Instagram Stories Unveiled: Exploring Links with Psychological Distress, Personality, and Gender.

Instagram is one of the most used platforms, and ephemeral stories are proving to be the most used medium for users to share content on the platform. However, there have been few studies examining this type of content in relation to emotional well-being. This study examined the association between the number of published Instagram stories, psychological well-being, personality traits, and gender in a sample of 734 Instagram users from Italy, including 281 men and 453 women, with a mean age of 25.19 years (SD = 7.08). Participants were recruited online and asked to complete an online questionnaire. Differences were found between genders in terms of time spent on Instagram, but not in terms of the number of stories posted in the past week. In the overall sample, a small positive correlation was found between the number of Instagram stories posted and extraversion. When considering gender differences, small effect sizes were observed for emotional dysregulation, agreeableness, and neuroticism, indicating a stronger association with Instagram stories in the female group, and for openness, indicating a stronger association in the male group. Results of multiple regression analyses suggest that among females, psychological variables, including personality and emotional distress, may have a stronger association with Instagram stories. To our knowledge, this is the first study to report these differences. The findings help to clarify how certain characteristics of social media platforms relate to psychological well-being and personality differently in men and women in their journey to using social media.

Childhood trauma and factors influencing primary school teachers' reporting of child abuse: Insights from Italy.

BACKGROUND: Childhood traumatic experiences can profoundly impact individuals, posing risks to the physical and psychological well-being of children and influencing their psychological development. Teachers in primary schools play a critical role in identifying and reporting suspected cases of child abuse and maltreatment (CAM), which initiates child protection interventions. However, the psychological factors that influence teachers' likelihood of reporting suspected CAM cases remain largely unexplored. AIM: This study investigates the influence of teachers' childhood traumatic experiences and psychological factors (i.e., cognitive empathy and psychological detachment) on their reporting behavior regarding child abuse and maltreatment, addressing an important social issue. PARTICIPANTS: The study involved 1380 primary school teachers from Italy (88.3 % female; aged 21-69, Mage 46.7, DS 10.3). RESULTS: The results reveal that teachers with a history of childhood emotional abuse tend to report a higher number of suspected child abuse and maltreatment cases. Other forms of traumatic childhood experiences were not significantly associated with teachers' reporting suspected cases of CAM. Additionally, cognitive empathy and psychological detachment emerge as significant predictors of teachers' reporting behavior. CONCLUSIONS: This research contributes to the existing literature by providing unique insights into actual reporting behavior within an unexplored cultural context.

Treatment mechanism of the WHO caregiver skills training intervention for autism delivered in community settings.

This study examined the mechanism of effect of the WHO Caregiver Skills Training (CST) through secondary analysis of a pilot RCT conducted in community settings. Participants were 86 caregivers (77% mothers) of children with ASD (78% male, mean age: 44.8 months) randomized to CST (n = 43) or treatment as usual (n = 43). The primary outcomes, measured at baseline (t1), immediately post-intervention (t2), and 3 months post-intervention (t3), were derived from the coding of caregiver-child free play interactions with the Brief Observation of Social-Communication Change (BOSCC) and the Joint Engagement Rating Inventory scale (JERI). At t3 positive treatment main effects had been observed for caregiver skills supportive of the interaction and for flow of the interaction (JERI), albeit only non-significant changes in the expected direction for child outcomes: autism phenotypic behaviors (BOSCC), joint engagement and availability to interact (JERI). This study tested the theory of change of CST, hypothesizing that the intervention would lead to an improvement on all child and dyad outcomes through an increase in the caregiver skills supportive of the interaction. Serial mediation analyses revealed that the effect of the intervention was significantly influenced by change in caregiver skills. Participation in the intervention led to notable increases in caregiver skills at t2 and t3, which subsequently contributed to improvements at t3 in flow of the interaction, autism phenotypic behavior, joint engagement, and availability to interact. We confirmed our a priori hypothesis showing that change in caregiver skills significantly mediated the effect of treatment on the dyad primary outcome, as well as on the other child outcomes that had shown non-significant changes in the expected direction. Implications for intervention design and policy making in the context of public health services are discussed.

Sense of Belonging at School and on Social Media in Adolescence: Associations with Educational Achievement and Psychosocial Maladjustment.

Belongingness is a key factor in the psychological development and school adjustment of children and adolescents. Going beyond the existing literature, the present study evaluated the association between two sources of belongingness, namely sense of belonging at school (SOBAS) and on social media (SOBOSM), and both psychological maladjustment and educational achievement. Sample consisted of 698 early-to-late adolescents (52.3% female, mean age = 13.79 ± 2.09). Both SOBAS and SOBOSM showed negative direct associations with psychological maladjustment. SOBOSM showed a negative direct association with educational achievement. Social media addiction mediated the links between both SOBAS and SOBOSM and psychological maladjustment and education achievement. Overall, findings suggest that adolescents reporting high sense of belonging both at school and on social media may at lower risk for psychological maladjustment. However, adolescents reporting low SOBAS and high SOBOSM may also be a greater risk of SMA, possibly impacting their psychological health and school adjustement.

PE-Iv (Panorama Education-Italian version): the adaptation/validation of 5 scales, a step towards a SEL approach in Italian schools.

Implementing a Social and Emotional Learning (SEL) approach in school requires monitoring certain skills. As awareness of SEL increases in Italy, it is necessary to provide instruments to monitor these skills within a systemic approach. This study presents the cultural adaptation/validation of 5 scales from Panorama Education, which are widely used in school districts in the United States, to the Italian middle/high school context: Grit, Sense of Belonging, Self-Management, Social Awareness, and Self-Efficacy. After cultural adaptation, 709 middle/high school students answered an online questionnaire (2021). Psychometric properties showed good internal consistency and confirmatory factor analysis showed a good fit index. The differences in gender and grade level support the validity of the instrument.

The representation of bullying in Italian primary school children: A mixed-method study comparing drawing and interview data and their association with self-report involvement in bullying events.

Bullying continues to be a social issue affecting millions of students of all ages worldwide. Research on bullying seems to be dominated by quantitative research approaches employed standardized categories and measures, ultimately limiting our knowledge about children's own view on bullying. Our research follows another direction, aiming to explore the representation of bullying in a sample of Italian primary school children by using and comparing the functioning of two qualitative research instruments: interviews, and children's drawings. In addition, aided by quantitative analyses, we aimed to investigate whether students' involvement in different bullying roles (as bullies, victims, or defenders), as measured by self-assessment, correlated with different characteristics of the representation of bullying emerging from children's drawings and interviews. We recruited a convenient sample of 640 primary school students (mean age = 9.44; SD = 0.67), 53.3% of whom were male. The results showed that all forms of bullying, i.e., physical, verbal, and social bullying, could be identified in interview and drawing data, although references to all types of bullying were more frequent in interview data. In terms of bullying criteria, the presence of a power imbalance between the bully and the victim was most frequently detected in both the interview data and the drawing data, while repetition was more easily detected in the interview data. The interview data showed that sadness was the most frequently reported victim emotions, followed by fear, anger, and lack of emotion. The drawing data showed a similar pattern, although victims were more frequently described as lacking emotions compared to the interview data. In both interview and drawing data, age and female gender were positively associated with references to verbal bullying, and negatively associated with references to physical bullying. Additionally, bully/victim children were more likely than uninvolved children to depict physical bullying in the drawings, while this association was not detected in interview data. In summary, our study shows that, compared with drawings, interviews tend to provide a more comprehensive view of children's own representation of bullying, while drawing data tend to show stronger connections with children's current personal experiences of bullying.

Introducing the QACP: development and preliminary validation of an instrument to measure psychotherapist's core competencies.

The movement towards the conceptualization, description and evaluation of psychotherapists' competencies has been widely developed in the last years and has relevant implications for psychotherapy, training, and continuous education. In Italy, this movement has been supported by the Committee for Psychotherapists' Competencies established in 2010 by FIAP (Italian Federation of Psychotherapy's Associations) and CNSP (National Association of Psychotherapy's Training Institutes) and has involved more than 1000 psychotherapists from different approaches, by means of conferences, expert meetings, workshops, and focus groups. One of the outcomes of this process has been the development of a new self-assessment tool for core competencies (i.e., those that are shared by therapists from all modalities): the QACP (Questionario per l'Autovalutazione delle Competenze dello Psicoterapeuta). The present study aims to present the process of development and the preliminary proofs of the validity of this tool. Construct and knowngroup validity of the questionnaire were examined, and reliability was estimated by computing the internal consistency reliability coefficients for both the overall and the subscale scores. Overall, the instrument showed satisfactory psychometric characteristics. The limitations of the study and the results are discussed and directions for further research are proposed.

The Post-Traumatic Stress Disorder Checklist for DSM-5: Psychometric Properties of the Italian Version.

BACKGROUND: The present study aimed to investigate the psychometric properties of the Italian version of the PTSD Checklist for the DSM-V (PCL-5) in a group of adults who had experienced heterogenous traumatic events. METHODS: Six hundred and one participants met the inclusion criteria and completed a set of questionnaires through an online survey. Before administering the survey, the PCL-5 was translated into Italian according to the back-translation method. The factorial structure of the PCL-5 was assessed through multiple confirmatory factor analyses. Gender measurement invariance and concurrent and criterion validity were also evaluated. RESULTS: The instrument had a seven-factor structure and it worked in a similar manner for males and females. With regard to the concurrent validity, results showed that higher PCL-5 scores were associated with higher levels of depression and rumination and lower levels of life satisfaction. Regarding criterion validity, results revealed that PCL-5 scores were, on average, higher for females than for males, and the temporal distance from the traumatic event was negatively correlated with the total PCL-5 score. CONCLUSIONS: The findings indicated that the Italian version of the PCL-5 was able to provide valid and reliable scores for the assessment of PTSD symptoms in the Italian population.

Mining Digital Traces of Facebook Activity for the Prediction of Individual Differences in Tendencies Toward Social Networks Use Disorder: A Machine Learning Approach.

More than three billion users are currently on one of Meta's online platforms with Facebook being still their most prominent social media service. It is well known that Facebook has designed a highly immersive social media service with the aim to prolong online time of its users, as this results in more digital footprints to be studied and monetized (via psychological targeting). In this context, it is debated if social media platforms can elicit addictive behaviors. In the present work, we demonstrate in N = 1,094 users that it is possible to predict from digital footprints of the Facebook users their self-reported addictive tendencies toward social media (R > 0.30) by applying machine-learning strategies. More specifically, we analyzed the predictive power of a set of models based on different sets of features extracted from digital traces, namely posting activity, language use, and page Likes. To maximize the predictive power of the models, we used an ensemble of linear and non-linear prediction algorithms. This work showed also sufficient accuracy rates (AUC above 0.70) in distinguishing between disordered and non-disordered social media users. In sum, individual differences in tendencies toward "social networks use disorder" can be inferred from digital traces left on the social media platform Facebook. Please note that the present work is limited by its cross-sectional design.

Dataset on individual differences in self-reported personality and inferred emotional expression in profile pictures of Italian Facebook users.

We retrieved the current profile picture of 2234 Italian Facebook users who also answered self-report questionnaires on demographic variables and personality. Data were collected between March and June 2018 using a Facebook web application. Profile pictures consisting of 200 × 200 resolution jpegs were obtained by sending a request via the Facebook Graph API and analyzed using online commercial services allowing for the scoring of facial expressions in image data, namely Microsoft Azure Face API and MEGVII Face++ Detect API. Both services provide emotional expression scores if at least one face is successfully detected in the picture. Using the Microsoft Azure Face API we obtained scores for anger, contempt, disgust, fear, joy, sadness, surprise, and neutrality. Using the MEGVII Face++ Detect API, pictures were scored for the presence of anger, disgust, fear, joy, sadness, and surprise, and neutrality. Higher scores on each emotion refer to a stronger expression of the respective emotion. The dataset presented here consists of data of N =728 Facebook users with a profile picture in which both APIs detected only one face. Regarding self-report data, the dataset includes the following demographic information about the participants: gender and age. The dataset also includes participants' personality scores based on a short validated assessment of Big Five traits (Ten Item Personality Inventory), and Impulsivity/Sensation Seeking (IMPSS8). A document including the questions administered in the online survey is attached to the dataset. This dataset can be useful to generate insights on the association between demographic variables, including age and gender, and personality (Big Five traits and Impulsivity/Sensation Seeking), and emotional expression as derived from social media pictures. It can be useful for researchers and data scientists who do research in social sciences, in particular psychoinformatics, to train models in order to infer personality of users of social media platforms from profile pictures.

Pilot Randomized Controlled Trial of the WHO Caregiver Skills Training in Public Health Services in Italy.

Parents of children with ASD (N = 86; mean age 44.8 months; 67 boys) were randomized to either WHO Caregiver Skills Training (CST) delivered in public health settings in Italy or enhanced treatment-as-usual. Primary blinded outcomes were 3-months post-intervention change scores of autism severity and engagement during caregiver-child interaction. CST was highly acceptable to caregivers and feasibly delivered by trained local clinicians. Intention-to-treat analysis showed a large and significant effect on parent skills supporting joint engagement and a smaller significant effect on flow of interaction. Expected changes in child autism severity and joint engagement did not meet statistical significance. Analysis of secondary outcomes showed a significant effect on parenting stress, self-efficacy, and child gestures. Strategies to improve the effectiveness of CST are discussed.

How Plausible are the Accounts of Child Victims of Sexual Abuse? A Study of Bizarre and Unusual Scripts Reported by Children.

Child sexual abuse is a serious social problem. In reports of sexually abused children, victims' narratives often contain elements that suggest the abuse was recorded to create images for child pornography with sadistic, bizarre, or perverted details. The presence of unusual or bizarre elements in the accounts of abused children affects their credibility. The purpose of this paper is to assess the presence and prevalence of these elements in the reports of children with suspected sexual abuse and to examine their consistency with verified cases of child abuse. We conducted two studies. In Study 1, we developed a list of 16 categories of unusual and bizarre scripts reported by children in reports of sexual abuse. In Study 2, we validated the list by examining the presence of the identified scripts in the actual experiences of both individuals convicted of crimes related to child pornography and Italian police officers who were involved with child pornography as part of their official duties. Our findings suggest that children's accounts of sexual abuse should be considered credible even if they contain unusual or bizarre elements that also occur in child pornography and therefore may reflect events actually experienced rather than merely the child's fantasy or imagination.

Smartphone and social media use contributed to individual tendencies towards social media addiction in Italian adolescents during the COVID-19 pandemic.

INTRODUCTION: Adolescents in remote education during the COVID-19 pandemic had few opportunities to socialize in person, resulting in a significant rise in the use of social networks or instant messaging applications. However, excessive use may promote addictive tendencies towards these platforms, with negative consequences for adolescents' well-being. AIMS: In this study, we investigated the prevalence of smartphone and social media application use in early-to-late adolescents in remote education. We examined the relative impact of different social media applications on self-reported tendencies toward social media addiction. METHODS: The sample consisted of 765 Italian adolescents (Age: M = 14.11 ± 2.2; 401 females) who reported on use of the smartphone, social media applications, namely WhatsApp, Facebook, Twitter, TikTok, Instagram, Snapchat, Telegram, Messenger, and YouTube. Mean differences in social media addiction across group reporting different patterns of social media use were investigated. The contribution of each social media application in predicting social media addiction was determined using a random forest algorithm. RESULTS: On average, adolescents using just WhatsApp and YouTube reported the lowest social media addiction compared with peers also using Instagram or TikTok (or both of them). Overall, we found time spent on smartphone, and use of TikTok were the strongest predictors of social media addiction, followed by use of Facebook, Telegram, Messenger, and Twitter. Instagram, Snapchat, and WhatsApp use showed no effect when examined together with the other platforms. CONCLUSIONS: Findings indicated that TikTok was the most addictive application during the COVID-19 pandemic, overshadowing other very popular applications with similar visual affordances.

The long psychological shadow of COVID-19 upon healthcare workers: A global concern for action.

INTRODUCTION: The outbreak of COVID-19 has posed unprecedented psychological pressure upon every National Health Service in the world. In Piedmont, one of the most affected areas in Italy, 4550 healthcare workers were assessed online in May-June 2020, after the acute outbreak of March-April 2020, that compelled the Italian government to enforce, what was then, the first total lockdown in the Western world. METHODS: Socio-demographic information of healthcare workers was gathered along with responses to: General Anxiety Disorder-7, Impact of Event Scale-Revised, Beck Depression Inventory-II, Peritraumatic Dissociative Experiences Questionnaire. Information about the need for psychological support was also gathered. RESULTS: The regression models predicted the presence of moderate to severe symptoms for all the conditions assessed. Almost half of healthcare workers presented at least one clinically relevant symptom, and among them one in every four expressed the need of receiving psychological support. CONCLUSIONS: Evidence calls for an increase of psychological services within the National Health System in Italy so as to guarantee for healthcare workers the psychological support necessary to cope with the long shadow of COVID-19, whose long-term impact is likely to reveal itself more strongly the more the acute stage of it is passed. LIMITATIONS: The assessment of the psychological symptoms was performed without knowing the life and professional situations of the sample, and their medical records. Healthcare workers from only one region in Italy were involved, and some professionals (e.g. self-employed healthcare workers) were not included.

A Balancing Act During Covid-19: Teachers' Self-Efficacy, Perception of Stress in the Distance Learning Experience.

One of the many drastic changes caused by Covid-19 was the quick implementation of distance learning which represented a great technological challenge to many teachers and students. In fact, Italy ranks 24th amongst the 27-EU member countries in digital competitiveness which testifies to the significant delays and gaps in basic digital skills amongst the population. Based on the difficulties encountered in organizing distance learning, we assumed that teachers' perceived stress increased. Given that transversal skills can be associated with this relationship, we hypothesized that among these skills, self-efficacy mediated the relationship between the difficulties in organizing distance learning and perceived stress. Since we targeted teachers from Italy and other European countries, we also hypothesized that this mediator effect would be different for both samples. Our sample was composed of a total of 366 primary/middle school teachers of which 86% female. After doing a mediation analyses with Process, Hayes' Model 4, we confirmed H1 but not H2: resulting in a partial mediation effect of self-efficacy for each individual group of teachers. Since difficulties of distance learning can affect the perception of stress, we believe that the promotion of transversal skills, such as self-efficacy, can better equip teachers when facing stressful situations.

Student-teacher conflict moderates the link between students' social status in the classroom and involvement in bullying behaviors and exposure to peer victimization.

INTRODUCTION: Student-teacher relationships have been shown to influence bullying-related behaviors in students. In this study we considered the moderating role of student-teacher conflict and students' social status in the classroom and involvement in bullying behaviors and peer victimization. METHODS: Sample consisted of 1742 students (47.2% females, mean age = 10.79; SD = 1.36; range = 8-14) clustered in 113 classrooms, of which 1017 (58.4%) attended primary schools and 725 (41.6%) attended lower secondary schools. We implemented a series of multilevel analyses aimed at determining the role of student-teacher conflict, and students' social status among classroom peers (i.e., average, popular, rejected, neglected, and controversial statuses), as well their interaction, in influencing verbal, physical, and social forms of bullying and victimization at school. RESULTS: Student-teacher conflict had a significant positive effect on all bullying and victimization variables. Regarding students' social status, rejected students showed increased bullying and victimization when compared with average students, except in social bullying. Significant interactions emerged indicating that a highly conflictual student-teacher relationship exacerbated bullying behaviors and the risk of victimization among rejected students. Additionally, popular students who had conflictual relationship with their teachers were more likely to engage in physical bullying then average students. CONCLUSIONS: Our study suggests the importance of low conflictual student-teacher relationships in acting as a buffer for aggressive student-student interactions in the classroom, especially when these interactions involve students rejected by their classroom peers.

Cyberbullying and cybervictimization among preadolescents: Does time perspective matter?

Time perspective has been recognized as an important psychological dimension with a pervasive and powerful influence on human behavior. To the authors' knowledge, no studies have focused on the relationship between time perspective and cyberbullying behavior. The first aim of this research is to fill this gap by investigating the relationship between different time perspectives and both cyberbullying and cybervictimization among 6th to 8th grade students. The second objective was to investigate the relationship between time perspective, cyberbullying behaviors, peer problems, and the quality of relationship with teachers. A sample consisting of 403 students aged between 11 and 14 years from Italian middle schools (56% females, mean age = 12.2 years) were recruited. Participants filled in a self-report questionnaire measuring cyberbullying and cybervictimization as well as the Time Perspective questionnaire. The analyses showed the presence of significant correlations between time perspective and both cyberbullying and cybervictimization. In particular, cybervictimization showed a quite large positive correlation with a past-negative orientation and a negative correlation with past-positive orientation. Instead, the involvement in active cyberbullying was positively correlated with a past-negative orientation and negatively correlated with future orientation. The findings advance the understanding of psychological factors influencing cyberbullying during early adolescence and suggest the importance of past-positive and past-negative orientations in accounting for both active cyberbullying and cybervictimization. As expected, future orientation appeared to represent a protective factor against involvement in cyberbullying behaviors.

Student-teacher relationship quality and prosocial behaviour: The mediating role of academic achievement and a positive attitude towards school.

BACKGROUND: The current research investigated the association between teacher-student relationship (both teacher-perceived and student-perceived relationship quality) and students' prosocial behaviours, as well as the mediating roles of students' attitudes towards school and perceived academic competence in this association. SAMPLE: Four hundred and fifty-nine Italian primary students (aged 4-9, Mage  = 7.05, SDage  = 1.37) and 47 teachers (aged 26-60, Mage  = 48.35, SDage  = 8.13) participated and finished all the questionnaires and scales. METHODS: Multiple regression analyses and bootstrapping analyses were employed to test the direct and the mediating effects between the teacher/student-perceived relationship and students' prosocial behaviours. RESULTS: Results indicated that (1) teacher-student relationship was positively associated with students' prosocial behaviour; and (2) students' attitudes towards school could significantly mediate the association between teacher/student-perceived relationship and students' prosocial behaviours. CONCLUSIONS: Our understanding of how teacher-student relationship helps to enhance students' prosocial behaviours, as well as the intervention programmes that aim to enhance students' prosocial behaviours, may benefit from these findings.

The association between the Big Five personality traits and smartphone use disorder: A meta-analysis.

BACKGROUND AND AIMS: Personality is one of the most frequently investigated variables to shed light on the putatively addictive use of the smartphone. By investigating associations between personality and individual differences in addictive smartphone use, researchers aim to understand if some personality traits predispose technology users to develop addictive behaviors. Here, based on existing empirical literature, we aimed at determining the strength of associations between Big Five personality traits and smartphone use disorder (SmUD) by a meta-analytic approach. METHOD: For each Big Five personality trait, we performed a meta-analysis of correlations representing their association with SmUD. We also investigated possible publication bias and the moderating effects of age, gender, nationality, length of personality assessments, and time of publication. RESULTS: We found n = 26 eligible studies. In line with both the Interaction of Person-Affect-Cognition-Execution (I-PACE) model and the framework on problematic mobile-phone use by Billieux, we observed a positive association between Neuroticism and SmUD (r = 0.25), while the association between Extraversion and SmUD was not significant. Partially in line with the aforementioned theoretical frameworks, Conscientiousness was negatively associated with SmUD (r = -0.16). Remaining traits showed smaller associations. No significant publication bias emerged. Moderator analyses showed that time of publication moderated the link between Conscientiousness and SmUD. Moreover, Agreeableness and Conscientiousness showed a heightened inverse association with SmUD among older samples. CONCLUSIONS: The present meta-analysis provides robust empirical evidence that Big Five personality traits can help to understand individual differences in SmUD, supporting the usefulness of their assessment when planning and targeting interventions aimed at at-risk individuals.

Panic disorder: attack of fear or acute attack of solitude? Convergences between affective neuroscience and phenomenological-Gestalt perspective.

There is consensus among scientists in considering Panic Attack (PA) as an exaggerated fear response triggered by intense activation of the amygdala and related Fear brain network. Current guidelines for treatment (e.g. National Institute for Clinical Excellence, NICE, 2011), that are based on this view, do not achieve satisfactory results: one-third of all treated patients report persistent PAs and other Panic Disorder (PD) symptoms, and several meta-analyses report the high likelihood of relapse. Here we review findings from Affective Neuroscience and clinical insights from a phenomenological-Gestalt perspective, putting into question the link between PD and activation of the Fear brain network. We propose an alternative hypothesis about PD etiology: PD is mainly connected to the Panic system, that is activated in situations of separation from affective support and overexposure to the environment. In our view, PA can be understood as an acute attack of solitude which is not adequately recognized by the patient due to the intervention of a dissociative component that makes it impossible to integrate all neuro-physiological responses activated by the Panic/Separation brain system within a coherent emotional feeling. This perspective can explain many evidences that otherwise remain isolated elements without a comprehensive frame: i.e., the association with agoraphobia, the onset of PD during adolescence and young adult life, the need to be accompanied, the connection with air hunger and other respiratory anomalies, the efficacy of antidepressants and the lack of activation of the Hypothalamic-Pituitary-Adrenal (HPA) axe. We discuss future steps to test this hypothesis and the consequences for psychotherapeutic treatment.