Emotions are at the core of human nature. There is evidence that emotional reactivity in foreign languages compared to native languages is reduced. We explore whether this emotional distance could modulate fear conditioning, an essential mechanism for the understanding and treatment of anxiety disorders. A group of participants was verbally informed (either in a foreign or in a native language) that two different stimuli could be either cueing the potential presence of a threat stimulus or its absence. We registered pupil size and electrodermal activity and calculated the difference in psychophysiological responses to conditioned and to unconditioned stimuli. Our findings provided evidence that verbal conditioning processes are affected by language context in this paradigm. We report the first experimental evidence regarding how the use of a foreign language may reduce fear conditioning. This observation opens the avenue to the potential use of a foreign language in clinical contexts.

Title 1 Descriptive title identifying the study design, population, interventions, and, if applicable, trial acronym ______1_______ Trial registration 2a Trial identifier and registry name. If not yet registered, name of intended registry ______1_______ 2b All items from the World Health Organization Trial Registration Data Set _Not applicable_ Protocol version 3 Date and version identifier _____1 & 4______ Funding 4 Sources and types of financial, material, and other support ___11______ Roles and responsibilities 5a Names, affiliations, and roles of protocol contributors _____10,11___ 5b Name and contact information for the trial sponsor _Not applicable__ 5c Role of study sponsor and funders, if any, in study design; collection, management, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication, including whether they will have ultimate authority over any of these activities ____10,11____ 5d Composition, roles, and responsibilities of the coordinating centre, steering committee, endpoint adjudication committee, data management team, and other individuals or groups overseeing the trial, if applicable (see Item 21a for data monitoring committee)

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BACKGROUND Compassion-based interventions delivered over the Internet are showing promising results for the promotion of psychological health and well-being. Several studies have highlighted their feasibility, acceptance and preliminary efficacy. However, this is an incipient field of research, and to the best of our knowledge, there is no data available from Spanish-speaking countries. OBJECTIVE The aim of this study is to investigate the feasibility, acceptance and preliminary efficacy of Internet Attachment-Based Therapy (iABCT), an online version of attachment-based compassion therapy (ABCT), in Spanish speakers from the general population. METHODS This feasibility study features a single-arm, uncontrolled and within-group design with an embedded qualitative and quantitative process evaluation at baseline, immediately after the intervention and at 3-month follow-up. A minimum of 35 participants from the general population will be allocated to iABCT. Feasibility measures will include attrition rate, patterns of use of the web-based system, participants’ acceptability, usability, and opinion. Primary outcome: Pemberton Happiness Index (PHI). Secondary outcomes: The Compassion Scale, Self-Compassion Scale (SCS-26), Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short form (FSCRS-SF), Five Facets of Mindfulness Questionnaire (FFMQ-15), the Relationships Questionnaire, (RQ), the General Health Questionnaire (GHQ-12), Non-Attachment Scale (NAS-7), International Positive and Negative Affect Schedule Short Form (I-PANAS-SF), The Purpose-In-Life Test (PIL-10) and difficulties regarding the practice of compassion (Compassion Practice Quality Questionnaire). Mixed models for primary and secondary outcomes measures are planned. Qualitative content analysis for the participants’ qualitative responses will be also performed. RESULTS Not yet recruiting. The Internet-based intervention programme is under construction. Recruitment is due to commence in February 2020. CONCLUSIONS To our knowledge, the present study will, for the first time, show data on the feasibility, acceptability and preliminary efficacy of online compassion (and self-compassion) training – i.e. the adapted iACBT – in Spanish-speaking countries from the general population. Further aspects of their implementation (i.e. facilitators, barriers and unwanted effects) and mechanisms of change will be investigated. This study will allow the revision and fine-tuning of the developed intervention, study design and planning procedures, as well, powering a future randomized controlled trial. CLINICALTRIAL Clinicaltrials.gov: NCT03918746. Registered on April 17, 2019.

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