Metacognitive Interpersonal Therapy in group (MIT-G) for young adults with personality disorders: A pilot randomized controlled trial.

Young adults with personality disorders (PD) other than borderline are in urgent need of validated treatments to help them in managing important life transitions. Therapeutic interventions focused upon social and interpersonal difficulties may facilitate these individuals in maximizing opportunities for employment, forming stable romantic relationships, and belong to social groups. It is also important that they are offered evidence-based, first-line time-limited treatments in order to maximize effectiveness and reduce costs. We developed a 16-session programme of group-based Metacognitive Interpersonal Therapy (MIT-G) including psychoeducation on the main interpersonal motives, an experiential component enabling practice of awareness of mental states; and use of mentalistic knowledge for purposeful problem-solving. We report a feasibility, acceptability, and clinical significance randomized clinical trial. Participants meeting inclusion criteria were randomized to receive MIT-G (n = 10) or waiting list+TAU (n = 10). Dropout rate was low and session attendance high (92.19%). Participants in the MIT-G arm had symptomatic and functional improvements consistent with large effect sizes. In the MIT-G arm similarly large effects were noted for increased capacity to understand mental states and regulate social interactions using mentalistic knowledge. Results were sustained at follow-up. Our findings suggest potential for applying MIT-G in larger samples to further test its effectiveness in reducing PD-related symptoms and problematic social functioning.

The Metacognitions about Gambling Questionnaire: Development and psychometric properties.

Recent research has suggested that metacognitions may play a role across the spectrum of addictive behaviours. The goal of our studies was to develop the first self-report scale of metacognitions about gambling. We conducted three studies with one community (n = 165) and two clinical (n = 110; n = 87) samples to test the structure and psychometric properties of the Metacognitions about Gambling Questionnaire and examined its capacity to prospectively predict severity of gambling. Findings supported a two factor solution consisting of positive and negative metacognitions about gambling. Internal consistency, predictive and divergent validity were acceptable. All the factors of the Metacognitions about Gambling Questionnaire correlated positively with gambling severity. Regression analyses showed that negative metacognitions about gambling were significantly associated to gambling severity over and above negative affect and gambling-specific cognitive distortions. Finally only gambling severity and negative metacognitions about gambling were significant prospective predictors of gambling severity as measured three months later. The Metacognitions about Gambling Questionnaire was shown to possess good psychometric properties, as well as predictive and divergent validity within the populations that were tested.

Metacognitive interpersonal therapy in group: a feasibility study.

Patients with personality disorders (PDs) other than borderline, with prominent features of social inhibition and over-regulation of emotions, are in need of specialized treatments. Individuals present with poor metacognition, that is the capacity to understand mental states and use psychological knowledge for the sake of purposeful problem solving; and are guided by maladaptive interpersonal schemas. We developed a short-term group intervention, Metacognitive Interpersonal Therapy in Groups (MIT-G), incorporating psychoeducational and experiential elements, to help these individuals become more aware of their drives when interacting with others; and to help them adopt more flexible behaviors via improvements in metacognition. We present results of an effectiveness study, evaluating whether we could replicate the initial positive results of our first pilot randomized controlled trial. Seventeen young adults outpatients with personality disorders were included in the 16 session program. Effect sizes were calculated for change from baseline to treatment end for the primary outcome, symptoms and functioning (Clinical Outcomes in Routine Evaluation Outcome Measure) and then for one putative mechanism of change - metacognition. Emotional dysregulation and alexithymia were also assessed. Qualitative evaluations of the acceptability and subjective impact of the treatment were also performed. MIT-G was acceptable to participants. There were medium to large magnitude changes from pre- to post- treatment on wellbeing, emotion dysregulation, alexithymia and metacognition. These gains were maintained at follow-up. There was evidence of clinically significant change on key variables. MITG appears acceptable to patients, as evidenced by the absence of drop-out from treatment. In light of the positive outcomes of this study and the expanding evidence base, MIT-G is a candidate for dissemination and investigations in larger trials as a possible effective intervention for PDs characterized by tendencies to overcontrol.

The effect of rumination on craving across the continuum of drinking behaviour.

BACKGROUND: Rumination is an abstract, persistent, and repetitive thinking style that can be adopted to control negative affect. Recent studies have suggested the role of rumination as direct or indirect cognitive predictor of craving experience in alcohol-related problems. AIMS: The goal of this study was to explore the effect of rumination induction on craving across the continuum of drinking behaviour. METHODS: Participants of three groups of alcohol-dependent drinkers (N=26), problem drinkers (N=26) and social drinkers (N=29) were randomly allocated to two thinking manipulation tasks: distraction versus rumination. Craving was measured before and after manipulation and after a resting phase. RESULTS: Findings showed that rumination had a significant effect on increasing craving in alcohol-dependent drinkers, relative to distraction, but not in problem and social drinkers. This effect was independent of baseline depression and rumination and was maintained across the resting phase. CONCLUSIONS: Rumination showed a direct causal impact on craving that is specific for a population of alcohol-dependent drinkers.

[The role of the environmental factors on the development of adaptive skills in intellectual disabilities subjects]. / Il ruolo dei fattori ambientali sullo sviluppo delle competenze adattive nei soggetti con disabilità intellettiva.

AIMS: The aims of the study was to evaluate if environmental factors can influence the effectiveness of therapeutic intervention of subjects with intellectual disabilities. METHODS: 46 adolescents and adults with mental retardation, in semi-residential rehabilitative treatment, have been assessed over a 2-years period. The evolution of adaptive functioning over time has been assessed through the AAMD-ABS. The development of the adaptive skills at follow-up has been correlated with socio-economic and cultural factors. RESULTS: Linear regression showed that age of both parents, mother's health status, lack of one parent, SES, and housing conditions, represent significant covariates to predicting evolution of the adaptive functioning; these factors independently influence effectiveness of the therapy from the kind of treatment. CONCLUSION: The results demonstrate that effectiveness of the therapy can be conditioned from ability to fulfil the needs of the families, through social and supporting programs.