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Díez-Solinska A, Goñi-Balentziaga O, Beitia-Oyarzabal G, Muñoz-Culla M, Vegas O, Azkona G. Chronic defeat stress induces monoamine level dysregulation in the prefrontal cortex but not in the hippocampus of OF1 male mice. Behav Brain Res 2024; 467:115023. [PMID: 38688411 DOI: 10.1016/j.bbr.2024.115023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
Chronic social stress can increase susceptibility to chronic diseases such as depression. One of the most used models to study the physiological mechanisms and behavioral outcomes of this type of stress is chronic defeat stress (CDS) in male mice. OF1 male mice were subjected to a stress period lasting 18 days. During that time, non-stressed animals were housed in groups. The cluster analysis of the behavioral profile displayed during the first social interaction divided subjects into two groups: active/aggressive (AA) and passive/reactive (PR). The day after the end of the stress period, the following behavioral analyses were performed: the sucrose preference test (SPT) on day 19, the open field test (OFT) on day 20, and the forced swim test (FST) on day 21. Immediately after completing the last test, animals were weighed, and blood samples were obtained. Then, they were sacrificed, and their prefrontal cortices and hippocampi were removed and stored to analyze monoamine levels. Stressed animals displayed anhedonia, and solely the PR mice continued to show higher levels of immobility in the OFT and FST. All stressed animals, regardless of the coping strategy, presented higher plasma corticosterone levels. In addition, stressed mice showed lower levels of tyrosine, dopamine, DOPAC, MHPG, kynurenine, kynurenic acid, and 5-HIAA levels but higher serotonin levels in the prefrontal cortex, not in the hippocampus. In conclusion, our results show that CSD induces differences in monoamine levels between brain areas, and these differences did not respond to the coping strategy adopted.
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Affiliation(s)
- Alina Díez-Solinska
- Department of Basic Psychological Processes and their Development, University of the Basque Country (UPV/EHU), Donostia-San Sebastian 20018, Spain
| | - Olatz Goñi-Balentziaga
- Department of Clinical and Health Psychology, and Research Methods, School of Psychology, University of the Basque Country (UPV/EHU), Donostia-San Sebastian 20018, Spain
| | - Garikoitz Beitia-Oyarzabal
- Department of Basic Psychological Processes and their Development, University of the Basque Country (UPV/EHU), Donostia-San Sebastian 20018, Spain
| | - Maider Muñoz-Culla
- Department of Basic Psychological Processes and their Development, University of the Basque Country (UPV/EHU), Donostia-San Sebastian 20018, Spain; Biogipuzkoa Health Research Institute, Donostia-San Sebastian 20014, Spain
| | - Oscar Vegas
- Department of Basic Psychological Processes and their Development, University of the Basque Country (UPV/EHU), Donostia-San Sebastian 20018, Spain; Biogipuzkoa Health Research Institute, Donostia-San Sebastian 20014, Spain
| | - Garikoitz Azkona
- Department of Basic Psychological Processes and their Development, University of the Basque Country (UPV/EHU), Donostia-San Sebastian 20018, Spain.
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Goñi-Balentziaga O, Azkona G. Perceived professional quality of life and mental well-being among animal facility personnel in Spain. Lab Anim 2024; 58:73-81. [PMID: 37684027 DOI: 10.1177/00236772231187177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Animal facility personnel provide the husbandry and care of laboratory animals. We aimed to investigate their work-related quality of life, empathy and mental well-being. Participants living in Spain were contacted by email and asked to complete an anonymous online questionnaire, in which they answered the Professional Quality of Life scale, the Cognitive and affective empathy test, the Warwick-Edinburgh Mental Well-Being Scale, and their perceived human-animal interaction. Participants were asked whether they were receiving psychological therapy or were taking anxiolytics, hypnotics or antidepressant medication. The study comprised 80 participants. No differences were observed related to personal or professional variables. Participants working with small carnivores reported higher total empathy, and those working with non-human primates reported higher emotional comprehension. Higher human-animal interaction was reported by participants working with small carnivores, farm animals and non-human primates. More than half of the participants reported high levels of mental well-being, positively correlated with emotional comprehension, emphatic joy and compassion satisfaction. Participants working with farm animals reported higher levels of secondary traumatic stress that was positively correlated with human-animal interaction and negatively with mental well-being. Most participants reported low-average levels of burnout, which was negatively correlated with mental well-being. The percentage of animal facility personnel in psychotherapy was higher than in the general population, and the consumption of anxiolytics was a little lower and antidepressants higher. Overall, our results indicate that animal-facility personnel who felt stress or worse mental well-being were in therapy and took medication to improve their condition.
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Affiliation(s)
- Olatz Goñi-Balentziaga
- Department of Clinical and Health Psychology and Research Methodology, Euskal Herriko Unibertsitatea (UPV/EHU), Spain
| | - Garikoitz Azkona
- Department of Basic Psychological Processes and their Development, Euskal Herriko Unibertsitatea (UPV/EHU), Spain
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Díez-Solinska A, Azkona G, Muñoz-Culla M, Beitia-Oyarzabal G, Goñi-Balentziaga O, Gómez-Lazaro E, Vegas O. The role of sociability in social instability stress: Behavioral, neuroendocrine and monoaminergic effects. Physiol Behav 2023; 270:114306. [PMID: 37516231 DOI: 10.1016/j.physbeh.2023.114306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 07/31/2023]
Abstract
Extensive literature has reported a link between social stress and mental health. In this complex relationship, individual strategies for coping with social stress are thought to have a possible modulating effect, with sociability being a key factor. Despite the higher incidence of affective disorders in females and sex-related neurochemical differences, female populations have been understudied. The aim of the present study was, therefore, to analyze the behavioral, neuroendocrine, and neurochemical effects of stress in female OF1 mice, paying special attention to social connectedness (female mice with high vs low sociability). To this end, subjects were exposed to the Chronic Social Instability Stress (CSIS) model for four weeks. Although female mice exposed to CSIS had increased arousal, there was no evidence of depressive-like behavior. Neither did exposure to CSIS affect corticosterone levels, although it did increase the MR/GR ratio by decreasing GR expression. Female mice exposed to CSIS had higher noradrenaline and dopamine levels in the hippocampus and striatum respectively, with a lower monoaminergic turnover, resulting in an increased arousal. CSIS increased serotonin levels in both the hippocampus and striatum. Similarly, CSIS was found to reduce kynurenic acid, 3-HK, and IDO and iNOS enzyme levels in the hippocampus. Interestingly, the observed decrease in IDO synthesis and the increased serotonin and dopamine levels in the striatum were only found in subjects with high sociability. These highly sociable female mice also had significantly lower levels of noradrenaline in the striatum after CSIS application. Overall, our model has produced neuroendocrine and neurochemical but not behavioral changes, so it has not allowed us to study sociability in depth. Therefore, a model that induces both molecular and behavioral phenotypes should be applied to determine the role of sociability.
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Affiliation(s)
- Alina Díez-Solinska
- Department of Basic Psychological Processes and their Development, School of Psychology, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Garikoitz Azkona
- Department of Basic Psychological Processes and their Development, School of Psychology, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain.
| | - Maider Muñoz-Culla
- Department of Basic Psychological Processes and their Development, School of Psychology, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain; Biodonostia Institute, 20018 Donostia-San Sebastian, Spain
| | - Garikoitz Beitia-Oyarzabal
- Department of Basic Psychological Processes and their Development, School of Psychology, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Olatz Goñi-Balentziaga
- Department of Clinical and Health Psychology, and Research Methods, School of Psychology, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Eneritz Gómez-Lazaro
- Department of Basic Psychological Processes and their Development, School of Psychology, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain
| | - Oscar Vegas
- Department of Basic Psychological Processes and their Development, School of Psychology, University of the Basque Country (UPV/EHU), 20018 Donostia-San Sebastian, Spain; Biodonostia Institute, 20018 Donostia-San Sebastian, Spain
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Aliri J, Prego-Jimenez S, Goñi-Balentziaga O, Pereda-Pereda E, Perez-Tejada J, Labaka Etxeberria A. Gender awareness is also nurses' business: Measuring sensitivity and role ideology towards patients. J Nurs Manag 2022; 30:4409-4418. [PMID: 36217683 PMCID: PMC10092084 DOI: 10.1111/jonm.13866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 09/02/2022] [Accepted: 09/28/2022] [Indexed: 12/30/2022]
Abstract
AIM This study aims to validate the Nijmegen Gender Awareness in Medicine Scale, which assesses gender sensitivity and gender-role ideology towards patients in the Spanish language for use among physicians and nurses. BACKGROUND Women are more likely to suffer pain, delays and health consequences related to low therapeutic effort. Health professionals' gender awareness may minimize such bias; however, the only instrument to assess such awareness is limited to physicians and lacks a Spanish version. METHODS After using the back-translation method, a sample of 167 Spanish nurses and nursing students completed the instrument. In order to obtain additional validity evidence, 98 health professionals filled in gender sensitivity and gender-role ideology towards patients' subscales and the short versions of the Ambivalent Sexism Inventory. RESULTS Gender-role ideology towards patients correlated strongly with sexist attitudes, demonstrating convergent validity, and Cronbach's alpha coefficients showed an adequate internal consistency. CONCLUSIONS Nijmegen Gender Awareness in Medicine Scale perfectly applies to nurse population, and this adaptation also broadens its use for Spanish professionals. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers and educators can use this applicable tool to treat low gender awareness levels as a modifiable risk factor and promote a gender-sensitive caring culture.
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Affiliation(s)
- Jone Aliri
- Clinical and Health Psychology and Research Methodology Department, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain
| | - Sara Prego-Jimenez
- Clinical and Health Psychology and Research Methodology Department, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain.,University Hospital Donostia, San Sebastian, Spain
| | - Olatz Goñi-Balentziaga
- Clinical and Health Psychology and Research Methodology Department, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain
| | - Eva Pereda-Pereda
- Osakidetza-Basque National Health Service, Vitoria-Gasteiz, Basque Country, Spain.,Group of Mental Health and Psychiatric Care, Biodonostia Health Research Institute, San Sebastian, Basque Country, Spain
| | | | - Ainitze Labaka Etxeberria
- Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), San Sebastian, Basque Country, Spain
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Prego-Jimenez S, Pereda-Pereda E, Perez-Tejada J, Aliri J, Goñi-Balentziaga O, Labaka A. The Impact of Sexism and Gender Stereotypes on the Legitimization of Women's Low Back Pain. Pain Manag Nurs 2022; 23:591-595. [DOI: 10.1016/j.pmn.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 11/28/2022]
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Labaka A, Gómez-Lazaro E, Goñi-Balentziaga O, Pérez-Tejada J, Vegas O, Garmendia L. Venlafaxine reduces the striatal il6/il10 ratio and increases hippocampal GR expression in female mice subjected to chronic social instability stress. Stress 2021; 24:561-571. [PMID: 33769212 DOI: 10.1080/10253890.2021.1895111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Women are twice as likely as men to develop depression and antidepressant treatment is more frequent in females. Moreover, neuroinflammatory changes related to affective disorders differ in accordance with sex. Despite this evidence, female populations have been largely omitted from preclinical experiments studying antidepressants. The aim of this work is to analyze the potential restorative effect of venlafaxine on an animal model of depression. Female CD1 mice were subjected to chronic social instability (CSI) stress for 7 weeks, and were administered venlafaxine during the last 3 weeks of the stress period. Behavioral and physiological parameters were then analyzed. Stressed mice showed a decreased sucrose preference and increased whisking behavior, and had a lower body weight, higher plasma corticosterone levels and increased hypothalamic GR expression. They also had lower levels of 5-HT, 5-HIAA and NA and a higher KYN/TRYP ratio in the hippocampus. Moreover, CSI increased striatal IL-6 mRNA expression levels. Venlafaxine treatment reduced the striatal IL-6/IL-10 ratio and increased hippocampal GR expression, although it did not reverse stress-induced behavioral changes. In conclusion, seven weeks of exposure to CSI produced depressive-like alterations in female mice. The venlafaxine treatment regimen was found to have a modest anti-inflammatory effect in the striatum and increased hippocampal GR mRNA, although it failed to redress stress-induced behavioral disturbances.
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Affiliation(s)
- Ainitze Labaka
- Department of Basic Psychological Processes and their Development, University of the Basque Country UPV/EHU, San Sebastian, Spain
- Department of Nursing II, Faculty of Medicine and Nursing, University of the Basque Country UPV/EHU, San Sebastian, Spain
| | - Eneritz Gómez-Lazaro
- Department of Basic Psychological Processes and their Development, University of the Basque Country UPV/EHU, San Sebastian, Spain
| | - Olatz Goñi-Balentziaga
- Department of Basic Psychological Processes and their Development, University of the Basque Country UPV/EHU, San Sebastian, Spain
| | - Joana Pérez-Tejada
- Department of Basic Psychological Processes and their Development, University of the Basque Country UPV/EHU, San Sebastian, Spain
- Oncologic Center (Onkologikoa), San Sebastian, Spain
| | - Oscar Vegas
- Department of Basic Psychological Processes and their Development, University of the Basque Country UPV/EHU, San Sebastian, Spain
- Biodonostia Institute, San Sebastian, Spain
| | - Larraitz Garmendia
- Department of Basic Psychological Processes and their Development, University of the Basque Country UPV/EHU, San Sebastian, Spain
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Goñi-Balentziaga O, Ortega-Saez I, Vila S, Azkona G. Working with laboratory rodents in Spain: a survey on welfare and wellbeing. Lab Anim Res 2021; 37:18. [PMID: 34315536 PMCID: PMC8314439 DOI: 10.1186/s42826-021-00098-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/15/2021] [Indexed: 11/19/2022] Open
Abstract
Background Replacement, reduction and refinement, the 3R principles, provide a framework to minimize the use and suffering of animals in science. In this context, we aimed to determine the actual perception that individuals working with laboratory rodents in biomedical research have on animal welfare and on their interaction with the animals, as well as how they perceive its impact on their social relations. To this end, we designed an anonymous on-line survey for people working with rodents, at three responsibility levels, in Spain. Results Of the 356 participants, 239 were women (67 %); 263 were researchers (74 %), and 93 animal facility staff (26 %), of which 55 were caretakers/technicians (15 %), and 38 welfare officer/veterinarians (11 %). Animal facility staff indicated environmental enrichment to be a universal practice. About half of the participants reported that, in their opinion, animals suffer “little to none” or “minor” stress and pain. Animal caretakers/technicians and researchers perceived higher levels of stress and pain than welfare officers/veterinarians. Participants judged decapitation the most unpleasant method to kill rodents, whereas anaesthetic overdose was the least one. A sizable proportion − 21 % of animal caretakers/technicians and 11.4 % of researchers - stated that they were never given the choice not to euthanize the rodents they work with. Overall, women reported higher interactions with animals than men. Nevertheless, we could detect a significant correlation between time spent with the animals and interaction scores. Notably, 80 % of animal facility staff and 92 % of researchers rarely talked about their work with laboratory rodents with people outside their inner social circle. Conclusions Overall, the participants showed high awareness and sensitivity to rodent wellbeing; animal facility staff reported a similar perception on welfare questions, independently of their category, while researchers, who spent less time with the animals, showed less awareness and manifested lower human-animal interaction and less social support. Regarding the perception on social acceptance of laboratory animal work, all groups were cautious and rarely talked about their job, suggesting that it is considered a sensitive issue in Spain. Supplementary Information The online version contains supplementary material available at 10.1186/s42826-021-00098-w.
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Affiliation(s)
- Olatz Goñi-Balentziaga
- Department of Clinical and Health Psychology and Research Methodology, Euskal Herriko Unibertsitatea (UPV/EHU), Donostia, Spain
| | - Iván Ortega-Saez
- Scientific and Technological Centers (CCIT), University of Barcelona (UB), Barcelona, Spain
| | - Sergi Vila
- Scientific and Technological Centers (CCIT), University of Barcelona (UB), Barcelona, Spain
| | - Garikoitz Azkona
- Department of Basic Psychological Processes and their Development, Euskal Herriko Unibertsitatea (UPV/EHU), Donostia, Spain.
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Goñi-Balentziaga O, Garmendia L, Labaka A, Lebeña A, Beitia G, Gómez-Lázaro E, Vegas O. Behavioral coping strategies predict tumor development and behavioral impairment after chronic social stress in mice. Physiol Behav 2020; 214:112747. [PMID: 31765663 DOI: 10.1016/j.physbeh.2019.112747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/08/2019] [Accepted: 11/21/2019] [Indexed: 01/06/2023]
Abstract
The aims of this study were to identify behavioral strategies to cope with social defeat, evaluate their impact on tumor development and analyze the contributions of both to changes in physiology and behavior produced by chronic defeat stress. For this purpose, OF1 mice were inoculated with B16F10 melanoma cells and subjected to 18 days of repeated defeat stress in the presence of a resident selected for consistent levels of aggression. Combined cluster and discriminant analyses of behavior that manifested during the first social interaction identified three types of behavioral profiles: active/aggressive (AA), passive/reactive (PR) and an intermediate active/non-aggressive (ANA) profile. Animals that showed a PR coping strategy developed more pulmonary metastases at the end of the social stress period than animals in other groups. The ANA but not AA group also showed higher tumor metastases than non-stressed subjects. In addition, the ANA group differed from the other groups because it displayed the highest corticosterone levels after the first interaction. Chronic stress reduced sucrose consumption, which indicates anhedonia, in all the stressed groups. However, the PR subjects exhibited a longer immobility time and swam for less time than other subjects in the forced swim test (FST), and they travelled a shorter distance in the open field test (OFT). In this test, the ANA group also travelled smaller distances than the non-stressed group, but the difference was more moderate. In contrast, tumor development but not stress increased behaviors associated with anxiety in the OFT (e.g., time in the center) in all tumor-bearing subjects. In summary, although the effects of social stress and tumor development on behavior were rather moderate, the results indicate the importance of behavioral coping strategies in modulating the effects of chronic stress on health.
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Affiliation(s)
- Olatz Goñi-Balentziaga
- Department of Basic Psychological Processes and their Development, University of The Basque Country, 70 Tolosa Av., 20018 San Sebastian, Spain.
| | - Larraitz Garmendia
- Department of Basic Psychological Processes and their Development, University of The Basque Country, 70 Tolosa Av., 20018 San Sebastian, Spain.
| | - Ainitze Labaka
- Department of Basic Psychological Processes and their Development, University of The Basque Country, 70 Tolosa Av., 20018 San Sebastian, Spain.
| | - Andrea Lebeña
- Department of Basic Psychological Processes and their Development, University of The Basque Country, 70 Tolosa Av., 20018 San Sebastian, Spain.
| | - Garikoitz Beitia
- Department of Basic Psychological Processes and their Development, University of The Basque Country, 70 Tolosa Av., 20018 San Sebastian, Spain.
| | - Eneritz Gómez-Lázaro
- Department of Basic Psychological Processes and their Development, University of The Basque Country, 70 Tolosa Av., 20018 San Sebastian, Spain.
| | - Oscar Vegas
- Department of Basic Psychological Processes and their Development, University of The Basque Country, 70 Tolosa Av., 20018 San Sebastian, Spain.
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Goñi-Balentziaga O, Perez-Tejada J, Renteria-Dominguez A, Lebeña A, Labaka A. Social instability in female rodents as a model of stress related disorders: A systematic review. Physiol Behav 2018; 196:190-199. [DOI: 10.1016/j.physbeh.2018.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/29/2018] [Accepted: 09/05/2018] [Indexed: 01/29/2023]
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Abstract
Depression is the leading cause of disability worldwide, and its prevalence is 2 times higher in women than in men. There is, however, a lack of data on sex-specific pathophysiology of this disorder. The purpose of this systematic review is to identify the biological sex differences found in major depressive disorder (MDD) in studies published in the last 10 years. We conducted a literature search using the Medline, PsycInfo, PubMed, and Web of Science databases, selecting English-language studies that included physiological measures compared by sex in addition to MDD. We identified 20 relevant studies, which consisted primarily of mixed methodology and samples. The reported physiological measures comprised a variety of serum biomarkers, gene mRNA expression, and brain activity. Findings suggest different biological patterns in those with MDD depending on sex. Specifically, women presented higher levels of inflammatory, neurotrophic, and serotonergic markers and a stronger correlation between levels of some inflammatory and neurotrophic factors and the severity of symptoms. This review provides information about possible different biological patterns for women and men with depressive disorder and may have important implications for treatment. Future research should include homogeneous samples; make comparisons based on sex, control sex hormone fluctuations and pharmacological treatment; and use consistent criteria for evaluating psychobiological changes in MDD.
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Affiliation(s)
- Ainitze Labaka
- Department of Basic Psychological Processes and their Development, University of the Basque Country, San Sebastián, Spain
| | - Olatz Goñi-Balentziaga
- Department of Basic Psychological Processes and their Development, University of the Basque Country, San Sebastián, Spain
| | - Andrea Lebeña
- Department of Basic Psychological Processes and their Development, University of the Basque Country, San Sebastián, Spain
| | - Joana Pérez-Tejada
- Department of Basic Psychological Processes and their Development, University of the Basque Country, San Sebastián, Spain
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