Shared and distinct abnormalities in sleep-wake patterns and their relationship with the negative symptoms of Schizophrenia Spectrum Disorder patients.

Sleep and rest-activity-rhythm (RAR) abnormalities are commonly reported in schizophrenia spectrum disorder (SSD) patients. However, an in-depth characterization of sleep/RAR alterations in SSD, including patients in different treatment settings, and the relationship between these alterations and SSD clinical features (e.g., negative symptoms) is lacking. SSD (N = 137 altogether, N = 79 residential and N = 58 outpatients) and healthy control (HC) subjects (N = 113) were recruited for the DiAPAson project. Participants wore an ActiGraph for seven consecutive days to monitor habitual sleep-RAR patterns. Sleep/rest duration, activity (i.e., M10, calculated on the 10 most active hours), rhythm fragmentation within days (i.e., intra-daily variability, IV; beta, steepness of rest-active changes), and rhythm regularity across days (i.e., inter-daily stability, IS) were computed in each study participant. Negative symptoms were assessed in SSD patients with the Brief Negative Symptom Scale (BNSS). Both SSD groups showed lower M10 and longer sleep/rest duration vs. HC, while only residential patients had more fragmented and irregular rhythms than HC. Compared to outpatients, residential patients had lower M10 and higher beta, IV and IS. Furthermore, residential patients had worse BNSS scores relative to outpatients, and higher IS contributed to between-group differences in BNSS score severity. Altogether, residentials and outpatients SSD had both shared and unique abnormalities in Sleep/RAR measures vs. HC and relative to one another, which also contributed to the patients' negative symptom severity. Future work will help establish whether improving some of these measures may ameliorate the quality of life and clinical symptoms of SSD patients.

Working alliance in treating staff and patients with Schizophrenia Spectrum Disorder living in Residential Facilities.

OBJECTIVES: Working Alliance (WA) is important in the care of patients with Schizophrenia Spectrum Disorders (SSD). This study aims to determine which sociodemographic and clinical factors are associated with WA, as assessed by patients and staff members in Residential Facilities (RFs), and may predict WA dyads' discrepancies. METHODS: Three hundred and three SSD patients and 165 healthcare workers were recruited from 98 RFs and characterized for sociodemographic features. WA was rated by the Working Alliance Inventory (WAI) for patients (WAI-P) and staff members (WAI-T). SSD patients were assessed for the severity of psychopathology and psychosocial functioning. RESULTS: Pearson's correlation revealed a positive correlation (ρ = .314; p < .001) between WAI-P and WAI-T ratings. Linear regression showed that patients with higher education reported lower WAI-P ratings (ß = -.50, p = .044), while not being engaged in work or study was associated with lower WAI-T scores (ß = -4.17, p = .015). A shorter lifetime hospitalization was associated with higher WAI-P ratings (ß = 5.90, p = .008), while higher psychopathology severity negatively predicted WAI-T (ß = -.10, p = .002) and WAI-P ratings (ß = -.19, p < .001). Better functioning level positively foresaw WAI-T (ß = .14, p < .001) and WAI-P ratings (ß = .12, p < .001). Regarding discrepancies, staff members' age was associated with higher dyads discrepancy in Total scale and Agreement subscale scores, which were also associated with more severe negative symptoms, while patients' age was negatively correlated to Relationship subscale discrepancy. CONCLUSIONS: This study provides insight into the factors that influence WA in SSD patients and health workers in RFs. The findings address interventions to improve WA and ultimately patient outcomes.

Comparing Adherence to the Experience Sampling Method Among Patients With Schizophrenia Spectrum Disorder and Unaffected Individuals: Observational Study From the Multicentric DiAPAson Project.

BACKGROUND: The Experience Sampling Method (ESM) is a valid method of remotely recording activities and mood, but the predictors of adherence to ESM in patients with Schizophrenia Spectrum Disorder (SSD) are not known. Studies on adherence are significant as they highlight the strengths and weaknesses of ESM-based study designs and allow the development of recommendations and practical guidelines for implementing future studies or treatment plans. OBJECTIVE: The aim of this study was to compare the adherence to ESM in patients with SSD and unaffected control individuals, investigate their patterns, and report the predictors of adherence. METHODS: In total, 131 patients with SSD (74 in residential facilities and 57 outpatients) and 115 unaffected control individuals were recruited at 10 different centers in Italy as part of the DiAPAson project. Demographic information, symptom severity, disability level, and level of function were recorded for the clinical sample. Participants were evaluated for daily time use and mood through a smartphone-based ESM 8 times a day for 7 consecutive days. Adherence was measured by the response rate to ESM notifications. Results were analyzed using the chi-square test, ANOVA, Kruskal-Wallis test, and Friedman test, and a logistic regression model. RESULTS: The overall adherence rate in this study was 50% for residents, 59% for outpatients, and 78% for unaffected control individuals. Indeed, patients with SSD had a lower rate of adherence to ESM than the unaffected control group (P≤.001), independent of time slot, day of monitoring, or day of the week. No differences in adherence rates between weekdays and weekends were found among the 3 groups. The adherence rate was the lowest in the late evening time slot (8 PM to 12 AM) and days 6-7 of the study for both patients with SSD and unaffected control individuals. The adherence rate among patients with SSD was not predicted by sociodemographic characteristics, cognitive function, or other clinical features. A higher adherence rate (ie, ≥70%) among patients with SSD was predicted by higher collaboration skills (odds ratio [OR] 2.952; P=.046) and self-esteem (OR 3.394; P=.03), and lower positive symptom severity (OR 0.835; P=.04). CONCLUSIONS: Adherence to ESM prompts for both patients with SSD and unaffected control individuals decreased during late evening and after 6 days of monitoring. Higher self-esteem and collaboration skills predicted higher adherence to ESM among patients with SSD, while higher positive symptom scores predicted lower adherence rates. This study provides important information to guide protocols for future studies using ESM. Future clinical or research studies should set ESM monitoring to waking hours, limit the number of days of monitoring, select patients with more collaborative skills and avoid those with marked positive symptoms, provide intensive training sessions, and improve participants' self-confidence with technologies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12888-020-02588-y.

Catastrophizing moderates the relationship between pain severity and depressive symptomatology among women with endometriosis.

The link between pain severity, depressive symptomatology and catastrophizing among women with endometriosis is still under-investigated. The aim of this study was to (i) evaluate differences in depressive symptomatology between women with and without endometriosis; (ii) investigate if pain severity is associated with depressive symptoms; and (iii) test if catastrophizing moderates the link between these two variables. A total of 172 women with a diagnosis of endometriosis and 62 healthy controls volunteered for this cross-sectional study. Depressive symptomatology, pain severity, and catastrophizing were assessed.Compared to healthy controls, women with endometriosis were more likely to score above the cutoff for depressive symptomatology, with 60.5% of the latter being classified as having a subthreshold depression or minor depression and 15.7% as having moderate or severe major depression. Pain severity was significantly associated with depressive symptoms even after controlling for several covariates. Finally, the moderation model suggested that among patients with endometriosis, the relationship between pain severity and depressive symptomatology depended on the level of catastrophizing, with this association being stronger for high levels of the moderator.Mental health practitioners working with women with endometriosis may consider those who report high levels of pain severity and of catastrophizing at high risk of depression and are advised to promote adaptive coping strategies among patients to foster a better adaptation to this chronic disease.

Openness buffers the impact of Belief in Conspiracy Theories on COVID-19 vaccine hesitancy: Evidence from a large, representative Italian sample.

As COVID-19 continues to incur enormous personal and societal costs, widespread vaccination against the virus remains the most effective strategy to end the pandemic. However, vaccine hesitancy is rampant and has been steadily rising for decades. Seeking to remedy this, personality psychologists have begun to explore psychological drivers of vaccine hesitancy, including the Big Five. Openness to Experience presents itself as a vexing case as previous attempts to study its association with vaccine hesitancy have yielded mixed findings. In this preregistered study, we hypothesise that the impact of Openness to Experience on Vaccine Hesitancy depends on its interplay with other factors, namely conspiracy beliefs. To test this, we apply logistic regressions, simple slopes analyses, and propensity score matching to a nationally representative sample of 2500 Italian citizens, collected in May 2021. Contrary to our original hypothesis (i.e., Openness will have a positive association with Vaccine Hesitancy at high - and a negative at low - levels of Conspiracy Beliefs) we find that high Openness diminishes the impact of Belief in Conspiracy Theories on Vaccine Hesitancy. Consistent with previous research, we propose that Openness serves as a buffer against extreme positions by allowing individuals to be exposed to a greater diversity of information.

Attachment anxiety, reflective functioning and well-being as predictors of burn-out and psychological distress among psychotherapists: A longitudinal study.

OBJECTIVE: This study aims to longitudinally investigate the effects of individual's factors on subsequent burn-out/psychological distress in a sample of mental health practitioners, testing if higher attachment anxiety and avoidance and lower reflective functioning (i.e., certainty and uncertainty of mental states) and well-being at baseline may lead to a greater psychological distress and burn-out 1 year later. METHODS: The sample consisted of 40 experienced psychotherapists (females: 72.5%; mean age: 47.40 ± 9.48 years) who completed a battery of questionnaires at baseline and 1 year later. Statistical analyses were conducted with Bayesian multiple linear regressions. RESULTS: Greater attachment anxiety and certainty about mental states and lower individual's well-being at baseline predicted greater burn-out 1 year later. Similarly, greater attachment anxiety and lower individual's well-being at baseline predicted psychological distress at 1 year follow-up. Of note, uncertainty of mental states and avoidant attachment were not associated with outcomes. CONCLUSION: These findings suggest that the levels of burn-out and psychological distress among psychotherapists may be alleviated with interventions targeting attachment insecurity, specific aspects of reflective functioning (i.e., certainty about mental states) and well-being.

Who is likely to vacillate in their COVID-19 vaccination decision? Free-riding intention and post-positive reluctance.

Despite the actual availability of COVID-19 vaccines to combat the pandemic, many people are still vacillating in their decision to vaccinate. In this study, we considered the effect of two relevant contextual issues on vaccination intention: the number of people infected with COVID-19 is increasing, and the pace of vaccination is gaining speed. Specifically, we hypothesized that having already contracted SARS-CoV-2 (post-positive reluctance) could lead people to underestimate the importance of vaccination. Moreover, as the number of vaccinated people increases, more hesitant people could fall into the free-riding intention category, benefitting from the immunity provided by others' vaccinations. Vaccine hesitancy becomes more critical as the vaccination campaign proceeds: at one point, it will be inevitable to deal with hesitant people. This study is part of a WHO Regional Office for Europe project and involved a representative sample of 5006 Italians interviewed in January-February 2021. In case of post-positive reluctance, both young age and female gender increase vaccine hesitancy, while a high level of education reduces free-riding intention. Considering post-positive reluctance and free riding, a protective effect on hesitancy is associated with negative affective states, adherence to protective behaviors, trust in health information sources, and resilience. In contrast, increased vaccine hesitancy is associated with a high level of conspiracy-mindedness and trust in media information sources. Recognizing and studying the post-positive reluctance and the phenomenon of free-riding people can help us to become more efficient in combatting the virus.

Quality of residential facilities in Italy: satisfaction and quality of life of residents with schizophrenia spectrum disorders.

BACKGROUND: Recovery and human rights promotion for people with Schizophrenia Spectrum Disorders (SSDs) is fundamental to provide good care in Residential Facilities (RFs). However, there is a concern about rehabilitation ethos in RFs. This study aimed to investigate the care quality of Italian RFs, the quality of life (QoL) and care experience of residents with SSD. METHODS: Fourty-eight RFs were assessed using a quality assessment tool (QuIRC-SA) and 161 residents with SSD were enrolled. Seventeen RFs provided high intensity rehabilitation (SRP1), 15 medium intensity (SRP2), and 16 medium-low level support (SRP3). Staff-rated tools measured psychiatric symptoms and psychosocial functioning; user-rated tools assessed QoL and satisfaction with services. RFs comparisons were made using ANOVA and Chi-squared. RESULTS: Over two-thirds patients (41.5 y.o., SD 9.7) were male. Seventy-six were recruited from SRP1 services, 48 from SRP2, and 27 from SRP3. The lowest QuIRC-SA scoring was Recovery Based Practice (45.8%), and the highest was promotion of Human Rights (58.4%). SRP2 had the lowest QuIRC-SA ratings and SRP3 the highest. Residents had similar psychopathology (p = 0.140) and functioning (p = 0.537). SRP3 residents were more employed (18.9%) than SRP1 (7.9%) or SRP2 (2.2%) ones, and had less severe negative symptoms (p = 0.016) and better QoL (p = 0.020) than SRP2 residents. There were no differences in the RF therapeutic milieu and their satisfaction with care. CONCLUSIONS: Residents of the lowest supported RFs in Italy had less severe negative symptoms, better QoL and more employment than others. The lowest ratings for Recovery Based Practice across all RFs suggest more work is needed to improve recovery.

Going beyond the surface: a mixed-method exploration of infertility-related quality of life of women with endometriosis.

Literature about the impact of infertility and endometriosis on Quality of Life (QoL) is scarce and needs further investigation. Our aim was to deeply investigate the QoL of women with diagnoses of both endometriosis and infertility with failed Assisted Reproductive Treatments (ART). We conducted a concurrent mixed-method study composed of both quantitative and qualitative surveys. The quantitative survey included 22 women who completed the FertiQoL. The qualitative survey included 15 of them who provided written answers to open-ended questions aimed at deeply exploring their QoL. Data were initially analyzed separately and then combined in a meta-matrix. From the quantitative survey emerged that women at higher risk for low QoL were those who have experienced previous spontaneous miscarriages and that the domains of the FertiQoL related to fertility treatment (i.e. increased pain severity, disturbed daily life routine, and dissatisfaction with services) were the most critical. From the Interpretative Phenomenological Analysis (IPA) of qualitative survey, narrations about the physical, relational, social, emotional-cognitive, and behavioural impact of the diseases emerged. Mixed findings showed that the QoL of this population was scarce and that different levels (the inner world, the behaviours, the relational context, and the environmental context) are strictly connected and interact between them in influencing QoL. Multi-level preventive or supportive programs (with specific attention to pain experience, coping strategies, quality of services and governmental support) are required for this population.

Psychological and cognitive factors implicated in pain experience in women with endometriosis.

Sixty women with a diagnosis of endometriosis (30 with low pain severity - LP; 30 with high pain severity - HP) were evaluated at study entry (T0) and after three months (T1). At T0 they were compared for different psychological dimensions to sixty-two age-paired healthy women (CG). HP group had significantly higher scores on depressive symptomatology, sexual distress, and catastrophizing than CG, and higher scores on worry traits than LP. Metacognitive beliefs predicted sexual distress at T1, over and above pain severity. Pain affects different domains of mental health in this population. Coping strategies, metacognitive beliefs, and worry traits may modulate pain experience and psychological distress.

Self-reported reflective functioning mediates the association between attachment insecurity and well-being among psychotherapists.

Objective: Subjective well-being is a crucial variable for mental health practitioners. This study examines the influence of therapists' attachment dimensions and self-reported reflective functioning on their perceived well-being. Further, it examines if reflective functioning mediates the association between attachment insecurity and well-being. Method: A total of 416 experienced psychotherapists were enrolled in this cross-sectional study, and completed self-report measures of attachment insecurity, reflective functioning, and well-being. We tested the hypothesized mediation model with path analysis that examined indirect effects. Results: Both attachment anxiety and avoidance dimensions had a significant negative association with perceived well-being with small to medium effects. "Certainty" in reflective functioning had a small positive effect on therapist well-being. Reflective functioning mediated the association between insecure attachment dimensions and well-being, suggesting that therapist's lower ability to mentalize may partially account for the effects of higher attachment insecurity on lower well-being. Conclusion: The well-being of psychotherapists with greater insecure attachment may deserve special attention, and therapists' mentalizing capacities may be targeted by researchers and trainers as a core ability to be cultivated in order to preserve therapists' professional and personal resources.

Negative metacognitive beliefs predict sexual distress over and above pain in women with endometriosis.

The aim of the study was to assess the predictive value of dyspareunia, general chronic pain, and metacognitive beliefs to sexual distress in a sample of women with endometriosis. Ninety-six women (mean age = 34.60 ± 6.44 years) with a diagnosis of endometriosis took part to this cross-sectional study. Sociodemographic and clinical data were collected by means of a structured ad hoc questionnaire. Metacognitive beliefs and sexual distress were assessed by means of the Metacognitions Questionnaire (MCQ30) and the Female Sexual Distress Scale-R (FSDS-r). General chronic pain intensity was collected by means of a Numeric Rating Scale. Data were subjected to Hierarchical logistic regression. We found high percentages of dyspareunia and sexual distress (i.e., 66% and 76%). Findings suggested that dyspareunia and chronic pain did not predict sexual distress, while negative beliefs about worries predicted sexual distress over and above them (p = .040, odd ratio 1.159). In the target population, metacognitive beliefs may have more influence on sexual distress than pain symptomatology.

Higher levels of Depressive Symptoms are Associated with Increased Resting-State Heart Rate Variability and Blunted Reactivity to a Laboratory Stress Task among Healthy Adults.

Laboratory stress tasks induce strong changes in linear and non-linear indices of heart rate variability (HRV) among healthy adults, due to a task-induced parasympathetic withdrawal. Previous findings suggested that negative affectivity and its correlates (i.e., depressive symptoms, anxiety, hostility, type D personality, and situational stress) could profoundly affect autonomic activity. However, to date no studies considered these psychological dimensions simultaneously while trying to disentangle their acute effects on HRV during a laboratory stress task. A total of 65 healthy participants completed a battery of questionnaires and later underwent a psychosocial stress protocol, which involves a stressful and a non-stressful mental arithmetic task, with the latter serving as a control condition for the former. During the entire procedure, autonomic activity was recorded through a portable ECG device. We analysed longitudinal changes in HRV indices using Mixed Models, taking into account respiration rates and the associations between psychophysiological variables through bivariate Pearson's r (partial) correlation indices. We found significant changes in linear (e.g., HF power, RMSSD) and non-linear (e.g., Poincaré Plot and Correlation Dimension D2) HRV indices during the procedure, with the lowest point reached during the stressful mental arithmetic task. Interestingly, only depressive symptomatology was significantly and positively related to a higher resting-state HRV and to a blunted reactivity to the stress task, even after controlling for baseline values. Results suggest that healthy individuals with higher levels of depressive symptoms could experience atypical cardiovascular responses to stressful events: several speculative interpretations, considering autonomic, behavioral, and motivational dysregulations, are discussed.

Attachment comes of age: adolescents' narrative coherence and reflective functioning predict well-being in emerging adulthood.

This study investigated the effects of adolescents' attachment security and reflective functioning (RF) (assessed by the adult attachment interview [AAI]) in the prediction of well-being in adulthood. Adolescents (N = 79; M = 14.6 years old; SD = 3.5 years) completed the AAI at Time 1 (T1), which was subsequently coded for inferred attachment experiences, narrative coherence, and RF by three nonoverlapping teams of raters. Participants completed the Psychological General Well-being Index at T1 and 8 years later (Time 2, T2). Analyses showed that (a) both adolescent narrative coherence and RF were significant predictors of almost all indices of well-being at T2 in adulthood; (b) both narrative coherence and RF indirectly linked inferred loving parental care and T2 well-being; (c) when included in the same model, RF was a significant indirect effect linking inferred loving parental care and T2 well-being. These findings contribute to theory in suggesting that both RF and narrative coherence are predictive of subsequent psychological well-being and operate as links between inferred parental care and subsequent adjustment. Possible mechanisms underlying these findings are discussed.

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.

Behavioral, cognitive, and emotional coping strategies of women with endometriosis: a critical narrative review.

Endometriosis is a disabling and long-term medical condition affecting quality of life and mental health. Behavioral, cognitive, and emotional coping strategies, emotional intelligence, and metacognition could in part explain the link between the disease and impaired psychological and life functioning. This critical narrative review aimed at examining the state of the art of the relationships between endometriosis and these factors. According to PRISMA principles, we performed a systematic search for quantitative and qualitative studies on multiple electronic databases as regards coping strategies, emotional intelligence, and metacognition in women with endometriosis. Studies were subjected to interpretative and critical narrative synthesis. A total of 9 papers were included in the review. Three main categories were identified in thematic analysis and resumed in the manuscript. Findings suggested that (a) pain is considered the major stressor; (b) they usually use both adaptive and maladaptive coping strategies; (c) women with endometriosis and related chronic pain seem to repress emotions more likely than healthy ones; (d) suppressing own emotions, pain catastrophizing, and having a passive coping style are related to higher self-reported pain; and (e) emotional and avoidance coping styles are associated to poor mental status, while positive coping strategies focusing on the problem or on emotions, detached and rational styles are associated to better mental health. Few studies with mixed results and some methodological flaws have focused on coping strategies in women with endometriosis. No studies focusing on metacognition or emotional intelligence were found. Methodological biases, suggestions for future research, and implications for clinical practice were discussed.

An investigation of the psychometric properties of the Geriatric Anxiety Scale (GAS) in an Italian sample of community-dwelling older adults.

BACKGROUND: The Italian older adult population is increasing and psychiatric problems, such as anxiety among older adults, represent major challenges for public welfare. A strong need exists for instruments specifically developed to assess anxiety among Italian older adults. The Geriatric Anxiety Scale (GAS) is a 30-item self-report questionnaire that evaluates anxiety among older adults and has demonstrated strong psychometric properties in several languages. OBJECTIVE: The present study aimed to validate an Italian version of the GAS (GAS-I) and to preliminarily investigate its psychometric properties. METHOD: The translation was performed using a five-stage procedure, following a forward-back process and paying attention to cultural issues. The GAS-I was administered to 231 community-dwelling older adults with other commonly-used questionnaires of anxiety, depression, and quality of life. RESULTS: Results confirmed good psychometric qualities of the questionnaire. Confirmatory factor analyses evidenced a unidimensional structure of the GAS-I, in accordance with other validated versions. Convergent and discriminant validity were highly satisfactory. The three-factor model also provided an acceptable fit to the data. Receiver operating characteristic curve analyses revealed good discriminatory power of the GAS-I. CONCLUSION: These findings demonstrate that the GAS-I is a reliable and valid self-report questionnaire to measure anxiety among Italian older adults.

Correction to: Post-operative cognitive decline (POCD) after gynaecologic surgery: current opinions and future applications.

The original version of this article unfortunately contained a mistake. The given names and family names of all authors were interchanged.

Post-operative cognitive decline (POCD) after gynaecologic surgery: current opinions and future applications.

OBJECTIVE: Postoperative cognitive decline (POCD) is known to occur quite frequently after a cardiac surgery, especially in older population. Few studies specifically focused on its incidence and characteristics in gynecological setting. METHODS: Current opinions and future applications of POCD studies in gynecological setting have been discussed. RESULT: There are still many questions and issues about POCD in gynecological setting that remain unanswered as well as numerous research fields that have not been still explored. In particular, from this article emerges the need of further studies in gynecological setting focusing on: (a) the evaluation of long-term effect of POCD (e.g. over 3 months after surgery); (b) elderly population; (c) a wide range of cognitive functions (memory, attention, concentration, orientation, etc.); (d) the evaluation of risk and protective factors for subsequent POCD development; (e) the relationships between POCD and previous psychological or neuroendocrine factors; (f) the difference on POCD outcomes between different anaesthesia and disorders. CONCLUSION: Promoting studies on this topic is significant for the reduction of sociosanitary costs, mortality rates, social dependences and the likelihood of comorbidity.

Therapeutic alliance and binge-eating outcomes in a group therapy context.

The therapeutic alliance in individual and group psychotherapy is associated with treatment outcomes for a variety of disorders. However, debate persists about the centrality of the alliance in determining positive outcomes. We examined the alliance-outcome relationship across 20 sessions of emotionally focused group therapy (EFGT) for binge-eating disorder (BED). We hypothesized that (1) previous session alliance increase will predict lower subsequent session binge eating level while controlling for previous session binge eating level; and (2) previous session binge eating decline will predict higher subsequent session alliance level while controlling previous session alliance level. Participants were 118 individuals with BED who received 20 sessions of EFGT in 8 groups. Levels of binge eating and therapeutic alliance to the therapist were measured weekly. Linear growth in alliance during group therapy was associated with reduced binge eating at 6 months' posttreatment. We also found that the group's and the individual's alliance scores and binge-eating episodes were significantly associated across treatment, suggesting a mutual influence of the group's and individual's experience of the alliance with the therapist. Regarding the first hypothesis, previous session alliance increase was significantly associated with lower subsequent session binge eating. Regarding the second hypothesis, previous session binge-eating decline was not significantly related to higher subsequent session alliance. The findings provide evidence in a group therapy context for a model in which alliance change influences subsequent symptom levels, but not the other way around. (PsycINFO Database Record