| 1. |
- Ferreira, Cláudia, et al.
(författare)
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Randomized controlled trial of an Acceptance and Commitment Therapy and compassion-based group intervention for persons with inflammatory bowel disease : the LIFEwithIBD intervention
- 2024
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This study tested the acceptability and efficacy of an Acceptance and Commitment Therapy and compassion-based intervention (LIFEwithIBD) in people with IBD through a two-arm RCT.Methods: Participants were recruited at the Gastroenterology Department of the Coimbra University Hospital between June and September 2019. Of the 355 patients screened, those who accepted to participate were randomly assigned to one of two conditions: experimental group (LIFEwithIBD; n = 25) or control group (waitlist; n = 29). Participants completed self-report measures at baseline (T0), post-intervention (T1), and 3-month (T2) and 12-month (T3) follow-ups. Intervention acceptability was assessed. Efficacy was examined using intent-to-treat ANCOVA at post-intervention after adjusting for baseline values of depressive, anxiety, and stress symptoms (primary outcomes). Linear mixed models for all longitudinal outcomes were also analysed. Inflammatory and disease biomarkers were determined at T0 and T3.Results: Acceptability results revealed a high level of satisfaction and perceived usefulness regarding the intervention. Both groups experienced a significant decrease in stress symptoms and IBD symptom perception at T1. No significant differences were observed at follow-up for the primary outcomes. The experimental group reported significantly lower Crohn’s disease Symptom severity at T2 than the control group. Post-hoc analyses designed to mitigate floor effects revealed substantial treatment effects for the experimental group regarding anxiety symptoms. No significant differences were observed in clinical biomarkers from T0 to T3.Conclusion: The LIFEwithIBD intervention shows promising, although preliminary, benefits for managing disease activity and reducing anxiety symptoms in IBD patients with high severity of psychological distress.
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| 2. |
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| 3. |
- Carvalho, S. A., et al.
(författare)
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A pilot randomized controlled trial of online acceptance and commitment therapy versus compassion-focused therapy for chronic illness
- 2022
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Ingår i: Clinical Psychology & Psychotherapy. - : Wiley. - 1063-3995 .- 1099-0879. ; 29:2, s. 524-541
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Tidskriftsartikel (refereegranskat)abstract
- Literature suggests that acceptance and commitment therapy (ACT) is effective in improving well-being and in reducing psychopathological symptoms commonly experienced by people with chronic illness (CI). Compassion-focused therapy (CFT) reduces psychological distress, especially in individuals with high levels of shame and self-criticism, but few studies have explored CFT in CI. Additionally, studies almost exclusively compared ACT and CFT with inactive controls (wait-list; treatment as usual). Also, there is an interest in developing cost-effective mental health solutions, such as low-intensity online psychological interventions. This randomized controlled trial (RCT) aimed to assess the acceptability and compare the efficacy of four-session online ACT (n = 25) and CFT (n = 24) interventions in a sample of people with CI. Results showed both interventions were acceptable, with attrition rates at post-intervention comparable to those found in similar studies (around 50%). Intention-to-treat analyses showed that participants presented significantly less illness-related shame, less uncompassionate self-responding and more valued living after the intervention, although no difference was found between conditions. Results were sustained at 3- and 6-month follow-up. Results did not find statistical differences between conditions through reliable change index (RCI). Correlation between demographics and RCI showed that, at post-intervention, younger participants presented more behavioural awareness, men presented more valued action, and participants with CI for shorter periods presented less uncompassionate self-responding and less anxiety. Results suggest that low-intensity (four sessions) online ACT and CFT are cost-effective approaches to promote mental health of individuals with CI. Results and limitations are thoroughly discussed.
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| 4. |
- Carvalho, Sérgio A., et al.
(författare)
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Cognitive fusion and depressive symptoms in women with chronic pain : A longitudinal growth curve modelling study over 12 months
- 2019
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Ingår i: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 26:5, s. 616-625
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Tidskriftsartikel (refereegranskat)abstract
- This study aims to (a) explore individual differences in women with chronic pain (CP) in regard to pain intensity, functional impairment, cognitive fusion, and depressive symptoms and (b) longitudinally test whether cognitive fusion is a significant predictor of depression symptoms, while controlling for pain intensity and functional impairment, over a 12-month period. This study follows a longitudinal design and was conducted in a sample of 86 women with CP who responded to an online battery of questionnaires in three equally spaced assessment moments. In order to explore the growth trajectory of variables of interest, latent growth curve models were examined. Also, correlation analyses were conducted between demographic and illness-related variables and depressive symptoms, as well as between all variables in all assessment moments. Cognitive fusion and functional impairment (but not pain intensity) were significantly associated with baseline levels of depressive symptoms. Cognitive fusion significantly predicted the growth trajectory of depressive symptoms, whereas pain intensity and functional impairment did not. No demographic (age, marital status, education, socio-economic) nor illness-related variables (number of CP diagnoses, duration of CP, taking medication) were associated with depressive symptoms at any point. These results suggest that the trajectory of depressive symptoms in women with CP is not predicted by the intensity of pain nor pain-related functional impairment, but rather by the tendency to get entangled with internal experiences (e.g., thoughts, emotions, and physical sensations), which may or may not be related to pain-specific contents. Clinical implications are discussed.
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| 5. |
- Carvalho, Sérgio A., et al.
(författare)
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Efficacy of an ACT and Compassion-Based eHealth Program for Self-Management of Chronic Pain (iACTwithPain) : Study Protocol for a Randomized Controlled Trial
- 2021
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic pain (CP) has serious medical and social consequences and leads to economic burden that threatens the sustainability of healthcare services. Thus, optimized management of pain tools to support CP patients in adjusting to their condition and improving their quality of life is timely. Although acceptance and commitment therapy (ACT) is considered an evidence-based psychological approach for CP, evidence for the efficacy of online-delivered ACT for CP is still scarce. At the same time, studies suggest that self-compassion mediates the change in disability and psychopathological symptoms in ACT interventions for CP, although self-compassion is not a specific target in ACT. Thus, an explicit focus on self-compassion might increase the efficacy of ACT interventions for CP, although this hypothesis has not been tested. This study aims to develop an eHealth ACT and compassion-based self-management intervention for CP, the iACTwithPain, and to compare its efficacy in improving health outcomes to a similar ACT-only intervention and a medical TAU group.Methods: The eHealth platform that will host the interventions will be developed using a flat design identity and will be interactive. The iACTwithPain intervention will comprise eight weekly self-management sessions and will be developed taking into consideration the psychological flexibility model applied to CP, with the addition of explicit compassion-based components. To analyze whether the iACTwithPain intervention will present superiority in improving CP's impact and related health markers over the two other conditions, this study will follow an RCT design with three arms. CP patients will be recruited through direct contact with patient associations and healthcare services and a national press release in Portugal. Outcome measurement will be conducted at baseline, post-intervention and at 3- and 6-month follow-ups. The interventions' acceptability will also be assessed.Discussion: The iACTwithPain intervention is expected to improve CP patients' psychosocial functioning, quality of life, and empowerment, by promoting adaptive disease management and regulation of pain-related internal experiences. Results will contribute to a better understanding on the pertinence of adding compassion elements to ACT for CP and to reach an optimized intervention for CP.
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| 6. |
- Carvalho, Sérgio A., et al.
(författare)
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Self-as-context and depressive symptoms in the general population : A further analysis of the self experiences questionnaire
- 2022
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Ingår i: Current Psychology. - : Springer. - 1046-1310 .- 1936-4733. ; 41:12, s. 8897-8907
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Tidskriftsartikel (refereegranskat)abstract
- The current study aims to contribute to the psychometric validation of the Self Experiences Questionnaire (SEQ), a measure of self-as-context as conceptualized by Acceptance and Commitment Therapy, and to contribute to a better understanding of the relationship between self-as-context, other psychological flexibility processes, and depressive symptoms. The sample (N = 266; 72.6% women) was obtained through paper-pencil and online collection methods in the general Portuguese population. Confirmatory factor analysis, reliability analyses, and convergent and divergent analyses were conducted. A mediation analysis of the effects of self-as-distinction and self-as-observer on depression symptoms through openness to experience, behavioral awareness, and valued action (while controlling for brooding) was performed using PROCESS. Items 8, 12 and 15 were removed to achieve the best model fit, which resulted in a 12-item final version of the SEQ. This version appears to be a psychometrically valid two-dimensional measure of self-as-distinction and self-as-observer, as well as a one global measure of self-as-context. Results from mediation analyses suggested that the relationship of self-as-observer and self-as-distinction with depressive symptoms is mediated by the ability to be behaviorally aware and to act according to personal values, but not by the ability to be open to experience. The behaviorally-oriented aspects of psychological flexibility seem to have particular importance on the presentation of depressive symptoms. More studies are nonetheless needed to analyze SEQ's structure and validity in order to attain a consensual version of the questionnaire.
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| 7. |
- Carvalho, Sérgio A., et al.
(författare)
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Self-Compassion and Depressive Symptoms in Chronic Pain (CP) : A 1-Year Longitudinal Study
- 2020
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Ingår i: Mindfulness. - : Springer. - 1868-8527 .- 1868-8535. ; 11:3, s. 709-719
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Self-compassion is associated with less depressive symptoms, better mental health outcomes, and less disability in chronic pain (CP). However, it remains longitudinally unexplored the role of self-compassion in CP. Also, although it acknowledged the conceptual overlapping between mindfulness and self-compassion, few studies have explored the role of self-compassion in CP while controlling for mindfulness in a longitudinal design.Methods: The current study conducts correlational and hierarchical linear regression analyses in a sample of 86 women with CP who completed an online battery of questionnaires that assess pain intensity, functional impairment, depressive symptoms, mindfulness, and self-compassion in three time points: baseline (T0), 6 months (T1), and 12 months (T2).Results: Results show that self-compassion (but not mindfulness) significantly predicts depressive symptoms at T1 and at T2 above and beyond depressive symptoms and functional impairment. Also, the interaction between functional impairment and self-compassion at T0 significantly predicts depressive symptoms at T1, but not at T2.Conclusions: These findings expand the current knowledge on the role of self-compassion in CP in showing that self-compassion is a significant predictor of later depressive symptoms in CP and suggesting its potential role in buffering the impact of functional impairment in future levels of depressive symptoms.
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| 8. |
- Carvalho, S. A., et al.
(författare)
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Self-compassion in Acceptance and Commitment Therapy for chronic pain: a pilot study
- 2022
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 22:3, s. 631-638
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Evidence shows that Acceptance and Commitment Therapy (ACT) is an empirically supported psychological approach for chronic pain (CP) management. Although self-compassion is not explicitly a target of ACT, it seems to be one mechanism of change in ACT for CP. However, research is lacking on the benefits of including explicit self-compassionate exercises in ACT for CP. The current study pilot tested a Compassionate ACT 8-session group program (COMP.ACT; n=9), as well as an ACT-only 8-session group program (ACT; n=7), in a sample of women with CP. Methods: The current study follows a quasi-experimental design, and conducts Reliable and Significant Change analyses comparing pre- to post-intervention scores of self-report measures. Results: No differences were found between conditions at baseline, nor between completers and drop-outs. Although preliminary, results showed COMP.ACT led to greater clinical improvements in depression and anxiety, while ACT led to greater improvements in stress and uncompassionate self-responding. Reliable and Significant Change analysis showed that some participants improved significantly (in psychopathological symptoms, valued living and uncompassionate self-responding) in both conditions, while the majority did not change significantly. Conclusions: More research is needed to conclude whether explicit self-compassion exercises are useful in ACT for CP. Limitations and implications are further discussed.
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| 9. |
- Coelho, Helena L., et al.
(författare)
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The mediating role of shame and fear of compassion on the relationship between major life events and depressive symptoms
- 2021
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Ingår i: Current Psychology. - : Springer. - 1046-1310 .- 1936-4733. ; 40:9, s. 4553-4562
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Tidskriftsartikel (refereegranskat)abstract
- An extensive body of research has showed the impact of major life events on depressive symptoms. However, the underlying psychological processes that contribute to this association are still unclear. The present study aims to explore the mediating role of external shame and fears of receiving compassion on the associations of the number of major life events and their appraisals by the individual with depressive symptoms. Participants were 400 Portuguese-speaking adults from the general population (121 men and 279 women) with ages between 18 and 65 years, that completed self-report measures. Correlation analysis showed significant and positive associations between the number of major life events that occurred in the previous year and the positive and negative appraisal of such events, external shame, fears of receiving compassion, and depressive symptoms. Path analysis revealed that external shame and fears of receiving compassion fully mediated the effects of number of life events on depressive symptoms. Furthermore, results showed a direct effect of negative appraisal of major life events on depressive symptoms. This study sheds light on the psychological processes that may underlie the relationship between the cumulative number of major life events and depressive symptoms. Specifically, it suggests that the occurrence of major life events can impact on depressive symptoms when associated with feelings of shame and fears of receiving compassion from others.
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| 10. |
- Coutinho, Mariana, et al.
(författare)
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Experiential avoidance, committed action and quality of life : Differences between college students with and without chronic illness
- 2021
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Ingår i: Journal of Health Psychology. - : Sage Publications. - 1359-1053 .- 1461-7277. ; 26:7, s. 1035-1045
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to explore, through structural equation modelling, experiential avoidance and committed action's effects on the association between anxiety and psychological quality of life and whether this relationship presents significant differences across a sample of 115 college students with chronic illness and a sample of 232 students without illness. Students with chronic illness presented higher levels of anxiety and experiential avoidance and lower levels of quality of life. The association between anxiety and psychological quality of life was partially explained by experiential avoidance and committed action. This path model was shown to be invariant between the two groups of students.
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