Marta Alda’s research while affiliated with University of Zaragoza and other places

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Publications (31)


Study measures, assessment area, and time of assessment.
Means and standard deviations for expectation and satisfaction scales.
T-tests comparing expectations of dropouts and completers.
Exploring the Relationship Between the Acceptability of an Internet-Based Intervention for Depression in Primary Care and Clinical Outcomes: Secondary Analysis of a Randomized Controlled Trial
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May 2019

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601 Reads

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25 Citations

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Marta Alda

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Background: Depression is one of the most prevalent psychological disorders worldwide. Although psychotherapy for depression is effective, there are barriers to its implementation in primary care in Spain. The use of the Internet has been shown to be a feasible solution. However, the acceptability of Internet-based interventions has not been studied sufficiently. Objective: To assess the acceptability of an Internet-based intervention (IBI) for depression in primary care, and explore the relationship between expectations and satisfaction and the improvement in the clinical variables in primary care patients receiving this intervention. Furthermore, it offers data about the effects of some sociodemographic characteristics on these acceptability variables and analyzes whether the expectations are related to finalizing the intervention. Methods: Data were based on depressive patients who were participants in a randomized controlled trial. In the present study, we present the data from all the participants in the Internet intervention groups (N = 198). All the participants filled out the expectation and satisfaction scales (six-item scales regarding treatment logic, satisfaction, recommending, usefulness for other disorders, usefulness for the patient, and unpleasantness), the Beck Depression Inventory-II, and the secondary outcome measures: depression and anxiety impairment, and positive and negative affect. Results: Results showed that participants’ expectations and satisfaction with the program were both high and differences in expectations and satisfaction depended on some sociodemographic variables (age: older people have higher expectations; sex: women have greater satisfaction). A positive relationship between these variables and intervention efficacy was found: expectations related to “usefulness for the patient” were a statistically related predictor to the results on the BDI-II (Beta = 0.364), and the perception of how logical the treatment is (Beta = 0.528) was associated with change in the clinical variable. Furthermore, the higher the expectations, the higher the improvements exhibited by the patients in all measures evaluated during the ten intervention modules. High expectations were also directly related to finalizing the intervention. Conclusions: This is the first study in Spain to address this issue in the field of IBIs for depression in primary care. The IBI showed high acceptance related to the intervention’s efficacy and completion. Research on IBI acceptability could help to implement the treatment offered. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01611818.

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Zen meditation, Length of Telomeres, and the Role of Experiential Avoidance and Compassion

June 2016

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852 Reads

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73 Citations

Mindfulness

Mindfulness refers to an awareness that emerges by intentionally focusing on the present experience in a nonjudgmental or evaluative manner. Evidence regarding its efficacy has been increasing exponentially, and recent research suggests that the practice of meditation is associated with longer leukocyte telomere length. However, the psychological mechanisms underlying this potential relationship are unknown. We examined the telomere lengths of a group of 20 Zen meditation experts and another 20 healthy matched comparison participants who had not previously meditated. We also measured multiple psychological variables related to meditation practice. Genomic DNA was extracted for telomere measurement using a Life Length proprietary program. Highthroughput quantitative fluorescence in situ hybridization (HT-Q-FISH) was used to measure the telomere length distribution and the median telomere length (MTL). The meditators group had a longerMTL (p =0.005) and a lower percentage of short telomeres in individual cells (p= 0.007) than those in the comparison group. To determine which of the psychological variables contributed more to telomere maintenance, two regression analyses were conducted. In the first model, which applied to the MTL, the following three factors were significant: age, absence of experiential avoidance, and Common Humanity subscale of the Self Compassion Scale. Similarly, in the model that examined the percentage of short telomeres, the same factors were significant: age, absence of experiential avoidance, and Common Humanity subscale of the Self Compassion Scale. Although limited by a small sample size, these results suggest that the absence of experiential avoidance of negative emotions and thoughts is integral to the connection between meditation and telomeres. Keywords Telomere length . Mindfulness . Experiential avoidance . Compassion


Compassion and values-based mindfulness intervention: the mindfulness intervention programme by the University of Zaragoza, Spain, and the Federal University of São Paulo-UNIFESP, Brazil

September 2015

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949 Reads

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1 Citation

Actas Espanolas de Psiquiatria

Mindfulness-based interventions, such as Mindfulness- Based Stress Reduction (MBSR) originated in the United States in the 1970s. They were developed in the context of private health care, for patients with a high cultural and socio-economic level and who were highly motivated to practise them. Moreover, the use of mindfulness techniques has mainly been limited to English-speaking countries, and it is generally understood that the characteristics and types of therapist-patient relationships that are formed in those countries are very different from those occurring in Latin American and Southern European countries. Little use has been made to date of mindfulness in systems of public and universal health care. Aside from the cultural differences between our countries and English-speaking ones, clinical experience suggests that the main reason for this is the complexity of target patients, who commonly present with somatic and psychological comorbidity, and a general lack of compliance with the practice of mindfulness. One of the consequences of this is that the philosophy governing the intervention requires modification, with the resulting changes in the structure and content of intervention programmes. This article presents the general programme for mindfulness interventions developed by our group for public and universal health care systems, with particular focus given to primary care. It consists of seven two-hour sessions, each of which is held on a weekly basis. The programme content is summarized in the article. This intervention is applicable to medical patients, psychiatric patients with minor disorders and healthy individuals.


Table 2 Internal consistency and test-retest reliability of the subscales and total MSBS score 
Table 3 Correlation between MSBS and other psychological variables 
Validation of the Spanish version of the Multidimensional State Boredom Scale (MSBS)

May 2015

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720 Reads

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34 Citations

Health and Quality of Life Outcomes

Background Boredom, which is a common problem in the general population, has been associated with several psychiatric disorders. The Multidimensional State Boredom Scale (MSBS) was developed, based on a theoretically and empirically grounded definition of boredom, to assess this construct. The aim of the present study was to assess the psychometric properties of the Spanish validated version of the MSBS in a multi-age sample recruited from the general population. Methods The patients (N = 303) were recruited from primary care settings. In addition to the sociodemographic variables and the MSBS, the General Health Questionnaire 28 items (GHQ-28), Positive and Negative Affect Scale (PANAS), Negative subscale and the Mindful Attention Awareness Scale (MAAS) were administered. We used confirmatory factor analysis (CFA) to analyse the dimensionality of the MSBS. Cronbach’s α coefficient was used to analyse the internal consistency of the scale. The consistency of the MSBS over time (test-retest reliability) was assessed using the intra-class correlation coefficient. The construct validity was examined by calculating Pearson’s r correlations between the MSBS with theoretically related and unrelated constructs. Cronbach’s α for MSBS was 0.89 (95 % CI, 0.87–0.92), ranging from 0.75 to 0.83 for the 5 subscales. Results The characteristics of the final sample (N = 303) were that the participants were primarily female (66.77 %) with a mean age of 49.32 years (SD, 11.46) and primarily European (94.71 %). The CFA of the MSBS confirmed that the original five-factor model showed good fit indices: CFI = .96; GFI = .94; SRMR = .05; and RMSEA = .06 [.05–.08]. Cronbach’s α for MSBS was 0.89 (95 % CI, 0.87–0.92), ranging from 0.75 to 0.83 for the 5 subscales. The MSBS showed a test-retest coefficient measured with an ICC of 0.90 (95 % CI, 0.88–0.92). The ICC for the 5 subscales ranged from 0.81 to 0.89. The MSBS showed a significant negative correlation with MAAS and a significant positive correlation with the GHQ (total score and subscales) and PANAS-Negative Affect. Conclusions The Spanish version of the MSBS has been validated as a reliable instrument for measuring boredom in the general population. This study will facilitate the assessment of boredom for clinical and research purposes in Spanish-speaking populations.


Effectiveness of Group Acceptance and Commitment Therapy for Fibromyalgia: A 6-month Randomised Controlled Trial (EFFIGACT study)

April 2014

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918 Reads

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166 Citations

Pain

In the last decade, there has been burgeoning interest in the effectiveness of third-generation psychological therapies for managing fibromyalgia (FM) symptoms. The present study examined the effectiveness of Acceptance and Commitment Therapy (ACT) on functional status as well as the role of pain acceptance as a mediator of treatment outcomes in FM patients. A total of 156 patients, diagnosed with FM, were enrolled at primary healthcare centres in the city of Zaragoza (Spain). The patients were randomly assigned to a group-based form of ACT (GACT), recommended pharmacological treatment (RPT; pregabalin + duloxetine), or wait-list (WL). The primary endpoint was functional status (measured with the Fibromyalgia Impact Questionnaire, FIQ). Secondary endpoints included pain catastrophising, pain acceptance, pain, anxiety, depression, and HRQoL. The differences between groups were calculated using linear mixed-effects (Intention-to-Treat approach) and mediational models through path analyses. Overall, GACT was statistically superior to both RPT and WL immediately post treatment and improvements were maintained at six months with medium effect sizes in most cases. Immediately post treatment, the NNT for 20% improvement compared to RPT was 2 (95%CI 1.2–2.0), for 50% improvement was 46, and for achieving a status of no worse than mild impaired function (FIQ total score < 39) was also 46. Unexpectedly, four of the five tested path analyses did not show a mediation effect. Changes in pain acceptance only mediated the relationship between study condition and HRQoL. These findings are discussed in relation to previous psychological research on FM treatment.


Flowchart of the study.
Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial

October 2011

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152 Reads

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62 Citations

Arthritis Research & Therapy

No randomised, controlled trials have been conducted to date on the efficacy of psychological and pharmacological treatments of pain catastrophising (PC) in patients with fibromyalgia. Our aim in this study was to assess the effectiveness of cognitive-behaviour therapy (CBT) and the recommended pharmacological treatment (RPT) compared with treatment as usual (TAU) at the primary care level for the treatment of PC in fibromyalgia patients. We conducted a six-month, multicenter, randomized, blinded, parallel group, controlled trial in which patients were randomly assigned to one of three study arms: CBT (n = 57), RPT (n = 56) and TAU at the primary care level (n = 56). The major outcome of this study was PC in patients with fibromyalgia. The secondary variables were pain acceptance, depression, anxiety, pain, global function and quality of life. CBT significantly decreased global PC at the six-month follow-up examination with effect sizes of Cohen's d = 0.73 and 1.01 compared with RPT and TAU, respectively. CBT was also more effective than RPT and TAU at increasing pain acceptance at the six-month follow-up examination (effect sizes of Cohen's d = 0.77 and 0.80, respectively). Compared with RPT and TAU, CBT was more effective at improving global function based on the Fibromyalgia Impact Questionnaire (six-month effect sizes Cohen's d = 0.44 and 0.53, respectively) and quality of life based on the European Quality of Life Scale (six-month effect sizes Cohen's d = 0.11 and 0.40, respectively). There were no differences among the three treatments with regard to pain and depression. CBT shows higher efficacy than RPT and TAU not only in key outcomes in FM, such as function and quality of life, but also in relevant mediators of treatment effects, such as pain catastrophising and pain acceptance. ISRCTN: ISRCTN10804772.


Validation of a Spanish language version of the Pain Self-Perception Scale in patients with fibromyalgia

November 2010

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546 Reads

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39 Citations

The Pain Self-Perception Scale (PSPS) is a 24-item questionnaire used to assess mental defeat in chronic pain patients. The aim of this study was to develop a Spanish language version of the PSPS (PSPS-Spanish), to assess the instrument's psychometric properties in a sample of patients with fibromyalgia and to confirm a possible overlapping between mental defeat and pain catastrophizing. The PSPS was translated into Spanish by three bilingual content and linguistic experts, and then back-translated into English to assess for equivalence. The final Spanish version was administered, along with the Hospital Anxiety Depression Scale (HADS), Pain Visual Analogue Scale (PVAS), Pain Catastrophizing Scale (PCS) and Fibromyalgia Impact Questionnaire (FIQ), to 250 Spanish patients with fibromyalgia. PSPS-Spanish was found to have high internal consistency (Cronbach's α = 0.90 and the item-total r correlation coefficients ranged between 0.68 and 0.86). Principal components analysis revealed a one-factor structure which explained 61.4% of the variance. The test-retest correlation assessed with the intraclass correlation coefficient, over a 1-2 weeks interval, was 0.78. The total PSPS score was significantly correlated with all the questionnaires assessed (HADS, PVAS, PCS, and FIQ). The Spanish version of the PSPS appears to be a valid tool in assessing mental defeat in patients with fibromyalgia. In patients with fibromyalgia and Post-Traumatic Stress Disorder (PTSD), PSPS-Spanish correlates more intensely with FIQ than in patients without PTSD. Mental defeat seems to be a psychological construct different to pain catastrophizing.


Table 1 Research studies on JHS and anxiety 
Table 1 (continued) 
Joint Hypermobility and Anxiety: The State of the Art

October 2010

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1,201 Reads

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53 Citations

Current Psychiatry Reports

Joint hypermobility (JH) is considered a common benign, hereditary, overlap, connective tissue disorder with a prevalence in the general population of about 10% in European populations and 25% in other ethnic groups. JH shows an association with mitral valve prolapse and fibromyalgia. However, the most significant and important association between joint hypermobility syndrome (JHS) and any other disorder from a clinical point of view is with panic disorder. This article summarizes all published studies on JHS and anxiety, analyzing the main results and limitations. An overview of the etiologic explanation of the association between JH and anxiety, with special focus on genetic findings, is also included. The most relevant conclusions are the following: JHS is more prevalent in individuals with panic disorder/agoraphobia, and patients with JHS present with greater prevalence of panic disorder/agoraphobia. In addition, there is an association between JHS severity and severity of anxiety, and mitral valve prolapse plays a secondary role in the association between JHS and anxiety. New fields of research based on these data are suggested.


Association Between Joint Hypermobility Syndrome and Panic Disorder: A Case–Control Study

January 2010

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59 Reads

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41 Citations

Psychosomatics

A significant association between joint hypermobility syndrome (JHS) and panic disorder was observed in a sample of rheumatology outpatients. The aim of this study was to assess whether JHS is more frequent in panic-disorder than in control subjects. The authors conducted a case-control study comparing 55 untreated patients with panic disorder and three matched-control groups: psychiatric patients, fibromyalgia patients, and healthy persons. JHS was more frequent among panic-disorder than among psychiatric patients, the healthy group, or the fibromyalgia group. In the panic-disorder group, there was a significant correlation between severity of JHS and anxiety. The strong association between JHS and panic disorder points to a genetic association. There is also a possibility that JHS and mitral valve prolapse, another condition frequently associated with panic disorder, share a common pathophysiological mechanism.


Diferencias en el manejo diagnóstico y terapéutico de los pacientes psiquiátricos hospitalizados inmigrantes y españoles: un un estudio controlado

January 2010

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28 Reads

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1 Citation

Actas Espanolas de Psiquiatria

Differences in the diagnosis and treatment of immigrant and local psychiatric inpatients admitted to a general hospital in Spain: a controlled study Aim. This study has aimed to assess whether there are differences between immigrant and local psychiatric inpatients admitted to a general hospital in Spain in relation to diagnostic or treatment management. Methods. We carried out a cohort study, with a sample of N=102 immigrant patients and N=102 local patients, matched by gender, age and diagnosis, admitted to the psychiatric ward Results. Mean hospital stay was significantly shorter for immigrants (8.1 days) compared to local population (12.6 days). Use of security services (Odds ratio, OR= 5.13) and mechanical restraint (OR= 2.68) was greater for immigrants. Regression analyses for these three variables confirm that maximum explained variance is due to the " time in Spain " variable. After a period of 3 years in Spain, immigrants tended to receive diagnosis and treatment differing little from that offered to locals. Immigrants are offered fewer complex complementary tests such as EEG, CT scan or MRI. With regard to treatment, immigrants are administered more depot neuroleptics (OR= 4.7), but less clozapine or electroconvulsive therapy. Discussion. These data seem to confirm that there is racial bias in health care professionals, similar to that found in other countries. Data are discussed in the light of related bibliography. Diferencias en el manejo diagnóstico y terapéutico de los pacientes psiquiátricos hospitalizados inmigrantes y españoles: un estudio controlado Objetivo. El objetivo de este estudio es evaluar si, en España, existen diferencias entre pacientes psiquiátricos in-migrantes y nacionales ingresados en un hospital general, en relación a su manejo diagnóstico o terapéutico. Material y métodos. Estudio de cohortes, con una muestra de N=102 pacientes inmigrantes y N=102 españo-les, ingresados en la planta de psiquiatría del Hospital Uni-versitario Miguel Servet de Zaragoza, y apareados por sexo, edad y diagnóstico. Resultados. La estancia media hospitalaria es significati-vamente más baja en inmigrantes (8,1 días) que en nacionales (12,6). Existe una mayor utilización de los servicios de seguridad (OR= 5,13) y de sujeción mecánica (OR= 2,68) en inmigrantes. Para estas tres variables, los análisis de regresión demuestran que el factor que más varianza explica es el tiempo de estancia del inmigrante en España. A los 3 años de estancia se equipa-ran las diferencias en estas tres variables entre inmigrantes y nacionales. A los inmigrantes se les solicita significativamente menos pruebas complementarias complejas como EEG o TAC/ RNM. En cuanto al tratamiento, los inmigrantes reciben signi-ficativamente mas neurolépticos depot (OR= 4,7), pero menos clozapina o terapia electroconvulsiva. Discusión. Estos datos parecen confirmar la existencia de un sesgo racial discriminativo de los profesionales sani-tarios, similar al encontrado en otros países. Se discuten los hallazgos en base a la bibliografía previa.


Citations (22)


... Transportation issues and time constraints, as well as cost concerns and the stigma attached to mental health services, are some other barriers that patients face in accessing psychotherapy [13,14]. Also, a lack of professionals, trained in this area, coupled with the amount of time spent during face-to-face therapy sessions creates more difficulties when trying to reach all individuals who need to be treated [15]. It can also be concluded that adapting interventions for limited resources, addressing barriers to patient access, and overcoming treatment's intricacies via alternative avenues, such as telephone care are some challenges within primary care settings when it comes to implementing psychotherapy. ...

Reference:

Measuring the Impact of and Challenges in Using Psycho-Therapy Sessions in Primary Health Care, Riyadh, Saudi Arabia
Exploring the Relationship Between the Acceptability of an Internet-Based Intervention for Depression in Primary Care and Clinical Outcomes: Secondary Analysis of a Randomized Controlled Trial

... Moreover, other studies also found that increased telomerase activity was associated with the practice of mindfulness meditation [66,67], and also, as the meditation time increased, both mindfulness and plasma telomerase exhibited improvement, suggesting that engaging in meditation may have the potential to positively influence plasma telomerase levels, thereby contributing to increased longevity, delaying cellular aging, and enhanced mental and physical well-being [67]. Another study also reports on significantly longer telomere length following Zen meditation practice [68]. ...

Zen meditation, Length of Telomeres, and the Role of Experiential Avoidance and Compassion

Mindfulness

... To assess students' boredom, the Short-Spanish version of the Multidimensional State Boredom Scale (MSBS) was used (Alda et al., 2015). The scale consists of seven items (e.g. ...

Validation of the Spanish version of the Multidimensional State Boredom Scale (MSBS)

Health and Quality of Life Outcomes

... The analysis showed a significant sociodemographic result; that is, a high percentage of mechanical restraint measures applied to immigrants. Another study conducted in Spain showed that being an immigrant increased the probability of mechanical restraint (OR = 2.68), and the variable that explained the most variance was the length of an immigrant's stay in a foreign country (Díez, Campayo, & Sobradiel, 2010). A Norwegian study found a higher percentage of immigrants in the group of patients who received coercive measures, but when this variable was controlled in the regression analysis, being an immigrant was not a predictor of mechanical restraint (Knutzen et al., 2011). ...

Diferencias en el manejo diagnóstico y terapéutico de los pacientes psiquiátricos hospitalizados inmigrantes y españoles: un un estudio controlado
  • Citing Article
  • January 2010

Actas Espanolas de Psiquiatria

... En cuanto a normas de buena práctica en Atención Primaria de los trastornos por somatización García Campayo et al. (114) recomiendan: 1. Comenzar la intervención en Atención Primaria. 2. Realizarla mediante un sistema en escalado en cuanto a tiempo y especialización de los profesionales. ...

Tratamiento psicológico en el trastorno de somatización : eficacia y propuestas de intervención

Revista de Psicopatología y Psicología Clínica

... Furthermore, current meta-analytic results could be consistent with acceptance and commitment therapy (ACT) framework (Hayes, 2004). Accordingly, it has been posited a key role of self-as-context process in explaining painful experiences and its treatment among patients with FM (Ljótsson et al., 2014;Luciano et al., 2014;Yu et al., 2017;Wicksell et al., 2013). The self-as-context captures a sense of self that is not based on the content of one's psychological experiences (e.g., thoughts, feelings, judgments, body sensations) but rather on a sense of taking a perspective on these (e.g., a distinction between one's experiences and the 'I' who notices these experiences) (Hayes et al., 2012;Yu et al., 2016). ...

Effectiveness of Group Acceptance and Commitment Therapy for Fibromyalgia: A 6-month Randomised Controlled Trial (EFFIGACT study)
  • Citing Article
  • April 2014

Pain

... The Spanish version of the Pain Catastrophizing Scale (PCS) will be used [51]. This is a brief 13-item questionnaire that assesses pain-related behaviors and cognition. ...

Validación de la versión española de la Escala de Catastrofización ante el Dolor (Pain Catastrophizing Scale) en la fibromialgia [Validation of the Spanish version of the Pain Catastrophizing Scale in fibromyalgia]
  • Citing Article
  • October 2008

Medicina Clínica

... In order to better stress how this condition can occur in different cultures and environments, some authors proposed to rename it as "Extreme Severe Withdrawal" (ESW) rather than hikikomori. This point of view was supported by the increasing reports of hikikomori condition from countries outside Japan, such as South Korea, India, Australia, Bangladesh, Iran, Taiwan, Thailand, USA, Oman, France, Italy, Spain, Brazil, Hong Kong, China, and Canada [19,20,[30][31][32][33][34][35]. ...

Un caso de hikikomori en España
  • Citing Article
  • September 2007

Medicina Clínica

... In our study, participants proved to be less prone to engage in experiential avoidance and more willing to experience uncomfortable emotions and sensations immediately after the intervention. This is concordant to a large body of evidence that demonstrated the benefits of process-based therapies to increase acceptance, especially in relation to chronic pain [99][100][101]. Furthermore, the level of cognitive fusion decreased shortly after the intervention. In a similar light, it has been proven that a single-session treatment is effective for modifying common cognitive features associated with emotional distress in chronic pain patients [102][103][104]. ...

Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: A randomised controlled trial

Arthritis Research & Therapy

... Distraction without reframing what happened negatively impacts the severity of the perceived pain (28,37). Excessive persistence or "overdoing" means that the activity is prolonged or performed at a higher intensity than the patient can tolerate (i.e., when perseverance in the activity permits a task to be completed without a flare-up of discomfort, this appears to be a functional approach; on the contrary, it represents a maladaptive overdoing) (33,38). ...

Coping with fibromialgia: Usefulness of the Chronic Pain Coping Inventory-42
  • Citing Article
  • November 2007

Pain