NoiBene, a Group Intervention for Promoting Mental Health Among University Students: A Study Protocol for a Randomized Controlled Trial.

University students' mental health has become a public health issue since increasingly students report high levels of psychological distress. Mental health difficulties influence students' lives, such as academic performance, relationships satisfaction, and quality of life. Moreover, different kinds of obstacles often hinder help-seeking behavior. Such evidence strongly suggests the need to implement prevention and promotion strategies to increase health and well-being in educational contexts. This article presents a study protocol for implementing and evaluating NoiBene, an evidence-based group intervention that aims to promote mental health and well-being, improve a series of transversal competencies (e.g., emotional awareness, commitment to values, assertiveness, goal setting), and decrease dysfunctional transdiagnostic mechanisms (i.e., perfectionism, repetitive thinking, experiential avoidance). A randomized controlled trial will be conducted to evaluate the protocol's efficacy. Participants will be assigned to one of the three conditions: the NoiBene Group condition (NB-G), the NoiBene guided web-based condition (NB-WB), or the waiting list condition (WLC). The NB-G intervention consists of six face-to-face group meetings, each dedicated to specific issues related to well-being or vulnerabilities. Every meeting includes an explanation of the theoretical contents, individual and group exercises, and role-plays. The NB-WB intervention covers the same topic addressed in the NB-G intervention. In this case, participants carry out a series of online modules, including theoretical explanations, practical exercises, useful activities, and self-monitoring tools. Students will individually meet the Tutor once every 2 weeks. The primary outcome will include an increase in mental health and well-being. Secondary outcomes will include changes in emotional awareness, assertiveness, perfectionism, rumination, worry, self-criticism, experiential avoidance, and academic performance and satisfaction. We expect that participants in both NoiBene conditions will show these outcomes. However, we hypothesized that the NB-G conditions will be more effective than the NB-WB in improving assertiveness. Besides treatment efficacy, we expect that students can benefit from the NB-G or NB-WB differently based on their specific behavioral and motivational patterns. Outcomes will be assessed at pre-, post-intervention and 6-months follow-up. In conclusion, we believe that NoiBene is a promising tool that can improve students' well-being, and it could have positive implications for preventing mental health disorders among students.

Anaclitic-sociotropic and introjective-autonomic personality dimensions and depressive symptoms: a systematic review.

Sociotropy (anaclitic) and autonomy (introjective) are conceptualised as two personality dimensions that confer vulnerability to depression. According to Blatt and Beck's theories, sociotropic individuals exhibit distinctive patterns of symptoms such as prominent anxiety, depressed mood, helplessness, crying and somatic concerns, while self-critical ones seem to exhibit a pattern of symptoms including prominent guilt, hopelessness, feelings of failure and worthlessness and other cognitive symptoms.This systematic review was performed with the aim of investigating whether and to what extent psychological dimensions of anaclitic-sociotropic and introjective-autonomy are related to a specific core of depressive symptoms. The search was conducted in three databases (PubMed, PsycINFO and Scopus) and 27 articles were selected.Results showed a weak association between somatic symptoms and dependent personality traits, while the relationship between self-criticism and cognitive symptomatology was significantly higher. These findings are discussed in the context of future research, necessary to corroborate the existence of a form of depression characterised by somatic features usually ignored by diagnostic criteria, essential to direct psychological treatments to these depressive personality differences.

The Impact of COVID-19 Pandemic on Italian University Students' Mental Health: Changes across the Waves.

To reduce the spread of COVID-19, the Italian government imposed a rigid lockdown and, for a whole year, continued to declare stringent rules to curb the community spread. This study provides an overview of university students' symptomatology and help-seeking behaviour before and during the pandemic. It aims to evaluate the impact of the different phases of the pandemic on students' mental health. We collected data in four-time points between March 2019 and March 2021. A total of 454 students (F = 85; M = 15) were included in the study. Students answered a socio-demographic and a standardized questionnaire (i.e., SCL-90-R) to evaluate a broad range of symptomatology. The results suggest that students experienced moderate to severe levels of depressive, obsessive-compulsive and anxiety symptomatology. About 14% of the sample met the criteria for at least one mental health disorder, but most were not receiving mental health care. During the lockdown, compared with other phases, female students reported worse symptoms in the obsessive-compulsive, interpersonal sensitivity, depression, paranoid ideation, and psychoticism dimensions. The increasing symptomatology disappeared after the lifting of the lockdown. The results showed no difference in the male groups. Preventive and support strategies should be improved in the university context.

The influence of visual and phonological features on the hemispheric processing of hierarchical Navon letters.

The possibility of allocating attentional resources to the "global" shape or to the "local" details of pictorial stimuli helps visual processing. Investigations with hierarchical Navon letters, that are large "global" letters made up of small "local" ones, consistently demonstrate a right hemisphere advantage for global processing and a left hemisphere advantage for local processing. Here we investigated how the visual and phonological features of the global and local components of Navon letters influence these hemispheric advantages. In a first study in healthy participants, we contrasted the hemispheric processing of hierarchical letters with global and local items competing for response selection, to the processing of hierarchical letters in which a letter, a false-letter conveying no phonological information or a geometrical shape presented at the unattended level did not compete for response selection. In a second study, we investigated the hemispheric processing of hierarchical stimuli in which global and local letters were both visually and phonologically congruent (e.g. large uppercase G made of smaller uppercase G), visually incongruent and phonologically congruent (e.g. large uppercase G made of small lowercase g) or visually incongruent and phonologically incongruent (e.g. large uppercase G made of small lowercase or uppercase M). In a third study, we administered the same tasks to a right brain damaged patient with a lesion involving pre-striate areas engaged by global processing. The results of the first two experiments showed that the global abilities of the left hemisphere are limited because of its strong susceptibility to interference from local letters even when these are irrelevant to the task. Phonological features played a crucial role in this interference because the interference was entirely maintained also when letters at the global and local level were presented in different uppercase vs. lowercase formats. In contrast, when local features conveyed no phonological information, the left hemisphere showed preserved global processing abilities. These findings were supported by the study of the right brain damaged patient. These results offer a new look at the hemispheric dominance in the attentional processing of the global and local levels of hierarchical stimuli.

Dissociation between line bisection and mental-number-line bisection in healthy adults.

Healthy adults bisect visual horizontal lines slightly to the left of their true center. This bias has been termed "pseudoneglect" and is considered to reflect right hemisphere dominance in the orienting of spatial attention. A previous investigation reported a positive correlation between pseudoneglect and a corresponding negative bias towards numbers lower than the true midpoint, i.e. supposedly to the left of the midpoint, during the mental bisection of number intervals that were defined by two visual arabic digits presented one to the left and one to the right of a horizontal line (Longo and Lourenco, 2007, Neuropsychologia, 45, 7, 1400-1407). Here, studying a sample of 60 healthy participants we verified whether this correlation still holds when the endpoints of number intervals are defined verbally, i.e. with no visual-spatial cues suggesting their left-to-right arrangement. Participants bisected horizontal lines (2 cm, 10 cm and 20 cm), short number intervals (3-, 5-, 7- and 9-unit) and large number intervals (16-, 24-, 32-, 40-, 48-, 56-, and 64-unit). Pseudoneglect was observed both in line and number interval bisection, confirming the results of Longo and Lourenco (2007). Nonetheless, the study of correlations between bisection biases averaged across different line and number intervals lengths and between all possible pairings of line and number interval lengths revealed no significant or systematic pattern. During line bisection pseudoneglect increased as a function of line length while with short number intervals pseudoneglect decreased and turned into an opposite positive bias as a function of interval length. With large number intervals no linear relationship was present between bisection bias and interval length and, as in Longo and Lourenco (2007), the higher was the starting point of the number interval the larger was pseudoneglect. These results show that verbally defined number intervals are not mentally inspected with the same mechanisms that are engaged by the bisection of horizontal visual lines. This suggests that number intervals are not inherently arranged along the mental equivalent of a left-to-right oriented horizontal line. This spatial representation seems rather adopted when, as in the case of the SNARC task, "left" vs. "right" codes must be used for the selection of responses associated with numbers or when, as in the case of Longo and Lourenco (2007), the numerical material to be processed is arranged in left-to-right order.

Damage to white matter pathways in subacute and chronic spatial neglect: a group study and 2 single-case studies with complete virtual "in vivo" tractography dissection.

The exact anatomical localization of right hemisphere lesions that lead to left spatial neglect is still debated. The effect of confounding factors such as acute diaschisis and hypoperfusion, visual field defects, and lesion size may account for conflicting results that have been reported in the literature. Here, we present a comprehensive anatomical investigation of the gray- and white matter lesion correlates of left spatial neglect, which was run in a sample 58 patients with subacute or chronic vascular strokes in the territory of the right middle cerebral artery. Standard voxel-based correlates confirmed the role played by lesions in the posterior parietal cortex (supramarginal gyrus, angular gyrus, and temporal-parietal junction), in the frontal cortex (frontal eye field, middle and inferior frontal gyrus), and in the underlying parietal-frontal white matter. Using a new diffusion tensor imaging-based atlas of the human brain, we were able to run, for the first time, a detailed analysis of the lesion involvement of subcortical white matter pathways. The results of this analysis revealed that, among the different pathways linking parietal with frontal areas, damage to the second branch of the superior longitudinal fasciculus (SLF II) was the best predictor of left spatial neglect. The group study also revealed a subsample of patients with neglect due to focal lesion in the lateral-dorsal portion of the thalamus, which connects the premotor cortex with the inferior parietal lobule. The relevance of fronto-parietal disconnection was further supported by complete in vivo tractography dissection of white matter pathways in 2 patients, one with and the other without signs of neglect. These 2 patients were studied both in the acute phase and 1 year after stroke and were perfectly matched for age, handedness, stroke onset, lesion size, and for cortical lesion involvement. Taken together, the results of the present study support the hypothesis that anatomical disconnections leading to a functional breakdown of parietal-frontal networks are an important pathophysiological factor leading to chronic left spatial neglect. Here, we propose that different loci of SLF disconnection on the rostro-caudal axis can also be associated with disconnection of short-range white matter pathways within the frontal or parietal areas. Such different local disconnection patterns can play a role in the important clinical variability of the neglect syndrome.

No inherent left and right side in human 'mental number line': evidence from right brain damage.

Spatial reasoning has a relevant role in mathematics and helps daily computational activities. It is widely assumed that in cultures with left-to-right reading, numbers are organized along the mental equivalent of a ruler, the mental number line, with small magnitudes located to the left of larger ones. Patients with right brain damage can disregard smaller numbers while mentally setting the midpoint of number intervals. This has been interpreted as a sign of spatial neglect for numbers on the left side of the mental number line and taken as a strong argument for the intrinsic left-to-right organization of the mental number line. Here, we put forward the understanding of this cognitive disability by discovering that patients with right brain damage disregard smaller numbers both when these are mapped on the left side of the mental number line and on the right side of an imagined clock face. This shows that the right hemisphere supports the representation of small numerical magnitudes independently from their mapping on the left or the right side of a spatial-mental layout. In addition, the study of the anatomical correlates through voxel-based lesion-symptom mapping and the mapping of lesion peaks on the diffusion tensor imaging-based reconstruction of white matter pathways showed that the rightward bias in the imagined clock-face was correlated with lesions of high-level middle temporal visual areas that code stimuli in object-centred spatial coordinates, i.e. stimuli that, like a clock face, have an inherent left and right side. In contrast, bias towards higher numbers on the mental number line was linked to white matter damage in the frontal component of the parietal-frontal number network. These anatomical findings show that the human brain does not represent the mental number line as an object with an inherent left and right side. We conclude that the bias towards higher numbers in the mental bisection of number intervals does not depend on left side spatial, imagery or object-centred neglect and that it rather depends on disruption of an abstract non-spatial representation of small numerical magnitudes.

Positive correlation in the bisection of long and short horizontal Oppel-Kundt illusory gradients: Implications for the interpretation of the "cross-over" effect in spatial neglect.

Right brain damaged patients with left spatial neglect typically bisect long horizontal lines to the right of their midpoint. However, bisections of very short lines can favour the emergence of a paradoxical "cross-over" effect in which lines are bisected to the left of the true midpoint. It has been suggested that in healthy participants similar variations in the position of the subjective line midpoint can be observed in the bisections of long and short Oppel-Kundt (O-K) illusory gradients (Savazzi et al., 2007). This analogy was taken as proof that patients with neglect suffer a distorted representation of horizontal space that is equivalent to illusory distortions that O-K gradients induce in the intact brain (Savazzi et al., 2007). In contrast to this proposal, however, it has been noted that reversal of O-K illusion with short gradients was never described in literature (Doricchi et al., 2008). To resolve this incongruence, it was argued that such a reversal can be observed in healthy participants showing strong conventional illusory effects with long gradients (Savazzi, 2008). This proposal suggests that the greater the shift in the conventional direction of the illusion for long gradients, the greater the shift in the opposite direction with equivalent short gradients (i.e., negative correlation). Here we tested this hypothesis in a sample of 100 healthy participants who bisected horizontal O-K illusory gradients of different lengths (2, 4, 8 and 16cm). We found no reversal of O-K illusion with short gradients and a positive, rather than negative, correlation between bisection of long and short gradients. Participants showing strong illusory effects in the bisection of long gradients showed analogous effects in the bisection of very short ones. These findings do not support the space anisometry interpretation of line bisection performance and the cross-over effect in patients with neglect.

A deficit of spatial remapping in constructional apraxia after right-hemisphere stroke.

Constructional apraxia refers to the inability of patients to copy accurately drawings or three-dimensional constructions. It is a common disorder after right parietal stroke, often persisting after initial problems such as visuospatial neglect have resolved. However, there has been very little experimental investigation regarding mechanisms that might contribute to the syndrome. Here, we examined whether a key deficit might be failure to integrate visual information correctly from one fixation to the next. Specifically, we tested whether this deficit might concern remapping of spatial locations across saccades. Right-hemisphere stroke patients with constructional apraxia were compared to patients without constructional problems and neurologically healthy controls. Participants judged whether a pattern shifted position (spatial task) or changed in pattern (non-spatial task) across two saccades, compared to a control condition with an equivalent delay but without intervening eye movements. Patients with constructional apraxia were found to be significantly impaired in position judgements with intervening saccades, particularly when the first saccade of the sequence was to the right. The importance of these remapping deficits in constructional apraxia was confirmed through a highly significant correlation between saccade task performance and constructional impairment on standard neuropsychological tasks. A second study revealed that even single saccades to the right can impair constructional apraxia patients' perception of location shifts. These data are consistent with the view that rightward eye movements result in loss of remembered spatial information from previous fixations, presumably due to constructional apraxia patients' damage to the right-hemisphere regions involved in remapping locations across saccades. These findings provide the first evidence for a deficit in remapping visual information across saccades underlying right-hemisphere constructional apraxia.

Spatial orienting biases in the decimal numeral system.

Humans map numbers upon a mental number line (MNL) on which small integers are placed to the left of larger ones [1-9]. Here, we show that human adults systematically shift the subjective midpoints of number intervals away from the borders separating contiguous tens along the MNL. Number intervals are erroneously bisected further to the right the closer they are to the left starting point of the tens and further to the left the closer they are to the right endpoint of the tens. Similarly, right-brain-damaged patients neglecting the left side of the MNL [10-12] show enhanced pathological rightward deviation in the bisection of number intervals located toward the left starting point of the tens and reduced deviation for intervals located toward the right endpoint of the tens. These data disclose the effects that the recursive grouping of symbolic decimal numerals within the tens has brought on the phylogenetically and ontogenetically foregoing spatial representation of magnitudes [13-16].