The nested hierarchical model of self and its non-relational vs relational posttraumatic manifestation: an fMRI meta-analysis of emotional processing.

Different kinds of traumatic experiences like natural catastrophes vs. relational traumatic experiences (e.g., sex/physical abuse, interpersonal partner violence) are involved in the development of the self and PTSD psychopathological manifestations. Looking at a neuroscience approach, it has been proposed a nested hierarchical model of self, which identifies three neural-mental networks: (i) interoceptive; (ii) exteroceptive; (iii) mental. However, it is still unclear how the self and its related brain networks might be affected by non-relational vs relational traumatic experiences. Departing from this background, the current study aims at conducting a meta-analytic review of task-dependent fMRI studies (i.e., emotional processing task) among patients with PTSD due to non-relational (PTSD-NR) and relational (PTSD-R) traumatic experiences using two approaches: (i) a Bayesian network meta-analysis for a region-of-interest-based approach; (ii) a coordinated-based meta-analysis. Our findings suggested that the PTSD-NR mainly recruited areas ascribed to the mental self to process emotional stimuli. Whereas, the PTSD-R mainly activated regions associated with the intero-exteroceptive self. Accordingly, the PTSD-R compared to the PTSD-NR might not reach a higher symbolic capacity to process stimuli with an emotional valence. These results are also clinically relevant in support of the development of differential treatment approaches for non-relational vs. relational PTSD.

The noise in our brain: A systematic review and meta-analysis of neuroimaging and signal-detection studies on source monitoring in psychosis.

OBJECTIVES: Noisy thoughts or perceptions are characteristics of psychosis (PSY) and, they are deeply related to source monitoring (SM) - the ability to discriminate the origin of internal/external experiences. METHODS: This MOOSE, PRISMA-compliant meta-analysis compared SM performances in PSY compared to healthy controls (HC) focusing on signal-to-noise discrimination in order to: i) test whether neuroimaging procedures (fMRI/EEG) might be a group-specific source of noise for SM; ii) compare error- and accuracy-based indexes; iii) to meta-analyze signal-detection measures (i.e., discrimination index and response bias); iv) to determine the best index capturing SM deficits in psychosis. We conducted a 3-level meta-analysis for each aim to estimate pooled effect-sizes (Cohen's d). SM type, source discrimination and stimulus modality were used as meta-regressors. Heterogeneity (I2), publication bias (Egger's test) and multiple comparisons (Bonferroni correction) were considered. RESULTS: Sixteen neuroimaging, 44 error/accuracy-based behavioral and 7 signal-detection trials were included (2297 PSY, age range = 18.78-52.6; 1745 HC, age range = 21.1-53.3). The noise generated by neuroimaging procedures slightly influenced error, but not accuracy. Accuracy-based (d = -0.83), but not error-based, indexes showed significant and large SM impairments in PSY compared to HC. Overall SM performance differences between PSY and HC were larger in discrimination index (d = -0.65) and accuracy (d = -0.61), followed by response bias (d = -0.59, ns) and error-based (d = 0.35) indexes. CONCLUSION: Although both accuracy and discrimination indexes differentiate patients with PSY from HC, discrimination index is more reliable and may better capture the bi-directional nature of the internal/external source confusion.

Heart rate variability alterations in takotsubo syndrome and related association with psychological factors: a systematic review and meta-analysis.

Psychological factors may have a precipitant role in takotsubo syndrome (TS). Aberrant Heart Rate Variability (HRV) has been reported in TS, suggesting inflexibility of the autonomous nervous system. Nevertheless, results on HRV alterations and their link with psychological factors in TS are conflicting. This work aimed to systematically explore whether TS may be associated with HRV alterations and their association with specific psychological profiles in TS patients. A literature search was conducted across databases (Pubmed, Scopus, PsycInfo, Web of Science) and empirical studies including TS patients which were evaluated in one or more HRV indices were retrieved. HRV and psychological outcomes were extracted. 10 empirical studies with 194 TS patients were included. Results showed significant alteration of HRV in TS patients, with indices compared to controls, and a progressive increase over time. Nevertheless, retrieved data presented mixed results, as also shown by a large heterogeneity in the meta-analytic findings. 2 studies found significant relationships between HRV alterations and trait-rather than state-psychological outcomes (i.e., coping strategies and emotional arousal), pointing to the need to explore the role of psychological vulnerabilities, rather than single traumatic stressors, in the association between HRV and TS.

The self and our perception of its synchrony - Beyond internal and external cognition.

The self is the core of our mental life which connects one's inner mental life with the external perception. Since synchrony is a key feature of the biological world and its various species, what role does it play for humans? We conducted a large-scale psychological study (n = 1072) combining newly developed visual analogue scales (VAS) for the perception of synchrony and internal and external cognition complemented by several psychological questionnaires. Overall, our findings showed close connection of the perception of synchrony of the self with both internal (i.e., body and cognition) and external (i.e., others, environment/nature) synchrony being associated positively with adaptive and negatively with maladaptive traits of self. Moreover, we have demonstrated how external (i.e., life events like the COVID-19 pandemic) variables modulate the perception of the self's internal-external synchrony. These findings suggest how synchrony with self plays a central role during times of uncertainty.

Dissociative Dimensions and Their Implications for Emotional Dysregulation Underlying Borderline Personality Disorder Features.

ABSTRACT: Emotion dysregulation is considered a core feature of borderline personality disorder (BPD). The role of dissociation in BPD has been discussed from different perspectives. Nevertheless, implications of dissociation for BPD features are not clear. The current study estimated mediation effects of dissociative dimensions on the relationships between several emotion regulation strategies (ERSs) and BPD features among 281 adults recruited from the general population. The online survey administered a comprehensive self-report battery for the assessment of maladaptive and adaptive ERSs together with dissociative dimensions. Borderline personality disorder features were also self-report screened. Results showed significant indirect effects of dissociation on the relationships between ERSs and BPD features. Dissociation was a full mediator of the relationship between deficits with problem-solving skills and BPD criteria. The study confirmed that emotion dysregulation is a core feature of BPD and that the dissociative dimensions should be included as relevant maladaptive mechanisms sustaining BPD emotional difficulties.

The Initial Efficacy of Stand-Alone DBT Skills Training for Treating Impulsivity Among Individuals With Alcohol and Other Substance Use Disorders.

Impulsivity is considered a core feature of substance use disorders (SUDs), including personological (i.e., negative urgency, positive urgency, lack of premeditation) and neuropsychological (i.e., cognitive and motor disinhibition, impulsive choice) dimensions. Dialectical Behavior Therapy Skills Training (DBT-ST) as a stand-alone treatment is an effective intervention for alcohol use disorder (AUD) and other SUDs. However, there are no studies that have investigated changes in impulsivity levels during a DBT-ST program, especially testing the therapeutic effects of DBT skills. Twenty-nine patients with AUD and other SUDs were admitted to a 3-month DBT-ST program. Self-report (i.e., UPPS-P) and computerized neuropsychological (i.e., Attentional Network test; Go/No-Go task; Iowa Gambling Task) measures of impulsivity were administered at the beginning and end of the DBT-ST. Distress tolerance (DTS), mindfulness (MAAS, FFMQ) and emotion regulation (DERS) were also assessed pre- and post-intervention. The study included two age- and gender-matched control groups: (a) untreated patients with SUDs (N = 29); (b) healthy controls (HCs) (N = 29). Twenty-four (82.7%) patients concluded the DBT-ST program. Emotion-based forms of impulsivity significantly improved during the program. At the end of treatment, impulsivity levels were significantly lower than those of untreated patients with SUDs and they were not significantly different from HCs. Cognitive disinhibition significantly decreased during the treatment. The improvement in impulsivity was explained by pre- posttreatment changes in distress tolerance, mindfulness and emotion regulation. Motor disinhibition did not improve during the treatment. These findings supported the initial efficacy of the DBT-ST program for addressing different features of impulsivity among individuals with AUD and other SUDs. Future follow-up studies should demonstrate the role of impulsivity domains in long-term relapse prevention.

Genetic factors linked to aberrant neural activity of individuals with substance use disorder phenotypes: A systematic review and meta-analysis of EEG studies.

Background: Alterations in EEG activity have been considered valid endophenotypes of substance use disorders (SUDs). Empirical evidence has supported the association between genetic factors (e.g., genes, single nucleotide polymorphisms [SNPs]) and SUDs, considering both clinical samples and individuals with a positive family history of SUDs [F+SUD]). Nevertheless, the relationship between genetic factors and intermediate phenotypes (i.e., altered EEG activity) among individuals with SUD phenotypes remains unclear.Objective(s): The current study aims at summarizing genetic factors linked to aberrant EEG activity among individuals with SUDs and those with F+SUD.Methods: Sixteen studies (5 [N = 986] + 11 from the Collaborative Studies On Genetics of Alcoholism [COGA] sample [432 ≤ N ≤ 8810]) were included for a qualitative systematic review. Thirteen studies (5 + 8 studies from the COGA sample) were used for multi-level meta-analytic procedures.Results: Qualitative analyses highlighted a multivariate genetic architecture linked to alterations in EEG waves among individuals with SUD phenotypes (i.e., augmented resting-state beta waves; reduced resting-state alpha waves; reduced resting-state and task-dependent theta waves). The most recurrent genetic factors were involved in cellular energy homeostasis, modulation of inhibitory and excitatory neural activity together with neural cell growth. Meta-analytic results showed a moderate association between genetic factors and altered resting-state and task-dependent EEG activity. Meta-analytic results also suggested non-additive genetic effects on altered EEG activity.Conclusions: Complex genetic interactions mediating neural activity and brain development might constitute a causal pathway toward intermediate phenotypes associated with phenotypic features, which in turn are linked to SUDs.

Neurobiological Dysfunctional Substrates for the Self-Medication Hypothesis in Adult Individuals with Attention-Deficit Hyperactivity Disorder and Cocaine Use Disorder: A Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography Study.

Objectives: Attention-deficit hyperactivity disorder (ADHD) in adulthood shows high co-occurrence rates with cocaine use disorder (CoUD). The self-medication hypothesis (SMH) provides a theoretical explanation for this comorbidity. This study investigates the neurobiological mechanisms that could support SMH in adult patients with attention-deficit hyperactivity disorder with cocaine use disorder (ADHD-CoUD). Materials and Methods: We included 19 ADHD-CoUD patients (84.2% male; age: 32.11 years [7.18]) and 16 CoUD patients (68.7% male; age: 36.63 years [8.12]). All subjects underwent a fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) brain scan. We tested brain metabolism differences between ADHD-CoUD and CoUD patients using voxel-based and regions of interest (ROIs)-based analyses. The correlation between dependence/abstinence duration and regional brain metabolism was also assessed in the two groups. Lastly, we investigated the integrity of brain metabolic connectivity of mesocorticolimbic and nigrostriatal dopaminergic systems, and large-scale brain networks involved in ADHD and addictions. Results: The voxel-wise and ROIs-based approaches showed that ADHD-CoUD patients had a lower metabolism in the thalamus and increased metabolism in the amygdala and parahippocampus, bilaterally, than CoUD subjects and healthy controls (HCs). Metabolism in the thalamus negatively correlated with years of dependence in ADHD-CoUD patients. Moreover, connectivity analyses revealed that ADHD-CoUD patients had a more preserved metabolic connectivity than CoUD patients in the dopaminergic networks and large-scale networks involved in self-regulation mechanisms of attention and behaviors (i.e., anterior default mode network [ADMN], executive network [ECN], and anterior salience network [aSAN]). Conclusions: We demonstrated distinct neuropathological substrates underlying substance-use behaviors in ADHD-CoUD and CoUD patients. Furthermore, we provided neurobiological evidence in support of SMH, demonstrating that ADHD-CoUD patients might experience short-term advantages of cocaine assumption (i.e., compensation of dopaminergic deficiency and related cognitive-behavioral deficits).

Neural responses to emotional stimuli across the dissociative spectrum: Common and specific mechanisms.

AIM: Departing from existing neurobiological models of dissociation, the current study aims at conducting a quantitative meta-analytic review of neural responses to emotional stimuli among individuals ascribed to the dissociative spectrum (DS). Accordingly, the study explored common and specific brain mechanisms across borderline personality disorder, conversion/somatoform disorders, posttraumatic stress disorder, posttraumatic stress disorder related to repeated interpersonal traumatic experiences, and dissociative disorders. METHODS: The meta-analysis included studies that administered emotional stimuli during functional magnetic resonance imaging acquisition among individuals included in the DS. There were two conducted meta-analytic procedures: (i) a Bayesian network meta-analysis for a region-of-interest-based approach; and (ii) robust voxel-based approach. RESULTS: Forty-four independent studies were included for a total of 1384 individuals (DS = 741 patients). The network meta-analysis showed specific patterns of neural activity considering an extended brain network involved in emotion regulation for each condition ascribed to the DS. The voxel-based meta-analysis highlighted an increased activity of dorsal anterior cingulate cortex as a common neurological signature of the DS. CONCLUSION: The common neural feature of the DS captures an implicit appraisal of emotion-eliciting stimuli as threatening and/or noxious for mental and physical integrity of the individual together with painful subjective experiences associated with physiological emotional reactions. Specific brain responses across the DS suggested the engagement in different mechanisms to address emotional stimuli, including implicit avoidance reactions and attempts to overcontrol of affective states together with a disruption of integrative processes of emotional mind-body features.

The Complexity of Impulsivity Dimensions among Abstinent Individuals with Substance Use Disorders.

Impulsivity is a complex construct that has been operationalized considering personality dimensions (e.g., negative urgency [NU], lack of perseverance [LPe], lack of premeditation [LPr], positive urgency [PU]), and neuropsychological processes (i.e., cognitive disinhibition, motor disinhibition, impulsive decision-making). Empirical research suggested that they could represent core features of substance use disorders (SUDs). However, there are no studies that have comprehensively assessed them among patients with SUDs. Furthermore, the quality of relationships among such domains remains unclear. The current case-control study included 59 abstinent patients with SUDs and 56 healthy controls (HCs). There were two independent assessment phases: i) the administration of UPPS-P impulsive behavior scale; ii) a computerized neuropsychological battery (i.e., Attentional Network Test, Go/No-Go task, Iowa Gambling task). Patients with SUDs reported higher levels of NU and PU than HCs. NU, LPe, and LPr were associated to the co-occurrence of multiple SUDs. Motor disinhibition was the core dimension of SUDs. Cognitive disinhibition and Impulsive decision-making were also associated to SUDs. Self-report and neuropsychological dimensions of impulsivity were not correlated within the clinical group. HCs showed significant associations among these domains of impulsivity. Impulsivity should be viewed as a complex system of personality traits and neuropsychological processes among individuals with SUDs.

Emotion Regulation Strategies as Risk Factors for Developmental Psychopathology: a Meta-analytic Review of Longitudinal Studies based on Cross-lagged Correlations and Panel Models.

Cross-sectional relationships between emotion regulation strategies (ERSs) and several psychopathological conditions among children and adolescents have been well-demonstrated. However, the longitudinal associations of ERSs on psychopathological manifestations during development remain unclear, especially considering their reciprocal influences over time. This meta-analytic review was based on a set of ERSs referring to a comprehensive evidence-based model of ER processes. Three hundred thirty-five studies were screened. The meta-analytic procedures were based on 60 studies (N = 20, 191; age: M [SD] = 10.27 [4.36]; years of follow-up: M [SD] = 2.23 [2.76]), which primarily assessed prospective associations between ERt1 and internalizing/externalizing psychopathology (PSY)t2. The cross-lagged correlations among these variables were also considered. Results showed: i) a small prospective association between ERt1 and PSY t2, which was independent of age and length of follow-up period. Adaptive and maladaptive domains of ER were significant moderators. Deficits in adaptive ER seemed more associated to externalizing PSY, whereas maladaptive ER was more associated to internalizing PSY; ii) cross-lagged correlations were comparable with ERt1 - PSY t2 associations. Nevertheless, the detrimental effects of PSY t1 on levels of adaptive ERt2 were larger than the protective effects of adaptive ERt1 on PSYt2. iii) When the other cross-lagged correlations were controlled for, the meta-analytic cross-lagged panel model demonstrated that maladaptive ERt1 was a significant predictor of PSYt2. ER processes should be considered transdiagnostic risk factors for psychopathology during development. Homotypic and heterotypic continuity of psychopathological conditions might reflect the stability or dynamic organization of adaptive and maladaptive ERSs over time.

Is Repetitive Transcranial Magnetic Stimulation (RTMS) a Promising Therapeutic Intervention for Eating Disorders and Obesity? Clinical Considerations Based on a Meta-Analytic Review.

Objective: Repetitive Transcranial Magnetic Stimulation (rTMS) has been introduced to treat eating disorders (EDs), especially Anorexia, Bulimia Nervosa (AN and BN) and other EDs not otherwise specified (NOS). Provisional rTMS single-case studies and clinical trials have been carried out for the treatment of binge eating disorder (BED) and obesity. However, it is still unclear whether and to what extent rTMS might be considered an effective intervention for these conditions. Method: This meta-analysis includes 15 independent studies examining the clinical effects of rTMS among different EDs and obesity (N = 402 patients). Several primary and secondary treatment outcomes have been considered. Cohen's d was used as an effect size measure. The analyses estimate heterogeneity across findings, sources of variability and publication bias together with an assessment of the quality of the studies. Results: The analyses show that rTMS induced large improvements in body mass index (BMI) among obese individuals. Null clinical effects have been detected for primary outcomes (i.e., BMI, binge eating and compensatory behaviors; urge to binge and to eat; severity of EDs symptoms) among individuals with AN, BN and other EDs-NOS. rTMS shows moderate therapeutic effects on the affective functioning (i.e., negative affectivity, depressive and anxious symptoms) of individuals with EDs. rTMS should be considered a promising intervention for the treatment of obesity. Conclusions: This evidence might provisionally support the hypothesis on the implementation of rTMS for BED. Furthermore, rTMS could be included as an ancillary intervention for the other EDs, especially considering secondary treatment outcomes. Future controlled trials are needed to clarify the clinical effects of rTMS for EDs.

Persistent Deficits in Self-Regulation as a Mediator between Childhood Attention-Deficit/Hyperactivity Disorder Symptoms and Substance Use Disorders.

BACKGROUND: The link between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) has been largely demonstrated. Some scholars have hypothesized that self-regulation mechanisms might play a key role in explaining this association. Objective(s): The current study tested the hypothesis that retrospective childhood ADHD symptoms might lead to more severe SUDs and this association should be mediated by current self-ratings of behavioral disinhibition, inattention, and emotional dysregulation among 204 treatment-seeking adults (male: 67.3%; female: 32.7%) with a primary diagnosis of alcohol use disorder and other SUDs. Methods: The mediational model was estimated through self-report measures of childhood ADHD symptoms (independent variable; WURS), current self-regulation mechanisms (mediators)-behavioral disinhibition (BIS-11 motor subscale), difficulties with attention regulation (MAAS) and emotion regulation (DERS)-and severity of SUDs (dependent variable; SPQ alcohol, illicit and prescribed drugs). Results: The analysis showed that alterations in the self-regulation system fully mediated the association between the severity of childhood ADHD symptoms and SUDs in adulthood. Behavioral disinhibition and difficulties in attention regulation were the most representative alterations in self-regulation processes that explained this association. Conclusions: These findings suggest it is useful to implement several therapeutic approaches (e.g. behavioral, mindfulness-based, and pharmacological) to increase the self-regulation abilities of children and adolescents with ADHD in order to reduce the probability of SUD onset in adulthood. However, future longitudinal neuroimaging and neuropsychological studies are needed to further support the role of self-regulation mechanisms in explaining the prospective association between childhood ADHD symptoms and SUDs in adulthood.

The investigation of mechanisms underlying addictive behaviors: a case-control study.

Background: The contradictory nature of behavioral addictions has sustained a nondefinitive debate regarding their construct validity. Objective(s): The current study aims at exploring mechanisms underlying two distinct classes of behaviors-behavioral addictions characterized by core alterations in reward processing systems (ARPS) and behaviors with a main function of maladaptive coping. Methods: This case-control study included 99 treatment-seeking individuals with a primary diagnosis of alcohol use disorder (male: N = 68; female: N = 31) and 74 healthy control (HC) subjects (male: N = 38; female: N = 36). The severity of maladaptive behaviors was measured through the Shorter PROMIS Questionnaire (SPQ). Latent mechanisms were assessed by the Disinhibition Domain of the Personality Inventory for DSM-5 (PID-5-DI) and the Acceptance and Action Questionnaire-II (AAQ-II). Results: The clinical group showed higher severity of behavioral addictions than HC. This difference was not replicated for the other class of maladaptive behaviors, except for compulsive buying. Ordinal regression analysis showed that the clinical group significantly predicted SPQ scores reflecting ARPS, SPQ shopping and starving subscales. This was not replicated for the overall SPQ score capturing maladaptive coping and binge eating behaviors. Controlling for PID-5-DI and AAQ-II scores, which were significantly associated to SPQ subscales, effects of the aforementioned clinical group were not significant. Conclusions: The study highlighted distinct and common mechanisms underlying different classes of maladaptive behaviors. Results supported future neuroscience research for clarifying the role of ARPS in compulsive sex and buying in order to consider them as addictive disorders.

Rumination as a widespread emotion-based cognitive vulnerability in borderline personality disorder: A meta-analytic review.

OBJECTIVE: The current quantitative review aims at comprehensively clarifying the role of rumination in borderline personality disorder (BPD) considering its relevance for several clinical models of the disorder. METHOD: This meta-analysis included 29 independent studies assessing different forms of rumination-general tendency to engage in ruminative thinking patterns and four types of emotion-based rumination among both nonclinical subjects reporting BPD features and patients with BPD. Furthermore, the study tested whether rumination could be considered a widespread emotion-based cognitive vulnerability in BPD. RESULTS: Meta-analytic procedures were based on 46 r coefficients that showed large pooled effect sizes for all forms of rumination. With the exception of interpersonal rumination, the remaining forms of rumination were equally involved in BPD features. CONCLUSIONS: Rumination should be considered a widespread emotion-based cognitive vulnerability in BPD. Future studies should provide longitudinal and contextual-based evaluations of rumination among treatment-seeking individuals with BPD.

Dissociation and emotion regulation strategies: A meta-analytic review.

OBJECTIVE: Clinical and neurobiological models posited that dissociative mechanisms might affect processes involved in emotional generation and regulation. However, there is a lack of a comprehensive theoretical framework that systematically includes dissociation within emotional functioning. METHODS: The current study aims at conducting a meta-analytic review on the relationship between dissociation and emotion regulation in order to empirically estimate to what extent dissociation is related to emotion regulation processes. The meta-analysis was based on r coefficient as effect size measure, using a random-effect approach. RESULTS: The meta-analysis included 57 independent studies for a total of 11596 individuals. Findings showed an overall moderate relationship between dissociation and emotion regulation (rw = .32; p < .05). The association between dissociation and emotion regulation was the same among clinical samples than non-clinical ones. Furthermore, dissociation showed moderate to large relationships with maladaptive domains of emotion regulation, namely disengagement (rw = 0.34; p < .01) (i.e., behavioral avoidance, experiential avoidance, thought and emotional suppression) and aversive cognitive perseveration (rw = 0.38; p < .001) (i.e., rumination, worry and nonacceptance). The analysis did not find significant relationship between dissociation and adaptive domain of emotional regulation (i.e., problem solving, mindfulness). CONCLUSION: Dissociation in the context of emotion regulation might be viewed as a basic neuro-mental mechanism that automatically contribute to the over-modulation of emotional states through avoidance reactions from internal and external reality. Future longitudinal studies are needed to clarify the causal relationships between dissociation and emotion regulation.

Investigating predictive factors of dialectical behavior therapy skills training efficacy for alcohol and concurrent substance use disorders: A machine learning study.

BACKGROUND: Dialectical Behavior Therapy Skills Training (DBT-ST) as stand-alone treatment has demonstrated promising outcomes for the treatment of alcohol use disorder (AUD) and concurrent substance use disorders (SUDs). However, no studies have so far empirically investigated factors that might predict efficacy of this therapeutic model. METHODS: 275 treatment-seeking individuals with AUD and other SUDs were consecutively admitted to a 3-month DBT-ST program (in- + outpatient; outpatient settings). The machine learning routine applied (i.e. penalized regression combined with a nested cross-validation procedure) was conducted in order to estimate predictive values of a wide panel of clinical variables in a single statistical framework on drop-out and substance-use behaviors, dealing with related multicollinearity, and eliminating redundant variables. RESULTS: The cross-validated elastic net model significantly predicted the drop-out. The bootstrap analysis revealed that subjects who showed substance-use behaviors during the intervention and who were treated with the mixed setting (i.e., in- and outpatient) program, together with higher ASI alcohol scores were associated with an higher probability of drop-out. On the contrary, older subjects, higher levels of education, together with higher scores of DERS awareness subscale were negatively associated to drop-out. Similarly, lifetime co-diagnoses of anxiety, bipolar, and gambling disorders, together with bulimia nervosa negatively predicted the drop-out. The machine learning model did not identify predictive variables of substance-use behaviors during the treatment. CONCLUSIONS: The DBT-ST program could be considered a valid therapeutic approach especially when AUD and other SUDs co-occur with other psychiatric conditions and, it is carried out as a full outpatient intervention.

Emotion Regulation, Physical Diseases, and Borderline Personality Disorders: Conceptual and Clinical Considerations.

This perspective paper aims at discussing theoretical principles that could explain how emotion regulation and physical diseases mutually influence each other in the context of borderline personality disorder (BPD). Furthermore, this paper discusses the clinical implications of the functional relationships between emotion regulation, BPD and medical conditions considering dialectical behavior therapy (DBT) as a well-validated therapeutic intervention, which encompasses these issues. The inflexible use of maladaptive emotion regulation strategies (e.g., suppression, experiential avoidance, and rumination) might directly increase the probability of developing physical diseases through a physiological pathway, or indirectly through a behavioral pathway. Some metabolic and chronic medical conditions could significantly impact emotional functioning through biological alterations involved in emotion regulation. Several empirical studies have shown high co-occurrence rates between BPD and several chronic physical diseases, especially ones linked to emotion-based maladaptive behaviors. DBT addresses physical diseases reported by individuals with BPD reducing problematic behaviors functionally associated to emotion dysregulation and identifying physical health as a goal for Building a Life Worth Living.