among adolescents in 9th grade. These data indicate that a brief universal intervention could prevent depressive symptoms under some conditions, but developmental characteristics can moderate the effectiveness of this approach.

The Protective Role of Dispositional Mindfulness Against the Perpetuation of Cyberbullying Victimization and Perpetration Among Adolescents.

Few studies have examined the protective factors that contribute to reducing long-term involvement in cyberbullying (CB). This study examined whether dispositional mindfulness is associated with the reduced stability over time (i.e., long-term involvement) of CB victimization and perpetration and with the lower reciprocity of both. This was a three-wave longitudinal study spaced 6 months apart. The sample consisted of 985 high school students from the Basque Country (Spain). The participants completed a mindfulness measure at time one and measures of CB victimization and perpetration at three time points. Dispositional mindfulness was negatively associated with both CB victimization and CB perpetration over time. The predictive association between CB victimization and perpetration was reciprocal from time two to time three. Moreover, the interaction between dispositional mindfulness and CB victimization indicated that victimization was less stable over time when mindfulness was higher. The model was invariant across gender or age. The results indicate that CB is a long-term problem and that dispositional mindfulness can be beneficial because it predicts a lower frequency of CB victimization and perpetration over time.