Validation of the Italian Version of the Telepresence in Videoconference Scale (TVS) in a Sample of Psychologists and Psychotherapists During the COVID-19 Pandemic.

OBJECTIVE: Telepresence may play a fundamental role in establishing authentic interactions and relationships in online psychological interventions and can be measured by the Telepresence in Videoconference Scale (TVS), which was validated only with patients to date. This post hoc study aimed to validate the Italian version of the TVS with mental health professionals. METHOD: The Italian TVS was included in an online survey, whose primary aim was to assess the experiences of Italian psychologists and psychotherapists with online interventions during the first wave of the COVID-19 pandemic and was filled in by 296 participants (83.4% females, mean age = 42 years old). RESULTS: Exploratory factor analysis supported the original factor structure only partially because the scale 'Absorption' (i.e., the feeling of losing track of time), as it was formulated, did not measure telepresence. Correlations were also explored between the TVS scales and some survey items pertaining to intimacy and emotional closeness to patients, comfort and positive as well as negative experiences with online interventions. CONCLUSION: The TVS may be a useful tool to measure physical and social telepresence in online interventions, both in patients and in professionals.

Pediatric quality of life multidimensional fatigue scale (PedsQL-MFS) detects the effects of a 3-week Inpatient body weight reduction program for children and adolescents with obesity.

BACKGROUND: Fatigue is a frequent complaint amongst children and adolescents with obesity, and it interferes with adherence to dietary and exercise regimes that could reduce obesity. The present study evaluated the effect of an inpatient 3-week body weight reduction program on body weight and fatigue. METHOD: One hundred children and adolescents with obesity (64% female; aged 11-18 years) undertook an inpatient program of personalized diet, daily exercise, education, and counselling. RESULTS: The sample evidenced a mean reduction in body mass (females: ΔM = 4.3 (sd = 2.1) kg, p < .001), males: ΔM = 6.2 (sd = 2.6) kg, p < .001), BMI standard deviation score (females: ΔM = 0.17 (sd = 0.07), males: ΔM = 0.24 (sd = 0.08), p < .001) and fatigue (females: ΔM = 7.8 (sd = 9.7), males: ΔM = 5.0 (sd = 6.9), p < .001) as measured by the Pediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) and improvements on the Attention problems subscale of the Youth Self Report (total sample: ΔM = 0.89 (sd = 2.44), p < .001). Reliable change analyses revealed fatigue changes were achieved by up to 34% females and 17% males, but the majority did not achieve reliable change and changes in fatigue were not correlated with changes in body mass. CONCLUSIONS: The program achieved clinically significant improvements in some children and adolescents. Future studies should explore predictors of treatment responsiveness. Trial registration Observational study. Not registered.

Weight stigma in patients with overweight and obesity: validation of the Italian Weight Self-Stigma Questionnaire (WSSQ).

PURPOSE: This study aimed to explore the factorial structure of the Italian Weight Self-Stigma Questionnaire (WSSQ) (Study1); and to test structural validity, internal consistency, test-retest reliability, and measurement invariance of the questionnaire across gender, Body Mass Index (BMI), age and occurrence of previous hospitalization for obesity (Study2). METHODS: At admission into a hospital-based program for weight reduction and rehabilitation, 150 inpatients with overweight/obesity (68% females) completed the WSSQ (Study1). In Study2, in addition to the WSSQ, 446 inpatients (61.9% females) completed the Weight Bias Internalization Scale (WBIS), the Body Uneasiness Test (BUT), and the Center for Epidemiologic Studies Depression Scale (CES-D). A subsample of 40 patients also re-completed the WSSQ at discharge from the hospital. RESULTS: The Italian WSSQ showed good overlap with the original factorial structure (Study1) and results were confirmed in Study2. Test-retest reliability and convergent validity showed adequate values. Measurement invariance revealed that WSSQ was perfectly invariant across both BMI and the occurrence of previous hospitalizations for obesity. In both studies, the internal consistency of the questionnaire was deemed acceptable. CONCLUSIONS: The Italian WSSQ is a valid, reliable, and invariant tool for the assessment of weight-related self-stigma among patients with overweight/obesity. Future studies should assess its longitudinal invariance as well as its responsiveness to weight reduction treatments. LEVEL OF EVIDENCE: V, descriptive study.

A post hoc comparison between inpatients with obesity and healthy-weight subjects in the size estimation accuracy of shoulders, waist, and hips widths and circumferences.

PURPOSE: This post hoc study aimed to assess the hypothesis that subjects with obesity could underestimate their body size. METHODS: Data from a previous study with different aims were used to compare 22 female inpatients with obesity with 21 healthy-weight women in the size estimation accuracy of their shoulders, waist, and hips circumferences and widths. The body estimation task with an individualized metric methodology was used to collect data. Frequentist and Bayesian analyses were performed. RESULTS: Samples differed significantly in the accuracy measures of shoulders width and hips as well as waist circumferences: inpatients with obesity underestimated them, while healthy-weight subjects estimated shoulders width accurately but overestimated their hips and waist circumferences. Multiple regression showed that the between-group difference in the accuracy measure of shoulders width was explained by the individuals' education level, while the difference in the accuracy measure of waist circumference resulted to be independent of both age and education level. CONCLUSION: This post hoc study supports the hypothesis that female patients with obesity might underestimate their body size. If these results will be confirmed in future studies, interventions specifically designed to equalize estimations to match the real measures of body size may play a key role in weight-reduction programs for people with obesity. LEVEL OF EVIDENCE: Level III, evidence obtained from cohort or case-control analytic studies.

Factor structure, reliability, inter-rater agreement and convergent validity of the parent and child Italian versions of the paediatric quality of life inventory multidimensional fatigue scale for children and adolescents in paediatric inpatients with obesity and their parents.

OBJECTIVE: This study aimed to examine the factor structure, reliability, inter-rater agreement and convergent validity of the child and parent Italian versions of the paediatric quality of life inventory multidimensional fatigue scale (PedsQL-MFS) in paediatric inpatients with obesity and one of their parents. METHODS: 100 pairs of children/adolescents (64% female, mean age = 15.34) with obesity and one of their parents completed the PedsQL-MFS and the Child Behaviour Checklist (CBCL) or the Youth Self Report. RESULTS: Confirmatory Factor Analysis indicated that the three correlated first-order factors model corresponding to the published subscales demonstrated acceptable fit and achieved strict invariance across parent and child informants. Bifactor Analysis supported the multidimensionality and the reliability of the total and subscale scores as multidimensional composites. Parent-child agreement was low with latent means higher for parent reports. PedsQL-MFS total scores were strongly correlated with Somatic Complaints scores on the CBCL, and moderately associated with anxiety, depression, social problems and school problems. CONCLUSIONS: Total scores of the child and parent Italian versions of the PedsQL-MFS demonstrated good reliability and convergent validity in paediatric inpatients with obesity and their parents, and are complementary rather than interchangeable. LEVEL OF EVIDENCE: No level of evidence.

Psychological factors and trajectories of post-surgical pain: A longitudinal prospective study.

A significant proportion of patients do not experience relief from pain during the early postsurgical period after joint arthroplasty and are at risk for developing chronic pain. The objectives of this study were to identify biopsychosocial factors associated with acute postsurgical pain trajectories and with pain intensity and interference after 1, 3, and 12 months. Two hundred ten patients listed for joint arthroplasty filled a presurgical battery of questionnaires assessing presurgical pain intensity, catastrophizing, emotional distress, state anxiety and depression, self-efficacy, central sensitization, and executive functions. From the day after surgery, they were asked to fill a 7-day diary, including questions about postsurgical pain and postsurgical state catastrophizing. Finally, they provided data about pain intensity and interference after 1, 3, and 12 months. Predictors of acute pain trajectories were investigated using multilevel growth curve analysis. Results showed that central sensitization was a predictor of the intercept of pain trajectories and daily postsurgical catastrophizing was a significant covariate of pain intensity in the acute phase. Analyses of follow-up data showed that central sensitization was a predictor of pain intensity and pain interference at 3 and 12 months, that emotional distress was related with pain intensity and interference at 1 month, and with pain interference at 3 months, and that cognitive flexibility was associated with pain interference at 1 month. Assessment of these factors could enable to identify patients at risk for worse outcomes and to plan targeted treatments to be implemented during the patient's inward stay.

Structural validity, measurement invariance, reliability and diagnostic accuracy of the Italian version of the Yale Food Addiction Scale 2.0 in patients with severe obesity and the general population.

PURPOSE: To examine the structural validity, measurement invariance, reliability, and some other psychometrical properties of the Italian version of the Yale Food Addiction Scale 2 (I-YFAS 2.0) in patients with severe obesity and the general population. METHODS: 704 participants-400 inpatients with severe obesity and 304 participants enrolled from the general population-completed the I-YFAS 2.0 and questionnaires measuring eating disorder symptoms. A first confirmatory factor analysis (CFA) tested a hierarchical structure in which each item of the I-YFAS 2.0 loaded onto one of the twelve latent symptoms/criteria which loaded onto a general dimension of Food Addiction (FA). The second CFA tested a first-order structure in which symptoms/criteria of FA simply loaded onto a latent dimension. Measurement invariance (MI) between the group of inpatients with severe obesity and the sample from the general population was also tested. Finally, convergent validity, test-retest reliability, internal consistency, and prevalence analyses were performed. RESULTS: CFAs confirmed the structure for the I-YFAS 2.0 for both the hierarchical structure and the first-order structure. Configural MI and strong MI were reached for hierarchical and the first-order structure, respectively. Internal consistencies were shown to be acceptable. Prevalence of FA was 24% in the group of inpatients with severe obesity and 3.6% in the sample from the general population. CONCLUSIONS: The I-YFAS 2.0 represents a valid and reliable questionnaire for the assessment of FA in both Italian adult inpatients with severe obesity and the general population, and is a psychometrically sound tool for clinical as well as research purposes. LEVEL OF EVIDENCE: Level V, descriptive study.

Correction to: Evaluation of the reliability and validity of the Italian version of the schema mode inventory for eating disorders-short form for adults with dysfunctional eating behaviors.

The article Evaluation of the reliability and validity of the Italian version.

Evaluation of the reliability and validity of the Italian version of the schema mode inventory for eating disorders: short form for adults with dysfunctional eating behaviors.

PURPOSE: To examine the psychometric properties and the factorial structure of the Italian version of the schema mode inventory for eating disorders-short form (SMI-ED-SF) for adults with dysfunctional eating patterns. METHODS: 649 participants (72.1% females) completed the 64-item Italian version of the SMI-ED-SF and the eating disorder examination questionnaire (EDE-Q) for measuring eating disorder symptoms. Psychometric testing included confirmatory factor analysis (CFA) and internal consistency. Multivariate analysis of covariance (MANCOVA) was also run to test statistical differences between the EDE-Q subscales on the SMI-ED-SF modes, while controlling for possible confounding variables. RESULTS: Factorial analysis confirmed the 16-factors structure for the SMI-ED-SF [S-Bχ2 (1832) = 3324.799; p < .001; RMSEA = 0.045; 90% CI 0.043-0.048; CFI = 0.880; SRMR = 0.066; χ2/df = 1.81; < 3]. Internal consistency was acceptable in all scales, with Cronbach's Alpha coefficients ranging from 0.635 to 0.873. CONCLUSIONS: The SMI-ED-SF represents a reliable and valid alternative to the long-form SMI-ED for assessment and conceptualization of schema modes in Italian adults with disordered eating habits. Its use is recommended for clinical and research purposes. LEVEL OF EVIDENCE: Level V, descriptive study.

Psychometric properties of the modified Yale Food Addiction Scale Version 2.0 in an Italian non-clinical sample.

PURPOSE: To assess the dimensionality and psychometric properties of the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) in an Italian non-clinical sample. METHODS: 262 adults (184 women) were administered the Italian versions of the mYFAS 2.0, and questionnaires measuring binge eating severity, anxiety and depression symptoms, and emotional dysregulation. RESULTS: 15 individuals (5.7%) met the criteria for a diagnosis of food addiction according to the mYFAS 2.0. Bayesian confirmatory factor analysis supported a single-factor solution for the mYFAS 2.0. The mYFAS 2.0 had good internal consistency (Ordinal α = 0.91), and convergent validity with binge eating severity (r = 0.67, p < 0.001), both anxiety (r = 0.31, p < 0.001) and depressive (r = 0.35, p < 0.001) symptoms, and difficulties in emotion regulation (r = 0.35, p < 0.001). Finally, both discriminant validity with dietary restraint (Gamma = 0.11; p = 0.52) and incremental validity in predicting binge eating severity over emotion dysregulation and psychopathology (b = 0.52; t = 11.11; p < 0.001) were confirmed. CONCLUSIONS: The Italian mYFAS 2.0 has satisfactory psychometric properties and can be used as a brief instrument for the assessment of addictive eating behaviors when time constraints prevent the use of the original version. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

Validation of the Italian Yale Food Addiction Scale in postgraduate university students.

PURPOSE: This study was aimed to examine the structural and construct validity of the Italian version of the Yale Food Addiction Scale in a multisite sample of postgraduate students. METHODS: Two hundred and fifty-six subjects (78.1% females) aged from 18 to 53 years (mean = 23.93, SD = 4.96) and attending different postgraduate university programs at multiple Italian universities completed the Italian YFAS, the Italian Binge Eating Scale (BES), the Italian Eating Attitudes Test-26 and the Italian Dutch Eating Behavior Questionnaire (DEBQ) online through Qualtrics. RESULTS: Confirmatory Factor Analysis showed that the single-factor model of the Italian YFAS including all original items had adequate fit indexes (χ2252 = 454.183; p < 0.001; normed χ2 = 1.802; RMSEA = 0.056; 90% CI 0.048-0.076; CFI = 0.761; WRMR = 1.592). However, item analysis revealed that item#25 had zero variance (all subjects were assigned the same score after item dichotomization) and item#24 had a low factor loading, and were thus removed. Furthermore, item#10 and item#11 showed to be almost perfectly correlated (r = 0.998) and were thus parceled. The resulting 19-item single-factor model revealed a better fit to the data (χ2152 = 235.69; p < 0.001; normed χ2 = 1.556; RMSEA = 0.046; 90% CI 0.034-0.058; CFI = 0.858; WRMR = 1.236) and its internal consistency was acceptable (KR-20 = 0.72). Also, a single-factor model including the seven diagnostic symptoms was tested and showed adequate fit values (χ220 = 41.911; p < 0.003; normed χ2 = 2.09; RMSEA = 0.065; 90% CI 0.037-0.093; CFI = 0.946; WRMR = 1.132). Statistically significant and small-to-high correlations were found with all convergent measures, in particular with the BES. CONCLUSION: The Italian 19-item YFAS resulted to be a valid and reliable tool for the assessment of food addiction in postgraduate students. LEVEL OF EVIDENCE: Level V, descriptive study.

Web-Based Interventions for Weight Loss or Weight Loss Maintenance in Overweight and Obese People: A Systematic Review of Systematic Reviews.

BACKGROUND: Weight loss is challenging and maintenance of weight loss is problematic. Web-based programs offer good potential for delivery of interventions for weight loss or weight loss maintenance. However, the precise impact of Web-based weight management programs is still unclear. OBJECTIVE: The purpose of this meta-systematic review was to provide a comprehensive summary of the efficacy of Web-based interventions for weight loss and weight loss maintenance. METHODS: Electronic databases were searched for systematic reviews and meta-analyses that included at least one study investigating the effect of a Web-based intervention on weight loss and/or weight loss maintenance among samples of overweight and/or obese individuals. Twenty identified reviews met the inclusion criteria. The Revised Assessment of Multiple SysTemAtic Reviews (R-AMSTAR) was used to assess methodological quality of reviews. All included reviews were of sufficient methodological quality (R-AMSTAR score ≥22). Key methodological and outcome data were extracted from each review. RESULTS: Web-based interventions for both weight loss and weight loss maintenance were more effective than minimal or control conditions. However, when contrasted with comparable non-Web-based interventions, results were less consistent across reviews. CONCLUSIONS: Overall, the efficacy of weight loss maintenance interventions was stronger than the efficacy of weight loss interventions, but further evidence is needed to more clearly understand the efficacy of both types of Web-based interventions. TRIAL REGISTRATION: PROSPERO 2015: CRD42015029377; http://www.crd.york.ac.uk/PROSPERO/display_record.asp? ID=CRD42015029377 (Archived by WebCite at http://www.webcitation.org/6qkSafdCZ).

Stages of change in obesity and weight management: factorial structure of the Italian version of the University of Rhode Island Change Assessment Scale.

PURPOSE: To examine the factorial structure of the University of Rhode Island Change Assessment Scale (IT-URICA) for weight management in a sample of Italian overweight and obese patients enrolled in a nutritional rehabilitation program. METHODS: 334 inpatients completed the translated and adjusted version of the IT-URICA at admission to the hospital. Psychometric testing included confirmatory factor analysis and internal consistency (Cronbach's α). RESULTS: The IT-URICA for weight management was successfully translated into Italian, and the factorial analysis confirmed the four-factor solution of the commonly accepted version of the measure. CONCLUSION: High levels of RTC are considered critical to the long-term success of weight management, and the IT-URICA may be an appropriate measure of motivational readiness for use among Italian overweight and obese patients. Its use is, therefore, recommended for clinical and research purposes.

Factor Structure of the Binge Eating Scale in a Large Sample of Obese and Overweight Patients Attending Low Energy Diet Therapy.

In the present study, we evaluated the dimensionality and psychometric properties of the Italian version of the Binge Eating Scale (BES) in a 669 (127 men and 542 women) obese and overweight patients seeking weight loss treatment. All participants were administered the Italian version of the BES. Fit statistics for the alternative SEM models demonstrated that both the one-factor and competing two-factor models had a comparable fit to the data. Thus, we selected the one-factor model as the most parsimonious. The BES had good internal consistency reliability (α = 0.89) with a moderate mean inter-item correlation (rii = 0.34). Given that we were not able to clearly determine the best model among the competing two-factor models and a comparable fit of these models with the one-factor model, we have suggested that the one-factor model is the best fitting model describing the dimensionality of the BES.

Psychometric properties of the Italian Yale Food Addiction Scale in overweight and obese patients.

AIM: To assess the dimensionality and psychometric properties of an Italian version of the Yale Food Addiction Scale (YFAS) in a sample of obese/overweight patients attending low-energy diet therapy. METHODS: Participants were 300 overweight and obese patients who were admitted to a private medical center in Rome, Italy. Controls were 300 (231 women and 69 men) adults from the general population. All of the participants were administered the YFAS and the binge eating scale (BES). RESULTS: The one-factor model of the YFAS reported in previous studies did not fit the data χ(2)(209) = 466.69, p < 0.001, root mean square error of approximation (RMSEA) = 0.07; 90% CI: 0.06/0.08; comparative fit index (CFI) = 0.91; weighted root mean square residual (WRMR) = 1.40]. Through item analysis, it was suggested that five items (items #10, #11, #22, #24, and #25) with low item-total correlations should be removed from the measure. A 16-item one-factor model revealed a better fit to the data (χ(2)(104) = 174.56; p < 0.001; RMSEA = 0.05; 90% CI: 0.04/0.07; CFI = 0.96), although the WRMR was slightly higher than that suggested as an indicator of good fit (WRMR = 1.01). The YFAS-16 had satisfactory internal consistency; it was able to discriminate obese patients from controls and strongly correlated with BES scores. CONCLUSION: The YFAS-16 assesses all of the "symptoms" represented in the original version and has satisfactory psychometric properties, although the percentage of food addiction diagnoses according to the YFAS-16 is lower than the percentage of diagnoses according to the original version of the questionnaire.

The ACTonHEART study: rationale and design of a randomized controlled clinical trial comparing a brief intervention based on Acceptance and Commitment Therapy to usual secondary prevention care of coronary heart disease.

BACKGROUND: Modifiable risk factors, including life-style habits and psychological variables, have been increasingly demonstrated to have an important role in influencing morbidity and mortality in cardiovascular patients, and to account for approximately 90% of the population risk for cardiac events.Acceptance and Commitment Therapy (ACT) has shown effectiveness in promoting healthy behaviors, and improving psychological well-being in patients with chronic physical conditions. Moreover, a first application of an acceptance-based program in cardiac patients has revealed high treatment satisfaction and initial evidences of effectiveness in increasing heart-healthy behaviour. However, no clinical trial to date has evaluated the efficacy of an acceptance-based program for the modification of cardiovascular risk factors and the improvement of psychological well-being, compared to usual secondary prevention care. METHODS: Approximately 168 patients will be recruited from an outpatient cardiac rehabilitation unit and randomly assigned to receive usual care or usual care + a brief ACT-based intervention. The ACT group will be administered five group therapy sessions integrating educational topics on heart-healthy behaviours with acceptance and mindfulness skills. Participants will be assessed at baseline, six weeks later (post treatment for the ACT condition), at six and twelve months follow-up.A partially-nested design will be used to balance effects due to clustering of participants into small therapy groups. Primary outcome measures will include biological indicators of cardiovascular risk and self-reported psychological well-being. Treatment effects will be tested via multilevel modeling after which the mediational role of psychological flexibility will be evaluated. DISCUSSION: The ACTonHEART study is the first randomized clinical trial designed to evaluate the efficacy of a brief group-administered, ACT-based program to promote health behavior change and psychological well-being among cardiac patients. Results will address the effectiveness of a brief treatment created to simultaneously impact multiple cardiovascular risk factors. Conducted in the context of clinical practice, this trial will potentially offer empirical support to alternative interventions to improve quality of life and reduce mortality and morbidity rates among cardiac patients. TRIAL REGISTRATION: clinicaltrials.gov/ (NCT01909102).

Can cardiac resynchronization therapy improve cognitive function? A systematic review.

INTRODUCTION: Cognitive impairment (CI) comprises a measurable deficit of different cognitive domains (memory, attention, problem solving, and motor speed), and has a high prevalence among congestive heart failure (CHF) patients. Only a few pilot studies have investigated the effects of cardiac resynchronization therapy (CRT) on cognitive performance. The purpose of this systematic review is to outline and evaluate results of published studies that assess the impact of CRT on neuropsychological function in CHF. METHODS: Electronic databases were searched for articles containing the following terms: CRT, cognition, cognitive, and neurocognitive. A data extraction was performed according to our objective from each study. Effect sizes were computed using Hedges' g. The within-group formula was used for cohort studies with a pre-post design, while the between-group formula was used for studies that compared independent groups. Multiple outcomes were combined in domain-specific synthetic scores as well as in a global score for each study, and a fixed-effect model was used to estimate the summary effects. RESULTS: Only three studies met criteria for inclusion in the analysis. The results of these studies were discordant and methodological limitations were identified. The meta-analysis of cognitive outcomes showed a nonsignificant overall effect (Hedges' g = 0.131, 95% confidence interval: -0.16 to 0.422), while the summary effects on executive functioning and attention reached statistical significance (Hedges' g = 0.374, 95% confidence interval: 0.085-0.662 and Hedges' g = 0.343, 95% confidence interval: 0.051-0.635, respectively). CONCLUSION: CI and related negative consequences have been largely documented in patients with heart failure but very few studies have assessed the plausible benefits of CRT on patients' cognitive function. Despite the statistical significance of the domain-specific pooled effects, their validity and clinical relevance is lacking due to methodological limitations.

Virtual reality for enhancing the cognitive behavioral treatment of obesity with binge eating disorder: randomized controlled study with one-year follow-up.

BACKGROUND: Recent research identifies unhealthful weight-control behaviors (fasting, vomiting, or laxative abuse) induced by a negative experience of the body, as the common antecedents of both obesity and eating disorders. In particular, according to the allocentric lock hypothesis, individuals with obesity may be locked to an allocentric (observer view) negative memory of the body that is no longer updated by contrasting egocentric representations driven by perception. In other words, these patients may be locked to an allocentric negative representation of their body that their sensory inputs are no longer able to update even after a demanding diet and a significant weight loss. OBJECTIVE: To test the brief and long-term clinical efficacy of an enhanced cognitive-behavioral therapy including a virtual reality protocol aimed at unlocking the negative memory of the body (ECT) in morbidly obese patients with binge eating disorders (BED) compared with standard cognitive behavior therapy (CBT) and an inpatient multimodal treatment (IP) on weight loss, weight loss maintenance, BED remission, and body satisfaction improvement, including psychonutritional groups, a low-calorie diet (1200 kcal/day), and physical training. METHODS: 90 obese (BMI>40) female patients with BED upon referral to an obesity rehabilitation center were randomly assigned to conditions (31 to ECT, 30 to CBT, and 29 to IP). Before treatment completion, 24 patients discharged themselves from hospital (4 in ECT, 10 in CBT, and 10 in IP). The remaining 66 inpatients received either 15 sessions of ECT, 15 sessions of CBT, or no additional treatment over a 5-week usual care inpatient regimen (IP). ECT and CBT treatments were administered by 3 licensed psychotherapists, and patients were blinded to conditions. At start, upon completion of the inpatient treatment, and at 1-year follow-up, patients' weight, number of binge eating episodes during the previous month, and body satisfaction were assessed by self-report questionnaires and compared across conditions. 22 patients who received all sessions did not provide follow-up data (9 in ECT, 6 in CBT, and 7 in IP). RESULTS: Only ECT was effective at improving weight loss at 1-year follow-up. Conversely, control participants regained on average most of the weight they had lost during the inpatient program. Binge eating episodes decreased to zero during the inpatient program but were reported again in all the three groups at 1-year follow-up. However, a substantial regain was observed only in the group who received the inpatient program alone, while both ECT and CBT were successful in maintaining a low rate of monthly binge eating episodes. CONCLUSIONS: Despite study limitations, findings support the hypothesis that the integration of a VR-based treatment, aimed at both unlocking the negative memory of the body and at modifying its behavioral and emotional correlates, may improve the long-term outcome of a treatment for obese BED patients. As expected, the VR-based treatment, in comparison with the standard CBT approach, was able to better prevent weight regain but not to better manage binge eating episodes.

Do life-events that obese inpatients think happened to them soon before their subjective problematic weight gain have an effect on their current psychopathology over and beyond BMI and binge eating?

The present study had two aims: (1) to investigate life-events that obese inpatients think happened to them during the 6 months preceding their subjective problematic weight gain and (2) to evaluate the associations of such life-events with psychopathology controlling for the effects of gender, age, BMI and binge eating in a large sample of obese inpatients referred to hospital for weight-loss treatment. The analysis used cross-sectional data on 2,900 obese adults from the hospital database. Psychopathology was assessed with the SCL-90 questionnaire, binge eating was evaluated with the Bulimic Investigatory Test, Edinburgh (BITE) and life-events were retrospectively assessed with a pre-defined self-report checklist asking patients to select the events that occurred to them in the 6 months preceding their problematic weight gain. Multivariate analysis of covariance was used to test the association between a pre-defined classification of patients according to the kind of life-events ("no event", "undefined events", "negative events" and "mixed events") with psychopathology controlling for gender, age, BMI and binge eating. The life-events factor was significantly associated with psychopathology even after adjusting for the effects of gender, age, BMI and binge eating. A significant linear trend was evident so that obese patients who reported both negative and undefined events or only negative events had higher levels of psychopathology than patients reporting only undefined events or no event. Though these findings should be considered with caution due to the subjective recall of problematic weight gain and the retrospective assessment of life-events, future studies investigating the link between obesity and psychopathology should not ignore the role of negative life-events that obese patients think happened to them before weight gain.

Does resilience mediate the association between mental health symptoms and linguistic markers of trauma processing? Analyzing the narratives of women survivors of intimate partner violence.

Intimate partner violence (IPV) is a serious issue for women from all cultures and backgrounds. Studies on the negative consequences of violence suggest that women with a history of abuse are more likely to display depressive and PTSD symptoms. However, recent research has focused on the mechanisms underpinning resilience and the processing of traumatic memories, including linguistic markers and how they may reflect the mental health of traumatized individuals. In this study, we analyzed trauma narratives to investigate whether resilience mediates the impact of PTSD and depression symptoms on five trauma-processing mechanisms (cognitive processing, emotional processing, perceived threat to life, self-perspective, and integration of traumatic memories). Forty-three abused women (mean age = 38.74 years; SD = 9.41) wrote about their traumatic experiences and completed instruments assessing their levels of PTSD, depression, and resilience. We used LIWC software to analyze the women's narratives in terms of linguistic markers of psychological processing. Mediation analysis indicated that resilience fully mediated the impact of mental health symptoms on emotional processing, perceived threat to life, and integration of traumatic memories and partially mediated cognitive processing and self-perspective. We discuss the clinical implications of these findings, emphasizing the need to focus on the resources and strengths of women survivors of abuse in designing targeted psychological interventions.