A Comprehensive Study of Positive Body Image as a Predictor of Psychological Well-Being in Anorexia Nervosa.

Recent data suggest a close association between positive body image (PBI) and eating disorder recovery. Nevertheless, the specific mechanisms through which PBI may facilitate recovery from anorexia nervosa (AN) remain unknown. To advance understanding of these mechanisms, this study examined core indices of PBI within AN, exploring its association with emotion regulation and well-being outcomes. Data were collected from 159 female participants, 64 with AN diagnosis and 95 healthy controls (HCs), who completed measures of PBI (body appreciation, functionality appreciation, and body responsiveness), emotion regulation, and psychological well-being (depression, anxiety, stress, and psychological quality of life). The AN group reported lower levels of PBI and psychological well-being, along with greater difficulties in regulating emotions, relative to HCs. PBI variables significantly predicted emotion regulation and psychological well-being in AN, accounting for 36% to 72% of the variance, with body appreciation emerging as the strongest predictor. These findings lend credence to the view that PBI can serve as a catalyst for psychological health. We hypothesize that enhancing PBI can improve interoceptive awareness, which is crucial for emotion regulation and reducing maladaptive food-related coping. Emphasizing a mind-body connection in lifestyle could be a relevant element to consider for both treating and preventing AN.

Psychometric analysis of the body responsiveness questionnaire in the Portuguese population.

Body responsiveness refers to the tendency to be attuned to the body's needs and use interoceptive information to guide behavior. Despite its potential beneficial effect on the development of positive body image, this construct is currently understudied. To boost research in this area, we examined the factor structure, gender invariance, and psychometric properties of a Portuguese translation of the Body Responsiveness Questionnaire (BRQ). A total of 650 men and women (aged 18-80 years) completed the Portuguese BRQ. To assess its convergent validity, participants also completed measures of body appreciation, emotion regulation, depression symptoms, and psychological quality of life. Exploratory factor analysis indicated a two-factor structure of the BRQ, which was upheld using confirmatory factor analysis: "Importance of Interoceptive Awareness" (ω = .85-.87) and "Perceived Connection" between body and mind (ω = .71-.74). BRQ scores had partial scalar invariance across gender, and no significant gender differences. Convergent and known-groups validity was supported. Participants with overweight/obesity (vs. normal weight) and middle-aged adults (vs. young adults) assigned higher importance to body signals to guide behavior. The Portuguese version of the BRQ is a psychometrically sound measure of body responsiveness and it may contribute to a comprehensive assessment of positive body image to guide intervention.

Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review.

Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.

Mediators and Theories of Change in Psychotherapy for Young People With Personality Disorders: A Systematic Review Protocol.

Background: Personality disorders (PDs) are a severe health issue already prevalent among adolescents and young adults. Early detection and intervention offer the opportunity to reduce disease burden and chronicity of symptoms and to enhance long-term functional outcomes. While psychological treatments for PDs have been shown to be effective for young people, the mediators and specific change mechanisms of treatment are still unclear. Aim: As part of the "European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders" (TREATme), funded by the European Cooperation in Science and Technology (COST), we will conduct a systematic review to summarize the existing knowledge on mediators of treatment outcome and theories of change in psychotherapy for young people with personality disorders. In particular, we will evaluate whether mediators appear to be common or specific to particular age groups, treatment models, or outcome domains (e.g., psychosocial functioning, life quality, and adverse treatment effects). Method: We will follow the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched for prospective, longitudinal, and case-control designs of psychological treatment studies, which examine mediators published in English. Participants will be young people between 10 and 30years of age who suffer from subclinical personality symptoms or have a personality disorder diagnosis and receive an intervention that aims at preventing, ameliorating, and/or treating psychological problems. Results: The results will be published in a peer-reviewed journal and at conference presentations and will be shared with relevant stakeholder groups. The data set will be made available to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. The review has been registered in PROSPERO (evaluation is pending, registration number ID 248959). Implications: This review will deliver a comprehensive overview on the empirical basis to contribute to the further development of psychological treatments for young people with personality disorders.

Mediators in Psychological Treatments for Anxiety and Depression in Adolescents and Young People: A Protocol of a Systematic Review.

INTRODUCTION: Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. AIM: We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. METHODS: A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with depression and/or anxiety and that have examined mediators of psychological treatments. A group of 20 reviewers from the COST-Action TREATme (CA16102) divided into 10 pairs independently screen studies for inclusion, extract information from the included studies, and assess the methodological quality of the included studies and the requirements for mediators. The methodological quality will be assessed by The Mixed Methods Appraisal Tool. Extracted data from the included studies will be collected and presented using a narrative approach. DISCUSSION: This systematic review will summarize and provide a comprehensive overview of the current evidence on mediators of psychological treatments for anxiety and depression for adolescents and young adults. Results will allow the identification of strategies to optimize intervention to enhance clinical outcomes. ETHICS AND DISSEMINATION: Ethics approval is not required. Findings from this systematic review will be published in a peer-reviewed journal and disseminated at conferences and meetings. PROSPERO registration number: CRD42021234641.

Eu gosto é do verão: psicodrama com adolescentes nas férias de verão / What I do like is the summer: psychodrama with adolescents on summer holidays / Me gusta lo verano: psicodrama con adolescentes en vacaciones de verano

Este artigo apresenta uma intervenção psicodramática com sete adolescentes ao longo de oito sessões no período de férias escolares de verão, que decorreu numa clínica hospitalar de Psiquiatria e Saúde Mental do norte de Portugal. A pertinência da manutenção do processo psicoterapêutico já iniciado em alguns adolescentes, e a necessidade de dar uma resposta psicoterapêutica a outros, fez com que se desse continuidade a um grupo de intervenção durante o verão, altura em que o acompanhamento grupal é habitualmente suspenso. Considera-se que a presença nestas sessões, para além da ação terapêutica, pôde constituir-se como uma continuidade do cumprimento de um compromisso semanal extrínseco ao contexto sociofamiliar pela promoção de trocas sociais com pares comprometidas pela interrupção escolar. O estudo, de caráter retrospectivo, teve como objetivo identificar os problemas/dificuldades, assim como compreender a experiência subjetiva dos adolescentes sobre o processo terapêutico em grupo de psicodrama. Para tal, foi aplicado um conjunto de instrumentos ideográficos antes, durante e após a intervenção. Os resultados deste estudo serão discutidos tendo em conta as implicações para a investigação e prática clínica psicodramática. A avaliação final da experiência sugere que o psicodrama promoveu mudanças ao nível do comportamento e funcionamento psicológico dos adolescentes, nomeadamente na diminuição da percepção de ansiedade e de desadequação no desempenho social, na melhoria do autoconceito e da identificação/expressão emocional que são reveladoras de saúde mental.

This article reports a psychodramatic intervention with seven adolescents over eight sessions during the summer school holidays, which took place in a hospital clinic of Psychiatry and Mental Health in Northern Portugal. The relevance for some of the adolescents to maintain the psychotherapeutic process already started, as well as the need to provide a psychotherapeutic response to others, has led to an intervention group during summer vacation, a period during which group monitoring is usually suspended. Besides the therapeutic effect, attendance of those sessions was regarded as the opportunity to fulfill a weekly commitment external to the socio-family context, by promoting social exchanges with peers, compromised by the school interruption. This retrospective analysis aimed to identify problems/difficulties, as well as to understand the subjective experience of adolescents about the therapeutic process in a group of psychodrama. To this end, a set of ideographic instruments was applied before, during and after the intervention. The results of this study will be discussed taking into account the implications for research and clinical psychodrama practice. The final evaluation of the experience suggests that psychodrama promoted changes in the behavior and psychological functioning of adolescents, namely in decreasing the perception of anxiety and inadequate social performance, in improving self-concept and identification/emotional expression revealing mental health.

Este artículo presenta una intervención psicodramática con siete adolescentes durante ocho sesiones durante las vacaciones escolares de verano, que tuvo lugar en una clínica hospitalaria de psiquiatría y salud mental en el norte de Portugal. La relevancia de algunos adolescentes para mantener el proceso psicoterapéutico ya iniciado y la necesidad de proporcionar una respuesta psicoterapéutica a otros ha llevado a un grupo de intervención durante el verano, cuando el monitoreo grupal generalmente se suspende. Se considera que la presencia en estas sesiones, más allá de la acción terapéutica, podría constituirse como una continuidad del cumplimiento de un compromiso semanal externo al contexto socio-familiar, promoviendo intercambios sociales con compañeros, comprometidos por la interrupción escolar. El estudio retrospectivo tuvo como objetivo identificar problemas/dificultades, así como comprender la experiencia subjetiva de los adolescentes sobre el proceso terapéutico en un grupo de psicodrama. Para ello, se aplicó un conjunto de instrumentos ideográficos antes, durante y después de la intervención. Los resultados de este estudio se discutirán teniendo en cuenta las implicaciones para la investigación y la práctica del psicodrama clínico. La evaluación final de la experiencia sugiere que el psicodrama promovió cambios en el comportamiento y funcionamiento psicológico de los adolescentes incluyendo disminución de la percepción de ansiedad y de desempeño social inadecuado, mejora del autoconcepto y la identificación/expresión emocional, revelando salud mental.

Psychometric properties of the Portuguese version of the Yale Food Addiction Scale.

PURPOSE: Rising rates of obesity have been recently associated to the novel concept of food addiction (FA). The Yale Food Addiction Scale (YFAS) is the most widely used measure for examining FA (1) and analysis of its reliability and validity is expected to facilitate empirical research on the construct. Here, we tested the psychometric properties of a Portuguese version of the YFAS (P-YFAS), establishing its factor structure, reliability and construct validity. METHODS: Data were obtained from 468 Portuguese individuals, 278 sampled from non-clinical populations, and 190 among obese candidates for weight-loss surgery. A battery of self-report measures of eating behavior was applied. RESULTS: Confirmatory factor analysis verified a one-factor structure with acceptable fit, with item analysis suggesting the need to eliminate item 24 from the P-YFAS. Internal consistency (KR-20 = .82) and test-retest stability were adequate. Correlation analyses supported convergent and divergent validity of the P-YFAS, particularly in the clinical sample. Both FA symptom count and diagnosis, according to the P-YFAS, adequately discriminated between samples, with classification of FA met by 2.5 and 25.8% of the participants in the non-clinical and clinical samples, respectively. CONCLUSIONS: These findings reinforce the use of P-YFAS in non-clinical and clinical populations. Future directions for extending YFAS validation are discussed.

Alexithymia in anorexia nervosa: the mediating role of depression.

The role of depression in the expression of alexithymia in anorexia nervosa (AN) has been controversially explained and several variables that may mask or increase the presence of emotional difficulties have scant examination in previous studies. This study aims to analyze the associations between alexithymia and state variables, such as age, BMI, illness duration, treatment duration, and medication status in AN participants, and to test the mediating role of depression in emotional difficulties. The Toronto Alexithymia Scale (TAS-20) and the Zung Self-Rating Depression Scale were administrated to 160 females: 80 participants with AN and 80 healthy controls. High levels of alexithymia were not a function of state variables. The mediating role of depression differed by the alexithymia dimension, with total mediation found for the TAS-DDF and partial mediation found for the TAS-DIF. Alexithymia is a relevant feature throughout the spectrum of AN and does not seem to be related to developmental maturation and some clinical features. Depression is probably the variable that best accounts for the variance in alexithymia, but is not a complete explanation for the known cognitive-affective disturbances in AN. Specific emotional competencies require scrutiny during psychiatric treatment.