A systematic review of the relationship between generic and specific metacognitive beliefs and emotion dysregulation: A metacognitive model of emotion dysregulation.

Although a probable association between metacognitive beliefs (also termed 'metacognitions') and emotion dysregulation has been suggested in the literature, the evidence is still sparse and inconclusive. The current study aims to present a comprehensive evaluation of the literature examining the association between metacognitive beliefs and emotion dysregulation. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'metacognitions/metacognitive beliefs/positive metacognitive beliefs/negative metacognitive beliefs/cognitive self-consciousness/beliefs about the need to control thoughts/cognitive confidence/negative beliefs about thoughts concerning uncontrollability and danger/AND difficulties emotion regulation/emotion dysregulation'. A total of 19 studies met the inclusion criteria. In both non-clinical and clinical populations, a higher endorsement of dysfunctional metacognitive beliefs was found to be associated with emotion dysregulation and vice versa. A higher endorsement of metacognitive beliefs may be associated, either directly or via maladaptive forms of mental control (e.g., worry, rumination and suppression) to emotion dysregulation. Metacognitive beliefs could be the potential therapeutic target in clinical interventions aimed at reducing emotion regulation difficulties.

The efficacy of a brief acceptance-based group intervention in a sample of female patients with fibromyalgia and comorbid obesity: a randomised controlled trial.

OBJECTIVES: A two-arm parallel randomised controlled trial was conducted to evaluate the efficacy of a group acceptance-based treatment (ABT) in improving pain acceptance, pain catastrophising, kinesiophobia, pain intensity and physical functioning compared to treatment as usual in patients with fibromyalgia (FM) and comorbid obesity. METHODS: Female individuals diagnosed with FM and obesity (n = 180) were randomly assigned to either a three-weekly group acceptance-based treatment plus treatment as usual (ABT+TAU) or only TAU. The variables of interest were assessed at baseline (T0) and after the interventions (T1). The treatment protocol for the ABT+TAU condition, designed for an inpatient rehabilitation context, is based on acceptance and commitment therapy but focuses specifically on pain acceptance, a crucial factor in fostering a more functional adaptation to chronic pain. RESULTS: Participants in the ABT+TAU group showed significant improvements in pain acceptance (i.e. the primary outcome), but also in pain catastrophising, kinesiophobia, and performance-based physical functioning (i.e. the secondary outcomes) compared to those in the TAU group. However, there were no significant differences in pain intensity between the two groups. CONCLUSIONS: These findings indicate that a brief group-based ABT intervention is effective in enhancing pain acceptance, reducing pain catastrophising and kinesiophobia, and improving performance-based physical functioning. Furthermore, the observed improvements in kinesiophobia and physical functioning may have particular relevance for individuals with comorbid obesity, as they can facilitate greater adherence to physical activity and promote weight loss.

The Italian COVID-19 Anxiety Syndrome Scale: Investigation of the COVID-19 anxiety syndrome and its association with psychological symptoms in an Italian population.

INTRODUCTION: The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a quick and reliable scale assessing dysfunctional coping strategies activated in response to COVID-19 fear and threat. The present study aimed to provide a preliminary validation of the Italian version of the C-19ASS and investigated whether the C-19ASS would mediate the relationship between the Big Five personality traits and psychological outcomes. METHOD: In Study 1, a community sample of 271 participants completed the Italian version of the C-19ASS and results were subjected to a Principal Component Analysis. In study 2, a community sample of 484 participants completed the Italian version of the C-19ASS and a series of measures assessing COVID-19 anxiety, COVID-19 fear, functional impairment, personality traits, depression, generalized anxiety and health anxiety. Internal consistency, concurrent and incremental validity were assessed. Path analyses were run. RESULTS: Factor analysis identified a two-factor solution (i.e., C-19ASS Perseveration and C-19ASS Avoidance) and confirmatory factor analysis suggested a two-factor model best fits the data. The Italian version of the C-19ASS showed good internal consistency. There was also evidence of convergent validity and incremental validity. Path analyses showed that C-19ASS Perseveration mediates the relationship between emotional stability and psychological symptoms (depression, generalized anxiety and health anxiety). CONCLUSION: The Italian version of the C-19ASS appears to be a reliable and valid measure of the COVID-19 anxiety syndrome. The COVID-19 anxiety syndrome could be a suitable therapeutic target to reduce psychological symptoms typically linked to pandemic events, such as depression generalized anxiety and health anxiety.

Metacognitive beliefs across eating disorders and eating behaviours: A systematic review.

BACKGROUND: Literature has pointed out a probable association between metacognitive beliefs and eating disorders. To date, no study has synthetized all research exploring the differences or similarities in metacognitive beliefs across different eating disorders diagnoses and eating problems. AIMS: To review the evidence on metacognitive beliefs across the spectrum of eating disorders and eating behaviours. METHOD: A comprehensive search was conducted on PubMed and PsycInfo. The search terms used were: 'eating disorders/anorexia/bulimia/binge eating disorder/binge eating' AND 'metacognitions/metacognitive beliefs'. A manual search of reference lists was also run. RESULTS: Eleven studies were identified. Anorexia Nervosa was broadly characterized by higher levels of metacognitive beliefs compared to the general population, particularly negative beliefs about worry and beliefs about the need to control thoughts. Positive beliefs about worry were higher in Anorexia Nervosa compared to Bulimia Nervosa and Eating Disorder Not Otherwise Specified, and in Bulimia Nervosa compared to Eating Disorder Not Otherwise Specified. Negative beliefs about worry were higher in Anorexia Nervosa compared to Bulimia Nervosa. Cognitive self-consciousness was higher in Anorexia Nervosa compared to Bulimia Nervosa and Eating Disorder Not Otherwise Specified. CONCLUSIONS: Metacognitive beliefs appear to be implicated in eating disorders and eating behaviours.

Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review.

BACKGROUND: It has been proposed that repetitive negative thinking (worry and rumination) may be more common among adults who have been exposed to childhood adverse experiences, leading to emotional disorders and other adverse outcomes. The current study aims to present a comprehensive evaluation of the literature examining the relationship between the exposure to childhood adversities, repetitive negative thinking and clinical outcomes in adulthood. METHODS: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'childhood adversity/childhood abuse/childhood neglect/early loss event AND worry or rumination'. RESULTS: A total of 18 studies met the inclusion criteria. In both non-clinical and clinical populations, worry and rumination seem to be common among adults exposed to childhood abuse or childhood neglect. Among adults who have been exposed to childhood adversities, rumination seems to be associated with worse clinical outcomes such as severe psychiatric symptoms, depression, dysphoria, suicidal ideation, cognitive complaints, post-traumatic stress symptoms and aggression. CONCLUSION: Early experiences of abuse and neglect may be associated with a tendency to engage in repetitive negative thinking, such as worry and rumination, in adulthood. Among adults, with a history of childhood adversities, tailored treatment to reduce repetitive negative thinking should be considered.

Transcranial direct current stimulation modulates implicit attitudes towards food in eating disorders.

OBJECTIVE: Neuromodulation of regions involved in food processing is increasingly used in studies on eating behaviors, but results are controversial. We assessed the effects of anodal transcranial direct current stimulation (a-tDCS) on food and body implicit preferences in patients with eating disorders (EDs). METHOD: Thirty-six ED patients and 36 healthy females completed three sessions with a-tDCS applied to the medial-prefrontal cortex (mPFC), the right extrastriate body area (rEBA) or in sham mode. Each participant then completed three Implicit Association Tests (IATs) on tasty/tasteless food, underweight/overweight body images, flowers versus insects as control. Differences in latency between incongruent and congruent blocks were calculated (D score). RESULTS: The tDCS by group interaction was significant for the IAT-food D score, with patients showing weaker preference for tasty food than controls in sham, but not a-tDCS sessions. In particular, rEBA stimulation significantly increased patients' D score compared to sham. Moreover, a-tDCS over mPFC and rEBA selectively increased patients' reaction times in the incongruent blocks of the IAT-food. DISCUSSION: A-tDCS on frontal and occipito-temporal cortices modulated food preferences in ED patients. The effect was specific for food images and selective in patients, but not in healthy participants. These findings suggest that neuromodulation of these regions could affect implicit food attitudes.

Metacognitive beliefs and childhood adversities: an overview of the literature.

Within the Self-Regulatory Executive Function theory, emerging data suggest that unhelpful metacognitive beliefs might be associated with exposure to early adversities, however the evidence is still sparse and inconclusive. This study aimed to conduct an overview of the literature to evaluate if exposure to childhood adversities might be associated with the presence of unhelpful metacognitive beliefs. A comprehensive research was conducted on PubMed, Science Direct, Google Scholar from inception to May 2017. The search terms used were: 'childhood adversity/childhood abuse/childhood neglect/childhood loss event' AND 'metacognition/metacognitive beliefs'. A manual search of reference lists was run. Five studies were identified: three on psychiatric patients, two on the general population. Findings suggest that: (a) exposure to childhood abuse or childhood neglect might be associated with unhelpful metacognitive beliefs in adulthood; (b) early adversities are more frequently associated with negative beliefs, than other metacognitive beliefs; (c) metacognitive beliefs seem to mediate the association between childhood adversities and, repetitive thinking and negative affect. In conclusion, metacognitive beliefs might be involved in the association between early adversities and negative emotions. Interventions able to identify and reduce metacognitive beliefs associated to childhood adversities could be considered for treating the emotional consequences of childhood adversities.

The Role of Emotional Competence in Takotsubo Cardiomyopathy.

OBJECTIVE: The current study examined the role of emotional competences and depression in takotsubo cardiomyopathy (TTC). METHODS: We compared 37 TTC patients who experienced emotion triggers (TTC-t: M (SD) age = 66.4 (12.8) years, 33 women) with 37 TTC patients who did not experience emotion triggers (TTC-nt: M (SD) age = 65.8 (11.1) years, 33 women) and 37 patients with acute myocardial infarction who experienced an emotion trigger (AMI-t: M (SD) age = 66.1 (10.1) years, 33 women). Three aspects of emotional competence (emotional intelligence, metacognitive beliefs, and emotional processing deficits) were assessed using the Trait Meta-Mood Scale (TMMS), the Meta-Cognitions Questionnaire 30, and the Emotional Processing Scale. Differences between-group means were evaluated using multivariate analysis of covariance, adjusting for depressive symptom (Hamilton Rating Scale for Depression). RESULTS: Compared with the TTC-nt and AMI-t comparison groups, TTC-t patients had low scores on emotional intelligence (TMMS Attention: F(2, 184) = 23.10, p < .001; TMMS Repair: F(2, 184) = 11.98, p < .001) and high scores in metacognitive beliefs and emotional processing deficits (e.g., Meta-Cognitions Questionnaire 30 Negative Beliefs about Thoughts: F(2, 184) = 56.93, p < .001), independent of the levels of depressive symptom. TTC-nt patients also had significantly lower scores on the Hamilton Rating Scale for Depression scale compared with AMI-t (p = .021) and TTC-t (p = .004) patients. CONCLUSIONS: TTC-t patients showed a specific dysfunctional profile of emotional competence, even after adjusting for depressive symptom. These results provided a better understanding of the psychological factors that contribute to TTC.

Effects of Anger Rumination on Different Scenarios of Anger: An Experimental Investigation.

Anger rumination has been defined as a repetitive thinking style focused on causes and consequences of anger. Different studies have shown the role of anger rumination as a maintaining factor for emotional arousal and stress that can lead to behavioral dysregulation. The present study aims at investigating whether the role of anger rumination in increasing anger is different with respect to different anger scenarios. Moreover, effects of anger rumination on anger will be compared with the effects of 2 different thinking styles (cognitive reappraisal and distraction). Participants were asked to complete a batch of questionnaires assessing trait and state anger and anger rumination; after that, they were asked to identify themselves in different scenarios aimed at eliciting anger for different reasons. Finally, a specific thinking style was induced by reading some suggestions to each participant. Levels of anger were recorded before and after each induction. The type of scenario did not show any influence on levels of anger. All the thinking styles reduced levels of anger, and anger rumination had the smallest impact on anger measurements with respect to reappraisal and distraction. Scenarios did not show any meditational effect on the predicting power of the thinking styles on levels of arousal. Among induced thinking styles, anger rumination led to higher levels of anger, whereas cognitive reappraisal and distraction led to a greater reduction in levels of anger.

Difficulties in emotion regulation: The role of repetitive negative thinking and metacognitive beliefs.

BACKGROUND: Using the Self-Regulatory Executive Function model as a basis, this study explored whether, in both general population and clinical samples, metacognitive beliefs and repetitive negative thinking (i.e., rumination and worry) are associated with higher levels of emotion dysregulation. METHODS: 395 participants from the general population and 388 outpatients seeking psychological treatment were recruited. Emotion dysregulation, metacognitive beliefs, rumination, worry, anxiety, depression, personality disorders were assessed. ANOVA and Welch's tests, correlation and path analyses were run. RESULTS: Repetitive negative thinking was found to play a mediating role in the relationship between metacognitive beliefs and emotion dysregulation in both general population and clinical samples. Moreover, metacognitive beliefs were found to be directly associated to emotion dysregulation. LIMITATIONS: The cross-sectional design. CONCLUSIONS: Emotion dysregulation appears to be associated with the tendency to engage in repetitive negative thinking and metacognitive beliefs. Repetitive negative thinking and metacognitive beliefs could be a suitable therapeutic target to reduce difficulties in emotion regulation.

Repetitive Negative Thinking and Eating Disorders: A Meta-Analysis of the Role of Worry and Rumination.

The role of worry and rumination in eating disorders (EDs) is controversial. This meta-analysis of the literature is aimed at clarifying the relationship between repetitive negative thinking (RNT) and EDs. In accordance with the PRISMA criteria, a comprehensive search of the literature was conducted on PubMed and PsycInfo from inception to March 2021. Search terms: "eating disorder/anorexia/bulimia/binge eating disorder" AND "worry/rumination/brooding/repetitive thinking". A manual search of reference lists was also run. Forty-three studies were included. RNT was found to be associated with anorexia, bulimia, and binge eating disorder. A moderating effect was found for "presence/absence ED diagnosis" and "subtype of ED symptom". ED patients showed higher RNT than the general population. No differences were observed for age or between worry and rumination in the magnitude of their association with EDs.

Daily and nightly anxiety among patients affected by night eating syndrome and binge eating disorder.

We tested if there were any differences about nocturnal and diurnal anxiety between patients either affected by Binge Eating Disorder (BED) or Night eating Syndrome (NES). Fifty four patients affected by BED, 13 by NES and 16 by both BED and NES were tested using the Self Rating Anxiety Scale (SAS) and the Sleep Disturbance Questionnaire (SDQ). Their nocturnal eating behavior was ascertained through the Night Eating Questionnaire (NEQ). Patients affected by both BED and NES scored significantly higher on SAS than other patients. Among NES patients we found a correlation between a SDQ subscale and two subscales of the NEQ. Among BED patients we found a correlation between SAS scores and the nocturnal ingestion subscale of the NEQ. Nocturnal eating is related to nocturnal anxiety among NES patients while it is related to diurnal anxiety among patients affected by BED. These findings support the hypothesis that BED and NES are distinct syndromes sharing overeating but with different pathways to excessive food intake.

Desire Thinking across addictive behaviours: A systematic review and meta-analysis.

INTRODUCTION: Desire Thinking (DT) is a voluntary cognitive process aimed at orienting to prefigure images, information, and memories about positive target-related experience. It comprises of two components: Imaginal Prefiguration and the Verbal Perseveration. DT has been found to be positively associated with alcohol use, gambling, nicotine use, and problematic Internet use. Despite this, neither qualitative nor quantitative reviews have been undertaken to critically summarize findings about the association between DT and addictive behaviours. The aim of this systematic review and meta-analysis is to evaluate the strength of the association between DT and addictive behaviours. METHOD: In accordance to PRISMA criteria, a research was conducted on PubMed and PsycInfo. A manual search of reference lists was also run. Search terms were: "addiction / gambling / alcohol / tobacco / nicotine / drug / cocaine / marijuana / cannabis / opioid / heroin / methadone / internet" AND "Desire Thinking". RESULTS: Ten studies were included. Both components of DT were found to be associated with addictive behaviours (alcohol use, nicotine use, gambling, problematic Internet use) in both clinical and community samples. The strength of the association between Verbal Perseveration and addictive behaviours appears to be stronger for alcohol and nicotine use than Internet use. The association between DT and addictive behaviours is not moderated by age. CONCLUSION: DT is present across different addictive behaviours. The assessment of DT and tailored interventions aimed to reduce the propensity to engage in DT should be considered in the treatment of addictive behaviours.

Perfectionism in depression, obsessive-compulsive disorder and eating disorders.

High levels of perfectionism have been observed in major depression, anxiety disorders and eating disorders. Though few studies have compared levels of perfectionism across these disorders, there is reason to believe that different dimensions of perfectionism may be involved in eating disorders than in depression or anxiety [Bardone-Cone, A. M. et al. (2007). Perfectionism and eating disorders: Current status and future directions. Clinical Psychology Review, 27, 84-405]. The present study compared patients with major depression, obsessive-compulsive disorder, and eating disorders on dimensions of perfectionism. Concern over Mistakes was elevated in each of the patient groups while Pure Personal Standards was only elevated in the eating disorder sample. Doubts about Actions was elevated in both patients with obsessive-compulsive disorder and eating disorders, but not in depressed patients. Analyses of covariance indicated that Concern over Mistakes accounted for most of the variance in the relationship of perfectionism to these forms of psychopathology.

Low perception of control as a cognitive factor of eating disorders. Its independent effects on measures of eating disorders and its interactive effects with perfectionism and self-esteem.

OBJECTIVE: There is a large body of research about perfectionism and low self-esteem in eating disorders (ED). However, little is known about the influence in ED of a distorted cognition in the domain of control: the perception of low control. The present study examined the main and interactive effects of concern over mistakes (an important dimension of perfectionism), self-esteem, and perception of control on drive for thinness, bulimia, and body dissatisfaction. METHOD: Forty individuals with ED and 55 controls completed the Multidimensional Perfectionism Scale, the Anxiety Control Questionnaire, the Rosenberg self-esteem scale, and the three symptomatic scales of the Eating Disorder Inventory, which are drive for thinness, bulimia and body dissatisfaction. Multiple linear regression was used to test the hypothesis that perception of low control has a significant effect on the symptomatic scales of the EDI. RESULTS: The ED group had significantly lower perception of control and self-esteem and higher concern over mistakes, drive for thinness, bulimia, and body dissatisfaction than the control group. Analysis of interactive effects suggested that a combination of a low perception of control and a low self-esteem seems to moderate the effects of concern over mistakes on drive for thinness, bulimia, and body dissatisfaction. DISCUSSION: ED are associated with a tendency to worry about mistakes, a low sense of self-esteem, and a low perception of control over internal feelings and external events. Perception of control and self-esteem seems to moderate the predictive power of concern mistakes on symptoms of ED. The results suggest that a low perception of control is an important cognitive factor in ED.

Visual evaluation of food amount in patients affected by Anorexia Nervosa.

OBJECTIVE: The study compares visual evaluation of an amount of food and an amount of nonedible objects in patients affected by Anorexia Nervosa and control subjects. METHOD: 59 anorexic subjects were asked to evaluate an amount of candies and plastic bricks shown to them. Their answers were compared to both the real number of objects and the parallel evaluations given by 56 control subjects. RESULTS: There were no significant differences in stimuli evaluation between patients affected by AN and control subjects. Both groups reported a significantly lower number of both candies and bricks in comparison to their real number. DISCUSSION: In an experimental condition not related with food intake there is the same under-evaluation of the amount of presented food and nonedible objects among patients affected by AN and Control Subjects. The clinical finding of overestimation of food intake among patients affected by AN seems not to be due to a perceptive bias.

Cognitive Attentional Syndrome and Metacognitive Beliefs in Male Sexual Dysfunction: An Exploratory Study.

Erectile dysfunction (ED) and premature ejaculation (PE) are two forms of male sexual disorder with both psychological and physical features. While their cognitive, attentional, and affective components have been investigated separately, there is a lack of knowledge about the role played by cognitive attentional syndrome in their onset and maintenance. The aim of the present study was to investigate the possible contribution of perseverative thinking styles and thought control strategies to the development and maintenance of ED and PE. The authors hypothesized that such modes of processing might constitute a cognitive attentional syndrome specific to these disorders and sustained by particular metacognitive beliefs. A semistructured interview was administered to 11 participants with ED and 10 with PE in order to assess their metacognitive beliefs and cognitive attentional processes. The results suggest that individuals with ED and PE adopt a range of cognitive attentional strategies aimed at improving their sexual performance, and endorse both positive and negative metacognitive beliefs about these thinking responses. Overall, their cognitive and attentional patterns worsened negative internal states, reduced sexual excitement, detached them from their bodily sensations, and hindered sexual functioning. These preliminary findings suggest that perseverative thinking, thought control strategies, and metacognitive beliefs may play a key role in the onset and maintenance of male sexual dysfunction.

Stressful task increases drive for thinness and bulimia: a laboratory study.

The scientific literature has suggested that stress undergirds the development of eating disorders (ED). Therefore, this study explored whether laboratory induced stress increases self-reported drive for thinness and bulimic symptoms measured via self-report. The relationship between control, perfectionism, stress, and cognition related to ED was examined using correlational methodology. Eighty-six participants completed an experimental task using a personal computer (PC). All individuals completed a battery of tests before and after the stressful task. Analyses showed a significant statistical increase in average scores on the drive for thinness and bulimia measured before and after a stressful task, and path analysis revealed two different cognitive models for the mechanism leading to drive for thinness and bulimia. These findings suggest that stress is an important factor in the development of the drive for thinness and bulimia.

Autonomy and Submissiveness as Cognitive and Cultural Factors Influencing Eating Disorders in Italy and Sweden: An Exploratory Study.

The aim of this exploratory study was to investigate the correlation between cultural and psychological factors in relation to predicting eating disorders in two different non-clinical Italian (n = 61) and Swedish (n = 31) female populations, thought to have different cultures and lifestyles. The Swedish sample would reflect an emancipated model of women pursuing autonomy and freedom but also an ideal of thinness, while the Italian sample would reflect a difficult transition from traditional submissiveness to modern autonomy. Both groups completed self-report instruments assessing cultural values (e.g., collectivism and individualism) and features of eating disorders (e.g., drive for thinness, bulimia, body dissatisfaction, self-esteem, parental criticism and perfectionism). Swedish women were found to display higher levels of bulimia, perfectionism, and individualism than Italian women, while regression analysis showed that in the Italian sample high levels of collectivism were correlated with measures of EDs. The results support the hypothesis that EDs are linked with both modern values of autonomy, independence and emancipation, and situations of cultural transition in which women are simultaneously exposed to traditional models of submission and opportunities for emancipation and autonomy.

Perfectionism, weight and shape concerns, and low self-esteem: Testing a model to predict bulimic symptoms.

Previous studies have tested multivariate models of bulimia pathology development, documenting that a confluence of perfectionism, body dissatisfaction, and low self-esteem is predictive of disordered eating. However, attempts to replicate these results have yielded controversial findings. The objective of the present study was to test an interactive model of perfectionism, weight and shape concerns, and self-esteem in a sample of patients affected by Eating Disorder (ED). One-hundred-sixty-seven ED patients received the Structured Clinical Interview for DSM-IV Axis I (SCID-I), and they completed the Eating Disorder Examination Questionnaire (EDE-Q), the Rosenberg Self-Esteem Scale (RSES), and the Multidimensional Perfectionism Scale (MPS-F). Several mediation analysis models were fit to test whether causal effects of concern over weight and shape on the frequency of bulimic episodes were mediated by perfectionism and moderated by low levels of self-esteem. Contrary to our hypotheses, we found no evidence that the causal relationship investigated was mediated by any of the dimensions of perfectionism. As a secondary finding, the dimensions of perfectionism, perceived criticism and parental expectations, were significantly correlated with the presence of bulimic symptoms. The validity of the interactive model remains controversial, and may be limited by an inadequate conceptualization of the perfectionism construct.