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ObjectivesBesides increasing longevity, the ultimate goal of medical care is to improve patients’ enjoyment of life, a concept akin to happiness. This study examined the determinants of happiness and quality of life (QoL) in patients with rheumatoid arthritis (RA).MethodsIn this observational, cross-sectional study, patients were assessed on disease activity, disease impact, personality, QoL and happiness. Structural equation modelling estimation was used to analyse the associations between these dimensions, pursuing three hypotheses: H1—disease activity and perceived impact of disease are negatively associated with overall QoL and happiness in patients with RA; H2—‘positive’ personality traits are related to happiness both directly and indirectly through perceived disease impact; H3—happiness has a mediating effect in the relation between impact of disease and QoL.ResultsData from 213 patients were analysed. Results supported all driving hypotheses. Happiness was positively related to ‘positive’ personality and, to a lesser extent, negatively related to impact of disease. Impact of disease, in turn, was positively related to disease activity and mitigated by ‘positive’ personality traits. Impact of disease had a much stronger relation with QoL than with happiness. Happiness mitigated the negative effect of disease impact on QoL.ConclusionOptimisation of QoL and happiness of people with RA requires effective control of the disease process and also improvement of the disease impact domains. Personality seems to play a pivotal mediating role in these relations.

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances and other symptoms, and has a substantial socioeconomic impact. Current biomedical and psychosocial treatments are unsatisfactory for many patients, and treatment progress has been hindered by the lack of a clear understanding of the pathogenesis of fibromyalgia. We present here a model of fibromyalgia that integrates current psychosocial and neurophysiological observations. We propose that an imbalance in emotion regulation, reflected by an overactive 'threat' system and underactive 'soothing' system, might keep the 'salience network' (also known as the midcingulo-insular network) in continuous alert mode, and this hyperactivation, in conjunction with other mechanisms, contributes to fibromyalgia. This proposed integrative model, which we term the Fibromyalgia: Imbalance of Threat and Soothing Systems (FITSS) model, should be viewed as a working hypothesis with limited supporting evidence available. We hope, however, that this model will shed new light on existing psychosocial and biological observations, and inspire future research to address the many gaps in our knowledge about fibromyalgia, ultimately stimulating the development of novel therapeutic interventions.Sections 'chronic primary pain', a new major category comprising five subtypes that reflect the distinct anatomical sites or body systems affected by pain 23 . Fibromyalgia belongs to the 'chronic widespread pain' subtype; the other four are complex regional pain syndrome, chronic primary headache or orofacial pain, chronic primary visceral pain, and chronic primary musculoskeletal pain.An even wider scope emerges when the broader overarching concept of central sensitivity syndromes is considered 24 . Central sensitivity syndromes comprise most COPCs as well as conditions not primarily typified by pain, such as periodic limb movement in sleep, multiple chemical sensitivity, female urethral syndrome and post-traumatic stress disorder 24 (see Fig. 2). All these conditions share evidence of central sensitivity and, to a lesser extent, similar neurotransmitter imbalance. They all show small-to-moderate response to serotoninnorepinephrine reuptake inhibitors and other centrally acting agents (for example, gabapentinoids) and little to no response to NSAIDs and opioids. These central sensitivity syndromes are frequently comorbid, are more common in women than in men, have a high prevalence of stress-related manifestations and psychopathology, and are associated with high sensitivity to daily and chronic stressors and increased sensitivity to everyday environmental sensory stimuli 24 .

Objectives: 1) to evaluate diff erent attachment styles depending on the attachment figure; 2) to explore the association between experiential avoidance and paranoid ideation frequency; 3) to test a mediation model in which the impact of adult attachment on frequency of paranoid ideation occurs through experiential avoidance. Method: We assessed adult-attachment, experiential avoidance and paranoid ideation frequency in a sample of 37 (30 male and 7 female) outpatients and inpatients with a psychosis-spectrum diagnosis. Results: The anxiety attachment pattern was significantly higher in all attachment figures. We found that attachment anxiety (mother) was associated with both experiential avoidance and paranoid ideation. An association between experiential avoidance and paranoid ideation frequency was also found. Results show that experiential avoidance mediated the relationship between attachment anxiety and paranoid ideation frequency. Conclusion: Our study highlights the importance of addressing therapeutically the mechanisms people with psychosis use to cope with the internal experience elicited by insecure attachment styles, specifically experiential avoidance, and suggests the adequacy of acceptance and mindfulness-based therapies in promoting recovery for psychotic patients.

Background: The overactivation of the threat-defence system combined with an underdeveloped affiliative system has been emphasised as important in psychosis, usually leading to negative affect and impaired social functioning. Difficulties in feeling safe and content in relationships with others, common in individuals with psychotic symptoms, have been linked to two specific outputs of the threat-defence system: Paranoid ideation and external shame. This study sought to explore the associations between paranoid ideation, external shame, and social safeness.Methods: Participants diagnosed with psychotic disorders (N = 37) completed a series of self-report questionnaires.Results: Results showed a significant negative association between social safeness and external shame and frequency of paranoid ideation, while external shame was positively associated with both frequency and distress of paranoid ideation. Results revealed that the relationship between frequency of paranoid ideation and social safeness was mediated by external shame.Conclusions: These findings suggest that feelings of being inferior and subordinate in the eyes of others increases vulnerability to difficulties in social connectedness and safeness. Treatment for paranoid ideation could benefit from integrating strategies to help patients deal with shame.

Cognitive fusion refers to the dominance of verbal processes over behavior regulation, in detriment of being sensitive to contextual contingencies and pursuing valued life goals. It is a core process within Acceptance and Commitment Therapy and seems to have a crucial role in the development and maintenance of psychopathology.The first goal of this investigation was to explore the factor structure, factorial invariance and psychometrics of the Portuguese version of the Cognitive Fusion Questionnaire (CFQ). A multigroup confirmatory factor analysis attested the invariant one-dimensional factor structure of the CFQ across three samples from the general population (n = 408; n = 291; n = 101) with different demographic characteristics. Additionally, the CFQ showed to be a psychometrically robust and reliable measure.A second major goal was to investigate the convergent and incremental validity of this version of CFQ (n = 408).Convergent validity was explored and attested with several psychological indicators. Regarding incremental validity, the predictive power of depressive symptoms of cognitive fusion and three related processes, with origin in different conceptual frameworks, was tested. Results showed that even when the effects of decentering, mindfulness and metacognitions were controlled for, cognitive fusion consistently maintained a significant and unique predictive power over depressive symptoms. These findings suggest that these processes relate differentially and independently with depressive symptoms and, moreover, that cognitive fusion has a superior contribution to its explanation. Given the evidence that cognitive fusion plays an important role in the comprehension of depressive symptoms, conceptual and clinical implications were discussed.

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Background Patients’ objectives and experiences must be core to the study and management of chronic diseases, such as systemic sclerosis (SSc). Although patient-reported outcomes have attracted increasing attention, evaluation of the impact of disease on the overall subjective well-being, equivalent to ‘happiness’, is remarkably lacking. Objectives To examine the determinants of happiness and quality of life in patients with SSc, with emphasis on disease features and personality traits. Methods Observational, cross-sectional multicentre study, including 142 patients, with complete data regarding disease activity, disease impact, personality, health-related quality of life (HR-QoL) and happiness. Structural equation modelling was used to evaluate the association between the variables. Results The results indicated an acceptable fit of the model to the data. Perceived disease impact had a significant negative direct relation with HR-QoL (β=-0.79, p < 0.001) and with happiness (β=-0.52, p < 0.001). Positive personality traits had a positive relation with happiness (β = 0.36, p = 0.002) and an important indirect association upon QoL (β = 0.43) and happiness (β = 0.23). Perceived disease impact is influenced by body image, fatigue, and SSc-related disability to a higher degree (β =  0.6–0.7) than by disease activity (β = 0.28) or form (β = 0.17). Impact of disease had a much stronger relation with HR-QoL than with happiness. Conclusions The results suggest that treatment strategies targeting not only disease control but also the mitigation of relevant domains of disease impact (body image, fatigue, global disability) may be important to improve the patients’ experience of the disease. The reinforcement of resilience factors, such as positive psychological traits, may also play a contributory role towards better patient outcomes.