Long-lasting symptoms in borderline personality disorder: Defining an emergent population with differential clinical and therapeutic features.

Although the clinical symptoms of borderline personality disorder (BPD) tend to remit over time, a substantial proportion continues to present "long-lasting symptoms" (LLS). This term refers to individuals who present some degree of clinical improvement, but low mood, feelings of emptiness, and poor psychosocial adjustment typically persist. The aim of this study was to compare the sociodemographic, clinical, and therapeutic variables in individuals with BPD with and without LLS. A total of 620 participants with BPD were included and subdivided into two groups: non-LLS group (n = 549, mean age = 28.02 [6.1] and range, 18-40 years) and LLS group (n = 71, mean age = 44.69 [3.6] and range, 41-56 years). The groups were compared in sociodemographic, clinical, and drug treatment characteristics. We also evaluated the impact of dialectical behavioral therapy-skills training (DBT-ST) on polypharmacy. The prevalence of individuals with long-lasting BPD symptoms increased significantly over a 20-year period (from <1% to 16%). The LLS group was characterized by less clinical severity, higher comorbidity with affective disorders but lower comorbidity with eating disorders, more disability, and more medication taking. Patients with LLS who received DBT-ST experienced a significant decrease in the use of benzodiazepines and the number of medications prescribed compared with those who did not receive DBT-ST. Clinicians should be aware of the specific features of older patients with BPD in order to better identify and address their specific therapeutic needs.

Identifying High-Risk Subgroups of College Students with Non-Suicidal Self-Injury: A Latent Profile Analysis and Two-Years Follow-up Study.

Non-Suicidal Self-Injury (NSSI) is associated with a heightened overall risk of future psychopathological problems. However, elucidating specific characteristics that determine an increased risk for certain individuals remains an area requiring further exploration. This study aimed to identify latent subgroups in a sample of college students with NSSI. Additionally, it sought to explore the differential associations of these subgroups with their psychopathological status (e.g., borderline symptoms and suicidal tendencies) both at baseline and after two years. The sample comprised 259 participants (89% females, Mage = 20.39, SD = 1.90) who reported engaging in NSSI in the last year. Three latent groups were found. The group exhibiting severe NSSI-features, high emotion dysregulation, and low perceived social support was the profile with high-risk of psychopathology both at baseline and follow-up. The findings enhance our understanding of the complex association between NSSI and future mental health issues, aiding in the early identification of at-risk individuals.

Physical health, primary care utilization and long-term quality of life in borderline personality disorder: A 10-year follow-up study in a Spanish sample.

OBJECTIVE: We aimed to study physical health and primary care utilization in the long-term course of borderline personality disorder (BPD) and their impact on quality of life (QOL) in a Spanish clinical sample. METHODS: This study is part of a longitudinal study following a clinical cohort with BPD. A total of 41 participants were re-evaluated at 10-year follow-up, when current medical conditions, primary care utilization, and quality of life were assessed. Comparative population data were extracted from the Catalan Health Survey ESCA. RESULTS: 68% of BPD patients reported physical health problems, and 32% informed of multiple medical illnesses at follow-up. Higher rates of musculoskeletal disorders and frequent use of general practitioner (GP) consultations were reported by BPD patients compared to the general population. Differences in physical health and use of primary care services between remitted and non-remitted BPD patients were not significant. BPD remission was independently associated with better long-term QOL. Comorbid somatic diseases worsened the long-term QOL of non-remitted BPD patients. CONCLUSION: Chronic somatic conditions are prevalent in people with BPD and interact negatively with persistent BPD pathology, worsening their QOL in the long-term. Health care strategies in the assistance of long-lasting BPD patients are recommended.

Non-suicidal self-injury in young adults with and without borderline personality disorder: the role of emotion dysregulation and negative urgency / Autolesión no suicida en adultos jóvenes con y sin trastorno límite de la personalidad: el papel de la desregulación emocional y la urgencia negativa

La Autolesión No Suicida (ANS) se define como un dolor auto-infligido que se utiliza como un mecanismo para aliviar la angustia psicoló-gica. Aunque ANS es común en el trastorno límite de la personalidad (TLP), también es un problema creciente en estudiantes universitarios. Si bien la desregulación emocional y la urgencia negativa están asociadas con ANS, poco se sabe sobre las dimensiones específicas que predicen la moti-vación (funciones) y la frecuencia de las autolesiones. Se exploró la relación entre la desregulación emocional, la urgencia negativa, y ANS en 86 adultos jóvenes, divididos en tres grupos: estudiantes universitarios con ANS, pa-cientes TLP con ANS y un grupo de control sano sin ANS. Realizamos análisis de regresión múltiple para predecir las funciones y frecuencia de ANS. La no aceptación de las emociones, una dimensión especifica de la desregulación emocional, predijo de manera única las funciones intraperso-nales de ANS, pero no las funciones interpersonales. Por último, la falta de estrategias de regulación emocional predijo la frecuencia de ANS solo en individuos con una alta urgencia negativa, es decir, individuos que tienden a actuar impulsivamente cuando experimentan emociones negativas, pero no en aquellos con una baja urgencia negativa. Los hallazgos resaltan las moti-vaciones subyacentes a la autolesión y revelan facetas de la desregulación emocional relevantes para el tratamiento de ANS.(AU)

Non-suicidal self-injury (NSSI) is defined as self-inflicted pain, and it is used as a mechanism to alleviate psychological distress. Although NSSI is prevalent in Borderline Personality Disorder (BPD), it is also an increasing concern among college student populations. While emotion dysregulation and negative urgency are associated with NSSI, little is known about which dimensions specifically predict the motivations (NSSI-functions) and frequency of self-harm. The current study explored the rela-tionship between emotion dysregulation, negative urgency, and NSSI in 86 young adults, divided into three groups: college students with NSSI, BPD patients with NSSI, and a healthy control group without NSSI. We con-ducted multiple regression analyses to predicted NSSI-functions and NSSI-frequency. Non-acceptance of emotions, a specific dimension of emotion dysregulation, uniquely predicted intrapersonal NSSI-functions (e.g., regu-lating distressing emotions), but not interpersonal NSSI-functions (e.g., communicating distress). Lastly, poor emotion regulation strategies pre-dicted NSSI-frequency only in individuals with high negative urgency, that is, individuals who tend to act impulsively when experiencing negative emotions, but not in those with low negative urgency. Findings shed light on the underlying motivations for engaging in self-injury, and they reveal facets of emotion dysregulation relevant for NSSI treatment.(AU)

Increasing Interoperability between Digital Twin Standards and Specifications: Transformation of DTDL to AAS.

Although standards and specifications for digital twins aim to create interoperability in Industry 4.0, each standard has its own goals, focuses and representations for digital twins. This paper examines an approach to increasing interoperability between established digital twin specifications by transformation. Accordingly, several specifications are presented and requirements for transformation are examined. Following the feasibility analysis, a mapping between the Digital Twin Definition Language (DTDL) and Asset Administration Shell (AAS) was created. To examine the feasibility of this approach, the transformation was implemented and tested for a physical asset. This paper demonstrates that a generic mapping between DTDL and AAS can be applied for transformation in use cases where DTDL models are provided while AAS is required.

Advancing the treatment of long-lasting borderline personality disorder: a feasibility and acceptability study of an expanded DBT-based skills intervention.

BACKGROUND: Long-term follow-up studies in patients with borderline personality disorder (BPD) consistently show persistent impairment in psychosocial adjustment, although symptoms tend to decrease over time. Consequently, it might be better to deemphasize symptom-oriented interventions and instead promote interventions that incorporate patient perspectives on recovery. In this study we aimed to examine the feasibility and acceptability of a novel intervention (dialectical behavioral therapy combined with positive psychology and contextual-based skills) in the clinical treatment of long-lasting BPD difficulties. METHODS: This was a qualitative study. We developed an initial 8-week group intervention for long-lasting BPD. Upon completion of the 8-week program, the participants were asked to participate in a group discussion to provide feedback. Based on that feedback, the intervention protocol was modified and then offered to a second group of patients, who also provided feedback. The protocol was revised again and administered to a third group. A total of 32 patients participated in the group interventions; of these, 20 provided feedback in the qualitative study. The main outcome measure was acceptability. RESULTS: The following overarching themes emerged from the group interviews: helpful, unhelpful and neutral practices; internal/external barriers; facilitators; and effects. Participants reported difficulties in imagining an optimal future and self-compassion. By contrast, positive skills were associated with an increase in positive emotions. The main internal barrier was facing difficult emotions. The main external barriers were language-related issues. The group format was perceived as a facilitator to success. Dropout rates, which were assessed as an additional measure of acceptability, decreased substantially in each successive group, from 60 to 40% and finally 20%. CONCLUSIONS: The intervention was feasible to implement in the clinical setting and participants rated the final set of skills highly. Most of the skills were considered useful. Participant feedback was invaluable to improve the intervention, as evidenced by the large increase in the retention rate from 40 to 80%. Randomized clinical trials are needed to test the efficacy of this intervention in promoting well-being in participants with long-lasting BPD.

Borderline personality traits mediate the relationship between low perceived social support and non-suicidal self-injury in a clinical sample of adolescents.

BACKGROUND: Non-suicidal self-injury (NSSI) is a serious public health concern among adolescents, especially in clinical settings. Social support plays a critical role in the onset and maintenance of NSSI in adolescence. NSSI is closely associated with borderline personality disorder (BPD), yet no previous work has analyzed the mediating role of borderline traits in the relationship between perceived social support (PSS) and NSSI. This study aimed to address this gap. METHODS: Participants were 228 adolescent patients (12 to 18 years old), who completed a clinical interview and self-report measures of BPD-traits, current psychological distress, emotion dysregulation and PSS. They were grouped based on the presence (vs. absence) of NSSI. Univariate and multivariate logistic regression analyses were used to identify risk factors of NSSI, and a mediation analysis was conducted to examine the intermediary role of borderline traits in the relationship between PSS and NSSI. RESULTS: NSSI was highly prevalent in our sample (58%) and was associated with higher clinical severity. Low PSS predicted NSSI in univariate, but not multivariate regression. Mediation analyses showed that borderline traits fully accounted for the relationship between low PSS and NSSI, even when controlling for current psychological distress and gender. LIMITATIONS: Cross-sectional design through self-report assessment. CONCLUSIONS: Findings suggest that adolescents with low PSS are especially vulnerable for developing NSSI due to elevated BPD traits. In clinical settings, interventions aimed to reduce borderline symptoms may be a promising treatment option for adolescents with NSSI and low PSS.

Effects of socioeconomic status in cognition of people with schizophrenia: results from a Latin American collaboration network with 1175 subjects.

BACKGROUND: Cognition heavily relies on social determinants and genetic background. Latin America comprises approximately 8% of the global population and faces unique challenges, many derived from specific demographic and socioeconomic variables, such as violence and inequality. While such factors have been described to influence mental health outcomes, no large-scale studies with Latin American population have been carried out. Therefore, we aim to describe the cognitive performance of a representative sample of Latin American individuals with schizophrenia and its relationship to clinical factors. Additionally, we aim to investigate how socioeconomic status (SES) relates to cognitive performance in patients and controls. METHODS: We included 1175 participants from five Latin American countries (Argentina, Brazil, Chile, Colombia, and Mexico): 864 individuals with schizophrenia and 311 unaffected subjects. All participants were part of projects that included cognitive evaluation with MATRICS Consensus Cognitive Battery and clinical assessments. RESULTS: Patients showed worse cognitive performance than controls across all domains. Age and diagnosis were independent predictors, indicating similar trajectories of cognitive aging for both patients and controls. The SES factors of education, parental education, and income were more related to cognition in patients than in controls. Cognition was also influenced by symptomatology. CONCLUSIONS: Patients did not show evidence of accelerated cognitive aging; however, they were most impacted by a lower SES suggestive of deprived environment than controls. These findings highlight the vulnerability of cognitive capacity in individuals with psychosis in face of demographic and socioeconomic factors in low- and middle-income countries.

A Functional Connectivity Study to Investigate the Role of the Right Anterior Insula in Modulating Emotional Dysfunction in Borderline Personality Disorder.

OBJECTIVE: Previous imaging studies in patients with borderline personality disorder (BPD) have detected functional brain dysfunctions. Mindfulness training may improve the symptoms of BPD, although the neural mechanisms involved remain poorly understood. This study had several key aims: a) to investigate the role of right anterior insula (rAI) functional connectivity in modulating baseline emotional status in BPD, b) to compare differences in connectivity changes after mindfulness training versus interpersonal effectiveness intervention, and c) to explore the correlation between longitudinal changes in imaging data and clinical indicators. METHODS: Thirty-eight patients with BPD underwent resting-state functional magnetic resonance imaging. Participants completed self-report clinical scales and participated in a dialectical-behavioral therapy (mindfulness versus interpersonal effectiveness modules). Changes in clinical and imaging variables were evaluated longitudinally after completion of the first 10-week sessions of psychotherapeutic intervention. RESULTS: At baseline, the rAI was strongly connected with the other salience network nodes and anticorrelated with most core nodes of the default mode network (p < .05, corrected). The functional connectivity of the rAI correlated with emotional dysregulation and deficits in mindfulness capacities (p < .05, corrected). After completion of psychotherapeutic intervention, both groups (mindfulness and interpersonal effectiveness) showed divergent posttherapy functional connectivity changes, which were in turn associated with the clinical response. CONCLUSIONS: The functional connectivity of the rAI seems to play an important role in emotion dysregulation and deficits in mindfulness capacities in individuals with BPD. Psychotherapy seems to modulate this functional connectivity, leading to beneficial changes in clinical variables.

Mindfulness in Borderline Personality Disorder: Decentering Mediates the Effectiveness.

BACKGROUND: Mindfulness skills training is a core component of dialectical behavior therapy (DBT) that has proven to be an effective stand-alone treatment for the general symptoms commonly present in patients with borderline personality disorder (BPD). The aim of the present study was to compare the effectiveness of mindfulness-based DBT skills training (DBT-M) to interpersonal effectiveness-based DBT skills training (DBT-IE) in reducing BPD symptoms. We also evaluated the specific mechanism of action of these therapies through two proposed mediators: decentering and emotion dysregulation. METHOD: A total of 102 participants diagnosed with BPD were included in the study. Multivariate repeated-measures ANOVAs were performed followed by a multiple mediation analysis. RESULTS: The analyses showed that DBT-M was more effective than DBT-IE in reducing BPD symptoms, although both interventions were effective in reducing emotion dysregulation. We identified a serial mediation model in which DBT-M reduced BPD symptoms by increasing decentering ability, which in turn reduced emotion dysregulation. This mediation effect showed that changes in decentering preceded improvements in emotion dysregulation. CONCLUSIONS: These findings underscore the key role of decentering as a primary mechanism of action in DBT-M, suggesting that this skill is a main component for BPD treatment.

Structural brain abnormalities in borderline personality disorder correlate with clinical severity and predict psychotherapy response.

Although previous imaging studies in borderline personality disorder (BPD) have found brain abnormalities, the results have been inconsistent. This study aimed to investigate structural brain abnormalities using voxel-based morphometry (VBM) and cortical thickness (Cth) analyses in a large sample of patients with BPD. Additionally, we aimed to determine the correlation between structural abnormalities and clinical severity and to assess its potential value at predicting psychotherapeutic response. Sixty-one individuals with BPD and 19 healthy controls underwent magnetic resonance imaging. Participants with BPD completed several self-report clinical scales, received dialectical-behavioral therapy skills training and post-therapy changes in clinical scores were also recorded. Gray matter volume (GMV) and Cth differences between groups were compared. Within the BPD group, we further characterized the structural brain correlates of clinical severity and investigated the relationship between pre-therapy structural abnormalities and therapeutic response. As potential confounders we included age, sex, educational level, and total intracranial volume (the latter only in VBM analyses). Compared to controls, the BPD group showed a reduced GMV/Cth in prefrontal areas but increased GMV in the limbic structures (amygdala and parahippocampal regions). Prefrontal abnormalities correlated with higher baseline scores on impulsivity and general BPD severity. Increased GMV in the parahippocampal area correlated with a greater emotion dysregulation. Importantly, several baseline structural abnormalities correlated with worse response to psychotherapy. Patients with BPD showed a reduced GMV in the prefrontal areas but a greater GMV in the limbic structures. Several structural abnormalities (i.e. middle and inferior prefrontal areas, anterior insula, or parahippocampal area) correlated with clinical severity and could potentially be used as imaging biological correlates biomarkers to predict psychotherapy response.

Predicting Non-Suicidal Self-Injury in Young Adults with and without Borderline Personality Disorder: a Multilevel Approach Combining Ecological Momentary Assessment and Self-Report Measures.

Non-suicidal self-injury (NSSI) is an increasingly prevalent phenomenon associated with many detrimental outcomes, ranging from poor academic performance to suicide attempts. Research on self-harming behaviors has identified emotion dysregulation, negative affect, and borderline pathology as strong risk factors of NSSI, whereas the potential protective effects of metacognitive skills such as decentering have not yet been explored. The current study combined ecological momentary assessment (EMA) and self-report measures to explore potential risk and protective factors of NSSI in a clinical group of Borderline Personality Disorder (BPD) patients with NSSI (N = 22), a subclinical group of college students with NSSI (N = 19), and a non-clinical healthy control group (N = 23). Participants completed self-report measures of borderline pathology, emotion dysregulation, decentering ability, and negative emotional symptoms, and they used the Sinjur App (EMA instrument) at least three times a day for 15 days to capture negative affect and NSSI in daily life. A multilevel mixed-effect regression analysis with both self-report and EMA measures was conducted to identify predictors of NSSI. The multilevel analysis showed that only momentary frustration directly predicted NSSI. Momentary guilt and anger only predicted NSSI when interacting with more stable traits of borderline pathology and negative emotional symptoms. Most importantly, greater decentering capacity protected against self-injury and attenuated the association between momentary sadness and NSSI. Findings contribute novel knowledge about NSSI, documenting the protective effects of decentering and highlighting the benefit of interventions that target metacognitive emotion regulation skills.

Emotional impact of the Covid-19 pandemic on healthcare workers in one of the most important infection outbreaks in Europe.

BACKGROUND AND OBJECTIVES: The Covid-19 pandemic has put healthcare professionals around the world in an unprecedented challenge. This may cause some emotional difficulties and mental health problems. The aim of the present study was to analyze the emotional status among the health care workers form the Hospital of Igualada (Barcelona), while they were facing with Covid-19 in one of the most affected regions in all of Europe. PATIENTS AND METHODS: A total of 395 participants were included in the study. A cross-sectional assessment was carried out between the months of March and April. Information about anxiety, depression, and stress was gathered. We also collected demographic data and concerning potentially stressful factors. RESULTS: A significant proportion of professionals reported symptoms of anxiety (31.4%) and depression (12.2%) from moderate to severe intensity. Symptoms of acute stress were reported by 14.5% of participants. We performed a regression analysis, which explained the 30% of the variance associated with the degree of emotional distress (R²â€¯= 0.30). The final model reveals that females (or young males), who are working in the frontline as nursing assistants, caretakers or radiology technicians, with the uncertainty of a possible infection, the perception of inadequate protection measures and having experienced the death of a close person by Covid-19, showed a heightened risk of experiencing psychological distress. CONCLUSIONS: Coping with the Covid-19 pandemic caused a significant impact on emotional status of healthcare workers involved in this study.

ANTECEDENTES Y OBJETIVO: La actual pandemia de Covid-19 ha puesto a los profesionales sanitarios de todo el mundo ante un desafío sin precedentes. Esto les ha podido causarles dificultades emocionales y problemas de salud mental. El objetivo del presente estudio fue analizar el estado emocional de los trabajadores del Hospital de Igualada (Barcelona), mientras se enfrentaban a uno de los focos de contagio más importantes de Europa. PACIENTES Y MÉTODOS: Se incluyó a un total de 395 trabajadores. Se realizó una evaluación transversal entre los meses de marzo y abril. Se recogió información sobre síntomas de ansiedad, depresión, estrés. También se recogieron datos demográficos y sobre factores potencialmente estresantes. RESULTADOS: Un porcentaje significativo de profesionales reportó síntomas de ansiedad (71.6%) y depresión (60.3%). El 14.5% informó de síntomas de estrés agudo. Se realizó un análisis de regresión que explicó el 30% de la variancia asociada al nivel de malestar emocional (R²â€¯= 0.30). Los factores de riesgo asociados a mayor malestar psicológico fueron el hecho de ser mujer (o hombre joven), trabajar como auxiliar de enfermería, celador o técnico de radiología, estar en contacto directo con pacientes Covid-19, no haber realizado la PCR, tener la sensación de no contar con los elementos de protección personales y haber experimentado la muerte de una persona cercana por Covid-19. CONCLUSIONES: El afrontamiento inicial de la situación de crisis asociada a la pandemia del Covid-19, tuvo un importante impacto emocional en los profesionales sanitarios analizados.

Impacto emocional de la pandemia de Covid-19 en los trabajadores sanitarios de uno de los focos de contagio más importantes de Europa / Emotional impact of the Covid-19 pandemic on healthcare workers in one of the most important infection outbreaks in Europe

ANTECEDENTES Y OBJETIVO: La actual pandemia de Covid-19 ha puesto a los profesionales sanitarios de todo el mundo ante un desafío sin precedentes. Esto les ha podido causar dificultades emocionales y problemas de salud mental. El objetivo del presente estudio fue analizar el estado emocional de los trabajadores del Hospital de Igualada (Barcelona), mientras se enfrentaban a uno de los focos de contagio más importantes de Europa. PACIENTES Y MÉTODOS: Se incluyó a un total de 395 trabajadores. Se realizó una evaluación transversal entre los meses de marzo y abril. Se recogió información sobre síntomas de ansiedad, depresión, estrés. También se recogieron datos demográficos y sobre factores potencialmente estresantes. RESULTADOS: Un porcentaje significativo de profesionales reportó síntomas de ansiedad (71,6%) y depresión (60,3%). El 14,5% informó de síntomas de estrés agudo. Se realizó un análisis de regresión que explicó el 30% de la variancia asociada al nivel de malestar emocional (Ry = 0,30). Los factores de riesgo asociados a mayor malestar psicológico fueron el hecho de ser mujer (o hombre joven), trabajar como auxiliar de enfermería, celador o técnico de radiología, estar en contacto directo con pacientes Covid-19, no haber realizado la PCR, tener la sensación de no contar con los elementos de protección personales y haber experimentado la muerte de una persona cercana por Covid-19. CONCLUSIONES: El afrontamiento inicial de la situación de crisis asociada a la pandemia de Covid-19 tuvo un importante impacto emocional en los profesionales sanitarios analizados

BACKGROUND AND OBJECTIVES: The Covid-19 pandemic has put healthcare professionals around the world in an unprecedented challenge. This may cause some emotional difficulties and mental health problems. The aim of the present study was to analyze the emotional status among the health care workers form the Hospital of Igualada (Barcelona), while they were facing with Covid-19 in one of the most affected regions in all of Europe. PATIENTS AND METHODS: A total of 395 participants were included in the study. A cross-sectional assessment was carried out between the months of March and April. Information about anxiety, depression, and stress was gathered. We also collected demographic data and concerning potentially stressful factors. RESULTS: A significant proportion of professionals reported symptoms of anxiety (31.4%) and depression (12.2%) from moderate to severe intensity. Symptoms of acute stress were reported by 14.5% of participants. We performed a regression analysis, which explained the 30% of the variance associated with the degree of emotional distress (Ry = 0.30). The final model reveals that females (or young males), who are working in the frontline as nursing assistants, caretakers or radiology technicians, with the uncertainty of a possible infection, the perception of inadequate protection measures and having experienced the death of a close person by Covid-19, showed a heightened risk of experiencing psychological distress. CONCLUSIONS: Coping with the Covid-19 pandemic caused a significant impact on emotional status of healthcare workers involved in this study

[Emotional impact of the Covid-19 pandemic on healthcare workers in one of the most important infection outbreaks in Europe]. / Impacto emocional de la pandemia de Covid-19 en los trabajadores sanitarios de uno de los focos de contagio más importantes de Europa.

BACKGROUND AND OBJECTIVES: The Covid-19 pandemic has put healthcare professionals around the world in an unprecedented challenge. This may cause some emotional difficulties and mental health problems. The aim of the present study was to analyze the emotional status among the health care workers form the Hospital of Igualada (Barcelona), while they were facing with Covid-19 in one of the most affected regions in all of Europe. PATIENTS AND METHODS: A total of 395 participants were included in the study. A cross-sectional assessment was carried out between the months of March and April. Information about anxiety, depression, and stress was gathered. We also collected demographic data and concerning potentially stressful factors. RESULTS: A significant proportion of professionals reported symptoms of anxiety (31.4%) and depression (12.2%) from moderate to severe intensity. Symptoms of acute stress were reported by 14.5% of participants. We performed a regression analysis, which explained the 30% of the variance associated with the degree of emotional distress (Ry=0.30). The final model reveals that females (or young males), who are working in the frontline as nursing assistants, caretakers or radiology technicians, with the uncertainty of a possible infection, the perception of inadequate protection measures and having experienced the death of a close person by Covid-19, showed a heightened risk of experiencing psychological distress. CONCLUSIONS: Coping with the Covid-19 pandemic caused a significant impact on emotional status of healthcare workers involved in this study.

Meditation focused on self-observation of the body impairs metacognitive efficiency.

In the last decade of research on metacognition, the literature has been focused on understanding its mechanism, function and scope; however, little is known about whether metacognitive capacity can be trained. The specificity of the potential training procedure is in particular still largely unknown. In this study, we evaluate whether metacognition is trainable through generic meditation training, and if so, which component of meditation would be instrumental in this improvement. To this end, we evaluated participants' metacognitive efficiency before and after two types of meditation training protocols: the first focused on mental cues (Mental Monitoring [MM] training), whereas the second focused on body cues (Self-observation of the Body [SoB] training). Results indicated that while metacognitive efficiency was stable in MM training group, it was significantly reduced in the SoB group after training. This suggests that metacognition should not be conceived as a stable capacity but rather as a malleable skill.

Therapeutic Presence: Its Contribution to the Doctor-Patient Encounter.

In this article, we propose a model of doctor-patient encounter that integrates the concept of therapeutic presence (TP), derived from psychotherapy research, as an indispensable substrate for the benefit of the therapeutic alliance between patient and doctor. To this end, the concepts of the doctor-patient relationship and doctor-patient communication are revisited to explore their therapeutic dimensions. The concept of TP is defined, and existing literature about the relationship between that concept, the therapeutic alliance, and mindfulness is reviewed, alongside an examination of related concepts that have developed within nursing and medicine. We conclude that TP emerges as a transtheoretical concept that can be integrated into our understanding of the doctor-patient encounter to improve both doctor-patient communication and the doctor-patient relationship. The way in which the biomedical model may limit a present medicine is discussed, and the means of integrating such a model of doctor-patient encounter into medical training and practice is analyzed.

[Effects of a mindfulness intervention in Chilean high schoolers]. / Mindfulness y promoción de la salud mental en adolescentes: efectos de una intervención en el contexto educativo.

BACKGROUND: Mindfulness has been conceptualized as paying attention to present moment experience in a non-judgmental manner, and the practice of developing that skill. AIM: To determine the impact of a mindfulness-based intervention on negative emotional states of anxiety, stress, and depression in Chilean high schoolers. MATERIAL AND METHODS: Eighty-eight teenagers aged 13 ± 0.6 years (46 females) were randomly assigned to a mindfulness group or a control (41 and 47, respectively). The mindfulness intervention consisted in eight weekly 45-minute sessions. A depression, anxiety, and stress scale (DASS-21) was applied at baseline, after the intervention, and at three and six-month follow-up. RESULTS: There was a significant reduction in anxiety, depression, and general symptomatology in the experimental group compared to the control group. However, these changes were not sustained at follow-up. CONCLUSIONS: These preliminary results suggest the feasibility and effectiveness of a mindfulness intervention in Chilean schools as a strategy to reduce negative emotional states and prevent risk factors in adolescent population groups.