"I cannot see your fear!" Altered recognition of fearful facial expressions in anorexia nervosa.

Background: The evidence about facial emotion recognition in anorexia nervosa as the role of alexithymic traits on this emotional ability is conflicting and heterogeneous. Objective: We assessed the capability of recognizing facial expressions of two primary emotions, fear, and anger, in the context of anorexia nervosa. Methods: Women affected by anorexia nervosa were compared with healthy weight women in a well-established implicit facial emotion recognition task. Both reaction time and level of accuracy were computed. Moreover, the individual levels of alexithymia were assessed through a standard self-report questionnaire. Results: Participants with anorexia nervosa reported a significantly lower performance in terms of reaction time and accuracy when the emotion of fear-but not anger-was the target. Notably, such an alteration was linked to the levels of alexithymia reported in the self-report questionnaire. Conclusion: In anorexia nervosa, difficulties in processing facial fearful (but not angry) expressions may be observed as linked to higher expressions of alexithymic traits. We suggested future research in which emotional processing will be investigated taking into account the role of the bodily dimensions of emotional awareness.

Early Respiratory Physiotherapy versus an Individualized Postural Care Program for Reducing Mechanical Ventilation in Preterm Infants: A Randomised Controlled Trial.

BACKGROUND: Tactile stimulation manoeuvres stimulate spontaneous breathing in preterm newborns. The aim of this study is to evaluate the effect of early respiratory physiotherapy on the need for mechanical ventilation during the first week of life in preterm infants with respiratory failure. METHODS: This is a monocentric, randomised controlled trial. Preterm infants (gestational age ≤ 30 weeks) not intubated in the delivery room and requiring non-invasive respiratory support at birth were eligible for the study. The intervention group received early respiratory physiotherapy, while the control group received only a daily physiotherapy program (i.e., modifying the infant's posture in accordance with the patient's needs). RESULTS: between October 2019 and March 2021, 133 preterm infants were studied, 68 infants in the study group and 65 in routine care. The study group showed a reduction in the need for mechanical ventilation (not statistically significant) and a statistically significant reduction in hemodynamically significant patent ductus arteriosus with respect to the control group (19/68 (28%) vs. 35/65 (54%), respectively, p = 0.03). CONCLUSIONS: early respiratory physiotherapy in preterm infants requiring non-invasive respiratory support at birth is safe and has proven to be protective against haemodynamically significant PDA.

Corrigendum: Assessing the needs and perspectives of patients with obesity and obstructive sleep apnea syndrome following continuous positive airway pressure therapy to inform health care practice: A focus group study.

[This corrects the article DOI: 10.3389/fpsyg.2022.947346.].

Corrigendum: Improving CPAP adherence in adults with obstructive sleep apnea syndrome: A scoping review of motivational interventions.

[This corrects the article DOI: 10.3389/fpsyg.2021.705364.].

Affective touch in anorexia nervosa: Exploring the role of social anhedonia and lifespan experiences.

BACKGROUND: The pleasantness of a gentle and slow, namely affective, touch experienced in interpersonal interactions motivates social closeness. In anorexia nervosa (AN), independent evidence suggests lower pleasantness of affective touch, as well as social withdrawal. We aim to probe both the experience of affective touch and its possible association with social anhedonia and lifespan experiences of affective bodily contacts in AN. METHODS: The pleasantness of affective and non-affective touch was compared between fourteen women with AN and fourteen healthy women. Stimuli were traditionally delivered with a brush, with the experimenter's hand, as novelty, and with a stick, as control. The pleasantness of imagined and real touch was probed. Self-report questionnaires assessed social anhedonia and lifespan experiences of affective touch. RESULTS: A preserved pleasantness of affective touch emerged in AN in both the imagery and real task, despite higher social anhedonia and less lifespan experience of affective touch than healthy women. LIMITATIONS: Affective touch involves loved ones; thus, the experimenter's touch may not resemble real-life interactions. Future research may take advantage of imagery procedures to solve this issue. CONCLUSIONS: Body-oriented therapy for AN recognizes touch as a therapeutic tool: ascertaining how touch is experienced is crucial to maximize rehabilitative outcomes. Furthermore, clarifying the possible interplay between interpersonal difficulties in AN and affective touch is especially relevant considering the possible role of the attachment style, which is intensively debated in AN, on affective touch.

Let the Body Talk: Preliminary Data of an Open Trial of Dance Movement Therapy for Eating Disorders.

BACKGROUND: There is growing support for considering Dance Movement Therapy (DMT) as an effective approach to improving physical and psychological symptoms in eating disorders (ED), but additional evidence is needed. The current study aims to investigate the effectiveness of a DMT intervention for inpatients with ED during an in-hospital rehabilitation program for ED in reducing emotion dysregulation and alexithymia and improving interoceptive awareness. METHODS: Forty-nine consecutive inpatient young women with ED (aged between 18 and 34 years) recruited from a clinical center for the rehabilitation of obesity and ED received four group sessions of DMT intervention. All participants completed the Difficulties in Emotion Regulation Scale (DERS), the Toronto Alexithymia Scale (TAS), and the Multidimensional Assessment of Interoceptive Awareness Scale (MAIA) before (Time 0) and after the intervention (Time 1). Paired-sample t-tests were run to assess differences between Time 0 to Time 1. RESULTS: From pre-to-post interventions, there was a significant reduction in the means of all of the subscales of DERS, suggesting an improvement in emotion regulation competencies, with the only exception for difficulties in awareness that increased (p = 0.016). We also found a significant reduction in alexithymia, as proved by significant differences in all of the subscales and the total score of TAS (p < 0.001), and significant improvements in interoceptive awareness as suggested by increased scores of the noticing (p = 0.043), emotional awareness (p < 0.001), body listening (p < 0.001), and trusting (p < 0.001) subscales of MAIA. CONCLUSION: Overall, our results point towards the efficacy of dance/movement in reducing symptoms of eating disorders. Our findings also suggest that dancing can be considered a useful intervention to increase emotional regulation, reduce alexithymia, and enhance interoceptive awareness.

Corrigendum: The mediating role of psychological inflexibility in the relationship between anxiety, depression, and emotional eating in adult individuals with obesity.

[This corrects the article DOI: 10.3389/fpsyg.2022.861341.].

Assessing the needs and perspectives of patients with obesity and obstructive sleep apnea syndrome following continuous positive airway pressure therapy to inform health care practice: A focus group study.

Objective: This study aims to investigate the lived experience in patients with obstructive sleep apnea syndrome (OSAS) and comorbid obesity following after continuous positive airway pressure (CPAP) therapy made with the disease the device, and to identify barriers and facilitators to the use of CPAP to improve rehabilitation provision and aid in disease self-management. Methods: Qualitative research was conducted using three focus groups with a representative sample of 32 inpatients (37% female) undergoing a 1-month pulmonary rehabilitation program at the IRCSS Istituto Auxologico Italiano San Giuseppe Hospital, Verbania, Italy. The focus groups were recorded on tape, and contemporaneous notes were made. The tapes were transcribed verbatim, and Interpretative Phenomenological Analysis was used to develop themes. Results: Six main themes were extracted: (1) Living the diagnosis as a shock; (2) You should not sleep on it: the importance of prevention; (3) The adjustment to CPAP; (4) Barriers and facilitators to the use of CPAP; (5) Three in a bed; and (6) The relationship with the healthcare system. Conclusion: Results of this study suggest potential avenues for interventions to increase adherence to CPAP, including the provision of information and continued support. Individual counseling providing strategies aimed at helping the person to cope with the emotional problem and relational difficulties associated with the use of CPAP, and at strengthening self-efficacy and self-management skills are also encouraged for optimal care during the rehabilitation program.

Gut Microbiota and Fear Processing in Women Affected by Obesity: An Exploratory Pilot Study.

The microbiota-gut-brain axis extends beyond visceral perception, influencing higher-order brain structures, and ultimately psychological functions, such as fear processing. In this exploratory pilot study, we attempted to provide novel experimental evidence of a relationship between gut microbiota composition and diversity, and fear-processing in obesity, through a behavioral approach. Women affected by obesity were enrolled and profiled for gut microbiota, through 16S rRNA amplicon sequencing. Moreover, we tested their ability to recognize facial fearful expressions through an implicit-facial-emotion-recognition task. Finally, a traditional self-report questionnaire was used to assess their temperamental traits. The participants exhibited an unbalanced gut microbiota profile, along with impaired recognition of fearful expressions. Interestingly, dysbiosis was more severe in those participants with altered behavioral performance, with a decrease in typically health-associated microbes, and an increase in the potential pathobiont, Collinsella. Moreover, Collinsella was related to a lower expression of the persistence temperamental trait, while a higher expression of the harm-avoidance temperament, related to fear-driven anxiety symptoms, was linked to Lactobacillus. Once confirmed, our findings could pave the way for the design of innovative microbiome-based strategies for the treatment of psychological and emotional difficulties by mitigating obesity-related consequences and behaviors.

The Mediating Role of Psychological Inflexibility in the Relationship Between Anxiety, Depression, and Emotional Eating in Adult Individuals With Obesity.

The aim of this cross-sectional study is to investigate the role of psychological inflexibility in the relationship between anxiety and depression and emotional eating in a sample of 123 inpatient Italian adult individuals with obesity. Participants completed the Anxiety and Depression subscales of the Psychological General Well-Being Inventory, the Acceptance and Action Questionnaire, and the Emotional Eating subscale of the Dutch Eating Behavior Questionnaire to assess anxiety and depression, psychological inflexibility, and emotional eating, respectively. Results showed that the indirect effect of PGWBI-A on DEBQ-EE through AAQ-II was significant [b = -0.0155; SE = 0.076; 95% BC-CI (-0.0320 to -0.023)]. Similarly, the indirect effect of PGWBI-D on DEBQ-EE through AAQ-II was significant [b = -0.0383; SE = 0.0207; 95% BC-CI (-0.0810 to -0.0002)]. These findings may help to plan and develop specific psychological interventions aimed at addressing emotional eating through targeting psychological inflexibility to be included in obesity treatment programs.

Self-perception in anorexia nervosa: When the body becomes an object.

OBJECTIVE: Women with anorexia nervosa (AN) act as if they have a larger body, as evidenced in obstacle avoidance tasks, where an allocentric perspective is adopted. This alteration emerges not only when they perform, but also when they imagine movements. However, no previous study has investigated own body centered tasks. As such, in this study we aim at documenting if women with AN show an altered behaviour also when the task requires a first-person perspective. METHOD: We explored the performance of eleven woman affected by AN compared to eighteen matched controls, in two motor imagery tasks based on a self-frame of reference, the Hand Laterality Task and the Mental Motor Chronometry Task. Moreover, two control tasks relative to visual imagery were administered. RESULTS: In the Hand Laterality Task, affected participants did not adopt a motor strategy to judge hands laterality (i.e. no biomechanical constraints effect). Crucially, they also showed an altered behavior in the control task. Similarly, they did not show the expected isochrony in the Mental Motor Chronometry Task, when actions pertained the left (but not the right) hand, in absence of any difference in the control task. CONCLUSIONS: Our findings reveal altered imagery processes in AN. Specifically, affected participants adopt a third-person, rather than a first-person perspective, even when the task requires to imagine their own body in an internal frame of reference. In other words, participants with AN objectify body stimuli. Different mechanisms (i.e., checking behaviour; mirror self-reflection; altered multisensory integration) can explain such an altered imagery in AN.

Short-Term Effects of a Multidisciplinary Residential Rehabilitation Program on Perceived Risks, Confidence Toward Continuous Positive Airway Pressure Treatment, and Self-Efficacy in a Sample of Individuals Affected by Obstructive Sleep Apnea Syndrome.

Continuous positive airway pressure (CPAP) therapy is the standard treatment for obstructive sleep apnea (OSA) syndrome. However, optimizing adherence to CPAP therapy of individuals remains very challenging for clinicians because of the role played by the psychological components. In this study, we verified the changes in cognitions and beliefs of individuals after a four-week multidisciplinary residential rehabilitation program targeting the adaptation to CPAP therapy for OSA syndrome. We assessed the components of perceived risks, confidence toward the treatment, and self-efficacy through the self-report questionnaire, namely the Self-Efficacy Measure for Sleep Apnea (SEMSA) questionnaire. We also explored the role played by the temperamental traits on the changes registered in these components after the treatment. Forty-five participants completed the rehabilitation program, showing a higher level of adherence to the treatment. Significant changes were observed in terms of confidence toward the treatment, although no change was reported in terms of perceived risks and self-efficacy. Moreover, those individuals with a higher persistent temperamental trait reported a significant improvement in perceived risks, in the absence of other significant results. After the rehabilitation treatment, our participants were more prone to consider the effect of CPAP treatment on health outcomes. This was in line with the educational aim of the rehabilitation treatment. The temperament seemed to play only a marginal role in the global changes reported by our participants. We discussed the need for behavioral interventions, in addition to education, in improving self-efficacy.

Improving CPAP Adherence in Adults With Obstructive Sleep Apnea Syndrome: A Scoping Review of Motivational Interventions.

Objective: This scoping review aims to provide an accessible summary of available evidence on the efficacy of motivational interventions to increase adherence to Continuous Positive Airway Pressure (CPAP) among patients with Obstructive Sleep Apnea Syndrome (OSAS) and of their specific aspects and strategies by assessing adherence measures. Methods: A literature search was performed in PubMed, Scopus, Medline, PsycINFO, and Web of Science databases using the concepts of "obstructive sleep apnea syndrome," "continuous positive airway pressure," "motivational intervention," and "adherence." Rigorous inclusion criteria and screening by at least two reviewers were applied. Data were extracted to address the review aims and were presented as a narrative synthesis. Results: Search for databases produced 11 randomized controlled trials, all including naïve CPAP users. Findings showed that motivational interventions were more effective than usual care and educational programs in increasing adherence to CPAP, despite results were not always maintained over time across studies. Discussion: To our knowledge, this is the first scoping review of the literature aimed to explore the characteristics and impact of motivational interventions to promote adherence to CPAP in patients with OSAS. More research providing a detailed description of motivational strategies, and testing of their association with positive treatment outcomes via both direct and indirect measures are needed to increase awareness on active mechanisms of change.

Effects of early respiratory physiotherapy on spontaneous respiratory activity of preterm infants: study protocol for a randomized controlled trial.

BACKGROUND: Tactile maneuvers stimulating spontaneous respiratory activity in preterm infants are recommended since birth, but data on how and how often these maneuvers are applied in clinical practice are unknown. In the last years, most preterm newborns with respiratory failure are preferentially managed with non-invasive respiratory support and by stimulating spontaneous respiratory activity from the delivery room and in neonatal intensive care unit (NICU), in order to avoid the risks of intubation and prolonged mechanical ventilation. METHODS: Preterm infants with gestational age < 31 weeks not intubated in the delivery room and requiring non-invasive respiratory support at birth will be eligible for the study. They will be randomized and allocated to one of two treatment groups: (1) the study group infants will be subject to the technique of respiratory facilitation within the first 24 h of life, according to the reflex stimulations, by the physiotherapist. The newborn is placed in supine decubitus and a slight digital pressure is exerted on a hemithorax. The respiratory facilitation technique will be performed for about three minutes and repeated for a total of 4/6 times in sequence, three times a day until spontaneous respiratory activity is achieved; thus, no respiratory support is required; (2) the control group infants will take part exclusively in the individualized postural care program. They will perform the technique of respiratory facilitation and autogenous drainage. OBJECTIVE: To evaluate the efficacy of early respiratory physiotherapy in reducing the incidence of intubation and mechanical ventilation in the first week of life (primary outcome). DISCUSSION: The technique of respiratory facilitation is based on reflex stimulations, applied early to preterm infant. Slight digital pressure is exerted on a "trigger point" of each hemithorax, to stimulate the respiratory activity with subsequent increase of the ipsilateral pulmonary minute ventilation and to facilitate the contralateral pulmonary expansion. This mechanism will determine the concatenation of input to all anatomical structures in relation to the area being treated, to promote spontaneous respiratory activity and reducing work of breathing, avoiding or minimizing the use of invasive respiratory support. TRIAL REGISTRATION: UMIN-CTR Clinical Trial UMIN000036066. Registered on March 1, 2019. Protocol 1. https://www.umin.ac.jp/ctr.

The Impact of Psychological Flexibility on Psychological Well-Being in Adults With Obesity.

Obesity is a global health problem that affects both physical and psychological health and well-being. Psychological flexibility is one of the key components related to psychological health. This cross-sectional study aims to investigate the impact of psychological flexibility on psychological well-being in a sample of 220 individuals with obesity. Multivariate analysis was performed to investigate the role of psychological flexibility in explaining psychological well-being, controlling for confounding factors (sex, age, and Body Mass Index). According to the results, psychological flexibility significantly explained psychological well-being. Our study provides additional evidence of the impact of psychological flexibility on psychological well-being. It also provides further support for the importance of integrating psychological flexibility in the psychological interventions for obesity.

The ACTyourCHANGE study protocol: promoting a healthy lifestyle in patients with obesity with Acceptance and Commitment Therapy-a randomized controlled trial.

BACKGROUND: As treatment of choice in promoting psychological flexibility, Acceptance and Commitment Therapy (ACT) was found to be effective in several conditions, and among different populations, including weight management in individuals with obesity. However, the mechanism of action of psychological flexibility is less known. The aim of the present study is, within the context of a brief ACT intervention for behavioral change and behavioral maintenance of a healthy lifestyle in a sample of inpatients with obesity, to explore the effect of each subcomponent of the psychological flexibility model on treatment processes and outcomes. METHODS: A randomized controlled trial will be conducted. Ninety Italian adult inpatients with obesity attending a rehabilitation program for weight loss will be randomly allocated into three experimental conditions targeting respectively each subcomponent of the psychological flexibility model: group Engage focused on values-oriented behaviors, group Openness focused on acceptance and cognitive defusion, and group Awareness focused on being present and aware of thoughts, feelings, and behaviors at every moment. Weight, BMI (kg/m2), the Psychological General Well-Being Inventory (PGWBI), the Outcome Questionnaire-45.2 (OQ-45.2), the Depression Anxiety and Stress Scale (DASS-21), the Difficulties in Emotion Regulation Scale (DERS), the Dutch Eating Behaviors Questionnaire (DEBQ), the Brief Values Inventory (BVI), the Committed Action Questionnaire (CAQ), the Italian-Cognitive Fusion Questionnaire (I-CFQ), the Five Facet Mindfulness Questionnaire (FFMQ), and the Acceptance and Action Questionnaire (AAQ-II) will be assessed at the beginning (time 0), at the end of psychological intervention (time 1), and after 3 (time 2) and 6 months (time 3) and 9 months (time 4) from discharge. During the following month after discharge, outpatients will be monitored in their adherence to a healthy lifestyle, using a wearable device. To assess the effectiveness of the intervention, mixed between-within 3 (conditions) × 4 (times) repeated measure ANOVAs will be conducted to examine changes from time 0 to time 1, 2, 3, and 4 in means of weight, BMI, and means of scores PGWBI, OQ-45.2, DASS, DERS, DEBQ, AAQ-II, BVI, CAQ, I-CFQ, and FFMQ, between three groups. DISCUSSION: This study will contribute to clarify the mechanism of action of each subcomponent of the psychological flexibility model and understand its impact on the promotion of a healthy lifestyle. TRIAL REGISTRATION: ClinicalTrials.gov NCT04474509 . Registered on July 4, 2020.

Psychological Well-Being in Obstructive Sleep Apnea Syndrome Associated With Obesity: The Relationship With Personality, Cognitive Functioning, and Subjective and Objective Sleep Quality.

Obstructive sleep apnea (OSA) syndrome severely affects psychological well-being. This syndrome frequently occurs in obesity; however, no previous study has investigated the level of psychological well-being in the case of OSA syndrome associated with obesity. In this work, we assessed the level of psychological well-being in fifty-two individuals affected by OSA syndrome and obesity through the Psychological General Well-Being Index. Moreover, we investigated the role of personality, cognitive functioning and attentional capabilities, subjective perception and objective measurement about sleeping, on the subjective perception of psychological well-being. Our sample reported a lower level of psychological well-being; the participants' scores were below the normative cut-off in all components, except for depression symptoms. A lower expression of harm avoidance temperament and a lower level of daily sleepiness predicted a higher level of psychological well-being. Psychological well-being seemed to be severely affected in individuals affected by OSA syndrome and obesity. The temperament and subjective perception of daily alertness and sleepiness, rather than the syndrome severity, seemed to play a crucial role in the individual perception of the psychological well-being.