Repositório do ISPA
Repositório Institucional do Ispa-Instituto Universitário
Entradas recentes
Living with a veteran with trauma: Impact on family functioning using the genogram as a research tool
Publication . Brites, Rute; Nunes, Odete; Hipólito, João; Brandão, Tânia; Correia, António; Nunes, Cristina
Introduction: Although the psychological impact of war on veterans, particularly the development of post-traumatic stress disorder (PTSD), has been well documented, the long-term effects on their families have been less widely studied. Research suggests that veterans’ trauma can disrupt relationships and contribute to secondary/intergenerational trauma within the family.
Objective: This study uses genograms to explore how PTSD symptoms experienced by veterans have influenced family rela
tionships over time, and to uncover patterns of intergenerational and systemic impact in families of Portuguese Overseas War veterans.
Method: A qualitative approach involving semi-structured interviews with 32 families (each comprising a veteran, their spouse, and at least one adult child) was used (n=100). The data were synthesized into genograms to visually map family structure, relationship quality, and patterns of psychological distress. Cross-family analysis was then conducted to identify common relational themes.
Results: Families were clustered into four main impact groups: maximum negative impact, limited negative impact, no impact,
and protective impact. These classifications reflect variations in family functioning, mental health symptoms, and relational patterns. In some families, the veteran’s trauma appeared to affect multiple subsystems, while in others, spouses played a buffering/protective role. A fifth group was identified, with no consistent pattern.
Conclusion: Findings emphasize the complexity and variability of trauma transmission within families, highlighting both vul
nerability and resilience. Using genograms proved effective in capturing systemic dynamics. These results emphasize the
importance of adopting a family-systems approach in the clinical treatment of veterans affected by PTSD and suggest avenues
for future research.
Adolescent deliberate Self-Harm: Predictors of family and personal risk
Publication . Candeias, Maria de Jesus Canelas; Gouveia-Pereira, Maria; Candeias, Marisa de Jesus
Deliberate self-harm in adolescents is a significant public health problem, associated with a range of psychiatric comor
bidities, and with serious consequences for the individual and their family. This study aimed to examine the impact of
demographic (gender and age), interpersonal (family functioning) and intrapersonal (borderline personality disorder, sui
cidal ideation and impulsivity) factors on deliberate self-harm. Method: A cross-sectional study was employed to collect
data from 744 secondary school-based adolescents. The data were collected using valid self-report measures, specifically
the Family Adaptability and Cohesion Evaluation Scale IV, the Borderline Personality Features Scale for Children, the
Suicidal Ideation Questionnaire, the Inventory of Deliberate Self-Harm Behaviours and the Barrat Impulsivity Scale.
Hierarchical multiple linear regression was employed for data analysis. Results: The results showed that gender, age and
family functioning, were significant in dependent predictors of deliberate self-harm. However, when intrapersonal factors
such as borderline personality disorder and suicidal ideation were included in the equation model, the effect was reduced.
Among these factors, suicidal ideation emerged as the most significant predictor, followed by borderline personality
disorder, whereas impulsivity was not an effective direct predictor. Conclusions: Findings suggest that intrapersonal fac
tors, particularly suicidal ideation and borderline personality disorder, have a stronger effect on deliberate self-harm than
demographic and interpersonal factors. This highlights the fundamental need for prevention and intervention strategies that
integrate mental health treatment and family support. These findings have significant implications for clinical practice and
provide a robust foundation for future research on effective interventions for at-risk adolescents.
Empatia e problemas externalizantes na adolescência
Publication . Pereira, Inês da Silva Matos; Fernandes, Marília
A empatia refere-se à capacidade de compreender e identificar os sentimentos e estados emocionais dos outros. Evidências demonstram que a empatia, sobretudo a afetiva, inibe
comportamentos negativos, tais como a violência. O estudo explora como empatia (afetiva e cognitiva) se relaciona com problemas externalizantes na adolescência, considerando diferenças
na idade e sexo, adotando uma abordagem multi-informantes (jovens, pais e professores). A amostra incluiu 346 jovens (10–15 anos), pais e diretores de turma, recorrendo ao QACEC para empatia, SDQ para problemas externalizantes e a escalas parentais/docentes (PCRS/TCRS) para avaliar a perspetiva dos informantes. Os jovens relataram níveis elevados de empatia afetiva e cognitiva, sendo que as raparigas apresentaram níveis mais elevados comparativamente aos
rapazes e uma associação negativa entre idade e empatia afetiva. Os níveis de comportamentos externalizantes reportados foram baixos em todos os informantes. Os resultados demonstraram divergências significativas entre os relatos dos informantes. Os resultados sustentam a utilidade de múltiplos informantes e apontam para investigar o papel mediador da regulação emocional em estudos longitudinais.
Attention, imagination and sexual function
Publication . Campos, Pedro Manuel Tomaz de Carvalho; Leal, Isabel Pereira
Sexual functioning is a complex phenomenon shaped by dynamic interactions between
cognitive, attentional, emotional, and relational processes. Attentional mechanisms and erotic
mental imagery play key roles in sustaining sexual engagement, but their combined and
independent contributions remain insufficiently understood. This thesis aimed to examine: 1)
how general inattention, intrusive worries during sexual activity (sexual worries), problematic
smartphone use (a common cause of distraction), and the vividness of partner-focused imagery
(an index of internally directed attention) independently shape sexual function, pleasure,
distress; 2) whether an intervention to stimulate sexual fantasy enhances sexual desire, sexual
pleasure, and partner-focused mental imagery vividness, and reduces sexual distress and sexual
worries. A multi-phase, quantitative design was employed. Study 1, a cross-sectional survey
with 559 heterosexual adults, explored associations between these attentional factors and sexual
outcomes. Study 2, a longitudinal study with 134 women, assessed whether these predictors
explained changes in sexual functioning, pleasure, and distress over one month. Study 3, a
randomized controlled trial with 60 participants, evaluated the effects of a four-week sexual
fantasy intervention against a positively valenced nonsexual imagery task. In Study 1, better
sexual function was independently by more vivid partner-focused imagination in women and
men, and by fewer sexual worries in women only; greater sexual distress was independently
predicted by less vivid partner-focused imagination and more sexual worries in women and
men, and by problematic smartphone use in women only; 3) greater sexual pleasure was
independently predicted by fewer sexual worries in women and by less problematic smartphone
use in men. In Study 2, better sexual function was longitudinally predicted by less problematic
smartphone use; sexual distress was longitudinally predicted by less vivid partner-focused
imagination; and sexual pleasure was longitudinally predicted by both less problematic
smartphone use and more vivid partner-focused imagination. All these results in Studies 1 and
2 were obtained independently of age and dysphoric feelings (a composite measure of
depression, anxiety, and stress). In Study 1 only, dysphoric feelings additionally predicted
poorer sexual function in men and women, and greater sexual distress and lesser sexual pleasure
in women. Although general inattention was correlated with poorer sexual function and greater
sexual distress for men and women in Study 1, it was never a significant predictor in multiple
regressions. Study 3, with its experimental design, showed that guided fantasy practice
increased sexual desire and pleasure, reduced intrusive sexual worries, and improved partner
focused imagery vividness over four weeks. These findings offer new insights for cognitive
affective models of sexual response, highlighting attention and imagination as dynamic,
modifiable processes central to sexual well-being. Practically, they highlight opportunities for
integrating attentional training and guided imagination exercises into clinical and educational
contexts, offering innovative, low-cost approaches to enhancing erotic connection, reducing
sexual distress, and fostering sexual health.
PURI-PRO (Portuguese URinary Incontinence PROject) – Sympton Impact Ande Health Intervention For Midde-Aged Women With Urinary Incontinence
Publication . Porto, Marta Monteiro da Silva Gonçalves; Pimenta, Filipa
Urinary incontinence (UI) is highly prevalent yet frequently undertreated and underreported, imposing substantial biopsychosocial costs during midlife. Many women are socially active
through defensive and hiding self-management coping strategies that provide short-term control but delay help-seeking. The PURI-PRO was designed as a sequential three-phase, mixed-methods
investigation to understand the UI cognitive, emotional, and behavioural dimensions, and their interconnections through the lens of the Common-Sense Model (CSM); the role of beliefs and coping in UI psychosocial consequences; and to test an eHealth intervention. Participants were Portuguese women aged 40–65 years who were recruited online using snowball sampling and self reported occasional and frequent UI. Phase 1 employed a qualitative, quantitative and cross sectional design (Objective 1; n = 34) to explore illness representations, emotions, and coping, as well as their interconnectedness, through directed content and textual analysis. The Portuguese Brief Illness Perception Questionnaire (Brief IPQ) was validated (Objective 2; n = 1,511). Phase 2 consisted of cross-sectional studies (Objectives 3–8; n = 1,538–2,648) to validate the KHQ Symptom Severity Subscale (KHQ-SSS), develop the UI-Self-Management Coping Strategies Instrument (UI-SMCSI) and UI-Social Isolation Questionnaire (UI-SIQ), and test mediation (role of UI-SMC in the relationship between symptom severity and social isolation) and moderation (coping and beliefs buffering UI severity impact on sexual function/quality of life [QoL]). The impact of UI severity on workplace productivity was also explored. Structural Equation Modelling and measurement invariance were applied. Phase 3 was a 1:1 randomised controlled trial (Objectives 9–10; EG = 46, CG = 52) of an eight-week synchronous eHealth intervention grounded in the CSM, the Health Action Process Approach (HAPA), and Cognitive–Behavioural Therapy
(CBT), using BCTTv1 behaviour change techniques. Outcomes were assessed at baseline, mid intervention, post-intervention, and follow-up using Conditional Latent Growth Modelling, with
mediation analyses testing the role of risk perception and intention in the relationship between symptom severity and primary outcomes at follow-up. Phase 1 (Objectives 1–2) identified two largely independent dimensions—cognitive illness representations and behavioural strategies—with peripherally-located emotions. An appraisal mechanism linked control and timeline beliefs to coping, suggesting an extension of the CSM. In Phase 2 (Objectives 3–8), coping buffered the effect of UI severity on sexual function, whereas beliefs did not. Severity, beliefs and coping strategies directly impacted QoL. Coping fully mediated the association between symptoms’ severity and social isolation. Workplace productivity was also negatively impacted by UI severity.
Phase 3 (Objectives 9–10) showed that the intervention reduced symptom severity, threatening illness representations, and defensive/hiding coping; improved condition-specific QoL and social
isolation; and strengthened volitional self-regulation. Planning and action control mediated the pathway from early motivation to outcomes. In conclusion, PURI-PRO reframes UI as a multi
determined clinical and changeable condition in which beliefs set the context, appraisals channel beliefs into behaviour, coping functions as mediator and moderator of psychosocial outcomes, while volition counterbalances the adverse effects of risk perception and intention. Contributions include an extension of the CSM, the development of three brief condition-specific PROMs, and experimental evidence that combining physiotherapy with evidence-based Health Psychology
models in multidisciplinary teams enhances UI care and condition-specific QoL.