PsicAP transdiagnostic protocol of group cognitive-behavioral training for emotional disorders in Dominican Republic: a randomized controlled trial protocol.

Emotional disorders (ED) such as anxiety, depression and somatization are extremely prevalent disorders that can affect an individual's quality of life and functionality. Primary Health Care (PHC) is the first place to identify most patients with these conditions. Mental health services in the Dominican Republic, as well as in Latin America and the Caribbean in general, are unable to provide appropriate care for most people with mental disorders. Using evidence-based treatment protocols is also crucial to make progress in helping people with ED. The PsicAP project is a group intervention that uses a transdiagnostic approach and is grounded in cognitive-behavioral techniques. The program is implemented in 7 group sessions, each lasting for one and a half hours. The program has been shown to be effective in reducing clinical symptoms, dysfunction, and in improving quality of life. It is also a non-time-intensive, low-cost treatment that is helpful for addressing EDs in a PHC context. The objective is to bring psychological treatments into PHC facilities of Dominican Republic, making them more accessible for a larger amount of the population.

Design and validation of virtual environments for the treatment of cleaning obsessive-compulsive disorder.

During the coronavirus outbreak, it was noted that pre-existing psychological illnesses worsened, and numerous research indicate that those with contamination-related obsessions and cleaning compulsions (C-OCD) may be more affected. Virtual Reality (VR) and other immersive technologies have shown to be effective for the treatment of disorders related to anxiety, thus showing their potential to transform OCD treatment by means of integrating virtual elements. VR exposure has shown benefits compared to live or imagined exposure, however, to be effective it must be able to elicit high emotional arousal in users. Based on this, the present work aimed to develop different virtual environments scenarios and evaluate their efficacy in generating an emotional response in people with C-OCD symptoms. Based on the literature review, two virtual scenarios were created (dirty public bathroom and unhygienic kitchen). Subsequently, two groups were then constituted: C-OCD group (n = 20, aged between 18 and 48 years) characterized by an obtained score of more than 13 points (cut-point) in the Yale-Brown Scale for Obsessive-Compulsive Disorder (Y-BOCS) and by showing C-OCD symptoms when doing the structured interview (SCID-I), and a control group (n = 20, aged between 18 and 56 years), all participants were residents of the Dominican Republic. Exposure to the virtual environments generated high levels of state and subjective anxiety in both groups, although significantly higher in the C-OCD group. The results obtained indicate that the VR scenarios developed are suitable for eliciting emotional responses and, consequently, that they can be used to complement the treatment of C-OCD.

Focusing on cybersickness: pervasiveness, latent trajectories, susceptibility, and effects on the virtual reality experience.

Although virtual reality (VR) usage has become widespread in the last decade, its adoption has been hampered by experiences of user discomfort known as cybersickness. The present study, in line with the "2020 cybersickness R&D agenda", sought to provide a broad examination of the cybersickness phenomenon, assessing its pervasiveness, latent trajectories, impacts on the VR experience, and predictor variables. The study was composed of 92 participants living in the Dominican Republic with ages ranging from 18 to 52 years (M = 26.22), who experienced a 10-min VR immersion in two environments designed for psychotherapy. The results indicated that cybersickness was pervasive, with 65.2% of the participants experiencing it, and 23.9% severely. Additionally, the latent trajectories of cybersickness were positive and curvilinear, with large heterogeneity across individuals. Cybersickness also had a substantive negative impact on the user experience and the intentions to adopt the VR technology. Finally, motion sickness susceptibility, cognitive stress, and recent headaches uniquely predicted greater severity of cybersickness, while age was negatively related. These combined results highlight the critical role that cybersickness plays on the VR experience and underscore the importance of finding solutions to the problems, such as technological advancements or special usage protocols for the more susceptible individuals. Supplementary Information: The online version contains supplementary material available at 10.1007/s10055-022-00636-4.

COVID-19 pandemic and health worker stress: The mediating effect of emotional regulation.

BACKGROUND/INTRODUCTION: Psychological and physical well-being of health personnel has been significantly affected by COVID-19. Work overload and continuous exposure to positive COVID-19 cases have caused them fatigue, stress, anxiety, insomnia and other detriments. This research aims: 1) to analyze whether the use of cognitive reevaluation and emotional suppression strategies decreases and increases, respectively, stress levels of health personnel; 2) to quantify the impact of contact with patients with COVID-19 on stress levels of medical staff. METHOD: Emotion regulation strategies (cognitive reevaluation and emotional expression) and stress levels were evaluated in 155 Dominican physicians who were treating people infected with COVID-19 at the moment of the study (67.9% women and 32.1% men; mean age = 34.89; SD = 9.26). In addition, a questionnaire created by the researchers quantified the impact that contact with those infected had on their stress levels. RESULTS: Contact with patients with COVID-19 predicts increased use of emotion suppression strategies, although is not associated with the use of cognitive reevaluation. These findings lead to an even greater increase in stress on health care providers. CONCLUSIONS: Contextual contingencies demand immediate responses and may not allow health personnel to use cognitive re-evaluation strategies, leaning more towards emotion suppression. However, findings regarding high levels of stress require the implementation of intervention programs focused on the promotion of more functional emotion regulation strategies. Such programs may reduce current stress and prevent post-traumatic symptoms.

Using Constrained Factor Mixture Analysis to Validate Mixed-Worded Psychological Scales: The Case of the Rosenberg Self-Esteem Scale in the Dominican Republic.

A common method to collect information in the behavioral and health sciences is the self-report. However, the validity of self-reports is frequently threatened by response biases, particularly those associated with inconsistent responses to positively and negatively worded items of the same dimension, known as wording effects. Modeling strategies based on confirmatory factor analysis have traditionally been used to account for this response bias, but they have recently become under scrutiny due to their incorrect assumption of population homogeneity, inability to recover uncontaminated person scores or preserve structural validities, and their inherent ambiguity. Recently, two constrained factor mixture analysis (FMA) models have been proposed by Arias et al. (2020) and Steinmann et al. (2021) that can be used to identify and screen inconsistent response profiles. While these methods have shown promise, tests of their performance have been limited and they have not been directly compared. Thus the objective of the current study was to assess and compare their performance with data from the Dominican Republic of the Rosenberg Self-Esteem Scale (N = 632). Additionally, as this scale had not yet been studied for this population, another objective was to show how using constrained FMAs could help in the validation of mixed-worded scales. The results indicated that removing the inconsistent respondents identified by both FMAs (≈8%) reduced the amount of wording effects in the database. However, whereas the Steinmann et al. method only cleaned the data partially, the Arias et al. (2020) method was able to remove the great majority of the wording effects variance. Based on the screened data with the Arias et al. method, we evaluated the psychometric properties of the RSES for the Dominican population, and the results indicated that the scores had good validity and reliability properties. Given these findings, we recommend that researchers incorporate constrained FMAs into their toolbox and consider using them to screen out inconsistent respondents to mixed-worded scales.

Design and Validation of Augmented Reality Stimuli for the Treatment of Cleaning Obsessive-Compulsive Disorder.

Fear to contamination is an easy-to-provoke, intense, hard-to-control, and extraordinarily persistent fear. A worsening of preexisting psychiatric disorders was observed during the COVID-19 (coronavirus disease 2019) outbreak, and several studies suggest that those with obsessive-compulsive disorder (OCD) may be more affected than any other group of people. In the face of worsening OCD symptoms, there is a need for mental health professionals to provide the support needed not only to treat patients who still report symptoms, but also to improve relapse prevention. In this line, it is recommended to improve alternative strategies such as online consultations and digital psychiatry. The aim of this study is to develop augmented reality (AR) stimuli that are clinically relevant for patients with cleaning OCD and assess their efficiency to obtain emotionally significant responses. Four AR stimuli were developed: a plastic bag full of garbage, a piece of bread with mold, a dirty sports shoe, and a piece of rotten meat. All stimuli were shown to a clinical group (17 patients with cleaning OCD) and a control group (11 patients without OCD). Relevant results were the design of the AR stimuli. These stimuli were validated with the statistical difference in perceived anxiety in the meat stimuli between the clinical and control groups. Nevertheless, when looking at effect sizes, all stimuli present effect sizes from small (plastic bag) to large (meat), with both shoe and bread between small and medium effect sizes. These results are a valuable support for the clinical use of these AR stimuli in the treatment of cleaning OCD.

Affective comorbidity in patients with hypertension: a case-control study on adults in the Dominican Republic / Comorbilidad afectiva en personas con hipertensión arterial: un estudio de caso-control en adultos dominicanos

Abstract Research on the relationship between hypertension and variables linked to negative affectivity has given rise to divergent findings and differing interpretations. The main objective of this paper was therefore to shed light on the issue by analyzing measures of depression, anxiety and anger in adults suffering from hypertension (HTN). Based on a case-control design, a group of individuals suffering from HTN (n=50) was compared with a control group of the same number of cases, age and sex. In general, the HTN Group showed higher levels of depression in its somatic dimension and of trait anger in its temperament dimension. Individuals with HTN presented symptoms of irritability and loss of energy (depressive-somatic symptoms) and propensity to anger easily (temperament anger symptoms). It has been demonstrated in preceding researches that addressing these comorbid psychological factors is of importance in increase adherence to medical treatment in patients who have been diagnosed with hypertension or similar pathologies.

Resumen En la literatura científica se encuentra un gran número de controversias y resultados dispares a la hora de explicar la relación entre la hipertensión arterial y algunas variables vinculadas a la afectividad negativa, como la depresión, la ansiedad y la ira. Teniendo esto en cuenta, en la presente investigación se planteó como objetivo principal analizar medidas de ansiedad, depresión e ira en personas adultas que padecen de hipertensión arterial (HTA). A partir de un diseño de caso-control, se contrastaron dos grupos, uno conformado por personas con HTA (n = 50) y otro de control equiparado en número de casos, edad y sexo. A nivel general, el grupo de HTA mostró mayores niveles de depresión -en su dimensión somática- y de ira-rasgo -en su dimensión de temperamento-. Asimismo, las personas con HTA presentaron síntomas de irritabilidad y pérdida de energía -síntomas depresivo-somáticos-, además de que tendían a enojarse con facilidad o rápidamente -síntomas de temperamento de ira-. El abordaje de estos factores psicológicos comórbidos resulta de relevancia dado que en estudios precedentes ha demostrado aumentar la adherencia al tratamiento médico en pacientes que han sido diagnosticados con hipertensión o patologías similares.

Class enumeration false positive in skew-t family of continuous growth mixture models.

Growth Mixture Modeling (GMM) has gained great popularity in the last decades as a methodology for longitudinal data analysis. The usual assumption of normally distributed repeated measures has been shown as problematic in real-life data applications. Namely, performing normal GMM on data that is even slightly skewed can lead to an over selection of the number of latent classes. In order to ameliorate this unwanted result, GMM based on the skew t family of continuous distributions has been proposed. This family of distributions includes the normal, skew normal, t, and skew t. This simulation study aims to determine the efficiency of selecting the "true" number of latent groups in GMM based on the skew t family of continuous distributions, using fit indices and likelihood ratio tests. Results show that the skew t GMM was the only model considered that showed fit indices and LRT false positive rates under the 0.05 cutoff value across sample sizes and for normal, and skewed and kurtic data. Simulation results are corroborated by a real educational data application example. These findings favor the development of practical guides of the benefits and risks of using the GMM based on this family of distributions.

Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic.

The Beck Depression Inventory-II (BDI-II) is currently one of the most widely used measures in both research and clinical practice for assessing depression. Although the psychometric properties of the scale have been well established through many studies worldwide, so far there is no study examining the validity and reliability of BDI-II in Republic Dominican. The purpose of the present study was twofold: (a) to examine the latent structure of BDI-II by testing several competing models proposed in the literature; and (b) to provide evidence of validity and reliability of the BDI-II in Republic Dominican. Confirmatory factor analysis indicated that a bifactor model with a general depression factor and three specific factors consisting of cognitive, affective and somatic showed the best fit to the data. Internal reliability was moderate to high for all subscales and for the total scale. Scores on BDI-II discriminated between clinical and general population, supporting for external validity. Practical implications are discussed and suggestions for further research are also made.

Evidencias de validez y fiabilidad de las Puntuaciones del STAXI-2 para población general y hospitalaria: Estudio con una muestra de adultos de República Dominicana / Evidence of validity and reliability of the STAXI-2 Scores for the general and hospital population: Study with a sample of adults from the Dominican Republic

Resumen Para evaluar la experiencia, expresión y control de la ira, Spielberger construyó el Inventario State-Trait Anger Expression Inventory. El presente trabajo se propuso evaluar la validez y confiabilidad de las puntuaciones de la versión española del STAXI-2 para población general y hospitalaria de República Dominicana. Con este fin se analizó su estructura factorial, se evaluó la consistencia interna del instrumento, y se obtuvieron evidencias de validez mediante el contraste de grupo (población general vs. hospitalaria). Para realizar el estudio se trabajó con muestra de total de 1034 participantes, de población general (N = 792) y hospitalaria (N = 242) de la ciudad de Santiago de los Caballeros, República Dominicana. El análisis factorial confirmatorio permitió verificar el ajuste de los modelos originales para todas las escalas de ira (i.e. modelo de tres factores para la escala de ira-estado; modelo de dos factores para la escala de ira-rasgo; y modelo de cuatro factores para la escala de control y expresión de la ira). Todas las dimensiones descritas alcanzaron índices de fiabilidad aceptables y óptimos. Finalmente, las escalas consideradas discriminaron adecuadamente entre población general y hospitalaria, especialmente cuando se consideró la muestra psiquiátrica. En conjunto los resultados permiten concluir que las puntuaciones de la versión española del STAXI-2 son válidas y confiables para medir el estado-rasgo, y control-expresión de la ira en República Dominicana.

Abstract To measure the experience, expression and control of anger, Spielberger built the Inventory State-Trait Anger Expression Inventory. This paper under took to evaluate the validity and reliability of the scores of the Spanish version of the STAXI-2 for the general and hospital population of the DR. To this end, the factorial structure was analyzed, the internal consistency of the instrument was evaluated, and evidence of validity was obtained by contrasting groups (general vs. hospital population). To conduct the study, we worked with a sample of 1034 participants from both the general population (N = 792) and hospital population (N = 242) from the city of Santiago de los Caballeros, Dominican Republic. The confirmatory factor analysis allowed to verify the adjustment of the original models for all anger scales (i.e. three-factor model for the anger-state scale, two-factor model for the anger-trait scale, and four-factor model for the scale of control and expression of anger). All the dimensions reached acceptable or optimal reliability indexes. Finally, the scales adequately discriminated between the general and hospital population, especially when the psychiatric sample was considered. Overall, the results allow us to conclude that the scores of the Spanish version of the STAXI-2 are valid and reliable to measure the state trait, and control-expression of anger in the DR.

Extracting Spurious Latent Classes in Growth Mixture Modeling With Nonnormal Errors.

Growth mixture modeling is generally used for two purposes: (1) to identify mixtures of normal subgroups and (2) to approximate oddly shaped distributions by a mixture of normal components. Often in applied research this methodology is applied to both of these situations indistinctly: using the same fit statistics and likelihood ratio tests. This can lead to the overextraction of latent classes and the attribution of substantive meaning to these spurious classes. The goals of this study are (1) to explore the performance of the Bayesian information criterion, sample-adjusted BIC, and bootstrap likelihood ratio test in growth mixture modeling analysis with nonnormal distributed outcome variables and (2) to examine the effects of nonnormal time invariant covariates in the estimation of the number of latent classes when outcome variables are normally distributed. For both of these goals, we will include nonnormal conditions not considered previously in the literature. Two simulation studies were conducted. Results show that spurious classes may be selected and optimal solutions obtained in the data analysis when the population departs from normality even when the nonnormality is only present in time invariant covariates.