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- Emotional Regulation Through Mindfulness: Links to Health Behavior and the Role of Distressed (Type D) PersonalityPublication . Teixeira, Ricardo João; Dores, Artemisa Rocha; Barreto, João Francisco; Nyklíček, IvanEmotional (dys) regulation is central to many forms of psychopathology and psychosomatic diseases. Little is known about the factors underlying individual differences in emotion regulation. It is plausible that both genetic (including stable personality factors) and environmental/socio-cultural influences determine one’s emotion regulation. Type D (“distressed”) personality, the combination of negative affectivity and social inhibition, has been associated with adverse health outcomes. Type D individuals have the tendency to experience negative emotions across time and situations but inhibit the expression of emotions and behavior because of fear of rejection or disapproval, which has proved to be unhealthy in the long term. Mindfulness as a form of emotion regulation is, in many ways, distant to the framing of emotion regulation in conventional scientific literature. With the growing evidence that mindfulness training can help people moderate distressing emotions and enhance positive affect, there is a need to clarify the mechanisms through which these effects occur, as well as their impact on health behaviors. Recent research outcomes indicate that mindfulness stress reduction training may not only affect psychological states, but also psychological trait characteristics, which in turn are relevant for one’s health.Considering that health behaviors reflect a person's health beliefs, could mindful living actually be a continuous health promoter? This paper intends to offer an extended literature review on emotional regulation and mindfulness, focusing on the role of ‘distressed’ personality in a more general health promotion and behavioral change framework.
- Assessing coping, emotional regulation, and psychosocial perceptions of academic stress in undergraduatesPublication . Teixeira, Ricardo J.; Dores, Artemisa Rocha; Barreto, João Francisco; Sucena, Ana; Martins, Helena; Magalhães, AndreiaLiterature suggests most college students appear to lack the knowledge and skills to effectively cope with stressful academic experiences (Gall, Evans, & Bellrose, 2000). Ineffective coping strategies may increase students’ health problems, demand for health services, and attrition rates (Morrison & O’Connor, 2005). This study aims to examine the associations, and processes between psychosocial variables deemed important in academic transitions.
- Personality organization, emotion regulation, and symptom distressPublication . Barreto, João Francisco; Matos, Paula MenaEvidence suggests that the severity of personality difficulties, regardless of their type, may be the most important determinant of current and future dysfunction (Hopwood et al., 2011). Otto F. Kernberg’s model of personality organization (PO) describes severity of personality disturbance as a continuum from normal-neurotic functioning, through borderline, to psychotic personality, along which the predominance of primitive defenses and the concomitant identity disturbance augments, with reality testing compromised in the psychotic pole (e.g., Kernberg & Caligor, 2005). The increasing influence of primitive, intense emotions lacking integration often manifest in affect dysregulation and behavioral correlates such as anger expression and impulsive self-destructive behaviors (Clarkin, Yeomans, & Kernberg, 2006). Still, there is little research into the paths through which PO affects symptoms, in which emotion (dys)regulation must play an important role.
- Psicoterapia da depressão no idosoPublication . Barreto, João FranciscoMuitas das dificuldades do idoso são as dificuldades adiadas, e agravadas, do Homem da nossa cultura, que parece ter cortado relações com a morte e não conseguir aceitar a vida como algo que não controla em absoluto. Não surpreende, por isso, que também a intervenção junto do idoso possa replicar estas dificuldades, como num “acting-out contratransferencial colectivo”. Porque, efectivamente, proporcionar ao idoso uma relação terapêutica onde possa triangular os conteúdos altamente ameaçadores do confronto com a morte e transformá-los em conteúdos de relação, exige do terapeuta um convívio razoável com os seus próprios “temas existenciais”.
- Inventory of personality organization: Preliminary validation of the European Portuguese versionPublication . Barreto, João Francisco; Matos, Paula MenaPersonality pathology is often organized in two orthogonal axes representing variations in type and severity (Westen et al., 2006). The psychoanalytic model developed by Otto F. Kernberg and colleagues (e.g., Kernberg & Caligor, 2005) is an example of the second trend, consisting of a dimensional approach describing personality organization (PO) in a continuum ranging from normal-neurotic (NPO), through high and low borderline (BPO), to psychotic (PPO) levels. • In this model, borderline-level PO underlies most of the personality disorders considered in the categorical-typological approach held in DSM-IV-TR (APA, 2000). Kernberg’s approach is clinically useful in identifying subthreshold/higher level personality pathology poorly covered by DSM-IV-TR Axis II, and understanding different meanings in common symptoms according to underlying levels of PO (Caligor et al., 2007). • As an effort at operationalization, Kernberg and Clarkin (1995) created the Inventory of Personality Organization (IPO), a self-report questionnaire including 3 primary scales (57 items): Identity Diffusion, Primitive Defenses, and Reality Testing. IPO has been used to investigate the relationship of PO to psychopathology and measure structural change as a psychotherapy outcome (cf. Ellison & Levy, 2011). • IPO has been translated into several languages and latent structure has been tested with clinical and nonclinical population (Berghuis et al., 2008; Iragashi et al., 2009; Lenzenweger et al., 2001; Normandin et al., 2002; Smits et al., 2009), yielding 2- or 3-factor solutions for the 3 primary scales. However, a recent study of the original English-language version conducted with a large nonclinical sample suggests that a 4-factor solution provides a better fit, with factors representing Instability of Self and Others, Instability of Goals, Psychosis, and Instability of Behavior (Ellison & Levy, 2011).
- Does attachment predict psychotherapists' mentalization with real patients?Publication . Barreto, João Francisco; Saraiva, Luísa; Matos, Paula MenaElaboration of countertransference experience (ECE): implicit and explicit psychological work to which therapists submit experiences with patients (Barreto & Matos, 2016) • Mentalizing process of a particular kind (therapists’ self-oriented mentalizing) through which therapists’ experiences acquire and increase in mental quality (ibd.) • Research addressing psychotherapists’ mentalization is extremely scarce, and very few studies within this field involved real patients as participants • Preliminary findings suggest that therapist mentalization processes benefit therapeutic work (Cologon et al., 2017; Rizq & Target, 2010; Reading, 2013) • Despite established association between the constructs, no studies to our knowledge have yet investigated the impact of attachment on therapist mentalizing processes • Evidence that patients’ attachment dimensions affect therapeutic process (e.g., Diener & Monroe, 2012) • Mixed results concerning the impact of therapist attachment and therapistpatient attachment match on therapy (e.g., Degnan et al., 2016) • Therapist attachment dimensions may impact psychotherapy in interaction with patients variables (Bucci et al., 2015; Schauenburg et al., 2010) • Relational similarity may benefit initial alliance, but dissimilarity may disconfirm transference expectations and facilitate transforming experiences (Bernier & Dozier, 2002; Mallinckrodt et al., 2009)
- Mentalizing countertransference? A model for research on the elaboration of countertransference experience in psychotherapyPublication . Barreto, João Francisco; Matos, Paula MenaAs a construct, the elaboration of countertransference experience (ECE) is intended to depict the implicit and explicit psychological work to which therapists submit their experiences with clients. Through ECE, defined as a mentalizing process of a particular kind, therapists' experiences are presumed to acquire and increase in mental quality and become available for meaning-making and judicious clinical use. In this paper, we claim that such an ongoing process facilitates engagement with common therapeutic factors, such as the therapeutic alliance and countertransference management, enhancing therapist responsiveness in psychotherapy. We synthesize relevant literature on countertransference, mentalization, and, in particular, therapists' mentalization, informed by a systematic literature review. As a result, we propose a model for assessing ECE in psychotherapy, comprising 6 diversely mentalized countertransference positions (factual-concrete, abstract-rational, projective-impulsive, argumentative, contemplative-mindful, and mentalizing), 2 underlying primary dimensions (experiencing, reflective elaboration), and 5 complementary dimensions of elaboration. Strengths and limitations of the model are discussed.
- Predicting early alliance developmentPublication . Barreto, João Francisco; Matos, Paula MenaThere is wide consensus that, in early stages of psychotherapy, a good alliance is an important predictor of positive outcome, particularly if rated by clients and in early stages of psychotherapy (Constantino et al., 2002; Horvath & Bedi, 2002). Both theory and empirical research have been concerned with delineating therapist and client specific contributions to alliance development, with particular emphasis on clinical, relational, and technical dimensions. Still, uncertainty persists and further evidence is needed. Although the relation between client attachment and alliance is relatively well established (e.g., Diener & Monroe, 2012), results seem more ambiguous regarding therapist attachment dimensions. Recent research suggests that the complexity of clients’ problems may work as a moderator, turning therapist attachment relevant as clinical impairment increases (Bucci et al., 2015; Schauenburg et al., 2010). Additionally, therapist and client attachment dimensions may interact in ways that affect alliance, although research addressing this hypothesis is still very scarce (see Degnan et al., 2016). In particular, dissimilar or non-complementary matches of therapist and client relational dimensions may benefit the therapeutic process (Bernier & Dozier, 2002). Dealing with difficulties coming from the relational match and/or clinical severity will probably require therapists to regulate their own reactions, turning countertransference management (CtM; Gelso & Hayes, 2007) into a relevant dimension in the process.
- Predicting early alliance from attachment, personality organization, and countertransference managementPublication . Barreto, João Francisco; Carvalho, Helena Moura; Matos, Paula MenaTherapeutic alliance has been widely recognized as an important predictor of psychotherapy outcome across therapeutic orientations (Horvath et al., 2011). In particular, evidence suggests that client rated alliance and assessment at early stages of the therapeutic process may be especially relevant (Constantino et al., 2002; Horvath & Bedi, 2002). Although several determinants of alliance have been investigated in the last decades, few studies have analyzed the interaction between therapists’ and clients’ attachment orientations for predicting alliance development (see Daniel, 2006). On the other hand, the kind and severity of the clients’ problems pose different challenges on the therapeutic alliance. Presumably, therapists’ capacity to manage countertransference (CT) demands coming from these dimensions will influence the extent to which the alliance is affected.
- Emotional footprint pedagogical project: storytelling in the development of communication skillsPublication . Dores, Artemisa R.; Sousa, Zita; Magalhães, Andreia; Barreto, JoãoThe way healthcare professionals communicate and relate with patients can be crucial for the quality of patient participation and health outcomes.
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