A Randomized Clinical Trial to Assess the Efficacy of a Psychological Treatment to Quit Smoking Assisted with an App: Study Protocol.

Numerous studies have shown the efficacy of smoking cessation interventions. However, some challenges, such as relapse rates, remain. The availability of information technologies (ICTs) offers promising opportunities to address such challenges. The aim of this paper is to describe the protocol followed to assess the efficacy of a face-to-face cognitive-behavioral intervention for smoking cessation using a smartphone application as a complement, compared with a control group. A single blind, two-arm, randomized controlled trial is proposed (NCT04765813). The participants will be smokers over 18 years old, who smoke at least eight cigarettes per day. Participants will be randomized to one of two conditions, using a 1:1 allocation ratio: (1) cognitive-behavioral smoking cessation treatment along with an App with active therapeutic components (SinHumo App); or (2) cognitive-behavioral treatment along with the use of a control App (without active components). The experimental App will be used during the eight treatment sessions and for 12 months after the end of treatment. The primary outcome measures will be 7-days point-prevalence abstinence at 12-months follow-up. We expect the experimental App to obtain higher abstinence rates at the end of treatment and at one-year post-treatment follow-ups and lower relapse rates, compared to the control App.

Mediational Effect of Fairburn's Transdiagnostic Mechanisms Between Attachment to the Mother and Eating Disorder Symptoms in a Clinical Sample.

Objective: Research has supported a link between insecure attachment and eating disorders (EDs); however, little is known about how this influence is exerted in young female EDs patients. This study tested, for the first time, a multiple mediational model, wherein the four Fairburn's transdiagnostic mechanisms mediated the relationship between attachment to the mother and ED symptoms. Methods: A total of 101 female young EDs patients aged 15-24 were administered the Inventory of Parent and Peer Attachment, Eating Disorder Inventory-3 and Eating Attitudes Test-26 to assess attachment, the four transdiagnostic maintaining mechanisms and ED symptoms, respectively. Results: Comparison analyses showed that there were no significant differences between the diagnostic groups in terms of attachment and the transdiagnostic variables. Multiple mediational analyses indicated that low self-esteem and clinical perfectionism were significant mediators between insecure attachment to the mother and ED symptoms, while controlling for depressive symptoms. Conclusion: These findings suggest that the distal risk influence of insecure attachment to the mother in the development of ED symptoms might be explained by low self-esteem and high clinical perfectionism, controlling for depressive symptoms. Further investigation into the efficacy of cognitive-behavioral treatments targeting insecure attachment representations for young EDs patients is recommended.

Brooding Rumination and Anxiety Sensitivity: Associations With Depressive and Anxiety Symptoms in Treatment-seeking Smokers.

BACKGROUND: This study explores the shared and specific associations of brooding rumination and anxiety sensitivity to depression and anxiety symptomatology in a sample of treatment-seeking smokers. METHODS: The sample was composed of 275 treatment-seeking adult smokers. Hierarchical linear regression analyses were conducted to examine the relations of both variables with depressive and anxiety symptoms. RESULTS: Greater brooding rumination and anxiety sensitivity predicted higher levels of depression and anxiety symptoms. A specific relationship emerged after controlling for comorbid symptoms (depressive or anxiety symptoms) where brooding rumination was associated with depressive symptoms and anxiety sensitivity with anxiety symptoms. CONCLUSIONS: The findings showed that the variables examined are transdiagnostically related to emotional symptoms, but this relationship was symptomatology-specific when controlling for comorbid symptoms (depressive or anxiety symptoms). Due to the impact of affective symptoms on abstinence outcomes, these findings have relevant clinical implications. In the context of smoking cessation treatment, identifying shared and specific vulnerabilities might contribute to tailoring and designing more precise and effective interventions for quitting smoking.

Brooding Rumination and Anxiety Sensitivity: Associations WithDepressive and Anxiety Symptoms in Treatment-seeking Smokers / Rumiación y Sensibilidad a la Ansiedad: Asociaciones con SíntomasDepresivos y de Ansiedad en Fumadores que Buscan Tratamiento ParaDejar de Fumar

Background: This study explores the shared and specific associations of brooding rumination and anxiety sensitivity to depression and anxiety symptomatology in a sample of treatment-seeking smokers. Methods: The sample was composed of 275 treatment-seeking adult smokers. Hierarchical linear regression analyses were conducted to examine the relations of both variables with depressive and anxiety symptoms. Results: Greater brooding rumination and anxiety sensitivity predicted higher levels of depression and anxiety symptoms. A specific relationship emerged after controlling for comorbid symptoms (depressive or anxiety symptoms) where brooding rumination was associated with depressive symptoms and anxiety sensitivity with anxiety symptoms. Conclusions: The findings showed that the variables examined are transdiagnostically related to emotional symptoms, but this relationship was symptomatology-specific when controlling for comorbid symptoms (depressive or anxiety symptoms). Due to the impact of affective symptoms on abstinence outcomes, these findings have relevant clinical implications. In the context of smoking cessation treatment, identifying shared and specific vulnerabilities might contribute to tailoring and designing more precise and effective interventions for quitting smoking.

Antecedentes: este estudio explora las asociaciones compartidas y específicas entre el factor reproches de la rumiación y la sensibilidad a la ansiedad con la sintomatología depresiva y ansiosa en una muestra de fumadores. Método: la muestra estaba formada por 275 fumadores adultos que demandaron tratamiento para dejar de fumar. Se realizó un análisis de regresión lineal jerárquica para examinar las relaciones de ambas variables con los síntomas depresivos y ansiosos. Resultados: mayores puntuaciones en rumiación-reproches y en sensibilidad a la ansiedad predijeron niveles más elevados de síntomas depresivos y ansiosos. Sin embargo, cuando se controlaron los síntomas comórbidos (depresivos o ansiosos), emergieron relaciones específicas entre la rumiación-reproches y los síntomas depresivos y entre la sensibilidad a la ansiedad y los síntomas ansiosos. Conclusiones: las variables examinadas se relacionan transdiagnósticamente con la sintomatología emocional, pero esta relación pasa a ser específica cuando se controlan los síntomas comórbidos (depresivos o ansiosos). Debido al impacto negativo que tienen los síntomas emocionales en la abstinencia, estos resultados pueden aportar implicaciones clínicas relevantes. La identificación de vulnerabilidades compartidas y específicas podría contribuir a adaptar y diseñar intervenciones más precisas y eficaces para dejar de fumar.

Treatment completion and anxiety sensitivity effects on smoking cessation outcomes.

INTRODUCTION: Treatment completion is associated with abstinence outcomes in smoking cessation interventions. Previous research has stated that anxiety sensitivity (AS) is associated with smoking-related variables and smoking-cessation outcomes. To date, research has not examined the interaction between AS and treatment completion on smoking-cessation outcomes over time. This study aims to examine the main and the interactive effects of treatment completion and AS (total score and specific dimensions) on smoking-cessation outcomes at 3-, 6-, and 12-month follow-ups. METHOD: The sample consisted of 210 smokers enrolled in an eight-session smoking-cessation cognitive-behavioral treatment (62.1% women; Mage = 45.2, SD = 11.0). Participants were classified as completers (attended the eight treatment sessions) and non-completers (attended ≤ 7 sessions). Abstinence was biochemically confirmed. RESULTS: Main effects indicated that completers had a higher likelihood of being abstinent over time when compared to non-completers. Regarding AS, those with greater AS-Physical Concerns had lower abstinence rates. Besides, a significant interaction between treatment completion, time and AS-Physical Concerns was found. Particularly, completers with greater AS-Physical Concerns had a higher likelihood of being abstainers than non-completers over time, while no significant differences were found for those with lower AS-Physical Concerns. CONCLUSION: These data highlight the relevance of AS-Physical levels and smoking-cessation treatment completion on abstinence outcomes over time among treatment-seeking smokers.

Mediational mechanisms involved in the relation between attachment insecurity and depression: A meta-analysis.

BACKGROUND: Several studies have investigated the intermediate variables or mediators through which attachment insecurity influence the development of depression. However, there has not been a systematic synthesis of this literature to date. The current meta-analytic review aimed at identifying such mediators and quantifying their effect size. METHODS: We systematically searched Medline, Pubmed, Psycinfo, Embase, Proceedings Web of Science and ProQuest Dissertations & Theses Global up until May 2019. 108 studies met inclusion criteria (i.e., investigated intermediate variables that explain the effect of attachment insecurity [exposure] on depressive symptoms [outcome]). Standardized regression coefficients of the indirect and total paths of mediation models of 80 studies were pooled using the inverse of their variance as a weight. Studies were coded and ranked for quality. RESULTS: Dysfunctional attitudes (ß = 0.10, 95% CI = 0.01 to 0.20), self-criticism (ß = 0.17, 95% CI = 0.04 to 0.28), low self-compassion (ß = 0.16, 95% CI = 0.02 to 0.29), and cognitive hyperactivating regulation strategies (ß = 0.13, 95% CI = 0.05 to 0.20), such as repetitive thinking (ß = 0.17, 95% CI = 0.07 to 0.28), and particularly, brooding rumination ß = 0.20, 95% CI = 0.07 to 0.32), mediated the association between insecure attachment and depressive symptoms. Indirect effects were only significant among adult populations. LIMITATIONS: The methodological quality of studies was mostly moderate to low and analyses revealed considerable heterogeneity. CONCLUSION: Our findings support the direct targeting of cognitive-emotional psychological mechanisms in prevention programs and treatment of depression. More longitudinal studies are needed to clarify the interplay of such mediators along with other interpersonal factors between insecure attachment and depression.

Sociotropy, Autonomy and Emotional Symptoms in Patients with Major Depression or Generalized Anxiety: The Mediating Role of Rumination and Immature Defenses.

The relationships between dimensions of personality (sociotropy and autonomy), coping strategies (rumination: brooding and reflection subtypes, and immature defenses) and symptoms of depression and anxiety were explored in patients with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). A total of 279 patients completed questionnaires including measures of personality dimensions, rumination, immature defenses, depression and anxiety. Our findings suggested that sociotropy and autonomy may be associated with both depressive and anxious symptoms in patients with MDD and with GAD. Multiple mediation analyses indicated that brooding always acted as a mediating link between personality vulnerabilities (sociotropy and autonomy) and depressive and anxiety symptoms, independently of the patient group. In addition, in patients with MDD and those with GAD, brooding and immature defenses functioned together by linking sociotropy and autonomy, respectively, with depressive symptoms. Our results also showed that, in patients with GAD, both types of rumination explained the relationship between sociotropy and autonomy and anxiety symptoms. Overall, our findings provided evidence of the transdiagnostic role of the brooding, linking the vulnerability of personality dimensions and emotional symptoms. They also indicated that reflection and immature defenses can operate in conjunction with brooding, depending on the type of vulnerability and emotional context.

Specific Relapse Predictors: Could Cognitive-Behavioral Treatment for Smoking Cessation Be Improved?

Relapse remains a frequent and complex phenomenon that is not yet well understood. An under-researched area of study that may provide relevant information concerns the assessment of specific post-treatment variables, rather than the composite measures commonly used to predict smoking relapse. The current study sought to examine the effects of post-treatment smoking-related variables, including withdrawal symptomatology, abstinence self-efficacy, and smoking urgency in negative-affect situations and smoking relapse at the 3 month follow-up. The sample comprised 130 participants who achieved abstinence for at least 24 h through a cognitive-behavioral smoking cessation treatment. Regression analysis was conducted for both composite measures and specific subscales and items. Data showed that composite measures of tobacco withdrawal, self-efficacy, and smoking urgency in negative-affect situations were not significant predictors of smoking relapse. However, the analysis including subscales, and specific items showed that lower self-efficacy in negative-affect-related situations (OR = 1.36) and three withdrawal symptoms-irritability/frustration/anger (OR = 2.99), restlessness/impatience (OR = 1.87), and craving (OR = 2.31)-were significant predictors of relapse. These findings offer new insights into the role of different smoking-related post-treatment variables in short-term relapse. Considering and specifically targeting these variables after achieving abstinence may potentially contribute to reducing smoking relapse.

Environmental reward and depressive symptoms in the relationship between avoidance and cigarette dependence in treatment-seeking smokers / Reforzamiento ambiental percibido y sintomatología depresiva en la relación entre la evitación conductual y la dependencia del tabaco en fumadores que buscan tratamiento para dejar de fumar

BACKGROUND: The current study sought to further examine the relation between avoidance, environmental reward, depressive symptoms and cigarette dependence. METHOD: The sample included 275 adult treatment-seeking daily smokers (Mage = 45.36, SD = 10.96; 61.5% female). To examine the relationships between the study variables, correlation and serial mediation analyses were conducted. RESULTS: A significant positive relationship between cigarette dependence, avoidance, and depressive symptoms, and a negative relationship with environmental reward was found. Mediation analysis revealed a significant indirect pathway from avoidance to cigarette dependence through depressive symptoms; and also a significant indirect serial pathway from avoidance to cigarette dependence through environmental reward and depressive symptoms. CONCLUSIONS: Our findings suggest the importance of avoidance, environmental reward and depressive symptoms in cigarette dependence. Our findings contribute to the understanding of behavioral and psychological factors related to cigarette dependence, which is a well-known barrier to abstinence. Thus, it could be useful to assess and address such variables in the context of smoking-cessation interventions

ANTECEDENTES: el presente estudio tiene como objetivo examinar la relación entre la conducta de evitación, el reforzamiento ambiental percibido, la sintomatología depresiva y la dependencia del tabaco. MÉTODO: la muestra estaba formada por 275 fumadores que demandan tratamiento para dejar de fumar (Medad = 45,36, DT = 10,96; 61,5% mujeres). Para examinar la relación entre las variables de estudio se realizaron análisis de correlación y de mediación serial. RESULTADOS: se encontró una correlación positiva significativa entre la dependencia del tabaco, la evitación y la sintomatología depresiva, y una correlación negativa significativa con el reforzamiento ambiental percibido. El análisis de mediación serial reveló una vía indirecta significativa entre la evitación y la dependencia del tabaco a través de la sintomatología depresiva; así como entre la evitación y la dependencia del tabaco a través del reforzamiento ambiental percibido y la sintomatología depresiva. CONCLUSIONES: los resultados de este estudio contribuyen a la comprensión de factores conductuales y psicológicos implicados en la dependencia del tabaco, la cual es considerada una barrera para lograr la abstinencia. Por lo tanto, la evaluación y abordaje de estas variables podría considerarse un aspecto relevante en el contexto de las intervenciones para dejar de fumar

Environmental reward and depressive symptoms in the relationship between avoidance and cigarette dependence in treatment-seeking smokers.

BACKGROUND: The current study sought to further examine the relation between avoidance, environmental reward, depressive symptoms and cigarette dependence. METHOD: The sample included 275 adult treatment-seeking daily smokers (M age = 45.36, SD = 10.96; 61.5% female). To examine the relationships between the study variables, correlation and serial mediation analyses were conducted. RESULTS: A significant positive relationship between cigarette dependence, avoidance, and depressive symptoms, and a negative relationship with environmental reward was found. Mediation analysis revealed a significant indirect pathway from avoidance to cigarette dependence through depressive symptoms; and also a significant indirect serial pathway from avoidance to cigarette dependence through environmental reward and depressive symptoms. CONCLUSIONS: Our findings suggest the importance of avoidance, environmental reward and depressive symptoms in cigarette dependence. Our findings contribute to the understanding of behavioral and psychological factors related to cigarette dependence, which is a well-known barrier to abstinence. Thus, it could be useful to assess and address such variables in the context of smoking-cessation interventions.

Behavioral activation and smoking cessation outcomes: The role of depressive symptoms.

INTRODUCTION: Depressive symptoms are related to smoking cessation outcomes. We examined the effects of behavioral activation (BA), as part of a cognitive behavioral intervention to quit smoking, in terms of abstinence rates according to depressive symptom level. We also analyzed whether BA could differentially benefit participants with higher versus lower anhedonia. METHODS: The sample was composed of 183 smokers (Mage = 45.3; 62.8% female) who participated in a randomized clinical trial assessing the effects of a BA intervention compared to a standard intervention. Smoking outcomes were biochemically confirmed point prevalence abstinence, and abstinence days after treatment during one year follow-up. The intensity of depressive symptomatology and anhedonic symptoms were assessed using the Beck Depression Inventory-II. RESULTS: No differences in abstinence rates were found in relation to depressive symptom level. The BA condition (vs. standard condition) predicted greater abstinence rates (OR = 1.91) in participants with lower scores on depressive symptoms, whereas in participants with higher scores, it did not (OR = 1.17). Moreover, the BA condition predicted greater abstinence rates in participants with lower scores on anhedonia. When examining days of abstinence during the one-year follow-up period, a significant interaction was found between depressive symptoms and treatment condition, favoring the BA condition. CONCLUSION: BA implemented as part of a cognitive behavioral intervention to quit smoking improves long-term abstinence rates, especially among those with fewer depressive symptoms.

Cognitive-behavioral treatment with behavioral activation for smoking cessation: Randomized controlled trial.

INTRODUCTION: Behavioral Activation is a behavioral-based treatment that has been proposed as suitable for smoking cessation, as it simultaneously addresses reinforcement-related variables and also mood management. The aim of this study was to compare the effects of a cognitive-behavioral smoking cessation treatment with components of behavioral activation (SCBSCT-BA) with a standard cognitive-behavioral treatment (SCBSCT), and a wait-list control group (WL). METHOD: The sample was comprised of 275 adults smokers (61.4% females, mean age = 45.36, SD = 10.96). After baseline assessment sessions, participants were randomized (ratio: 2.2.1.) to SCBSCT-BA, SCBSCT, or WL. Active groups received 8 weekly 1-hour face-to-face group sessions. Biochemically verified smoking abstinence and depressive symptoms were assessed at the end of treatment, and at 3-, 6-, and 12-month follow-ups. RESULTS: Significant treatment effects in 7-dayspoint prevalence abstinence rates were found for both active groups at the end of treatment. Abstinence rates at 12-months follow-up were 30% for SCBSCT-BA, and 18% for SCBSCT. Using Multiple Imputation for missing data, regression analysis showed significantly greater ORs for the SCBSCT-BA condition (vs. SCBSCT) at the end of treatment and at 3-months follow-up. At 6-, and 12-months follow-ups, ORs for the SCBSCT-BA condition, although greater, did not reach statistical significance. Multilevel analysis showed that abstinence was related to reductions in depressive symptoms. CONCLUSIONS: SCBSCT-BA obtained positive results at short and medium term. Participants who quit smoking experienced a significant reduction in depressive symptoms. Findings support the benefit of adding BA to a cognitive-behavioral smoking cessation treatment. TRIAL REGISTRATION: www.clinicaltrials.gov NCT02844595.

Exploring the reciprocal relationships between adolescents' perceptions of parental and peer attachment and disordered eating: A multiwave cross-lagged panel analysis.

OBJECTIVE: This prospective study explored bidirectional associations between attachment quality towards mother, father, and peers and disordered eating among a large population-based sample of boys and girls in the transition from preadolescence to adolescence. Specifically, we examined whether insecure attachment relationships emerged as a risk factor for or as an outcome of disordered eating. METHOD: A population-based sample of 904 adolescent girls and boys was assessed four times, at baseline (T1; Mage = 10.8 years) and at 2-, 4-, and 6-year follow-up (T2, T3, and T4). Prospective data were analyzed using cross-lagged panel models for each attachment figure (i.e., mother, father, peers) in a multigroup design to compare genders. RESULTS: Better attachment to the mother led to less pronounced disturbed eating in girls across the entire age range and in boys across two time periods. In girls, more pronounced disordered eating at T3 predicted worse attachment to the mother at T4 and better attachment to the father at T1 predicted less disturbed eating at T2. In boys, disordered eating at T1 predicted better attachment to the father at T2. Concerning peer attachment, better attachment at T1 predicted disordered eating at T2, in boys only. No other significant cross-lagged effects emerged. DISCUSSION: These findings highlight the differential and gender-specific contribution of attachment figures to the development of disordered eating in adolescence. Programs aimed at improving communication and trust in the relationship with parents might be promising in the prevention of disordered eating and the subsequent deterioration of parent-child attachment relationships.

Effect of Depressive Symptoms and Sex on the Relationship Between Loneliness and Cigarette Dependence: A Moderated Mediation.

Loneliness is a subjective and emotionally unpleasant experience of perceiving insufficient social relationships. Previous research has revealed that loneliness constitutes a psychosocial risk factor for depression, and is also related to unhealthy behaviors such as smoking. This study aims to examine the relation between loneliness, depression, and cigarette dependence, and to explore the role of sex in this relationship. A total sample of 275 adult treatment-seeking daily smokers (Mage = 45.3; 61.5% females) was used. Our results showed a significant correlation between higher scores of loneliness, depressive symptoms, and cigarette dependence. In addition, mediation analysis showed a significant indirect effect of loneliness on cigarette dependence, via depressive symptoms. Regarding the effect of sex, we found that this variable significantly moderated the relationship between depressive symptoms and cigarette dependence. Results of this study extend previous literature by showing that, in treatment seeking smokers, loneliness is a significant predictor of depressive symptoms, and through this relation, it predicts cigarette dependence. Additionally, sex was a significant moderator of this relation. These findings have several clinical implications, and also contribute to the understanding of cigarette dependence, which is a well-known barrier for smoking cessation.

Mediators linking insecure attachment to eating symptoms: A systematic review and meta-analysis.

In the last two decades, the number of studies focused on the mediators connecting insecure attachment with Eating Disorders (EDs), at both clinical and sub-clinical level, has considerably increased. However, there has not been a systematic synthesis of this literature to date. To fill this gap, the current meta-analytic review aimed at identifying and quantifying the extent to which mediators contribute to the explanation of this relationship. The present study was registered with PROSPERO (CRD42017076807). A comprehensive search process in seven different electronic databases retrieved 24 studies that examined how insecure attachment leads to ED symptoms through mediation analysis. Standardized regression coefficients of the indirect and total paths of 21 mediation models were pooled. Studies were coded and ranked for quality. We found evidence to show that maladaptive emotion regulation and depressive symptoms had the highest effect size for mediation (mediation ratio [PM] = 0.71). Further, body dissatisfaction, neuroticism, perfectionism, mindfulness and social comparison had significant, but moderate to low mediating effects (PM = 0.21-0.58). The methodological quality of these studies was mostly low to moderate and potential areas for development were highlighted. Our findings support the direct targeting of these psychological constructs in prevention programs and treatment of EDs. Future investigations addressing the time sequence between the variables will provide valuable clues to untangle the prospective contribution of each variable on the development and maintenance of eating pathology.

Exploring the link between perfectionism and depressive symptoms: Contribution of rumination and defense styles.

OBJECTIVE: This study investigated the mediating and moderating roles of emotion-focused coping strategies (rumination and immature defenses) in the relationship between perfectionism and depressive symptoms in a Spanish community sample. METHOD: 438 participants (67.4% female; mean age = 36.94 years) completed self-reports assessing perfectionism, rumination, immature defenses and depression. Multiple mediation, moderation and moderated mediation analyses were conducted. RESULTS: Brooding-rumination and immature defenses mediated the relationship between perfectionism and depressive symptoms. Also, brooding-rumination moderated the impact of perfectionism on depressive symptoms. The mediating effect of brooding in the relationship between perfectionism and depressive symptoms turned out to be moderated by immature defenses, such that the vulnerability link between perfectionism and depressive symptoms through brooding was stronger in individuals scoring high on immature defenses. CONCLUSION: Brooding-rumination and immature defenses may be essential mechanisms to explain the paths and conditions whereby maladaptive perfectionism gives rise to depression.

Cognitive-behavioral treatment with behavioral activation for smokers with depressive symptomatology: study protocol of a randomized controlled trial.

BACKGROUND: Smoking is an important risk factor for mental health-related problems. Numerous studies have supported a bi-directional association between cigarette smoking and depression. Despite the advances in understanding the comorbidity between both problems, the most effective psychological treatment that simultaneously targets smoking and depressive symptomatology remains unclear. The objective of this study is to assess the effectiveness of a cognitive-behavioral intervention for smoking cessation with components of behavioral activation for managing depressed mood. METHOD: A single blind, three-arm, superiority randomized controlled trial is proposed. Participants will be smokers over 18 years old, who smoke at least 8 cigarettes per day. Participants will be randomized to one of three conditions, using a 2:2:1 allocation ratio: 1) standard cognitive-behavioral smoking cessation treatment; 2) standard cognitive-behavioral smoking cessation treatment plus behavioral activation; or 3) a three-month delayed treatment control group. The primary outcome measures will be biochemically verified point-prevalence abstinence (carbon monoxide in expired air) and significant change from baseline in depressive symptoms to the end of treatment, and at the 3-, 6-, and 12-month follow-up. DISCUSSION: This study aims to assess the efficacy of a cognitive-behavioral intervention with behavioral activation components for smoking cessation and depressive symptoms, compared to a standard cognitive-behavioral intervention to quit smoking. As the relation between depressive symptoms, even at subclinical levels, and quitting smoking difficulties is well known, we expect that such intervention will allow obtaining higher abstinence rates, lower relapse rates, and mood improvement. TRIAL REGISTRATION: ClinicalTrials.gov : NCT02844595 . Retrospectively registered 19th July, 2016. The study started in January 2016, and the recruitment is ongoing.

Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder?

This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection), anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms.

Toward understanding the role of body dissatisfaction in the gender differences in depressive symptoms and disordered eating: a longitudinal study during adolescence.

This study was aimed at examining whether body dissatisfaction in early adolescence contributes to the development of gender differences in depressive symptoms and disordered eating across early to mid-adolescence, testing both a mediation hypothesis (higher levels of body dissatisfaction in girls, provided body dissatisfaction is a predictor of psychopathology beyond the effect of gender) and a moderation hypothesis (more detrimental effect of body dissatisfaction in girls). A community-based sample initially comprising 882 (49.55% female) adolescents (M(age) = 12.85) was followed-up after 2 and 4 years. Multilevel models were used to analyze the data. Results supported the mediation hypothesis for depressive symptoms and disordered eating, and the moderation hypothesis for disordered eating. Whereas gender differences in depressive symptoms may be simply linked to dissimilar levels of body dissatisfaction in girls and boys, gender differences in disordered eating may arise from both dissimilar levels and effects of body dissatisfaction for each gender.

Reciprocal associations between depressive symptoms and disordered eating among adolescent girls and boys: a multiwave, prospective study.

Symptoms of depression and eating disorders increase during adolescence, particularly among girls, and they tend to co-occur. Despite this evidence, there is meager research on whether depression increases the risk of future eating pathology, or vice versa, and we do not know whether these processes are different for adolescent girls and boys. Accordingly, this study explored the prospective reciprocal associations between depressive symptoms and disordered eating at different time points from preadolescence to mid-adolescence and tested the moderator effect of gender on these associations. A community-based sample of Spanish youth (N = 942, 49 % female) was assessed at ages of approximately 10-11 (T1), 12-13 (T2), 14-15 (T3), and 16-17 (T4) years. The bidirectional relationships between depressive symptoms and disordered eating were estimated in an autoregressive cross-lagged model with latent variables. A unidirectional, age-specific association between depressive symptoms at T1 and disordered eating at T2 was found. No other significant cross-lagged effect emerged, but the stability of the constructs was considerable. Gender did not moderate any of the links examined. Regardless of gender, the transition from childhood to adolescence appears to be a key period when depressive symptoms foster the development of disordered eating. These findings suggest that early prevention and treatment of depression targeting both girls and boys may result in lower levels of depressive symptoms and disordered eating in adolescence.