Are Prayer-Based Interventions Effective Pain Management Options? A Systematic Review and Meta-analysis of Randomized Controlled Trials.

This review examined the effects of private and communal participatory prayer on pain. Nine databases were searched. Six randomized controlled trials were included. For private prayer, medium to large effects emerged for 67% to 69% of between-group comparisons; participants in the prayer condition reported lower pain intensity (0.59 < d < 26.17; 4 studies) and higher pain tolerance (0.70 < d < 1.05; 1 study). Pre- to post-intervention comparisons yielded medium to large effects (0.76 < d < 1.67; 2 studies); pain intensity decreased. Although firm conclusions cannot be made because meta-analysis was based on only two studies, the analysis suggested prayer might reduce pain intensity (SMD = - 2.63, 95% CI [- 3.11, - 2.14], I = 0%). (PROSPERO: CRD42020221733).

FOODLIT-tool: Development and validation of the adaptable food literacy tool towards global sustainability within food systems.

Facing multiple anthropogenic challenges and considering the current global pandemic, food sustainability is stated as threatened by major intergovernmental agencies. Given the heterogeneity of food systems, the need to enhance food-related behaviours by promoting the acquisition of knowledge and competencies, and the demand to involve stakeholder's diversity, this study aims to develop and validate an instrument that measures food literacy (FL), its determinants and its influential factors in an adult sample. Based on the Food Literacy Wheel (FLW) framework and integrated within the FOODLIT-PRO - Food Literacy Project, this study has three phases and a total of 2406 participants: (1) item development and content validity, (2) instrument development entailing item reduction strategies, factor extraction methodologies (exploratory and confirmatory analyses) and sensitivity testing, with two samples of a total of 1447 adults, and (3) instrument validation encompassing tests of dimensionality (confirmatory factor analysis), reliability (composite reliability) and validity (convergent and discriminant validity), and measure invariance testing, with 959 adults. Concerning statistical and psychometric properties, (1) a pool of 40 items (26 for FL; single items: five for determinants and nine for influential factors) was developed with inductive and deductive methodologies and reflected the FLW, (2) a 5-factor structure was explored, demonstrated acceptable model fit, and good sensitivity indices, and (3) a 5-dimensional reliable structure with 24 items was validated, configural invariance was achieved, and convergent and discriminant validity were significant in most dimensions. The FOODLIT-Tool contributes with an innovative measure of FL in adults that allows for a tailored assessment when approaching food-related issues within global food systems, providing a multidisciplinary tool that can be cross-widely applied to promote food-related behaviour change.

FOODLIT-PRO: conceptual and empirical development of the food literacy wheel.

Pursuing food systems' sustainability is crucial. Given the risk constituted by unhealthy diets, scarce research on food-related adjacent fields, and inconsistency across food literacy conceptualizations, this study aims to explore the constructs' definition and develop a conceptual and empirical framework of food literacy. A quantitative approach was taken on previously obtained qualitative outcomes from 30 interviews with experts from food-related fields. Food literacy was defined by a four-dimension model: Cooking Skills, Preserve and Analyse, Choice and Acquisition, Search and Plan. The framework Food Literacy Wheel integrates the construct definition, food literacy determinants (Internal, External) and influential factors (Nutritional, Psychological, Health, Learning Contexts, Policy, Industry, Sustainability, Social and Cultural). Allowing a broader perspective of food literacy within major food systems, this study contributes with new insights for future instruments and interventions, paving the way to develop/implement food literacy-related multi-sectorial and multilevel actions.

Do coping responses predict better/poorer mental health in Portuguese adults during Portugal's national lockdown associated with the COVID-19?

Background: This study aimed at assessing the mental health status of adults living in Portugal during the national lockdown of March 2020 to May 2020, how study participants coped with stress during the national lockdown, as well as the association between coping responses and mental health status. Methods: 430 adults from the general population living in Portugal completed measures of mental health status and coping. Results: Participants reported a mental health status in the normal range. Most commonly used coping responses were acceptance, planning and active coping. The use of instrumental and emotional support, self-blame, venting, denial, behavioural disengagement, and substance use were associated with poorer mental health. Active coping, positive reframing, acceptance, and humour were associated with better mental health. However, only positive reframing and humour significantly predicted better mental health, while only substance use predicted poorer mental health. Conclusions: Findings suggest that there was not a significant negative impact of the Portuguese national lockdown in the adults living in Portugal. Findings supported positive reframing and humour as being adaptive coping responses in this context. These responses should be encouraged by healthcare professionals and targeted in the context of psychosocial intervention programs directed to most vulnerable populations.

Stress reduction intervention with mothers of children/adolescents with asthma: a randomized controlled study in Brazil.

Brazil has a high prevalence of pediatric asthma, which can be a stressor to parents/caretakers. Researchers aimed to assesses the efficacy of a stress reduction intervention for mothers of children/adolescents with asthma through a randomized controlled study. Stress, anxiety, and depression were evaluated in three moments. The intervention group (n = 20), entailed 5-weekly sessions; the control group (n =34) had waiting list format. There was a significant decrease in stress, anxiety, and depression in the intervention group. This study indicates that the intervention directed to mothers of children/adolescents with asthma was efficient not only in reducing stress but also anxiety and depression reduction.

Body Image Quality of Life Inventory: cross-national study in college students from four different countries.

PURPOSE: This study was aimed to examine the psychometric proprieties of the Body Image Quality of Life Inventory (BIQLI) among Brazilian, Portuguese, Mozambican, and Italian college students. METHODS: A total of 1630 subjects (Brazilians = 446; Portuguese = 480, Mozambicans = 360, and Italians = 344) completed the Portuguese (Brazilian, Portuguese, and Mozambican students) and the Italian versions (Italian students) of the BIQLI for measuring the effects of body image on one's quality of life. Psychometric testing included confirmatory factor analysis (CFA), discriminant and convergent validity, internal consistency, and composite reliability. The cross-national invariance of the BIQLI was assessed by multi-group analysis using ΔCFI. Moreover, the global score of the BIQLI for all countries was calculated by an algorithm and compared using the Welch's ANOVA and the Games-Howell post-test (α = 5%). RESULTS: CFA showed an inadequate fit of unifactorial model of the BIQLI. Therefore, an alternative model comprising nine first-order factors and one second-order factor was proposed and evaluated. This new model showed adequate fit in all samples, despite some limitations that were found with respect to its convergent and discriminant validity. The alternative BIQLI model was invariant among countries. Global scores for the influence of body image on quality of life were significantly different across countries, with the Italians presenting the lowest scores. CONCLUSIONS: The BIQLI factorial model found in this study represents a reliable and valid alternative to its original structure for the assessment of the effect of body image on college students' perceived quality of life. This model must be further tested in other populations. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Predictors of stress and depressive mood in Portuguese middle-aged women.

This cross-sectional study investigates the predictors of psychological symptoms-stress and depressive mood-in a sample of middle-aged women. A community sample of 1,003 women filled in the questionnaires and instruments, which included the Depression, Anxiety and Stress Scales and the Life Events Survey; sociodemographic, health, and menopause-related and lifestyle information was also collected. Structural equation modeling was used to build the model that had stress and depressive mood as dependent variables. Health status (both physical and psychological), recent life events, income and menopausal phase were significantly associated with the frequency of stress and depressive symptoms. Additionally, educational level and parity were also significant predictors of depressive mood. This study emphasizes that psychological symptoms occurrence in midlife depends not only on personal variables (such as health and menopausal status) but also on contextual ones (including recent stressful events) that can be a strong influence on how middle-aged women feel.

Menopausal symptoms: is spirituality associated with the severity of symptoms?

The aim of this study was to explore whether spirituality was associated with menopausal symptoms. Menopausal symptoms, spirituality, health and menopausal status, and socio-demographic variables were assessed in a community sample of 710 peri- and postmenopausal women. A structural model was explored using structural equation modeling. The results evidence spirituality as a significant contributor regarding the severity of most menopausal symptoms. Among others, spirituality had a significant weight in depressive mood (ß = -.414; p < .001), anxiety (ß = -.308; p < .001), cognitive impairment (ß = -.287; p < .001), aches/pain (ß = -.148; p < .001), vasomotor (ß = -.125; p = .005) and sexual symptoms (ß = -.211; p < .001). Some socio-demographic variables, as well as perceived health, also predicted the menopausal symptoms' severity. Therefore, spirituality can have a positive impact on the menopausal symptoms' reporting.

Corrigendum: Beliefs and strategies about urinary incontinence: a possible moderation role between symptoms and sexual function, and quality of life.

[This corrects the article DOI: 10.3389/fpsyg.2023.1252471.].

Cognitive and behavioral weight management strategies during the menopausal transition: Insights from the Menopause and Weight Loss (ME-WEL) project.

OBJECTIVE: Most women experience weight gain during the menopausal transition, often attributed to behavioral factors. Nevertheless, some women successfully maintain a healthy weight during this phase. This study aims to identify the successful cognitive and behavioral weight management strategies employed by postmenopausal women who effectively maintained a healthy weight during the menopausal transition (from premenopause to postmenopause). METHOD: Semi-structured interviews were conducted with 31 Portuguese postmenopausal women, aged 45-65 years (mean and standard deviation 54.06 ± 5.51) who successfully maintained a healthy weight (body mass index: 18.5 kg/m2-24.9 kg/m2) during the menopausal transition. The interviews were conducted via telephone (n = 29) and Zoom (n = 2), based on the participant's preference, and ranged from 11 to 52 min (22.06 ± 9.95). Using MAXQDA software, deductive-dominant content analysis of the interviews was performed. The Interface of R for the Multidimensional Analyses of Texts and Questionnaire software was used for lexical analysis. RESULTS: The qualitative analysis of cognitive and behavioral strategies for successful weight management yielded 17 categories and 37 sub-categories. Effective cognitive and behavioral strategies (e.g., planning content, stimulus control, support: help from others) were identified, mostly aligning with the Oxford Food and Activity Behaviors Taxonomy. Five new categories emerged: dietary choices, intuitive eating, food literacy, psychological self-care, and effortful inhibition. CONCLUSION: Knowing effective cognitive and behavioral weight management strategies for menopausal women is relevant, especially considering their status as a high-risk group. This knowledge provides a valuable guide for designing weight management interventions, emphasizing the essential role of behavioral change.

Beliefs and strategies about urinary incontinence: a possible moderation role between symptoms and sexual function, and quality of life.

Background: Urinary Incontinence (UI) has numerous repercussions in women's lives, and it is underreported/underdiagnosed. Objective: The present study aimed to understand: (1) the differences between women with and without urine loss regarding Quality of Life (QoL) and Sexual Function (SF); (2) the possible moderation role of UI-related beliefs and strategies on the relationship between UI-symptom severity and SF and QoL, in women with UI. Methods: Cross-sectional Design. Participants: Primary aim: Overall, 2,578 women aged 40-65 (Mage = 49.94, DPage = 6.76) were collected online. Secondary aim: 1,538 women who self-reported having urine loss occasionally/frequently (Mage = 50.19, DPage = 6.58). All data analyses were done with IBM SPSS Statistics and R statistical system 4.0 through RStudio. Statistical Path analysis was performed with the lavaan package to study the hypothetical association and moderating effects between the variables. Results: Primary aim: women without UI had a better SF [t(2576) = 3.13, p = 0.002; 95% C.I., 0.18 to 0.80] and QoL [t(2576) = 7.71, p < 0.001; 95% C.I., 3.14 to 5.28] than their counterparts with UI. Secondary aim: UI-related coping strategies attenuated the impact of UI-symptom severity on SF(ß = -0.07; p = 0.041); the more dysfunctional the UI-related beliefs were, the poorer QoL was (ß = -0.06; p = 0.031); the more frequent the UI-related hiding/defensive strategies were, the poorer QoL was (ß = -0.26; p < 0.001). Discussion: Limitations: online data collection, which thwarted the clarification of participants, if needed; absence of a UI medical diagnosis (only self-reported measures were used). Strengths and practical implications: (i) the crucial role of UI-related beliefs and strategies in the QoL of women with UI; (ii) the impact that UI-concealing/defensive strategies have in attenuating the impact of UI-symptom severity on SF, which might be perceived as a short-term benefit and hence contribute to maintaining the UI condition and constitute a barrier to help-seeking, (iii) impact of UI-symptom severity on QoL and SF (including a comparison group entailing women without UI, which is scarcely used); and (iv) the use of gold-standard and psychometrically robust instruments. Conclusion: Changing dysfunctional UI-related beliefs and strategies in clinical settings may improve the QoL; UI-concealing strategies may reinforce themselves by immediate effects on SF, but are not functional in the long term.

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self-report and physician assessment.

BACKGROUND: Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. METHODS: This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0-100). RESULTS: A total of 193 patients (72% female; median [P25-P75] age 28 [19-41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0-71]%; 1 month: 18 [0-48]%) than patient self-report (80 [60-95]) and physician assessment (82 [51-94]) (p < 0.001). A negligible non-significant correlation was found between the app and subjective measurements (ρ 0.118-0.156, p > 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). CONCLUSIONS: Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.

Menopause symptoms' predictors: the influence of lifestyle, health- and menopause-related, and sociodemographic characteristics.

This research explores a causal model of menopausal symptoms in peri- and postmenopausal women. A community sample of 710 women was assessed regarding menopausal symptoms, and sociodemographic, health- and menopause-related, and lifestyle characteristics. Structural equation modelling was used. Menopausal status predicted skin/facial hair changes (ß = .156; p <.001), vasomotor (ß = .122; p <.001) and sexual symptoms (ß = .158; p <.001). Age was significantly associated with cognitive impairment (ß = .087; p = .003), aches/pain (ß = .072; p = .006), urinary (ß = .115; p = .004) and also sexual symptoms (ß = .107; p = .021). Several menopausal symptoms are predicted, not only by menopausal status, but also by age progression, among other variables; this should be considered in the context of a well-adapted menopausal transition.

FOODLIT-Trial: Protocol of a Randomised Controlled Digital Intervention to Promote Food Literacy and Sustainability Behaviours in Adults Using the Health Action Process Approach and the Behaviour Change Techniques Taxonomy during the COVID-19 Pandemic.

Dietary quality and sustainability are central matters to the international community, emphasised by the burden of the COVID-19 pandemic. To promote healthier and more sustainable food-related practices, the protocol of a web-based intervention to enhance adults' food literacy is presented. The FOODLIT-Trial is a two-arm, parallel, experimental, and single-blinded randomised controlled trial delivered over 11 weeks. Based on the Food Literacy Wheel framework and supported by the Health Action Process Approach (HAPA) and the Behaviour Change Techniques Taxonomy, weekly content with customised behaviour change techniques (experimental group) is hypothesised to be more effective to promote food behaviour change when compared to a single-time and non-customised delivery of food-related international guidelines, with no theoretically informed approaches (comparison group). Primary outcome is food literacy, including food-related knowledge, skills, and behaviours, assessed with the FOODLIT-Tool; a secondary outcome includes psychological mechanisms that efficaciously predict change in participants' food literacy, measured with HAPA-driven items. Enlisted through online sources, participants will be assessed across five time points (baseline, post-intervention, and 3-, 6-, and 9-month follow-ups, i.e., T0-T4). A randomisation check will be conducted, analyses will follow an intention-to-treat approach, and linear two-level models within- (T0-T4) and between-level (nested in participants) will be computed, together with a longitudinal mediation analysis. If effective, the FOODLIT-Trial will provide for a multidimensional and cost-effective intervention to enable healthier and more sustainable food practices over the long term.

Mental, Physical and Socio-Economic Status of Adults Living in Spain during the Late Stages of the State of Emergency Caused by COVID-19.

Research has shown that the confinement measures implemented to curb the spread of COVID-19 can have negative effects on people's lives at multiple levels. The objective of this cross-sectional study was to better understand the mental, physical, and socio-economic status of adults living in Spain during the late stages of the state of emergency caused by COVID-19. Five hundred and forty-four individuals responded to an online survey between 3 June and 30 July 2020. They were asked to report data about their mental and physical health, financial situation, and satisfaction with the information received about the pandemic. Means, percentages, t-test, ANOVAs, and logistic regressions were computed. A third of the participants reported symptoms of anxiety, depression, and stress, and worries about their health and the future. Participants also described mild levels of fatigue and pain during lockdown (66%), and a reduction in household income (39%). Respondents that were female, younger, single, and with lower levels of education reported experiencing a greater impact of the COVID-19 pandemic. The data showed that the negative effects of lockdown were present in the late stages of the state of emergency. The findings can be used to contribute to the development of programs to prevent or mitigate the negative impact of confinement measures.

Weight management strategies in Middle-Aged Women (MAW): Development and validation of a questionnaire based on the Oxford Food and Activity Behaviors Taxonomy (OxFAB-MAW) in a Portuguese sample.

Background: The Oxford Food and Activity Behaviors (OxFAB) taxonomy systematize the cognitive-behavioral strategies adopted by individuals who are attempting to manage their weight. The present study aimed to (1) develop a questionnaire based on the OxFAB taxonomy, specifically adapted for middle-aged women-the OxFAB-MAW-stage of life and sex, which present a high incidence of obesity, (2) assess the psychometric properties of this tool, and (3) evaluate the discriminative power of the OxFAB-MAW (normal weight vs. obesity). Methods: Overall, 1,367 Portuguese middle-aged women between 45 and 65 years (M = 52.3, SD = 5.15) filled in a sociodemographic, health, and menopause-related questionnaire, as well as the OxFAB-MAW. Results: Confirmatory factor analysis demonstrated an acceptable model fit (comparative fit index = 0.928, Tucker-Lewis index = 0.913, root mean square error of approximation = 0.072, and standardized root mean square residual = 0.054). Five domains with one item were grouped into other domains, and the Weight Management Aids domain was also removed. The OxFAB-MAW showed factorial, convergent, discriminant, and external validity, as well as composite reliability. Conclusion: The OxFAB-MAW questionnaire is a valid, reliable, and theory-driven tool for assessing weight management strategies in middle-aged women, being able to discriminate between clinical and non-clinical groups (normal weight vs. obesity) in several domains. This instrument can be used to gather valid and reliable data, useful in both research and clinical settings (especially focused on structuring interventions and preventive obesity programs within this specific life cycle stage).

Immediate Effects of Hypnosis, Mindfulness Meditation, and Prayer on Cold Pressor Outcomes: A Four-Arm Parallel Experimental Study.

Purpose: Previous research supports the usefulness of hypnosis (HYP), mindfulness meditation (MM), and prayer as pain self-management strategies in adults with chronic pain. However, their effects on acute pain have been less researched, and no previous head-to-head study compared the immediate effects of these three approaches on pain-related outcomes. This study compared the immediate effects of HYP, MM, and Christian prayer (CP) on pain intensity, pain tolerance, and stress as assessed by heart rate variability (HRV). Participants and Methods: A total of 232 healthy adults were randomly assigned to, and completed, a single 20-minute session of MM, SH, CP, or an attention control (CN), and underwent two cycles (one pre- and one post-intervention) of Cold Pressor Arm Wrap (CPAW). Sessions were audio-delivered. Participants responded to pre- and post-intervention pain intensity measurements. Pain tolerance (sec) was assessed during the CPAW cycles. HRV was assessed at baseline, and at pre- and post-intervention CPAW cycles. The study protocol was pre-registered at the ClinicalTrials.gov registry (NCT04491630). Results: Small within-group decreases in pain intensity and small increases in pain tolerance were found for HYP and MM from the pre- to the post-intervention. Small within-group improvements in the LH/HF ratio were also found for HYP. The exploratory between-group pairwise comparisons revealed a medium effect size effects of HYP on pain tolerance relative to the control condition. The effects of CP were positive, but small and not statistically significant. Only small to medium, though non-significant, Time × Group interaction effects were found. Conclusion: Study results suggest that single short-term HYP and MM sessions, but not biblical-based CP, may be useful for acute pain self-management, with HYP being the slightly superior option. Future research should compare the effects of different types of prayer and examine the predictors and moderators of these pain approaches' effects on pain-related outcomes.

Representations and perceived consequences of menopause by peri- and post-menopausal portuguese women: a qualitative research.

Our aim in conducting this study is to describe the representations and perceived consequences of menopause, elicited through a semistructured interview with 36 Portuguese women, in peri- and post-menopause. The most prevalent response of the interviewed women was to see menopause as a normal/neutral phase of their life cycle (28.3%). Menses' cessation (58.7%) was identified as the most prevalent positive consequence of menopause, and a range of psychological changes (18.3%) was the most mentioned negative consequence. Health care provider's awareness of women's attitudes will allow them to communicate more effectively and to reinforce women's positive attitudes.

Prayer as a pain intervention: protocol of a systematic review of randomised controlled trials.

BACKGROUND: Pain is a universal experience and the most common reason for seeking healthcare. Inadequate pain management negatively impacts numerous aspects of patient health. Multidisciplinary treatment programmes, including psychosocial interventions, are more useful for pain management than purely biomedical treatment alone. Recently, researchers showed increasing interest in understanding the role of spirituality/religiosity and spiritual/religious practices on pain experience, with engagement in religious practices, such as prayer, showing to positively impact pain experience in religious individuals. This systematic review will seek to summarise and integrate the existing findings from randomised controlled trials assessing the effects of prayer and prayer-based interventions on pain experience. METHODS: The systematic review procedures and its report will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement. Electronic searches in nine databases (Web of Science Core Collection, MEDLINE, SCIELO Citation Index, PubMed, Cochrane Central Register of Controlled Clinical Trial, PsycINFO, Scopus, LILACS and Open-SIGLE) will be performed to identify randomised controlled trials of prayer-based interventions. Two independent researchers will assess studies for inclusion and extract data from each paper. Risk of bias assessment will be assessed independently by two reviewers based on the Consolidated Standards of Reporting Trials statement. Qualitative synthesis of the body of research will be conducted using a narrative summary synthesis method. Meta-analysis will be limited to studies reporting on the same primary outcome. Formal searches are planned to start in June 2021. The final report is anticipated to be completed by September 2021. DISCUSSION: Findings will be useful to (1) understand the condition of our knowledge in this field and (2) provide evidence for prayer effectiveness in reducing pain intensity and pain-related stress and increasing pain tolerance in adults experiencing acute or chronic pain. PROSPERO REGISTRATION NUMBER: CRD42020221733.

COPAHS Study: protocol of a randomised experimental study comparing the effects of hypnosis, mindfulness meditation, and spiritual practices on experimental pain in healthy adults.

BACKGROUND: There has been an increasing interest in studying the potential benefits of so-called complementary and alternative approaches for pain management, such as hypnosis and mindfulness-based interventions. More recently, researchers have been interested in studying the effects of spiritual practices on pain experience as well. These practices may increase pain tolerance, result in a positive re-appraisal of pain and influence other psychological variables that are known to be associated with pain experience. The purpose of this study is to evaluate and compare the immediate effects of self-hypnosis, mindfulness meditation, and a spiritual intervention relative to a control condition for increasing pain tolerance and reducing pain intensity and pain-related stress, in response to experimental painful stimulation. METHODS AND ANALYSIS: Recruitment is anticipated to start in November 2020. This is a randomised quantitative experimental mixed-design repeated-measures study with three assessment points: baseline (T0), pre-test (T1) and post-test (T2). Eligible healthy adults will be randomised to one of the four study conditions. Interventions will be a 20-minute audio-guided practice of either self-hypnosis, mindfulness meditation, or Christian prayer. Participants in the control group will not be instructed to use any specific strategy during the painful stimulation. Participants will be submitted to a first cycle of Cold Pressor Arm Wrap. They will then listen to a 20-minute audio recording inducing one of the three interventions, or, in the case of the control group, to a 20-minute audio recording of text from a natural history textbook. Primary outcomes are pain intensity and pain tolerance. Pain-related stress as measured by salivary cortisol level and heart rate variability are secondary outcomes. ETHICS AND DISSEMINATION: This study was approved by ISPA-University Institute's internal Ethics Committee for Research on 3rd December 2018 (reference I/010/12/2018). Findings will be published in peer-reviewed indexed journals and presented at conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov registry (NCT04491630). Stage: pre-results.