| 1. |
- Ferreira, N., et al.
(author)
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The impact of the coronavirus (COVID-19) pandemic on individuals with gastrointestinal disorders: A protocol of an international collaborative study
- 2021
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In: Journal of Psychosomatic Research. - : Elsevier BV. - 0022-3999 .- 1879-1360. ; 148
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Journal article (peer-reviewed)abstract
- Objective: The COVID-19 pandemic has had a significant impact on mental health across the globe. People living with a chronic gastrointestinal (GI) disorder might be particularly at risk of mental health complications given higher rates of comorbid anxiety and depression compared to the healthy population. As GI disorders affect up to 40% of the population worldwide, this international collaborative study seeks to evaluate the extent of the impact of the COVID-19 pandemic on GI symptoms specifically and more generally on the well-being of those living with chronic GI conditions. Methods: A longitudinal survey with three time points (baseline, 6-month, and 12-month) will be conducted online. Adult participants with GI disorders from multiple countries will be recruited via patient associations, social media advertising, utilizing snowball sampling. Participants will be invited to complete a battery of questionnaires including demographic and health parameters, and measures of gastrointestinal symptoms, fear of COVID-19, perceived impact of COVID-19, illness perceptions, coping, depression, anxiety, stress, catastroph-izing, and quality of life, using validated measures where available. Statistical analyses will include univariate descriptive models, multivariate models utilizing regression, mediation, and moderation, and latent growth models. Conclusions: This project may present novel information to the field of psychogastroenterology and may provide crucial information regarding the areas of impact for individuals with GI disorders during and following the pandemic. Further, this information can guide healthcare providers and patient associations on how to target support related to the pandemic mental health sequelae for these patients.
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| 2. |
- Mikocka-Walus, Antonina, et al.
(author)
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Exploring the Relationship Between Self-Isolation and Distress Among People with Gastrointestinal Disorders During the COVID-19 Pandemic
- 2022
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In: Journal of clinical psychology in medical settings. - : Springer. - 1068-9583 .- 1573-3572. ; 29:3, s. 654-665
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Journal article (peer-reviewed)abstract
- This study aimed to explore the association between perceived isolation and symptoms of distress in people with GI disorders at the time of the pandemic; and to examine factors which moderate this relationship. This online cross-sectional survey was advertised in May-September 2020 via patient organisations and associated social media. Overall, 831 people (82% female, mean age 49 years) from 27 countries participated. A significant relationship between social isolation and psychological distress was noted (r = .525, p < .001). GI symptoms moderated the association between isolation and distress (B = .047, t = 2.47, p = .015). Interventions targeting these factors may help to reduce distress in people with GI disorders at the time of major stressors such as the COVID-19 pandemic.
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| 3. |
- Carvalho, Sérgio A., et al.
(author)
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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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In: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 26:5, s. 616-625
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Journal article (peer-reviewed)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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| 4. |
- Carvalho, Sérgio A., et al.
(author)
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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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In: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 12
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Journal article (peer-reviewed)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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| 5. |
- Carvalho, Sérgio A., et al.
(author)
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Self-Compassion and Depressive Symptoms in Chronic Pain (CP) : A 1-Year Longitudinal Study
- 2020
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In: Mindfulness. - : Springer. - 1868-8527 .- 1868-8535. ; 11:3, s. 709-719
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Journal article (peer-reviewed)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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| 6. |
- Carvalho, S. A., et al.
(author)
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Self-compassion in Acceptance and Commitment Therapy for chronic pain: a pilot study
- 2022
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In: Scandinavian Journal of Pain. - : Walter de Gruyter GmbH. - 1877-8860 .- 1877-8879. ; 22:3, s. 631-638
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Journal article (peer-reviewed)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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| 7. |
- Ferreira, Cláudia, et al.
(author)
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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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In: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 15
-
Journal article (peer-reviewed)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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| 8. |
- Guiomar, Raquel, et al.
(author)
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Usability Study of the iACTwithPain Platform : An Online Acceptance and Commitment Therapy and Compassion-Based Intervention for Chronic Pain
- 2022
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In: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 13
-
Journal article (peer-reviewed)abstract
- Background: This pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates.Methods: Seventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform's usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention from a practitioner's point of view.Results: This study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format.Conclusion: This study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed.
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| 9. |
- Hayes, Bree, et al.
(author)
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Extending the Common Sense Model to Explore the Impact of the Fear of COVID-19 on Quality of Life in an International Inflammatory Bowel Disease Cohort
- 2022
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In: Journal of clinical psychology in medical settings. - : Springer. - 1068-9583 .- 1573-3572. ; 29:3, s. 678-688
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Journal article (peer-reviewed)abstract
- The aim of this cross-sectional study was to use an extended common sense model (CSM) to evaluate the impact of fear of COVID-19 on quality of life (QoL) in an international inflammatory bowel disease cohort. An online study involving 319 adults (75% female, mean (SD) 14.06 (15.57) years of symptoms) completed the Gastrointestinal Symptom Rating Scale, Brief Illness Perceptions Questionnaire, Fear of Contracting COVID-19 Scale, Brief-COPE, Depression, Anxiety and Stress Scale, and the EUROHIS-QOL. The extended CSM had an excellent fit (chi(2) (9) = 17.06, p = .05, chi(2)/N = 1.90, RMSEA = 0.05, SRMR = 0.04, CFI = .99, TLI = .97, GFI = 0.99), indicating the influence of gastrointestinal symptoms on QoL was mediated by illness perceptions, fear of COVID-19, adaptive and maladaptive coping, and psychological distress. Interventions targeting the fear of COVID-19 in the context of an individual's perceptions will likely enhance QoL during the pandemic.
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| 10. |
- Lo, B., et al.
(author)
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Fear of COVID-19 Among Patients with Inflammatory Bowel Disease as Compared to Patients with Other Gastrointestinal Conditions
- 2022
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In: Turkish Journal of Gastroenterology. - : AVES Publishing Co.. - 1300-4948 .- 2148-5607. ; 33:8, s. 664-672
-
Journal article (peer-reviewed)abstract
- Background: Although several studies have reported the impact of fears relating to coronavirus-19 on several chronic illnesses, there are few studies focused on gastrointestinal conditions. Therefore, the aim of this study was to compare the fear of coronavirus-19 in patients with inflammatory bowel disease to other gastrointestinal conditions and how the fear of COVID-19 manifests across different demographical backgrounds among inflammatory bowel disease respondents. Methods: Participants with gastrointestinal conditions (age >= 18) were recruited from 27 countries. Demographic, clinical, and psychosocial information was collected. An adapted scale for inflammatory bowel disease patients measuring the fear of coronavirus-19 and gastrointestinal-specific fear of coronavirus-19 was used. Results: In 831 participants (312 inflammatory bowel disease), only significant increases in gastrointestinal-fear of coronavirus-19 were found in between inflammatory bowel disease and other gastrointestinal conditions (mean [standard deviation]: 13.5 [5.5] vs 10.9 [5.0], P <.01). Among inflammatory bowel disease respondents, persons on sick leave had significantly more fear of coronavirus-19 than those employed (median [IQR], 31.0 [28.5-39.5] vs 26.0 [20.0-33.0], P =.035) and significantly more gastrointestinal-fear of coronavirus-19 compared to the employed (18.0 [14.5-22.0] vs 13.0 [9.0-17.0], P =.033) or respondents outside of the labor market (12.0 [7.0-16.0], P =.022). Persons living in a rural setting had significantly more fear of coronavirus-19 compared to persons living in regional setting (29.5 [22.0-37.8] vs 25.0 [20.0-31.3], P =.007) and gastrointestinal-fear of coronavirus-19 (15.0 [11.0-19.8] vs 12.0 [9.0-16.0], P =.02). Conclusion: Respondents with inflammatory bowel disease are more afraid of coronavirus-19 regarding their disease; especially, persons on sick leave or persons living in a rural setting. This should be taken into consideration to personalize the support that health care providers can offer in mitigating fear related to coronavirus-19.
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| 11. |
- Trindade, Inês A., 1990-, et al.
(author)
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Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain : A Systematic Review and Meta-Analysis
- 2021
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In: Journal of Pain. - : Elsevier. - 1526-5900 .- 1528-8447. ; 22:11, s. 1328-1342
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Research review (peer-reviewed)abstract
- Acceptance and Commitment Therapy (ACT) has been widely tested for chronic pain, with demonstrated efficacy. Nevertheless, although there is meta-analytical evidence on the efficacy of face-to-face ACT, no reviews have been performed on online ACT in this population. The aim of this meta-analysis is to determine the efficacy of online ACT for adults with chronic pain, when compared with controls. PubMed, PsycINFO, CENTRAL, and Web of Knowledge were searched for randomized controlled trials (RCTs) of online-delivered ACT for chronic pain. Effects were analyzed at post-treatment and follow-up, by calculating standardized mean differences. Online-delivered ACT was generally favored over controls (5 RCTs, N = 746). At post-treatment, medium effects for pain interference and pain acceptance, and small effects for depression, mindfulness, and psychological flexibility were found. A medium effect for pain interference and acceptance, and small effects for pain intensity, depression, anxiety, mindfulness, and psychological flexibility were found at followup. ACT-related effects for pain interference, pain intensity, mindfulness, and anxiety increased from post-treatment to follow-up. Nevertheless, the current findings also highlight the need for more methodologically robust RCTs. Future trials should compare online ACT with active treatments, and use measurement methods with low bias.Perspective: This is the first meta-analytical review on the efficacy of online ACT for people with chronic pain. It comprises 5 RCTs that compared online ACT with active and/or inactive controls. Online ACT was more efficacious than controls regarding pain interference, pain intensity, depression, anxiety, mindfulness, and psychological flexibility.
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| 12. |
- Trindade, Inês, 1990, et al.
(author)
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The LIFEwithIBD Intervention: Study Protocol for a Randomized Controlled Trial of a Face-to-Face Acceptance and Commitment Therapy and Compassion-Based Intervention Tailored to People With Inflammatory Bowel Disease
- 2021
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In: Frontiers in Psychiatry. - : Frontiers Media SA. - 1664-0640. ; 12
-
Journal article (peer-reviewed)abstract
- Background: There is ample evidence of the high mental health burden caused by Inflammatory Bowel Disease (IBD). Several constructs such as experiential avoidance, cognitive fusion, shame, and self-criticism have recently emerged as potential intervention targets to improve mental health in IBD. Psychotherapeutic models such as Acceptance and Commitment Therapy and compassion-based interventions are known to target these constructs. In this protocol, we aim to describe a two-arm Randomized Controlled Trial (RCT) testing the efficacy of an ACT and compassion-focused intervention named Living with Intention, Fullness, and Engagement with Inflammatory Bowel Disease (LIFEwithIBD) intervention + Treatment As Usual (TAU) vs. TAU in improving psychological distress, quality of life, work and social functioning, IBD symptom perception, illness-related shame, psychological flexibility, self-compassion, disease activity, inflammation biomarkers, and gut microbiota diversity. Methods: This trial is registered at (Identifier: NCT03840707, date assigned 13/02/2019). The LIFEwithIBD intervention is an adaptation to the IBD population of the Mind programme for people with cancer, an acceptance, mindfulness, and compassion-based intervention designed to be delivered in a group format. The LIFEwithIBD intervention's structure and topics are presented in this protocol. Participants were recruited at the Gastroenterology Service of the Coimbra University Hospital between June and September 2019. Of the 355 patients screened, 61 participants were selected, randomly assigned to one of two conditions [experimental group (LIFEwithIBD + TAU) or control group (TAU)] and completed the baseline assessment. Outcome measurement took place at baseline, post-intervention, 3- and 12-month follow-ups. Discussion: Results from this RCT will support future studies testing the LIFEwithIBD intervention or other acceptance and/or compassion-based interventions for IBD.
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| 13. |
- Carvalho, S. A., et al.
(author)
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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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In: Clinical Psychology & Psychotherapy. - : Wiley. - 1063-3995 .- 1099-0879. ; 29:2, s. 524-541
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Journal article (peer-reviewed)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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| 14. |
- Carvalho, Sérgio A., et al.
(author)
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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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In: Current Psychology. - : Springer. - 1046-1310 .- 1936-4733. ; 41:12, s. 8897-8907
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Journal article (peer-reviewed)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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| 15. |
- Coelho, Helena L., et al.
(author)
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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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In: Current Psychology. - : Springer. - 1046-1310 .- 1936-4733. ; 40:9, s. 4553-4562
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Journal article (peer-reviewed)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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| 16. |
- Coutinho, Mariana, et al.
(author)
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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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In: Journal of Health Psychology. - : Sage Publications. - 1359-1053 .- 1461-7277. ; 26:7, s. 1035-1045
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Journal article (peer-reviewed)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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| 17. |
- Dias, Bernardo Santos, et al.
(author)
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Influence of fears of compassion on body image shame and disordered eating
- 2020
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In: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 25:1, s. 99-106
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Journal article (peer-reviewed)abstract
- Purpose: The current study tested a path model examining the impact of fears of compassion in the adoption of disordered eating and whether social safeness and body shame would mediate this relationship.Methods: Participants were 645 women (aged between 18 and 55) from the general community, who completed an online survey.Results: Results indicated that fears of compassion were negatively associated with one's ability to feel secure and safe within close relationships, and positively linked with higher levels of body shame and disordered eating. The tested model accounted for 62% of the variance of disordered eating. Path analyses results revealed that the three dimensions of fears of compassion impacted on disordered eating. Particularly, fear of expressing compassion for others presented a direct impact on disordered eating. Moreover, fears of self-compassion and fears of receiving compassion from others partially impacted on disordered eating attitudes and behaviours, through the mechanisms of social safeness and body image-focused shame. These findings suggested that women who present higher levels of fear of self-compassion and of receiving signs of affection and compassion from others tend to feel more insecure in their social group, which seem explain body shame and the engagement in disordered eating behaviours.Conclusions: This study highlights the pathogenic impact of fears of compassion on body image and eating attitudes and behaviours. The current data seem to offer relevant insights for research and clinical practice, by supporting the relevance of developing compassionate abilities and attitudes to target body image and eating-related difficulties.
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| 18. |
- Duarte, Cristiana, et al.
(author)
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Body image and college women's quality of life : The importance of being self-compassionate
- 2015
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In: Journal of Health Psychology. - : Sage Publications. - 1359-1053 .- 1461-7277. ; 20:6, s. 754-764
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Journal article (peer-reviewed)abstract
- This study explored self-compassion as a mediator between body dissatisfaction, social comparison based on body image and quality of life in 662 female college students. Path analysis revealed that while controlling for body mass index, self-compassion mediated the impact of body dissatisfaction and unfavourable social comparisons on psychological quality of life. The path model accounted for 33per cent of psychological quality of life variance. Findings highlight the importance of self-compassion as a mechanism that may operate on the association between negative body image evaluations and young women's quality of life.
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| 19. |
- Duarte, Cristiana, et al.
(author)
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Normative body dissatisfaction and eating psychopathology in teenage girls : the impact of inflexible eating rules
- 2016
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In: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 21:1, s. 41-48
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Journal article (peer-reviewed)abstract
- Adolescence has been considered a critical time for the development of body image-related difficulties and disordered eating behaviours, especially in females. Although adherence to eating rules has been linked to disordered eating, literature has not yet explored how the inflexible subscription to those rules impacts on eating psychopathology. Therefore, the aim of the current study was to explore whether inflexible eating impacts on the relationships between weight and body image-related variables, and disordered eating.Participated in this study are 497 female adolescents from the community, aged between 14 and 18 years old, who completed self-report measures.Results revealed that the majority of the participants were dissatisfied with their weight and body shape. Moreover, 6.64 % of the participants demonstrated severe eating psychopathology. A path analysis revealed that BMI, body dissatisfaction and social comparisons based on physical appearance impact on disordered eating behaviours, through the mechanism of inflexible adherence to eating rules. This model explained 52 % of eating psychopathology's variance.Findings highlight the relevance of body image-related difficulties in adolescence and additionally they emphasise the importance of promoting more flexible attitudes towards eating in prevention and intervention programmes with female adolescents.
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| 20. |
- Ferreira, Cláudia, et al.
(author)
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Body image-related cognitive fusion as a main mediational process between body-related experiences and women’s quality of life
- 2015
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In: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 20:1, s. 91-97
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Journal article (peer-reviewed)abstract
- Purpose: Although the experience of body image has been considered an important indicator of women's psychological quality of life (QoL), it has also been suggested that the impact of unwanted body-related experiences on QoL may be mediated by emotional regulation processes. The aim of the current study was therefore to explore for the first time the role of body image-related cognitive fusion on these associations.Methods: This study comprised 779 young females who completed self-report measures. A path analysis was conducted to explore whether BMI, body dissatisfaction and feelings of inferiority based on physical appearance would impact on psychological QoL through body image-related cognitive fusion.Results: The model explained 39 % of psychological health, and revealed an excellent fit. Results showed that BMI did not directly impact on psychological health. Furthermore, the effects of increased body dissatisfaction and feelings of inferiority based on physical appearance on psychological health were fully and partially mediated by body image-related cognitive fusion, respectively.Conclusions: These findings suggest that the presence of body image-related negative experiences does not necessarily lead to impairment in women's QoL, which is rather dependent upon one's ability to observe these unwanted experiences as transient and subjective. Therefore, intervention programmes aiming at increasing women's QoL should focus on targeting emotional regulation processes in order to develop the ability to pursue life goals and values, even in the presence of unwanted experiences concerning body image.
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| 21. |
- Ferreira, Cláudia, et al.
(author)
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Defensive Responses to Early Memories with Peers : A Possible Pathway to Disordered Eating
- 2017
-
In: The Spanish Journal of Psychology. - : Cambridge University Press. - 1138-7416 .- 1988-2904. ; 19
-
Journal article (peer-reviewed)abstract
- Childhood and early adolescence experiences, specifically those that provide an adulthood enriched with warm and safe memories, are consistently stated in literature as powerful emotional regulators. In contrast, individuals who scarcely recall positive experiences may begin to believe that others see the self as inferior, inadequate and unattractive. In order to cope with a perceived loss of social desirability and achieve other's acceptance, individuals may become submissive, and women, particularly, may resort to the presentation of a perfect body image. Both mechanisms are defensive responses suggested to be associated with mental health difficulties, particularly disordered eating behaviors. The present study aimed at exploring the association between early memories of warmth and safeness with peers and eating psychopathology. Also, a path analysis was conducted to investigate the mediator role of submissiveness and perfectionistic self-presentation focused on body image on this association, in a sample of 342 female students. Results revealed that the absence of early positive memories with peers holds a significant effect over eating psychopathology's severity, and also that this effect is mediated through submissiveness and body image-related perfectionistic self-presentation. This model accounted for 13%, 19% and 51% of submissiveness, perfectionistic self-presentation of body image and eating psychopathology's variances, respectively, and showed excellent model fit.
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| 22. |
- Ferreira, Cláudia, et al.
(author)
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Do shame and perfectionistic self-presentation explain the link between early affiliative memories and eating psychopathology?
- 2018
-
In: Psychology, Health & Medicine. - : Taylor & Francis. - 1354-8506 .- 1465-3966. ; 23:5, s. 628-634
-
Journal article (peer-reviewed)abstract
- This study tested a model examining the impact that early affiliative memories (both with family and peers) on eating psychopathology, and whether these links are carried by the mechanisms of external shame and body image-related perfectionistic self-presentation, in a sample of 480 female college students. Path analyses' results revealed that this model accounted for 48% of disordered eating's variance and suggests that the lack of early positive emotional memories is associated with higher levels of shame (feelings of inferiority and unattractiveness), and with higher tendency to adopt body image-related perfectionistic strategies, that seem to explain excessive eating concern and rigid control of one's eating behaviors. This study offers important insights for future research and for the development of intervention programs, by revealing the importance of assessing and targeting shame and perfectionistic strategies and suggesting the importance of promoting adaptive emotion regulation strategies.
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| 23. |
- Ferreira, Cláudia, et al.
(author)
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Explaining rigid dieting in normal-weight women : the key role of body image inflexibility
- 2016
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In: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 21:1, s. 49-56
-
Journal article (peer-reviewed)abstract
- Restrictive dieting is an increasing behavior presented by women in modern societies, independently of their weight. There are several known factors that motivate diet, namely a sense of dissatisfaction with one's body and unfavorable social comparisons based on physical appearance. However, dieting seems to have a paradoxical effect and has been considered a risk factor for weight gain and obesity in women and for maladaptive eating. Nevertheless, the study of the emotional regulation processes that explain the adoption of inflexible and rigid eating behaviors still remains little explored. In this line, the present study aims to explore why normal-weight women engage in highly rigid and inflexible diets. We hypothesize that body and weight dissatisfaction and unfavorable social comparisons based on physical appearance explain the adoption of inflexible eating rules, through the mechanisms of body image inflexibility. The current study comprised 508 normal-weight female college students. Path analyses were conducted to explore the study's hypotheses. Results revealed that the model explained 43 % of inflexible eating and revealed excellent fit indices. Furthermore, the unwillingness to experience unwanted events related to body image (body image inflexibility) mediated the impact of body dissatisfaction and unfavorable social comparisons on the adoption of inflexible eating rules. This study highlights the relevance of body image inflexibility to explain rigid eating attitudes, and it seems to be an important avenue for the development of interventions focusing on the promotion of adaptive attitudes towards body image and eating in young women.
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| 24. |
- Ferreira, Cláudia, et al.
(author)
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Exploring drive for thinness as a perfectionistic strategy to escape from shame experiences
- 2015
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In: The Spanish Journal of Psychology. - : Cambridge University Press. - 1138-7416 .- 1988-2904. ; 18
-
Journal article (peer-reviewed)abstract
- Perfectionistic self-presentation defines the attempt at presenting the self as perfect through the public concealment of personal defects and/or through the display of attributes perceived as capable to gather positive attention of others. Although perfectionism has long been considered a central aspect of eating psychopathology mediational studies between this construct and these conditions are scarce. This study aimed at examining the mediational role of body image-related perfectionistic self-presentation in the effects of external shame and internal shame on drive for thinness, in a sample of young women. Results revealed body image-related perfectionistic self-presentation as a significant mediator (p <.05) of the relationships between external and internal shame, and drive for thinness. Furthermore, 86% and 69% of the effects of external shame and internal shame, respectively, were explained by their indirect effects through body image-related perfectionistic self-presentation on drive for thinness (95% CI). These results highlight that the control over eating may emerge as a maladaptive strategy to deal with shame when mediated by an endorsement in the belief that presenting a perfect body image is crucial to be accepted and valued by others. Study findings suggest that this perfectionistic strategy should be targeted while treating eating psychopathology.
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| 25. |
- Ferreira, Cláudia, et al.
(author)
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Getting entangled with body image : Development and validation of a new measure
- 2015
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In: Psychology and Psychotherapy. - : John Wiley & Sons. - 1476-0835 .- 2044-8341. ; 88:3, s. 304-316
-
Journal article (peer-reviewed)abstract
- Objectives: Several studies have highlighted the role of cognitive fusion on human suffering and a wide range of psychopathological conditions. Namely, this process has been regarded as a core aspect in eating disorders. Nevertheless, the study of cognitive fusion on eating psychopathology is scarce and a measure that specifically concerns body image was still to be created. The present study aimed therefore at developing and validating such measure, the Cognitive Fusion Questionnaire - Body Image (CFQ-BI).Design and methods: The current study was conducted using different samples of both genders, collected in the general and student populations. The dimensionality of the CFQ-BI was tested through an exploratory factor analysis and a confirmatory factor analysis (CFA). The scale's internal reliability and other psychometric qualities were also analysed.Results: The CFQ-BI's final structure was one-dimensional and comprised 10 items that assess body image-related cognitive fusion. This final structure explained a total of 73.41% of the variance. The adequacy of the questionnaire was corroborated through a CFA which revealed that CFQ-BI presents good global and local adjustment values and goodness-of-fit indices. Results also showed that the CFQ-BI holds a very good internal consistency (=.96), convergent, divergent and temporal reliabilities, and is able to discriminate cases from non-cases of eating psychopathology.Conclusions: The CFQ-BI was thus established as a short, robust, and reliable measure of body image-related cognitive fusion. This new measure may correspond to a significant contribution to research and clinical practice in the field of body image and eating-related difficulties.
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| 26. |
- Ferreira, Cláudia, et al.
(author)
-
How do warmth, safeness and connectedness-related memories and experiences explain disordered eating?
- 2018
-
In: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 23:5, s. 629-636
-
Journal article (peer-reviewed)abstract
- Literature suggested that the recall of early positive experiences have a major impact on the promotion of feelings of connectedness and social safeness, and seems to protect individuals against psychopathology. Recent research has also demonstrated that the absence of these positive rearing memories play a key role on disordered eating-related behaviours. The impact of early affiliative memories on disordered eating do not seem to be direct, and the mechanisms underlying this relationship are scarcely investigated. The present study aimed to clarify how memories of warmth and safeness explain the adoption of disordered eating attitudes, and tested the mediator role of social safeness, external shame and appearance-focused social comparison on aforementioned relationship, in a sample of 277 young women. The tested model explained 36% of eating psychopathology's variance and presented an excellent fit. Path analysis results indicated that the impact of rearing memories on eating psychopathology was fully mediated through the mechanisms of social safeness, external shame and appearance-focused social comparison. Specifically, these findings suggested that the extent to which positive rearing memories are associated with lower levels of disordered eating attitudes is influenced by the current feelings of social safeness and connectedness, which in turn are totally carried by decreased feelings of external shame and by lower endorsement on unfavourable comparison based on physical appearance with proximal targets (peers). These results seem to offer important insights for research and clinical work on body image and eating-related difficulties, suggesting the relevance of promoting warm and safe interactions with others.Level of evidenceLevel V, descriptive study.
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| 27. |
- Ferreira, Cláudia, et al.
(author)
-
Turning eating psychopathology risk factors into action : The pervasive effect of body image-related cognitive fusion
- 2014
-
In: Appetite. - : Elsevier. - 0195-6663 .- 1095-8304. ; 80, s. 137-142
-
Journal article (peer-reviewed)abstract
- Body image dissatisfaction and unfavourable social comparisons are significant risk factors to eating psychopathology. Nevertheless, the impact of these negative experiences depends on the cognitive and emotional processes involved. Previous research has shown that cognitive fusion is a nuclear process linked to psychological inflexibility, but its role on body image and eating difficulties remains unclear. This study aims to explore a model of the mediational role of body image-related cognitive fusion (CF-BI) on the relationship between body dissatisfaction, unfavourable social comparisons, and eating psychopathology in a sample of 345 female students. Results from path analyses show that the impact of unfavourable social comparisons on eating psychopathology is fully mediated by CF-BI. Moreover, CF-BI also revealed a mediational effect on the relationship between body image dissatisfaction and the severity of eating symptoms, in spite of the fact that a direct effect of body dissatisfaction still exists. The tested model highlights the crucial role that cognitive fusion, in the specific domain of body image, plays in the relationship between risk factors and the severity of disordered eating attitudes and behaviours. Furthermore, these findings present empirical support for the relevance of addressing acceptance and cognitive defusion techniques to prevent and treat eating disorders.
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| 28. |
- Ferreira, Cláudia, et al.
(author)
-
Understanding the Role of Self-Judgment in the Association between Body Dissatisfaction and Quality of Life on Normal-Weight and Overweight Portuguese Women
- 2016
-
In: The Spanish Journal of Psychology. - : Cambridge University Press. - 1138-7416 .- 1988-2904. ; 19
-
Journal article (peer-reviewed)abstract
- Literature has demonstrated the negative impact of body image dissatisfaction on women's quality of life. Nonetheless, it has been suggested that the relationship between body dissatisfaction and women's well-being is not linear, and that the processes that mediate this association remain unclear. This study aims to clarify the mediator role of self-judgment in the association between negative body image and psychological quality of life, in two groups: normal-weight and overweight women. This cross-sectional study comprised 200 normal-weight and 92 overweight female college students, aged between 18 and 24 years old, that completed self-report instruments of body dissatisfaction, self-judgment, and quality of life. Results showed that women who presented harsher self-judgment about their perceived failures tended to present lower levels in all quality of life domains. Also, results from mediation analyses indicated the relationship between body dissatisfaction and psychological quality of life was significantly mediated by the mechanisms of self-judgment in the two BMI groups (95% CI [-2.41 to -0.04]; 95% CI [-6.35 to -.89]). This mediational model accounted for 28.3% and 40.7% of psychological quality of life in the normal-weight and overweight groups, respectively. These results suggest that a lower ability to deal with one's failures or inadequacies (e.g., negative evaluation of body image) in a kind and accepting manner may significantly increase the negative impact of body dissatisfaction on one's psychological quality of life. In this way, it seems that, the focus of interventions should go beyond body dissatisfaction and also target the development of adaptive attitudes (opposed to self-critical attitudes) to deal with negative body-related experiences.
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| 29. |
- Ferreira, Cláudia, et al.
(author)
-
When thought suppression backfires : its moderator effect on eating psychopathology
- 2015
-
In: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 20:3, s. 355-362
-
Journal article (peer-reviewed)abstract
- Recently, several studies have pointed the importance of thought suppression as a form of experiential avoidance in different psychopathological conditions. Thought suppression may be conceptualized as an attempt to decrease or eliminate unwanted internal experiences. However, it encloses a paradoxical nature, making those thoughts hyper accessible and placing an extra burden on individuals. This avoidance process has been associated with several psychopathological conditions. However, its role in eating psychopathology remains unclear. The present study aims to explore the moderation effect of thought suppression on the associations between body image-related unwanted internal experiences (unfavorable social comparison through physical appearance and body image dissatisfaction) and eating psychopathology severity in a sample of 211 female students. Correlational analyses showed that thought suppression is associated with psychological inflexibility and eating disorders' main risk factors and symptoms. Moreover, two independent analyses revealed that thought suppression moderates, as it amplifies, the impact of unfavorable social comparisons through physical appearance (model 1) and body image dissatisfaction (model 2) on disordered eating attitudes and behaviors. Hence, for the same level of these body-related internal experiences, young females who reveal higher levels of thought suppression present higher eating psychopathology. Taken together, these findings highlight the key role of thought suppression in eating psychopathology and present important clinical implications.
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| 30. |
- Fonseca, Soraia, et al.
(author)
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The buffer role of psychological flexibility against the impact of major life events on depression symptoms
- 2020
-
In: Clinical Psychologist. - : Taylor & Francis. - 1328-4207 .- 1742-9552. ; 24:1, s. 82-90
-
Journal article (peer-reviewed)abstract
- Purpose: Major life events have been positively associated with depression symptoms. Although psychological flexibility has been associated with adaptive coping skills and negatively linked with depression symptoms, it remains unclear whether psychological flexibility may be a protective process against the pervasive impact of major life events. Thus, the present study aimed to explore the moderating effect of psychological flexibility on the association between the cumulative number of major life events and their negative appraisal with depression symptoms.Methods: Four hundred and one participants (280 females and 121 males), aged between 18 and 65 years old, completed a set of self-report measures assessing the number of major life events that had occurred in the previous 12 months and their appraisal, as well as psychological flexibility, and depression symptoms.Results: Correlation analyses showed a negative and strong association between psychological flexibility and depression symptoms. Path analyses revealed that psychological flexibility attenuated the effect of the cumulative number of major life events and their perceived negative impact on depression symptoms.Conclusions: This study highlights the buffer role of psychological flexibility on the association of number of major life events and their negative appraisal, with depression symptoms. These findings suggest that being able to be in contact with the present moment with an accepting and non-judging attitude towards internal experiences, and to engage in valued-based action, may protect individuals against the negative impact of major life events with regards to depression symptoms.
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| 31. |
- Knowles, Simon R., et al.
(author)
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Exploring the Impact of Covid-19-Related Perceptions on Psychological Distress and Quality of Life in an International Gastrointestinal Cohort Over Time Guided by the Common Sense Model
- 2023
-
In: Journal of clinical psychology in medical settings. - : Springer. - 1068-9583 .- 1573-3572. ; 30:4, s. 804-820
-
Journal article (peer-reviewed)abstract
- The aim of this longitudinal study was to examine changes in COVID-19 and illness-related perceptions, gastrointestinal symptoms, coping, catastrophising, psychological distress, and QoL during the COVID-19 pandemic. A total of 831 adults with a gastrointestinal condition completed an online questionnaire at baseline (May-October 2020). Of those, 270 (32.5%) participants (85.2% female, mean age = 47.3 years) provided follow-up data (March-May 2021). Repeated-measures multiple analysis of variance and a cross-lagged panel model were used to test the study hypotheses. Gastrointestinal symptoms and COVID-19 perceptions at follow-up were strongly predicted by their baseline values, while illness perceptions were predicted by baseline gastrointestinal symptoms. Cross-lagged relationships indicated a reciprocal relationship between gastrointestinal symptoms and psychological distress. Moreover, gastrointestinal symptoms had substantial predictive utility, strongly predicting future gastrointestinal symptoms, and to a lesser extent, more negative illness perceptions, greater psychological distress, and greater use of adaptive coping strategies across time.
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| 32. |
- Lucena-Santos, Paola, et al.
(author)
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Cognitive Fusion Questionnaire—Body Image : Psychometric Properties and Its Incremental Power in the Prediction of Binge Eating Severity
- 2017
-
In: Journal of Psychology. - : Routledge. - 0022-3980 .- 1940-1019. ; 151:4, s. 379-392
-
Journal article (peer-reviewed)abstract
- Given the clinical usefulness of the CFQ-BI (Cognitive Fusion QuestionnaireBody Image; the only existing measure to assess the body-image-related cognitive fusion), the present study aimed to confirm its one-factor structure, to verify its measurement invariance between clinical and non-clinical samples, to analyze its internal consistency and sensitivity to detect differences between samples, as well as to explore the incremental and convergent validities of the CFQ-BI scores in Brazilian samples. This was a cross-sectional study, which was conducted in clinical (women with overweight or obesity in treatment for weight loss) and non-clinical samples (women from the general population). The one-factor structure was confirmed showing factorial measurement invariance across clinical and non-clinical samples. The CFQ-BI scores presented an excellent internal consistency, were able to discriminate clinical and non-clinical samples, and were positively associated with binge eating severity, general cognitive fusion, and psychological inflexibility. Furthermore, body-image-related cognitive fusion scores (CFQ-BI) presented incremental validity over a general measure of cognitive fusion in the prediction of binge eating symptoms. This study demonstrated that CFQ-BI is a short scale with reliable and robust scores in Brazilian samples, presenting incremental and convergent validities, measurement invariance, and sensitivity to detect differences between clinical and non-clinical groups of women, enabling comparative studies between them.
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| 33. |
- Mendes, Ana Laura, et al.
(author)
-
The central role of self-reassurance to explain body and eating attitudes
- 2019
-
In: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 24:5, s. 861-868
-
Journal article (peer-reviewed)abstract
- Literature has emphasized the significant role of social acceptance and connectedness in well-being and the benefits of cultivating a positive body image in the prevention and treatment of body and eating-related difficulties. The current study aims to examine whether strategies of self-reassurance and body-image appreciation mediate the association of feelings of social safeness and acceptance with the "core" dimensions of body and eating-related psychopathology (restraint, eating concern, weight concern, and shape concern), while controlling the effects of body mass index (BMI). Participants were 309 Portuguese women, aged between 18 and 50 years that completed self-report measures. Results from the performed path analysis revealed that self-reassurance and body-image appreciation mediated the impact of feelings of social safeness and acceptance on eating psychopathology- related dimensions. Results seem to suggest that women who perceive the self as acceptable and desirable tend to adopt self-reassurance strategies. These strategies in turn seem to predict a protective and caring relationship with one's own body and decreased severity of eating psychopathology symptoms. This path model explained 22%, 27%, 51%, and 47% of restraint, eating concern, weight concern, and shape concern, respectively, and showed an excellent model fit. Our findings appear to offer significant insights in the field of body and eating-related psychopathology and seem to support the pertinence of creating intervention programs for women from the general community with body and eating-related difficulties that encourage the adoption of self-reassurance strategies and promote a positive and respectful relationship with one's own body image.
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| 34. |
- Nogueira, Maria Rita, et al.
(author)
-
Design and Usability of an E-Health Mobile Application
- 2020
-
In: Design, User Experience, and Usability. Case Studies in Public and Personal Interactive Systems. - Cham : Springer. - 9783030497569 - 9783030497576 ; , s. 314-328
-
Conference paper (peer-reviewed)abstract
- Health applications have increasingly been used to improve physical, mental and social well-being. Chronic pain (CP) is defined as pain that lasts for a period of three months and causes sporadic or constant discomfort. In Portugal, the treatments for this type of pain are almost exclusively pharmacological and with known limited effects. Endowing patients with self-management skills, will help them cope with pain in a more effective way. Psychological treatments (e.g. mindfulness-based interventions) may play a relevant role here, because they intervene on a cognitive, emotional and behavioural level, which in turn helps the chronic pain patient to deal with pain-related disorders and suffering. The current availability of connected and powerful smartphones and tablets creates an opportunity to propose alternative pain management solutions that may be used immediately when pain appears, which has been the argument that favoured the pharmacological solutions. For this we propose a mobile application that guides patients on the mindfulness practice and to self-manage the sensed pain. Learning to gradually adequate pain management may have several advantages such as: reduced the number of consultation visits and consequent waiting lists; increased cost-effectiveness; self-management of chronic pain at the patient’s pace and according to their needs; extend access to the treatment to patients that reside in low density regions. Being an alternative to traditional treatment, the proposed treatment will be under the guidance of qualified health professionals that will supervise treatment sessions and perform the required assessments. By promoting patients’ self-management, the control and monitoring of the chronic pain condition is expected to improve greatly, which in turn may prevent the aggravation of the clinical condition. This research and the mobile application are being developed in a collaboration between the Centre for Research in Neuropsychology and Cognitive Behavioral Intervention of the University of Coimbra and the Institute of Systems and Robotics.
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| 35. |
- Oliveira, Sara, et al.
(author)
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Development and initial validation of athletes’ perceptions of coach-related critical attitudes scale
- 2022
-
In: Current Psychology. - : Springer. - 1046-1310 .- 1936-4733. ; 41:11, s. 7512-7521
-
Journal article (peer-reviewed)abstract
- The aim of this study was to develop and validate the Athletes' Perceptions of the Coach-related Critical Attitudes Scale (APoCCAS), using three independent samples of Portuguese adult athletes. In the first stage, the items were developed to assess athletes' perceptions of coach-related critical attitudes and the items' factorial structure were explored via a principal components analysis. In a second stage, the findings of Principal Components Analysis were confirmed and cross-validated using confirmatory factor analysis with two independent samples of athletes. The development of a pool of items resulted in a 10-item with a unifactorial structure. This scale presented high internal consistency, adequate convergent validity, and presented a negative association with self-reassurance and positive associations with self-criticism, anxiety, and depressive symptoms. The APoCCAS demonstrated to be a short and reliable measure of the athletes' perceptions regarding coach-related critical attitudes and seems to be useful for practice and research fields in clinical sport psychology. By highlighting the associations between the athletes' perception of coach-related critical attitudes and mental health indicators, this study could create a space to alert coaches towards the effect of their attitudes on athletes' mental health.
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| 36. |
- Oliveira, Sara, et al.
(author)
-
The buffer effect of body compassion on the association between shame and body and eating difficulties
- 2018
-
In: Appetite. - : Elsevier. - 0195-6663 .- 1095-8304. ; 125, s. 118-123
-
Journal article (peer-reviewed)abstract
- Body compassion is a new construct which incorporates two multidimensional concepts: body image and self-compassion. Self-compassion has been revealed as a protective mechanism against body image and eating-related-related disturbances, including eating disorders. However, the study of this compassionate competence specifically focused on the domain of the body is still largely unexplored.This study aims to test whether body compassion moderate the impact of external shame on body image shame and disordered eating, in a sample of 354 women from the Portuguese general population.Correlation analyses showed that body compassion was negatively associated with experiences of shame and disordered eating. Path analysis results demonstrated the existence of a moderator effect of body compassion on the relationship between general feelings of shame and both body image shame and related behaviours, and disordered eating symptomatology. In fact, results suggested that body compassion buffered the impact of general feelings of shame on these psychopathological indices, with the tested model accounting for 46% and 39% of the variance of body image shame and disordered eating, respectively.This study contributes to a better understanding of the role of body compassion in body image and eating difficulties. Body compassion seems to be an important protector of these difficulties in women by buffering the effects of general shame on body image shame and related body concealment behaviours, as well as disordered eating. The findings from this study thus appear to offer important research and clinical implications, supporting the relevance of promoting body compassion in prevention and treatment programs for body image difficulties and disordered eating.
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| 37. |
- Palmeira, Lara, et al.
(author)
-
Can the impact of body dissatisfaction on disordered eating be weakened by one's decentering abilities?
- 2014
-
In: Eating Behaviors. - : Elsevier. - 1471-0153 .- 1873-7358. ; 15:3, s. 392-396
-
Journal article (peer-reviewed)abstract
- Decentering has been defined as the ability to deal with thoughts and emotions as subjective and ephemeral inner events. Since it implies a non-judging and present focused attitude towards thoughts and emotions, decentering has been considered as an important protective process against psychopathology, as it has been empirically shown to decrease depressive relapse rates. Nevertheless, its role in eating disordered attitudes and behaviours has not been fully uncovered.Therefore, the aim of the present study is to explore the moderator effect of decentering on the relationship between eating psychopathology and one of its main risk factors, body image dissatisfaction.The sample comprised 279 female students, aged between 14 and 21 years-old. Results revealed that decentering abilities were negatively linked to body image dissatisfaction and to the global score of eating psychopathology. Through a path analysis, the buffer effect of decentering was confirmed.The findings suggest that the ability to take a non-judgmental and accepting stance towards internal experiences diminishes the impact of one's body dissatisfaction on disordered eating attitudes and behaviours. This study seems especially pertinent since it uncovers a mechanism to lessen the pervasive impact of body image dissatisfaction, which is highly prevalent in women from Western societies.
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| 38. |
- Pinto, Catarina, et al.
(author)
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Social safeness and disordered eating : Exploring underlying mechanisms of body appreciation and inflexible eating
- 2017
-
In: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 22:2, s. 303-309
-
Journal article (peer-reviewed)abstract
- Feelings of social safeness and connectedness have been associated with adaptive emotion regulation processes and well-being indicators. Further, literature has demonstrated that interpersonal experiences play an important role in the etiology and maintenance of body and eating psychopathology. However, the study of the role of social variables and emotion regulation processes in the engagement in inflexible eating rules and eating psychopathology is still in its early stages. The current study aims to fill some gaps within the literature and explore the mediator role of body appreciation and inflexible eating rules in the link between social safeness and disordered eating. Participants were 253 women, aged between 18 and 50 years old, who completed a series of online self-report measures. Results from the tested path analysis model showed that social safeness holds a significant effect on eating psychopathology, through the mechanisms of body appreciation and inflexible eating rules. Also, results suggested that women who present higher levels of social safeness tend to present a more positive and respectful attitude towards their body and decreased adoption of inflexible eating rules, which seem to explain lower levels of disordered eating behaviours. These findings seem to present empirical support for the development of intervention programs that promote a positive, affectionate and healthy relationship with one's body image, in order to prevent the inflexible adherence to eating rules and disordered eating behaviours.
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| 39. |
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| 40. |
- Trindade, Inês A., 1990-, et al.
(author)
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Acceptability and preliminary test of efficacy of the Mind programme in women with breast cancer : An acceptance, mindfulness, and compassion-based intervention
- 2020
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In: Journal of Contextual Behavioral Science. - : Elsevier. - 2212-1447. ; 15, s. 162-171
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Journal article (peer-reviewed)abstract
- Although there is some evidence on the efficacy of mindfulness-based interventions in improving health and psychological outcomes in women with breast cancer, further research is needed to understand these findings' clinical significance. Furthermore, Acceptance and Commitment Therapy (ACT) intervention studies on breast cancer are scarce, and no compassion-based intervention has been tested for cancer patients. Given the complementarily and compatibility of mindfulness practice, ACT, and Compassion Focused Therapy, the current study combined these approaches to develop an integrative intervention specifically adapted to cancer patients, the Mind programme. Participants were recruited at the Radiotherapy Service of the Coimbra University Hospital (CHUC) and were assigned to one of two groups: the experimental group (Treatment As Usual + Mind Programme (8 weekly sessions and homework assignments) - n = 15) and the control group (Treatment As Usual - n = 17). There was a 100% retention on the experimental group, during the intervention. The effect size for psychological health (g = 0.79) was particularly noteworthy, suggesting that the intervention presented benefits that are comparable to mindfulness only-based interventions. The experimental group also improved on physical health (g = 0.16), quality of social relationships (g = 0.42), depression symptoms (g = - 0.42), and stress (g = - 0.32). Participants reported it was important for them to take part in the programme, and that it improved the way they deal with difficulties. Results indicate that the Mind programme may be a useful complement to the medical treatment of breast cancer and support the combination of acceptance, mindfulness, and compassion-based components in this context. Having an accessible and integrative psychological programme for people with cancer may significantly help improving quality of life and mental health in this population. Further implications are discussed.
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| 41. |
- Trindade, Inês A., 1990-, et al.
(author)
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An 18-month study of the effects of IBD symptomatology and emotion regulation on depressed mood
- 2017
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In: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 32:5, s. 651-660
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Journal article (peer-reviewed)abstract
- Depressive symptomatology in IBD patients is known to predict disease activity, which, in turn, can increase depressive symptoms in perpetuating a cycle between depression and IBD symptomatology. The mechanisms that contribute to the relationship between disease activity and depressive symptoms are not clearly investigated yet. Since emotion regulation has been considered particularly relevant to define the impact of adverse experiences on different outcomes, the current study aimed to examine the longitudinal influence of two maladaptive emotion regulation processes, cognitive fusion and brooding, on the association between disease activity and depressed mood.This study was conducted over an 18-month period, using a sample of 116 IBD patients that completed self-report validated measures in three different waves. Correlation analyses and cross-lagged panel models were performed.The main result from this study discovered that the experience of IBD symptomatology at baseline, although positively linked to the manifestation of depressed mood 18 months later (r = 0.25; p < 0.01), does not directly predict depressive symptoms. This relationship is rather indirect, as it is explained by the engagement in cognitive fusion (p = 0.028) and brooding (p = 0.017). These maladaptive emotion regulation processes, that were revealed to be consistent over time, link IBD symptoms with subsequent depressed mood.These findings indicate that clinicians should be aware of the emotion regulation processes patients tend to use to handle difficult experiences. The inclusion of psychological assessments and interventions in the healthcare of IBD patients should be seriously considered. Further implications are discussed.
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| 42. |
- Trindade, Inês A., 1990-, et al.
(author)
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Assessment of Chronic Illness-Related Cognitive Fusion : Preliminary Development and Validation of a New Scale with an IBD Sample
- 2018
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In: Journal of clinical psychology in medical settings. - : Springer. - 1068-9583 .- 1573-3572. ; 25:4, s. 356-366
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Journal article (peer-reviewed)abstract
- Although research recognizes the advantages of creating specific content measures, no specific measure of chronic illness-related cognitive fusion had been developed to date. The current study presents the development and validation of the Cognitive Fusion Questionnaire-Chronic Illness (CFQ-CI) in a sample of inflammatory bowel disease (IBD) patients and the analysis of the role of this construct in the psychological health of those patients. Results indicated that the 7-item CFQ-CI was a unidimensional measure of cognitive fusion in patients with chronic illnesses, and that scores had adequate/good internal consistency and construct, convergent, and discriminant validity. This study also showed that chronic illness-related cognitive fusion as assessed by the CFQ-CI acted as a mediator in the association between both IBD-related symptoms and shame with quality of life. The development of the CFQ-CI may thus contribute to a better understanding of the mechanisms influencing functional outcomes in chronic illness.
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| 43. |
- Trindade, Inês A., 1990-, et al.
(author)
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Chronic illness-related cognitive fusion explains the impact of body dissatisfaction and shame on depression symptoms in breast cancer patients
- 2018
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In: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 25:6, s. 886-893
-
Journal article (peer-reviewed)abstract
- Breast cancer is linked to psychological distress and mood disorders that are in turn associated with higher psychological dysfunction and decreased breast cancer survival. It is considered that psychological health in breast cancer is considerably affected by body image impairment, which in turn seems to be highly associated with shame. However, the impact of these variables on mental health may not be direct. The current study aimed to explore a comprehensive model regarding the role of chronic illness-related cognitive fusion in the relationship of body image dissatisfaction and chronic illness-related shame with depression symptoms. The sample was composed of 75 women with nonmetastatic breast cancer, recruited in a Radiotherapy Service in central Portugal. The conducted path model presented an excellent fit and accounted for 59% of the variance of depressive symptomatology. Further, it demonstrated that body image dissatisfaction's impact on depressed mood is significantly explained by the mechanisms of chronic illness-related shame and chronic illness-related cognitive fusion. It was also revealed that chronic illness-related cognitive fusion additionally mediated the impact of chronic illness-related shame on depression. These findings are suggestive of the importance of body image and chronic illness shame in the determination of breast cancer patients' depression symptoms and also the central role of chronic illness-related cognitive fusion in these relationships. Therefore, the implementation of acceptance and defusion-based psychotherapeutic interventions to improve mental health in cancer patients seems to be of great importance.
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| 44. |
- Trindade, Inês A., 1990-, et al.
(author)
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Chronic Illness-Related Shame : Development of a New Scale and Novel Approach for IBD Patients' Depressive Symptomatology
- 2017
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In: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 24:1, s. 255-263
-
Journal article (peer-reviewed)abstract
- The aims of the present study were to develop and validate a scale specifically focused on shame feelings derived from chronic illness-related experiences, the Chronic Illness-related Shame Scale (CISS) and to fill a gap in literature and analyse the role of this construct in the association between inflammatory bowel disease (IBD) symptomatology and depressed mood. This study comprised two samples: a sample of 161 IBD patients and a mixed sample of 65 chronic patients that reported medical data and completed self-report measures. The CISS's unidimensional seven-item structure was evaluated through confirmatory factor analyses. These analyses revealed good to excellent global and local adjustments in both samples. Results also showed that the CISS presents excellent internal consistencies and convergent, concurrent and divergent validity, being a valid, short and robust scale. Furthermore, the present study explored through path analyses, the role of CISS and self-judgement in the relationship between IBD symptomatology and depressed mood. Results showed that, although the level of IBD symptomatology directly predicted patients' depressive symptoms, the majority of this effect was mediated by CISS and self-judgement. Possible explanations for these findings are discussed in more detail in the succeeding text. The present study seems to highlight the pertinence of developing IBD patients' self-compassionate abilities to adaptively deal with symptomatology and related shame feelings. It thus may represent an avenue for the development of compassionate-based interventions for IBD patients and for the conduction of future studies exploring the shame phenomenon in other chronic illnesses.
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| 45. |
- Trindade, Inês A., 1990-, et al.
(author)
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Clarity of Personal Values and Committed Action : Development of a Shorter Engaged Living Scale
- 2016
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In: Journal of Psychopathology and Behavioral Assessment. - : Springer. - 0882-2689 .- 1573-3505. ; 38:2, s. 258-265
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Journal article (peer-reviewed)abstract
- The Engaged Living Scale (ELS) is a measure of the process of engaged living, defined by Acceptance and Commitment Therapy as the evaluation and performance of valued life activities. This 16-item measure was recently created and has been validated in middle-aged and chronic pain samples. The aim of the present study was to validate the ELS-16 in a young-adult sample and additionally to develop a shorter ELS. This study was conducted using different samples of Portuguese young-adult college students. The dimensionality of the ELS-16 (which was translated to Portuguese from the original Dutch) was tested through a CFA. The adequacy of the shorter ELS (ELS-9) was also tested through a CFA. The scales' internal reliability and other psychometric qualities were additionally analysed. Results from the CFA suggested that the model benefits from the establishment of correlations between pairs of error terms of items with similar contents. These results led to the decision to shorten the measure by excluding the item of each pair with the lowest communalities. The ELS-9 was then created and its CFA results revealed good to excellent adjustment values and goodness-of-fit indices. Results also showed that the ELS-16 and the ELS-9 present adequate to good psychometric properties. The present study thus shows that these instruments seem to be reliable measures of engaged living and to perform adequately in young-adult college students, with the ELS-9 being a new contribution to health research and allowing faster administrations.
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| 46. |
- Trindade, Inês A., 1990-, et al.
(author)
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Comprehensive assessment of Acceptance and Commitment Therapy processes (CompACT) : Measure refinement and study of measurement invariance across Portuguese and UK samples
- 2021
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In: Journal of Contextual Behavioral Science. - : Elsevier. - 2212-1447. ; 21, s. 30-36
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Journal article (peer-reviewed)abstract
- The need for a transnational validation is imperative at the stage of development of the CompACT, a self-report measure of psychological flexibility. This study aimed to translate, validate and test the factor structure of the Portuguese version of the CompACT and to conduct a measurement invariance analysis comparing the scale's performance in Portuguese and UK samples.Results from an Exploratory Factor Analysis demonstrated that the Portuguese version of the CompACT statistically performed better without 5 items from the Openness to Experience subscale. The 18-item Portuguese-adapted CompACT presented significant correlations in the expected directions and with the expected magnitudes with AAQ-II, CFQ-7, MAAS, CAQ-8, and DASS-21. Partial metric invariance was demonstrated between the Portuguese-adapted 18-item CompACT and the original CompACT in a UK sample. The non-correspondence between responses to these versions may be due to differences between the Portuguese and British cultures.This study contributes with the adaptation of the original CompACT to the Portuguese language and with the refinement of this instrument to an 18-item measure of psychological flexibility, that appears to be adequate for use in Portuguese samples. The lack of complete metric invariance of the CompACT found across the Portuguese and UK samples highlights the importance of psychometrically analyzing psychological instruments before use in cultural contexts distinct from the one targeted in the measure's original validation study.
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| 47. |
- Trindade, Inês A., 1990-, et al.
(author)
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COVID-19 Pandemic's Effects on Disease and Psychological Outcomes of People with Inflammatory Bowel Disease in Portugal : A Preliminary Research
- 2021
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In: Inflammatory Bowel Diseases. - : Oxford University Press. - 1078-0998 .- 1536-4844. ; 27:8, s. 1224-1229
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Journal article (peer-reviewed)abstract
- Aims: No empirical research on the psychological impact of the coronavirus disease 2019 (COVID-19) pandemic on people living with IBD, a population known to typically present high levels of anxiety and depression and to be potentially vulnerable to COVID-19, has yet been conducted. This study aimed to explore the links between contextual variables related to the COVID-19 pandemic and disease and psychological outcomes.Methods: The sample included 124 Portuguese patients with Crohn's disease or ulcerative colitis (85.48% women) who completed self-reported measures in an online survey during April 2020.Results: Fear of contracting COVID-19 and medication adherence were both high and unrelated. About half of the sample presented moderate (37.10%) to severe (14.50%) anxiety. Normal and mild anxiety levels were at 29.80% and 18.50%, respectively. Regarding depressive symptoms, 51.60% of the sample presented normal levels, 27.40% mild severity, 16.10% moderate, and 4.8% severe. No differences were found between Crohn's disease and ulcerative colitis patients. Regression analyses showed that anxiety explained IBD symptom perception (beta = 0.29; P = 0.022); fear of contracting COVID-19 (beta = 0.35; P < 0.001) and IBD symptom perception (beta = -0.22; P = 0.009) explained depressive symptoms; and fear of contracting COVID-19 (beta = 0.41; P < 0.001), IBD symptom perception (beta = 0.26, P < 0.001), and being in isolation (beta = -0.16, P = 0.041) explained anxiety. Type of medication was not linked to these outcomes.Conclusions: The COVID-19 pandemic does not seem to he affecting adherence to medication but seems to present relevant effects on psychological well-being. Inflammatory bowel disease health care professionals should be attentive of patients' psychological response to this pandemic and of its possible consequences on disease expression. This study additionally provided a psychometrically sound measure of fear of contracting COVID-19.
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| 48. |
- Trindade, Inês A., 1990-, et al.
(author)
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Developments on committed action : Validity of the CAQ-8 and analysis of committed action's role in depressive symptomatology in breast cancer patients and healthy individuals
- 2018
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In: Clinical Psychology and Psychotherapy. - : John Wiley & Sons. - 1063-3995 .- 1099-0879. ; 25:1, s. e42-e50
-
Journal article (peer-reviewed)abstract
- Committed action, a process of acceptance and commitment therapy's psychological flexibility model, is considered an understudied construct that currently can only be measured by one instrument, the Committed Action Questionnaire (CAQ-8). This study aims at analysing the psychometric properties of the CAQ-8 in healthy individuals and breast cancer patients. This study also aims to explore the specific meditational role of committed action in the well-established relationship between experiential avoidance and depression symptoms. The healthy sample comprised 294 adults from the general population, and the breast cancer samples comprised 82 participants. Both groups completed the validated self-report measures. CAQ-8's robustness was examined through validity analyses, confirmatory factor analyses, and multigroup analysis. The meditational model was conducted using structural equation modelling. The CAQ-8 presented good internal consistency and construct, convergent, concurrent, and divergent validity in both samples. Further, the CAQ-8 showed incremental validity over a measure of engaged living. Findings also demonstrated measurement invariance between healthy individuals and breast cancer patients. Regarding the conducted meditational model that was also invariant between the two analysed groups, it was demonstrated that part of the effect that experiential avoidance holds on depressive symptomatology is explained by committed action. This study suggests that the CAQ-8 is adequate for use in healthy and cancer populations. Moreover, it provides novel, empirical support regarding the links between committed action, experiential avoidance, and depressed mood, being also the first investigation to particularly study committed action in a cancer population. Implications for theory and practice are discussed.
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| 49. |
- Trindade, Inês A., 1990-, et al.
(author)
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Falling in the traps of your thoughts : The impact of body image-related cognitive fusion on inflexible eating
- 2015
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In: Eating Behaviors. - : Elsevier. - 1471-0153 .- 1873-7358. ; 19, s. 49-52
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Journal article (peer-reviewed)abstract
- Literature has shown that young women present high rates of body dissatisfaction, independently of their weight. Therefore, dieting may emerge as a strategy to control one's body image. Nonetheless, it also seems to be a source of great suffering rather than a solution.The aim of the present study was to explore what variables explain the inflexible engagement in eating rules. Our hypothesis is that an inflexible eating pattern results not exclusively from weight and body dissatisfaction and shame but mainly from emotional regulation processes (such as body image-related cognitive fusion).The sample of the present study comprised 659 female college students, aged between 18 and 25 years old, who completed self-report measures.Results revealed that the majority of the normal-weight participants desired to lose weight and to have a thinner body shape. Findings from the path analyses demonstrated that the effects of weight dissatisfaction and shame on the inflexible adhesion to eating rules were fully mediated through the mechanism of body image-related cognitive fusion. Furthermore, the effect of body dissatisfaction was partially operated by this process. This model was controlled by BMI and explained a total of 36% of inflexible adhesion to eating rules.In conclusion, these findings suggest that it is when a woman gets fused and entangled with her body image-related thoughts that these unwanted inner events most impact on her eating rules. This study thus offers important new data for research and clinical practise in the field of body image and eating difficulties.
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| 50. |
- Trindade, Inês A., 1990-, et al.
(author)
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Further validation of the cognitive fusion questionnaire – chronic illness (CFQ-CI) in different health condition samples
- 2020
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In: Journal of Contextual Behavioral Science. - : Elsevier. - 2212-1447. ; 16, s. 45-48
-
Journal article (peer-reviewed)abstract
- CFQ-CI was previously developed and preliminarily validated in a study with a single online-recruited inflammatory bowel disease (IBD) sample. The current study presents a further validation of CFQ-CI in four different samples of patients with chronic health conditions: a sample of 82 women with breast cancer, an online-recruited mixed sample of 100 people with cancer, a sample of 69 people with IBD, and an online-recruited mixed chronic illness sample of 93 participants. Confirmatory Factor Analyses, multi-group, reliability, and differences analyses were conducted.Results indicated that the scale is a robust unidimensional 7-item measure of chronic illness-related cognitivefusion, with excellent reliability and structural validity across the four studied samples and in both paper-penciland online-based collection methods. Measurement invariance was not established across the samples, suggesting that CFQ-CI does not appear tofunction equivalently across different illness diagnoses.This study confirms CFQ-CI as a robust, adequate, and simple measure of chronic illness-related cognitive fusion that can be used in different behavioural medicine research and clinical contexts. As the scale does not seem to present measurement invariance, comparing scores between different illness groups is not recommended.
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