Direct and indirect effects of psychological well-being and therapeutic alliance on therapy outcome in eating disorders.

Introduction: Outcome research in eating disorders (EDs) is commonly focused on psychopathological dysfunction. However, Ryff's model of psychological well-being (PWB) has shown promising-yet preliminary-results with ED patients. Additionally, despite substantial evidence highlighting the association between the therapeutic alliance and treatment outcome, findings in ED samples remain unclear. The present study aimed at exploring the direct effect of PWB dimensions and the early therapeutic alliance on ED patients' individual treatment responses, as well as the mediating role played by the early therapeutic alliance in the relationship between PWB dimensions and overall pre-post symptom change. Methods: A sample of N = 165 ED patients assigned female at birth, who were receiving treatment in a residential program, completed the Psychological Well-Being Scale at treatment intake and the Working Alliance Inventory after the first four psychotherapy sessions. Patients also completed the Outcome Questionnaire-45.2 at the same time point and during the week prior to discharge. Results: The PWB dimensions of autonomy, positive relations, and self-acceptance were associated with clinically significant change, while the dimensions of personal growth and self-acceptance were associated with reliable change. The early therapeutic alliance showed both direct and indirect effects on therapy outcome, predicting clinically significant and reliable symptom reduction. It also emerged as a significant mediator in the relationship between all PWB dimensions and overall symptomatic change. Conclusion: The identification of individual, adaptive characteristics in ED patients that might influence their development of an early therapeutic alliance may help therapists to predict relationship ruptures and tailor their interventions to enhance treatment effectiveness.

Daily Activities in European Children and Adolescents During COVID-19 School Closure: A Longitudinal Study Exploring Physical Activity, Use of Screens, and Sleep Patterns.

This longitudinal study aimed to analyze the evolution of patterns of daily activities (physical activity time, screen usage time, and sleep hours) in European youth during school closure due to the COVID-19 health crisis. Participants were 624 caregivers of children and adolescents aged 3-18 from Italy, Spain, and Portugal. Evaluations were online, and four time-points were considered: retrospective measurement of daily activities before confinement (T1), and two (T2), five (T3), and eight (T4) weeks after starting the lockdown. Generally accepted international guidelines on physical activity time, screen usage time, and hours of sleep by age group were used to determine whether the pattern might increase the risk for ill health or not. To estimate the evolution of daily activities, generalized estimating equations (GEE) were used. The percentage of children who practiced less than 60 min of daily exercise increased significantly from before home confinement (47.8%) to T2 (86.4%); it slightly decreased at T3 (79.8%), and remained stable at T4 (76.1%). The percentage of children who made excessive use of screens (according to their age group) significantly increased from T1 to T2 and remained stable and high in the rest of the evaluations. The percentage of children who slept fewer or more hours than recommended for their age group remained stable between T1 and T4, although there was a significant increase at T3. In general, results found unhealthier behaviors as confinement was extended. Results are discussed in order to find strategies for promoting healthy daily activities for future pandemics.

Childhood trauma and psychopathy: The moderating role of resilience.

OBJECTIVE: Despite accumulating evidence of significant albeit moderate associations between childhood trauma and psychopathy, little is known about the potential moderators of these associations. To advance knowledge in this area, the present study investigated the moderating role of resilience in the childhood trauma-psychopathy link. METHOD: A community sample of 521 adult participants from the Netherlands (40.1% men; Mage = 35.27 years, SD = 15.99) completed two self-report questionnaires measuring psychopathic personality traits: a self-report measure of resilience and a retrospective measure of childhood traumatic experiences. Correlation analyses were employed to investigate bivariate associations among study variables. Moderated multiple regression analyses with bootstrapping followed by simple slope analyses were employed to examine Childhood Trauma × Resilience interactions in predicting scores of psychopathy subscales. RESULTS: Childhood trauma had small positive associations with psychopathic traits across the board, with the exception of a small negative association with boldness traits, as well as a small negative association with resilience. Resilience was strongly and positively related to boldness, and negatively related to affective (callousness, meanness) and behavioral (antisocial, disinhibition) traits of psychopathy. Resilience moderated six out of seven associations between childhood trauma and psychopathic traits. CONCLUSIONS: Resilience appeared to represent a significant buffer in the associations between childhood traumatic experiences and psychopathic traits, such that these associations became weaker and nonsignificant (and even negative for boldness) at higher levels compared to lower levels of resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The role of glial cells in mental illness: a systematic review on astroglia and microglia as potential players in schizophrenia and its cognitive and emotional aspects.

Schizophrenia is a complex and severe mental disorder that affects approximately 1% of the global population. It is characterized by a wide range of symptoms, including delusions, hallucinations, disorganized speech and behavior, and cognitive impairment. Recent research has suggested that the immune system dysregulation may play a significant role in the pathogenesis of schizophrenia, and glial cells, such as astroglia and microglia known to be involved in neuroinflammation and immune regulation, have emerged as potential players in this process. The aim of this systematic review is to summarize the glial hallmarks of schizophrenia, choosing as cellular candidate the astroglia and microglia, and focusing also on disease-associated psychological (cognitive and emotional) changes. We conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Scopus, and Web of Science for articles that investigated the differences in astroglia and microglia in patients with schizophrenia, published in the last 5 years. The present systematic review indicates that changes in the density, morphology, and functioning of astroglia and microglia may be involved in the development of schizophrenia. The glial alterations may contribute to the pathogenesis of schizophrenia by dysregulating neurotransmission and immune responses, worsening cognitive capabilities. The complex interplay of astroglial and microglial activation, genetic/epigenetic variations, and cognitive assessments underscores the intricate relationship between biological mechanisms, symptomatology, and cognitive functioning in schizophrenia.

Anxiety and Stress among American, Chinese, Italian, and Russian Emerging Adults: Does Uncertainty Avoidance Matter?

Levels of anxiety and stress vary throughout the lifespan and across cultures. Uncertainty appears particularly relevant during emerging adulthood, thus potentially affecting both stress and anxiety. Uncertainty as a construct was identified by Hofstede (i.e., Uncertainty Avoidance Index, UAI), who defined it as the extent to which members of a culture feel threatened by ambiguous or unknown situations and tend to avoid them. The UAI was considered as a means to understand cultures in addition to the "classic" distinction between collectivist and individualistic cultures. The present study compared levels of anxiety and stress in 1790 university students (18-21 years old) from two individualistic (Italy and the US) and two collectivistic (China and Russia) countries, with a consideration of country UAI levels. Results showed that country-level UAI scores were associated with levels of anxiety and stress, controlling for age and sex. Italian and Russian students reported greater anxiety than American and Chinese ones. Chinese emerging adults reported the lowest stress levels, followed by American, Italian, and Russian students. The study findings provide initial evidence that anxiety and stress in emerging adults are associated with how a culture deals with perceived instability and uncertainty about the future.

Mother-to-infant bonding mediates the effects of depressive and anxious postpartum symptoms on parenting stress.

A number of studies have suggested close associations between maternal postpartum mental health (depressive and anxious symptoms), mother-infant bonding, and parenting stress. However, the relationship between maternal bonding and parenting stresshas hardly been explored in published literature. This cross-sectional study explored whether maternal bonding could mediate the effect of postpartum maternal mental health on parenting stress. This study assessed maternal bonding (MPAS), depressive and anxious symptoms (EPDS; STAI), and parenting stress (PSI) at 3 months postpartum in a community sample of 105 women (M (SD) = 32.60 (4.18) years old). Spearman's correlation analyses showed moderate to high correlations between these factors. The three mediation models run showed that mother's MPAS partially mitigates the effects of EPDS (b = 0.71; SE = 0.217; 95% CI = 0.290/1.136) and STAI State (b = 0.39; SE = 0.113; 95% CI = 0.178/0.625) on PSI, and totally mediated the relationship between STAI Trait and PSI (b = 0.59; SE = 0.155; 95% CI = 0.303/0.912). Maternal bonding resulted to be a relevant factor in the association between maternal mental health and parenting stress. This highlights the importance of interventions focusing on mother-infant relationship to reduce parenting stress and prevent developmental difficulties in children.

Flourishing and Self-Control in Adolescence: The Role of Perceived Parenting.

Self-control is the ability to control thoughts, emotions, and impulses to pursuit of long-term goals. Adolescents with high self-control experience higher flourishing levels. The latter refers to the fulfillment of needs for competence, relationship, and self-acceptance, as well as the possession of psychological capital such as flow and commitment. High levels of self-control also seem to be linked to a positive relationship with parents, which is crucial in adolescent flourishing. However, few studies investigated the association between flourishing, self-control, and perceived parenting in adolescence. The aim of this study was to investigate how the ability to exert self-control and the need to perceive and preserve a responsive relationship with parents would facilitate adolescents' experience of higher flourishing levels. The relationships among self-control, adolescents' perception of some paternal and maternal dimensions (closeness, communication, and parents' peer approval), and flourishing were analyzed in a sample of 335 Italian adolescents. Self-control was positively correlated with flourishing and the adolescent's perception of maternal and paternal dimensions. The PROCESS model showed that perceived maternal and paternal dimensions mediate the relationship between self-control and flourishing. These findings show the importance of self-control and parenting dimensions in promoting flourishing during adolescence.

Italian Validation of the Delaying Gratification Inventory in Adolescents.

The delay of gratification (DoG) is defined as the willingness to forego immediate satisfaction to achieve greater long-term gratification. This ability is essential in adolescence, as its development is crucial against desirable versus undesirable behaviors. This study investigated the psychometric proprieties of the Delaying Gratification Inventory (DGI) in Italian adolescents. A total of 621 Italian adolescents, ranging from 14 to 17 years old (M = 15.92, SD = 1.05; 47.7% boys), participated in the study. Confirmatory factor analysis identified a four-factor structure (delay of gratification concerning Food, Social Interaction, Money, and Achievement). The reliability of the Italian DGI was acceptable. Measurement invariance across gender was supported. Boys reached a higher DoG score in the Food subscale and a lower score in the Social Interaction and Achievement subscales than girls. Moreover, the Italian DGI dimensions were all positively correlated with self-control and prosocial behavior. Except for the Social Interaction subscale, positive correlations were found between the Food, Money, and Achievement subscales and self-esteem. The present findings suggest that the Italian DGI could be used for assessing DoG ability, a key regulatory ability that promotes healthy behaviors in adolescence.

Trauma-related disorders and the bodily self: current perspectives and future directions.

Trauma-related disorders are debilitating psychiatric conditions that influence people who have directly or indirectly witnessed adversities. Dramatic brain/body transformations and altered person's relationship with self, others, and the world occur when experiencing multiple types of traumas. In turn, these unfortunate modifications may contribute to predisposition to trauma-related vulnerability conditions, such as externalizing (aggression, delinquency, and conduct disorders) problems. This mini-review analyzes the relations between traumatic experiences (encoded as implicit and embodied procedural memories) and bodily self, sense of safety for the own body, and relationship with others, also in the presence of externalizing conducts. Furthermore, an emerging research area is also considered, highlighting principles and techniques of body-oriented and sensorimotor therapies designed to remodel bodily self-aspects in the presence of trauma, discussing their potential application with individuals showing externalizing problems.

Body Uneasiness and Dissatisfaction Among Lesbian, Gay, Bisexual, and Heterosexual Persons.

Introduction: While sexual minority people have been widely considered at risk for developing a range of body image concerns, evidence of body dissatisfaction and shame amongst LGB (lesbian, gay, and bisexual) individuals is mixed. This study investigated differences in body uneasiness, body dissatisfaction, and self-blaming/attacking attitudes between LGB and heterosexual individuals, as well as within LGB groups, while also examining the predictive role of body mass index (BMI). Methods: A sample of cisgender lesbian women (n = 163), gay men (n = 277), bisexual women (n = 135), bisexual men (n = 39), heterosexual women (n = 398), and heterosexual men (n = 219) completed an online survey assessing different aspects of body image between May and July 2020. Results: Gay and bisexual men reported greater body image disturbance and self-blaming attitudes relative to heterosexual men. In contrast, lesbian women reported lower body uneasiness than their bisexual and heterosexual counterparts, but greater self-hate. Moreover, lesbian and bisexual women showed more body dissatisfaction than gay men, and bisexual individuals reported more body uneasiness than individuals in other sexual minority subgroups. Higher BMI emerged as a significant predictor of body image concerns and dissatisfaction. Conclusions: Body image dimensions showed sexual identity-based differences. Determining the specific nuances of body image in LGB individuals can provide important information on potential risk factors that may impact mental health outcomes. Policy Implications: In-depth knowledge of body dissatisfaction and uneasiness in individuals with LGB identities may have critical implications for the development of personalized prevention and treatment strategies.

From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders.

PURPOSE: Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients' subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring. METHODS: Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients' subjective experiences (i.e., affective states, cognitive processes, relational patterns, somatic/bodily experiences and states) are examined, alongside their relevance to ED diagnosis and treatment. RESULTS: Overall, the reviewed studies support the diagnostic importance of these patterns of subjective experiences in EDs, highlighting their potential role as either predisposing or maintaining factors to target in psychotherapy. A growing body of multidisciplinary evidence also shows that bodily and somatic experiences are central to the diagnosis and clinical management of ED patients. Moreover, there is evidence that a PDM-based assessment may enable closer monitoring of patient progress during treatment, with regard to both subjective experiences and symptom patterns. CONCLUSIONS: The study suggests that current diagnostic frameworks for EDs would benefit from the addition of a person-centered perspective that considers not only symptoms, but also patients' full range of functioning-including their deep and surface-level emotional, cognitive, interpersonal, and social patterns-to improve patient-tailored interventions. LEVEL OF EVIDENCE: Level V, narrative review.

Italian Children's Accounts of the Lockdown: Insights and Perspectives.

COVID-19 lockdown-imposed restrictions emerged as a risk to children's well-being. However, the extant literature often ignored children's experiences, emotions, struggles, hopes, and expectations. Based on a large sample of Italian students (N = 906; mean age = 9.4 years, 48.8% female), we drew data from a post-lockdown school re-entry program where students completed narrative activities in 2020. These narratives underwent quantitative content analysis according to gender and school level. Overall, children reported mixed feelings about the lockdown; they felt safe at home but also experienced fear and missed their friends, school, and freedom. Screen-time, technology and friendships helped, but children struggled to make sense of the events. Our findings show how children attempted to make sense of the lockdown experience and may provide key information for the development of community coping programs to help children facing crises in the future.

Repeatable Battery for the Assessment of Neuropsychological Status: Italian Normative Data for Older Adults.

OBJECTIVE: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), widely used for detecting cognitive impairment in different neuropsychiatric conditions, is increasingly applied for measuring cognitive functioning in older individuals. Available normative data for RBANS Italian version suffer from under-representation of the older ages (>60 years) and are not corrected for education. Moreover, normative data are provided only for Indexes and Total scores. We thus administered RBANS Italian version in a larger sample of older adults, taking into account the effect of age, education and gender on all scores. METHOD: We used a regression-based model to assess the effect of age, education, and gender on RBANS Subtests, Indexes and Total scores in a consecutive series of healthy cognitively normal volunteers aged 60-79 years (N = 158). The obtained norms were compared with the Italian original normative data by means of Wilcoxon rank-sum test. RESULTS: Multiple linear regression analyses showed that age and educational level significantly influence performances on most RBANS scores. A free-to-use Excel to calculate subject's percentiles for any single score was developed. When compared with original normative values, our percentiles distribution of Indexes and Total scores did not reveal significant differences (p > .05). CONCLUSION: The obtained normative data show good concordance with previous norms. The instrument seems not significantly affected by educational level. The possibility to correct for any single score could make RBANS a more precise measure for capturing subtle cognitive deficits in prevention studies.

Health-Related Quality of Life in Children with Overweight and Obesity: An Explorative Study Focused on School Functioning and Well-being.

Overweight and obesity in childhood has reached epidemic levels, and their roles in physical and psychological health are now recognized. Recently, researchers have focused on the impact of these weight problems in health-related quality of life (HRQoL) domains, which are less investigated in children. This exploratory study examined the differences in HRQoL domains between a clinical group who were overweight/obesity treatment-seeking (n = 58) and a normal-weight group (n = 44) in a sample of 102 children, with a specific focus on school functioning and well-being. The second aim explored the link between our findings and other HRQoL dimensions. After controlling for sex and age, a multivariate analysis of variance showed lower levels in school functioning and well-being dimensions between overweight/obesity than normal-weight (F = 4.72; p < 0.05). Correlation analyses highlighted positive links between lower school functioning and well-being and lower levels of self-esteem (r = 0.308; p < 0.01) and social domains in terms of friendships (r = 0.522 ; p < 0.001) and family relationships (r = 0.561; p < 0.001) in children who were with overweight and obesity. This study discusses the implications of these findings in educational research and practices.

Primary and middle-school children's drawings of the lockdown in Italy.

This retrospective-descriptive study investigated how primary and middle-school children perceived the first COVID-19 lockdown in Italy (March-May 2020) as manifested in their drawings. Once school restarted after the first COVID-19 wave, and as part of a structured school re-entry program run in their class in September 2020, 900 Italian children aged 7-13 were asked to draw a moment of their life during the lockdown. The drawings were coded and quantitatively and qualitatively analyzed; several pictorial examples are illustrated in this article. Most children used colorful and full-body representations of the self, but in almost half of the pictures drawn by older students, the self was either missing or represented without the face visible. Most children drew the interior of their houses, and the outside world was completely invisible in over half of the pictures. The most represented activities among younger students were playing or sport, followed by screentime or technology-use. Domestic routines and distance learning were also depicted. Most children, but predominantly girls, drew characters showing emotional cohesion clues, and more younger pupils and girls depicted contentment as their main emotion. Conflicting emotions were virtually non-existent. Our data suggest that children coped with the lockdown through play, screen, and technology use. The high incidence of the missing self-representation in preadolescents could indicate how the enforced loneliness and lack of direct physical contact with others impacted their perception of the self. The findings presented here deepen our knowledge of the dynamics connected to the effects of the COVID crisis on children and young people and show how drawings can provide a valuable window into children's emotions and perceptions.

Possible Stress-Neuroendocrine System-Psychological Symptoms Relationship in Pregnant Women during the COVID-19 Pandemic.

The COVID-19 pandemic induced long-term damages that weigh on the national health systems of various countries in terms of support and care. This review aimed to highlight the mental health impact of the COVID-19 pandemic in pregnant women. We first report data on the immune system physiopathology and the main viral infections in pregnancy, including COVID-19. Then, the attention is focused on the main factors that affect the mental health of pregnant women during the COVID-19 pandemic, such as (1) the fear of being infected and transmitting the infection to the fetus, (2) the cancellation of checkups and pre-child courses, and (3) confinement and the inability to have close friends or a partner at the time of delivery or in the first days after delivery, as well as family tensions. Because of all this, pregnant women find themselves in a stressful condition independent of the pregnancy, and thus experience anxiety, depression, insomnia, hostility, delirium, and an alteration of the mother-baby relationship. Several studies have shown an involvement of the hypothalamic-pituitary-adrenal axis and the hypothalamic-pituitary-thyroid axis in response to the pandemic. We propose a possible involvement of the neuroendocrine system as a mediator of the psychological symptoms of pregnant women induced by COVID-19-related stress.

Hypercholesterolemia in Cancer and in Anorexia Nervosa: A Hypothesis for a Crosstalk.

The relationship between cholesterol and cancer has been widely demonstrated. Clinical studies have shown changes in blood cholesterol levels in cancer patients. In parallel, basic research studies have shown that cholesterol is involved in the mechanisms of onset and progression of the disease. On the other hand, anorexic patients have high cholesterol levels and a high susceptibility to cancer. In this review, we first present a brief background on the relations among nutrition, eating disorders and cancer. Using several notable examples, we then illustrate the changes in cholesterol in cancer and in anorexia nervosa, providing evidence for their important relationship. Finally, we show a new possible link between cholesterol disorder in cancer and in anorexia nervosa.

A three-wave panel study on longitudinal relations between problematic social media use and psychological distress during the COVID-19 pandemic.

BACKGROUND: It still remains unclear whether problematic social media use (PSMU) is a cause or a consequence of psychological distress. The present study aimed to investigate the temporal relationships between PSMU and psychological distress through a three-wave panel study (between April and July 2020, with an interval of 1 month between each period of time). METHODS: 3,912 adult Italian participants were surveyed during the COVID-19 pandemic for psychological distress (Depression, Anxiety and Stress Scale) and PSMU (Bergen Social Media Addiction Scale). Random-Intercept Cross-Lagged Panel Models were applied to disaggregate between-person from within-person associations as regards PSMU and an individual's distress. RESULTS: On a between-person level we found that adults with higher PSMU also reported heightened levels of psychological distress across the three waves. However, on a within-person level, no cross-lagged associations were found between changes in distress and subsequent changes in PSMU and vice versa. The results were largely unchanged with the inclusion of participants' gender and age or COVID-19-related fears as covariates, and when the three subscales of depression, anxiety and stress were examined in separate models. CONCLUSIONS: The current study suggests that the link between PSMU and psychological distress is mainly driven by trait-like differences and not by state-like individual changes over time.

Does Parental Reflective Functioning Mediate the Associations between the Maternal Antenatal and Postnatal Bond with the Child in a Community Sample?

Although establishing an affective tie with a child during perinatality is considered one of the most important maternal tasks, little is still known about the mediators of the association between maternal antenatal and postnatal bonding with the infant. This prospective study addresses this gap by evaluating a community sample of 110 Italian women to assess whether maternal pre- and postnatal bonds with the infant are mediated by parental reflective functioning (PRF), as assessed at the third trimester of pregnancy and three months postpartum. Controlling for confounding variables, the hierarchical regression analyses show the maternal prenatal quality of attachment to the fetus as the main predictor of maternal postnatal attachment to the child (ß = 0.315; t = 0.2.86; p = 0.005). The mediation analyses show that mothers' PRF (b = 0.245; SE = 0.119; 95% CI = 0.071, 0.531) explains 39% of the relationship between maternal pre- and postnatal bonding with the child. The findings of this study contribute to research on the association between prenatal and mother-to-infant bonding by additionally investigating the importance of taking into account maternal PRF as a mediating variable. This provides support for the clinical utility of interventions focused on maternal PRF.

The role of emotion regulation and intolerance to uncertainty on the relationship between fear of COVID-19 and distress.

The COVID-19 pandemic is increasing negative consequences on mental health around the globe. To date, research on what psychological factors could influence individuals' distress is still scarce. The current study aims to test a multiple mediation model to examine the role of Intolerance of Uncertainty (IU) and emotional regulation (i.e., expressive suppression and cognitive reappraisal) as joint factors, which can increase understanding of psychological distress due to the COVID-19 outbreak. An online survey measuring fear of COVID-19, IU, emotional regulation, and psychological distress was administered to 3863 Italian adults (females 73.3%; M age = 36.44; SD = 14.74) during lockdown. Results showed that IU partially mediated the effect of fear of COVID-19 on depression, anxiety and stress. Moreover, individuals with difficulties in managing the uncertainties due to their fear of COVID-19 may be at risk for heightened use of expressive suppression and depression. However, individuals with both higher IU and expressive suppression showed lower level of stress. High cognitive reappraisal has a mediational effect on the relationship between fear of COVID-19, IU, and lower psychological distress. Findings suggest that IU and emotional regulation should be targeted for informing the development of tailored treatments to reduce the negative consequences of the outbreak. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03071-5.