Unified protocol for the transdiagnostic treatment of emotional disorders in group format in spain: results of a noninferiority randomized controlled trial at 15 months after treatment onset

Evidence-based psychological treatments (EBPT) are an effective and efficient solution for the treatment of emotional disorders (EDs). However, their implementation and dissemination are not yet widespread. The Unified Protocol for Transdiagnostic Treatment of EDs (UP), applied in a group format, could be an effective option to be implemented in specialized public mental health services in Spain. The sample consisted of 533 users of public specialized mental health centers (77.3% women), with a mean age of 42.0 years (), who were randomized to the UP in group format condition () or treatment as usual (specific cognitive behavioral therapy for each disorder in individual format, ). Assessments were performed at preintervention (T1) and at 3, 6, 9 and 15 months after treatment onset (T2, T3, T4, and T5, respectively). The results showed a main effect of time in both conditions for all primary outcomes () and no statistically significant TimeCondition interaction. Similarly, the noninferiority tests showed that UP results were statistically noninferior compared to TAU. Effect sizes for psychological variables were higher in the UP condition at T5, even though the differences were not statistically significant. Statistically significant differences () in the evolution of the diagnostic criteria and comorbidity were found, with the highest percentage of patients no longer meeting main and secondary diagnosis criteria in the UP condition at all assessment moments (except for secondary diagnosis at T3). The results showed statistically significant differences in treatment retention between conditions at T5, being the UP condition the one with less dropouts. Finally, participants in the group UP condition showed high satisfaction with the treatment. The UP is an EBPT that has been shown to be effective when applied in groups and may represent an efficient option for its implementation in public mental health services in Spain

Azulejos sevillanos del siglo XIII :apuntes sobre ceramica morisca

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Surface-state electron dynamics in noble metals

Theoretical investigations of surface-state electron dynamics in noble metals are reported. The dynamically screened interaction is computed, within many-body theory, by going beyond a free-electron description of the metal surface. Calculations of the inelastic linewidth of Shockley surface-state electrons and holes in these materials are also presented. While the linewidth of excited holes at the surface-state band edge (${\bf k}_\parallel=0$) is dominated by a two-dimensional decay channel, within the surface-state band itself, our calculations indicate that major contributions to the electron-electron interaction of surface-state electrons above the Fermi level come from the underlying bulk electrons.Comment: 17 pages, 7 figures, to appear in Prog. Surf. Sc

Health professionals' perspective on the promotion of e-mental health apps in the context of maternal depression.

Our study focuses on exploring (1) the intention of health professionals to use and recommend e-mental health applications, (2) how this intention of health professionals might be influenced, (3) which group of health professionals might be most accessible to promote e-mental health applications for maternal depression, and (4) for which tasks they rate them to be most useful. Based on a questionnaire informed by the theory of planned behavior, we collected 131 responses of U.S., Spanish, and Swiss health professionals in the field of pregnancy and maternal care (including psychologists, psychiatrists, midwives, and doctors) by means of an online survey. We analyzed the gathered data applying a structured equation model. Our study reveals that health professionals would in general intend to recommend and use e-mental health applications. However, their attitude towards e-mental health applications varies regarding the respective use cases and also differs among health professions. We offer three alternative propositions for private or public organizations, associations, or any other entity whose purpose is service to the community for introducing e-mental health applications into practice

Applying the unified protocol to a single case of major depression with schizoid and depressive personality traits

Background: The study presents the use of the Unified Protocol (UP) in a case of a male diagnosed with major depressive disorder and schizoid and depressive personality traits. The therapeutic focus of UP is to identify maladaptive behaviors of emotion regulation and to train new regulation strategies such as cognitive re-appraisal or emotional exposure exercises. Method: This is a single-case research study. The intervention was carried out in twenty 1-hour sessions for 6 months. After treatment completion, follow-ups were conducted at three, six, and twelve months. Results: The results of the 12-month follow-up revealed a clinically significant change in depressive symptomatology (RCIBDI-II = -5.51), negative affect (RCINEGATIVE (PANAS) 3.61), quality of life (RCIICV-Sp = 4.61) and schizoid (RCIMCMI-III-Schizoid = -4.36) and depressive (RCIMCMI-III-Depressive = -5.24) personality traits. Schizoid and depressive personality traits did not interfere with the application, course, and compliance with treatment. These results are discussed with regard to similar studies, also based on the use of the UP to work on emotion regulation in the treatment of emotional disorders with clinical comorbidity. Conclusions: The training of emotion regulation strategies through UP could be an effective proposal to treat emotional disorders with pathological personality traits comorbidity

Long-term cost-effectiveness of group unified protocol in the spanish public mental health system

The limited material and human resources available in the Spanish public mental health system, combined with the high prevalence of emotional disorders nowadays, makes it necessary to search for and implement other more cost-effective formats. The versatility of the Unified Protocol (UP) for the transdiagnostic treatment of emotional disorders allows its application in group format, which could be a cost-effective solution for the system. The aim of the present study is to investigate the cost-effectiveness of the UP applied in group format in specialized care units compared to the Treatment as usual (TAU) in the Spanish public mental health system over a 15-month time period. The sample of this study consisted of 188 patients, diagnosed with an emotional disorder, randomized to the UP condition in group format or to the TAU condition in individual format. The findings of this study have shown the same beneficial results for the participants with symptoms of anxiety and depression in both conditions and greater improvements in quality of life in the UP condition. Regarding cost-effectiveness results, at the 15-month follow-up, participants in the UP condition received a greater number of sessions, with a lower total economic cost compared to the TAU condition. Finally, reductions in the number of participants using antidepressants and a reduction in medication burden were found in the UP condition over time. The results of this study show that UP applied in a group format can be a cost-effectiveness solution for the Spanish public mental health system. Trial registration number: NCT03064477 (March 10, 2017)

The use of information and communication technologies in perinatal depression screening: A systematic review

Perinatal mental illness refers to psychiatric disorders that exist during pregnancy and up to 1 year after childbirth. The aim of this systematic review was to discuss the use of Information and Communication Technologies (ICTs) on perinatal depression (PeD) screening in the past three decades. Published articles were searched between 1990 and 2018, both in English and Spanish. In the search, we used different keywords, such as "pregnancy, " "depression, " or "technology" in ScienceDirect, PubMed-NCBI, and Web of Science. We found 10 articles that combined the use of ICTs and a focus on PeD screening. Studied periods included pregnancy (n = 2) and postpartum (n = 8). The telephone was the most commonly used communication method (n = 5), followed by the Internet (n = 4). One investigation used both, the telephone and the Internet. The Edinburgh Postnatal Depression Scale was the most frequently used screening measure (n = 8). The proportion of depressed perinatal women varied across studies depending on the pregnancy status and the cutoff values used, showing a very broad range between 5.8 and 51.9 percent. Despite the increasing popularity of ICTs in health settings, their use in perinatal mental health screening is still rare. Overall, encouraging findings have been reported when using ICTs for screening of PeD, such as eliminating the need to travel to the health center to conduct the screening and allowing for a wider dissemination. However, more research is needed to support their inclusion in perinatal care

Can we predict the evolution of depressive symptoms, adjustment, and perceived social support of pregnant women from their personality characteristics? A technology-supported longitudinal study

Background: Research exploring the relationship between personality and important pregnancy outcomes (i.e., depressive symptoms, adjustment, and perceived social support) tends to be cross-sectional, arguably due to the difficulties of conducting longitudinal and mental health research in this population. The objective of this study is to use a web-based solution to longitudinally explore how personality traits are associated, not only with the co-occurrence of these outcomes but also with their evolution during pregnancy. Stability and change of these outcomes will also be investigated. Methods: The sample included 85 pregnant women attending several medical centers in Spain. The web-based assessment included sociodemographic and obstetric variables (ad hoc) and personality (at the second trimester only), and outcomes at both the second and the third trimester (i.e., depressive symptoms, adjustment, and perceived social support). Results: The results showed that adjustment worsened from the second to the third trimester of pregnancy. Neuroticism (N), low extraversion (E), and psychoticism (P) were cross-sectionally and longitudinally associated with outcomes. In addition, N and, to a lesser extent P, uniquely contributed to the evolution of these outcomes in the multivariate analyses, including autoregressions. Conclusion: Personality and especially N and P should be evaluated early during pregnancy mental health screening. The use of a web page appears to be a useful tool for that purpose. Technologies might also help disseminate mental health prevention programs for these women, which would be especially recommended for those with a personality profile characterized by high N and P and, to a lesser extent, low E

Predicting postpartum depressive symptoms from pregnancy biopsychosocial factors: A longitudinal investigation using structural equation modeling

The prediction of postpartum depression (PPD) should be conceptualized from a biopsychosocial perspective. This study aims at exploring the longitudinal contribution of a set of biopsychosocial factors for PPD in perinatal women. A longitudinal study was conducted, assessment was made with a website and included biopsychosocial factors that were measured during pregnancy (n = 266, weeks 16–36), including age, affective ambivalence, personality characteristics, social support and depression. Depression was measured again at postpartum (n = 101, weeks 2–4). The analyses included bivariate associations and structural equation modeling (SEM). Age, affective ambivalence, neuroticism, positive, and negative affect at pregnancy were associated with concurrent depression during pregnancy (all p < 0.01). Age, affective ambivalence, positive affect, and depression at pregnancy correlated with PPD (all p < 0.05). Affective ambivalence (ß = 1.97; p = 0.003) and positive (ß = -0.29; p < 0.001) and negative affect (ß = 0.22; p = 0.024) at pregnancy remained significant predictors of concurrent depression in the SEM, whereas only age (ß = 0.27; p = 0.010) and depression (ß = 0.37; p = 0.002) at pregnancy predicted PPD. Biopsychosocial factors are clearly associated with concurrent depression at pregnancy, but the stability of depression across time limits the prospective contribution of biopsychosocial factors. Depression should be screened early during pregnancy, as this is likely to persist after birth. The use of technology, as in the present investigation, might be a cost-effective option for this purpose

Influence of vulnerability factors in panic disorder severity

Background: We studied herein the predictive value for panic severity of three well-based vulnerability factors: personality traits (neuroticism and extraversion; NEO-PI-R), anxiety sensitivity (ASI), and perceived control (ACQ-R). Method: The sample was composed of 52 participants diagnosed with panic disorder, with or without agoraphobia, according to DSM-IV-TR criteria. Results: Our results revealed that the anxiety facet is a better predictor of panic severity than neuroticism. Anxiety sensitivity increases the predictive value for panic severity and, finally, perception of control of emotions is the only perception control subscale that increases the predictive value for panic severity more than the anxiety facet and anxiety sensitivity. Conclusions: This finding supports the assumption of the importance of taking into account the assessment of the lower order dimensions of the vulnerability factors in the field of psychopathology studies. Furthermore, the predictive value of perception of control of emotions indicates the importance of this specific vulnerability factor in the etiology of panic disorder (with or without agoraphobia) and, thus, shows the necessity to include emotion regulation strategies in the psychological treatments