Neural correlates of metacognition: Disentangling the brain circuits underlying prospective and retrospective second-order judgments through noninvasive brain stimulation.

Metacognition encompasses the capability to monitor and control one's cognitive processes, with metamemory and metadecision configuring among the most studied higher order functions. Although imaging experiments evaluated the role of disparate brain regions, neural substrates of metacognitive judgments remain undetermined. The aim of this systematic review is to summarize and discuss the available evidence concerning the neural bases of metacognition which has been collected by assessing the effects of noninvasive brain stimulation (NIBS) on human subjects' metacognitive capacities. Based on such literature analysis, our goal is, at first, to verify whether prospective and retrospective second-order judgments are localized within separate brain circuits and, subsequently, to provide compelling clues useful for identifying new targets for future NIBS studies. The search was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines among PubMed, PsycINFO, PsycARTICLES, PSYNDEX, MEDLINE, and ERIC databases. Overall, 25 studies met the eligibility criteria, yielding a total of 36 experiments employing transcranial magnetic stimulation and 16 ones making use of transcranial electrical stimulation techniques, including transcranial direct current stimulation and transcranial alternating current stimulation. Importantly, we found that both perspective and retrospective judgments about both memory and perceptual decision-making performances depend on the activation of the anterior and lateral portions of the prefrontal cortex, as well as on the activity of more caudal regions such as the premotor cortex and the precuneus. Combining this evidence with results from previous imaging and lesion studies, we advance ventromedial prefrontal cortex as a promising target for future NIBS studies.

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 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.

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.

Delay discounting of compliance with containment measures during the COVID-19 outbreak: a survey of the Italian population.

Aim: Unprecedented community containment measures were taken following the recent outbreak of COVID-19 in Italy. The aim of the study was to explore the self-reported future compliance of citizens with such measures and its relationship with potentially impactful psychological variables. Subjects and methods: An online survey was completed by 931 people (18-76 years) distributed across the Italian territory. In addition to demographics, five dimensions were measured: self-reported compliance with containment measures over time (today, at 7, 14, 30, 60, 90, and 180 days from now) at three hypothetical risk levels (10, 50, 90% of likelihood of contracting the COVID-19), perceived risk, generalized anxiety, intolerance of uncertainty, and relevance of several psychological needs whose satisfaction is currently precluded. Results: The mean compliance scores follow a hyperbolic-like curve, decreasing over time for the lowest level of risk (10%), whilst they tend to flatten for ≥ 50% risk (90%). Significantly higher levels of anxiety, intolerance of uncertainty, and perceived risk were reported by women compared to men (p < 0.001 for each variable). Outdoor sports was the only need associated with the discounting rate of compliance (r s = - 0.08, p = 0.018). Conclusion: The duration of containment measures plays a crucial role in tackling the spread of the disease as people will be less compliant over time. Psychological needs of citizens impacting on the compliance should be taken into account when planning an easing of the lockdown, along with interventions for protecting vulnerable groups from mental distress.

Effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders: a meta-analysis of sham or behaviour-controlled studies.

BACKGROUND: The possibility of using noninvasive brain stimulation to treat mental disorders has received considerable attention recently. Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are considered to be effective treatments for depressive symptoms. However, no treatment recommendation is currently available for anxiety disorders, suggesting that evidence is still limited. We conducted a systematic review of the literature and a quantitative analysis of the effectiveness of rTMS and tDCS in the treatment of anxiety disorders. METHODS: Following PRISMA guidelines, we screened 3 electronic databases up to the end of February 2020 for English-language, peer-reviewed articles that included the following: a clinical sample of patients with an anxiety disorder, the use of a noninvasive brain stimulation technique, the inclusion of a control condition, and pre/post scores on a validated questionnaire that measured symptoms of anxiety. RESULTS: Eleven papers met the inclusion criteria, comprising 154 participants assigned to a stimulation condition and 164 to a sham or control group. We calculated Hedge's g for scores on disorder-specific and general anxiety questionnaires before and after treatment to determine effect size, and we conducted 2 independent random-effects meta-analyses. Considering the well-known comorbidity between anxiety and depression, we ran a third meta-analysis analyzing outcomes for depression scores. Results showed a significant effect of noninvasive brain stimulation in reducing scores on disorder-specific and general anxiety questionnaires, as well as depressive symptoms, in the real stimulation compared to the control condition. LIMITATIONS: Few studies met the inclusion criteria; more evidence is needed to strengthen conclusions about the effectiveness of noninvasive brain stimulation in the treatment of anxiety disorders. CONCLUSION: Our findings showed that noninvasive brain stimulation reduced anxiety and depression scores compared to control conditions, suggesting that it can alleviate clinical symptoms in patients with anxiety disorders.

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.

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.

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.

The effect of desire thinking on facilitating beliefs in alcohol use disorder: An experimental investigation.

Permissive beliefs relate to the acceptability of engaging in alcohol use in spite of obvious potential negative consequences. They are considered the most proximal and precipitating cognitive factor in the decision to use alcohol and/or the activation of strategies to obtain it. Recent research suggested that 'desire thinking' may be involved in the escalation of craving and addictive behaviours and can play a role in strengthening permissive beliefs. The current study tested whether the induction of desire thinking would have a stronger effect on rate of conviction in permissive beliefs compared to a control cognitive response in the form of neutral thinking and whether this effect would be specific for patients with alcohol use disorder (AUD). Thirty AUD patients and 30 social drinkers (SD) were randomly allocated to two thinking manipulation tasks (desire thinking and neutral thinking). Current permissive beliefs were measured before and after manipulation and after a resting phase. Findings showed that desire thinking increased the level of current permissive beliefs after manipulation relative to the neutral thinking condition for the AUD group but not for the SD group. This effect was not purely dependent on the concurrent level of perceived craving. This study supports a causal relationship between the induction of desire thinking and rate of conviction in permissive beliefs and highlights the relevance of targeting desire thinking in the treatment for AUD patients.

Metacognitions and repetitive negative thinking in bipolar disorder and healthy controls: A comparative study.

BACKGROUND: Metacognitive deficits and repetitive negative thinking are poorly explored in bipolar disorder (BD). The majority of the published studies concerned patients with bipolar depression, without differentiating among BD subtypes. The most common dysfunctional metacognitions, measured with the Metacognition Questionnaire-30 (MCQ-30), were Negative Beliefs about the Uncontrollability and Danger of Worry (NB), Cognitive Confidence (CC) and Beliefs about the Need to Control Thoughts (NC). Worry and rumination also seem to influence every phase of BD. This study aimed to investigate metacognitions and repetitive negative thinking in euthymic patients with BD. METHOD: Using the MCQ-30, the Penn State Worry Questionnaire (PSWQ) and the Ruminative Responses Scale (RRS), we compared 57 BD-I and 48 BD-II patients with 78 healthy controls. RESULTS: Both BD groups showed significantly higher NB, CC, NC and total MCQ-30 scores. 'Positive Beliefs About Worry' (PBW) showed a significantly higher score only in the BD-II group. Rumination scores were significantly higher in both patient samples. Worry did not show any significant differences between groups. LIMITATIONS: The primary limitations are related to the size of the samples and the research design. CONCLUSIONS: Our findings suggested that metacognitive deficits and negative repetitive thinking were associated with euthymic BD. Rumination, NB, CC, and TC may represent trait-dependent features related to the inter-episodic phase of the disorder. A higher PBW score seemed to be a distinctive feature only for patients with euthymic BD-II. The results offer new perspectives in the psychotherapeutic treatment of these patients.

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.

Desire thinking as a predictor of drinking status following treatment for alcohol use disorder: A prospective study.

Research has indicated that craving is one of the strongest predictors of treatment outcome and relapse in Alcohol Use Disorders (AUD) but there is little consensus on the factors that may influence its activation and escalation. Research has also shown that desire thinking is an important cognitive process which may exacerbate craving in problem drinkers. The aim of present study was to explore, for the first time, the role of desire thinking in prospectively predicting relapse, craving and binge drinking in patients receiving treatment for AUD. One hundred and thirty-five patients admitted to two rehabilitation centres and two outpatient services for addiction and mental health problems were administered baseline, treatment completion and three months follow-up measures of anxiety and depression, AUD severity, binge drinking frequency, craving and desire thinking. Results indicated that the verbal perseveration component of desire thinking at treatment completion was the only significant predictor of relapse at follow-up over and above baseline AUD severity and binge drinking frequency. Furthermore, the imaginal prefiguration component of desire thinking and craving levels at treatment completion were found to predict craving levels at follow-up independently of AUD severity and binge drinking frequency at baseline. Finally, both the imaginal prefiguration and verbal perseveration components of desire thinking at treatment completion were found to be the only predictors of binge drinking frequency at follow-up independently of AUD severity and binge drinking frequency at baseline. Treatments for AUD should aim to reduce desire thinking in people to enhance clinical outcomes and reduce relapse risk.

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.

A Historical and Theoretical Review of Cognitive Behavioral Therapies: From Structural Self-Knowledge to Functional Processes.

This paper critically examines the historical conceptualization of cognitive behavioral psychotherapy approaches (CBT) as a direct clinical counterpart of the cognitive revolution. The main "second wave" cognitive psychotherapies, either standard cognitive therapy (CT) or constructivist, in spite of their differences, share a common conceptualization of psychopathological factors as superordinate structural cognitive content belonging to the self: self-beliefs, self-schemata, personality organizations and so on. On the other hand, rational emotive behavior therapy (REBT) is an exception given that in REBT self-knowledge is not the core psychopathological tenet, being rather a derivate mechanism. Moreover, in non clinical cognitive science cognition is conceived as a regulatory function that operates retroactively and not in a hierarchically super- ordered fashion centered on the self. A historical review suggests that in both CT and constructivist model the structuralistic model of self-centered cognition may have emerged for both cultural and scientific reasons: self-centered cognitive models may be more readily understandable to clinicians as they allow for a straightforward identification of operationalizable self-beliefs. The emergence of new "third wave" process-centered CBT approaches may represent a comeback to functionalism, where cognition is considered again a regulatory function and not a structure. In addition, REBT's interest in dysfunctional evaluations not focused on the self presaged this clinical and scientific turning point toward functionalism.

Role of rumination in the relationship between metacognition and shyness.

AIM: To explore the association between metacognitive beliefs, rumination and shyness in a non-clinical sample of adults. METHODS: One hundred and three healthy subjects from the general population were enrolled in the study. Shyness was evaluated using the Revised Cheek and Buss Shyness Scale, rumination was assessed using the Ruminative Response Scale, metacognition was evaluated using the Meta-Cognitions Questionnaire 30, and anxiety levels were measured using the State Trait Anxiety Inventory form Y. Correlation analyses, mediation models and 95% bias-corrected and accelerated (BCaCI) bootstrapped analyses were performed. Mediation analyses were adjusted for sex and anxiety. RESULTS: Shyness, rumination and metacognition were significantly correlated (P < 0.05). The relationship between metacognition and shyness was fully mediated by rumination (Indirect effect: 0.20; 95% BCaCI: 0.08-0.33). CONCLUSION: These findings suggest an association between metacognition and shyness. Rumination mediated the relationship between metacognition and shyness, suggesting that rumination could be a cognitive strategy for shy people. Future research should explore the relationship between these constructs in more depth.

The Body of Cognitive and Metacognitive Variables in Eating Disorders: Need of Control, Negative Beliefs about Worry Uncontrollability and Danger, Perfectionism, Self-esteem and Worry.

BACKGROUND: Many studies have described perfectionism and low self-esteem as traits associated with eating disorders (ED). More recently, research has shown the role played by worry, rumination, control and metacognitive beliefs. This paper investigates the role played by cognitive and metacognitive variables in the psychopathological mechanism of eating disorders, assuming that not only perfectionism and low selfesteem but also metacognitive beliefs and processes can discriminate between controls and EDs. METHOD: The Structured Clinical Interview for DSM, the Multidimensional Perfectionism Scale, the Rosenberg Self-Esteem Scale, the Anxiety Control Questionnaire, the Penn State Worry and the Metacognition Questionnaire were administered to the samples. RESULTS: Results suggested that metacognitive factors like negative beliefs about worry, uncontrollability and danger, need for control, and worry should be added to the body of cognitive factors underlying ED composed by the classical couple of cognitive factors including perfectionism and low self-esteem. CONCLUSIONS: It is possible that an individual with ED assumes that metacognitive processes like worry and rumination are a further proof of his or her lack of value, capacity to control, and self-control. Such appraisals may reinforce the painful sense of low self-esteem so typical in ED and, in turn, the perfectionistic striving for excellence.

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.

Anger and depressive ruminations as predictors of dysregulated behaviours in borderline personality disorder.

BACKGROUND: Anger and depressive ruminations have recently received empirical attention as processes related to borderline personality disorder (BPD). The Emotional Cascade Model (Selby, Anestis, & Joiner, 2008) suggests that negative affect (such as anger and sadness) may trigger rumination, which in turn may increase the duration and extent of negative affect, leading to dysregulated behaviours aimed at reducing such intense and unpleasant emotions. AIM: The aim of this study is to explore the relationships between emotional dysregulation, anger and depressive ruminations, and their role in predicting dysregulated behaviours (such as aggression and self-harm) in a clinical sample of patients with BPD. METHODS: Ninety-one patients with a diagnosis of BPD were recruited from three outpatient community mental health centres and asked to complete a comprehensive assessment for personality disorder symptoms, emotion dysregulation, anger and depressive ruminations, aggression, and self-harm. RESULTS: Anger and depressive ruminations were found to be significantly associated to, respectively, self-harm and aggression, beyond the variance accounted by emotional dysregulation. CONCLUSIONS: Rumination may act as a mediator between emotional dysregulation and dysregulated behaviours in BPD. Future research should examine whether clinical techniques aimed at reducing rumination may be helpful in reducing dysregulated behaviours in patients with BPD.