A systematic review on the role of therapist characteristics in the treatment of eating disorders.

Treating patients with eating disorders can be challenging for therapists, as it requires the establishment of a strong therapeutic relationship. According to the literature, therapist characteristics may influence intervention outcomes. The aim of this systematic review was to identify and synthesize existing literature on therapist interpersonal characteristics that could affect psychotherapy relationship or outcomes in the context of eating disorder treatment from both patients' and therapists' perspectives. We conducted a systematic search using electronic databases and included both qualitative and quantitative studies from 1980 until July 2023. Out of the 1230 studies screened, 38 papers met the inclusion criteria and were included in the systematic review. The results indicate that patients reported therapist's warmth, empathic understanding, a supportive attitude, expertise in eating disorders, and self-disclosure as positive characteristics. Conversely, a lack of empathy, a judgmental attitude, and insufficient expertise were reported as therapist negative characteristics, which could have a detrimental impact on treatment outcome. Few studies have reported therapist's perceptions of their own personal characteristics which could have an impact on treatment. Therapists reported that empathy and supportiveness, optimism, and previous eating disorder experience were positive characteristics. Conversely, clinician anxiety, a judgmental attitude, and a lack of objectivity were reported as negative characteristics that therapists felt could hinder treatment. This systematic review offers initial evidence on the personal characteristics of therapists that may affect the treatment process and outcomes when working with patients with eating disorders.

Metacognition as a transdiagnostic factor across eating disorders: a latent profile analysis study.

Background: Metacognition is a crucial aspect of understanding and attributing mental states, playing a key role in the psychopathology of eating disorders (EDs). This study aims to explore the diverse clinical profiles of metacognition among patients with EDs using latent profile analysis (LPA). Method: A total of 395 patients with a DSM-5 diagnosis of ED (116 AN-R, 30 AN/BP, 100 BN, 149 BED) participated in this study. They completed self-report measures assessing metacognition, eating psychopathology, depression, emotional dysregulation, personality traits, and childhood adversities. LPA and Welch ANOVAs were conducted to identify profiles based on metacognition scores and examine psychological differences between them. Logistic regression models were employed to explore associations between personal characteristics and different profiles. Results: A 3-class solution had a good fit to the data, revealing profiles of high functioning (HF), intermediate functioning (IF), and low functioning (LF) based on levels of metacognitive impairments. Participants in the IF group were older and had a higher BMI than those in the HF and LF groups. Individuals with BN were largely categorized into HF and LF profiles, whereas participants with BED were mainly included in the IF profile. Participants in the LF group reported an impaired psychological profile, with high levels of depression, emotional dysregulation, childhood adversity, and personality dysfunction. Multinomial logistic regression analyses showed significant associations between metacognitive profiles and emotional and neglect abuse, emotion dysregulation, and detachment. Conclusion: This exploratory study unveils distinct metacognitive profiles in EDs, providing a foundation for future research and targeted interventions. In this light, metacognitive interpersonal therapy could be a valid and effective treatment for EDs, as suggested by the initial promising results for these patients.

Quality of Life and Its Psychosocial Predictors among Patients with Disorders of Gut-Brain Interaction: A Comparison with Age- and Sex-Matched Controls.

The disorders of gut-brain interaction (DGBIs) are a heterogeneous group of chronic conditions that greatly reduce patients' quality of life (QoL). To date, biopsychosocial factors (such as gastrointestinal symptoms, alexithymia, and interpersonal problems) are believed to contribute to the development and maintenance of DGBIs, but their role in affecting patients' QoL is still under investigation. Out of 141 patients seeking treatment for their gastrointestinal symptoms, 71 were diagnosed with a DGBI (47 females, 66.2%; Mage: 41.49 ± 17.23 years) and were age- and sex-matched to 71 healthy controls (47 females, 66.2%; Mage: 40.45 ± 16.38 years) without any current gastrointestinal symptom or diagnosis. Participants completed a sociodemographic and clinical questionnaire and a survey investigating several psychosocial risk factors. We found greater symptom severity and difficulties in identifying feelings among patients compared to controls. Further, multiple linear regression analyses evidenced that, among patients, higher expressive suppression of emotions, difficulties in identifying feelings and interpersonal problems, and a lower cognitive reappraisal of emotions predicted lower QoL. Data suggest that the QoL of patients with DGBIs is affected not only by common risk factors (e.g., interpersonal problems) but also by specific difficulties in processing and regulating emotions. The implications of these findings are discussed.

Group member attachment style interacts with actor and partner helping alliance to predict decreasing binge eating episodes.

OBJECTIVE: An individual's attachment style may impact how they interact with their therapy group. This study examined the moderating role of a group member's attachment on the dynamic relationships between that group member's (actor) and other group members' (partner) therapeutic alliances and symptom outcomes. Method: This is a secondary analysis of data from a trial testing the outcome of emotionally-focused group therapy for binge-eating disorder. The sample consisted of 2,360 sessions nested within 118 group members who attended a 20-session treatment. Patients recorded binge eating episodes (BEE), their body weight and an alliance measure session-by-session. RESULTS: Dynamic structural equation modelling showed decreases in BEE and weight over the therapy. When attachment style was not included in the model, higher-than-average partner's alliance scores in the previous session were related to decreases in BEE in the current session. Attachment style moderated these actor and partner effects. For patients with preoccupied attachments, higher-than-average actor alliance in the previous session was related to subsequent decreases in BEE. For patients with dismissing or disorganized attachments, higher partner alliance in the previous session was related to subsequent decreases in BEE. CONCLUSION: Group members' attachment characteristics can play a role in the development of alliance-outcome patterns in group therapy.

Understanding Problematic Gaming During the Covid-19 Pandemic in Adolescents and Adults: A Systematic Review of the Literature.

Objective: A growing body of evidence suggests that online gaming increased during the COVID-19 outbreak. This systematic review aims to summarize extant literature that reported on problematic gaming among both adolescents and adults during the pandemic and to identify available research on the bidirectional association between problematic gaming and mental health outcomes. Method: A systematic search was carried out through PubMed, Web of Knowledge and AGRIS, Embase, Medline, PsychINFO (from January 2020 to January 2023), using keywords related to problematic gaming and mental health outcomes. Both cross-sectional and longitudinal empirical studies which used validated measures of problematic gaming and mental health outcomes during the COVID-19 pandemic were included. Results: Twenty-five empirical articles were eligible for the current review, comprising 28,978 participants. The majority of the selected studies had cross-sectional designs. Overall, most eligible studies showed significant association between problematic gaming and negative mental health outcomes during the pandemic. Correlations were mostly found between problematic gaming, depression and anxiety. Conclusions: Future research focusing on the relationship between problematic gaming and mental health outcomes should go beyond the considerable weaknesses due to methodological limitations of cross-sectional design, sampling and measures.

The Impact of the First and Second Wave of the COVID-19 Pandemic on Eating Symptoms and Dysfunctional Eating Behaviours in the General Population: A Systematic Review and Meta-Analysis.

BACKGROUND: The aim of this systematic review and meta-analysis was to examine the prevalence of feeding and eating disorder (FED) symptoms or dysfunctional eating behaviours (DEB) in the general population during the COVID-19 outbreak. METHOD: We searched eligible articles in biomedical databases from 1 January 2020 to 31 March 2022. Prevalence rates of FED or DEB changes between pre-pandemic and pandemic time and correlation with psychological distress were pooled with a meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I2) statistics. A total of 186 studies with 406,076 participants met the inclusion criteria. RESULTS: The more prevalent FED or DEB during the COVID-19 outbreak were: body image concerns (52%, 95% CI 0.38, 0.66), binge eating (40%, 95% CI 0.25, 0.55), and overeating (40%, 95% CI = 0.32-0.48). Pooled data of longitudinal studies (k = 8) only showed a significant difference in the prevalence of weight gain from pre-pandemic to the pandemic time. Finally, increased levels of psychological distress (k = 35) positively correlated with some ED symptoms. CONCLUSION: This meta-analysis evidenced a negative impact of the pandemic on eating symptoms and DEB in the general population.

Time Spent on Mobile Apps Matters: A Latent Class Analysis of Patterns of Smartphone Use among Adolescents.

The aims of the present study are: (1) to determine classes of adolescents with homogeneous patterns of smartphone or social media use; and (2) to examine the level of distress across the empirically derived profiles. Three hundred and forty adolescents (Mage = 15.61, SD = 1.19; 38.2% females) participated in a cross-sectional survey. Participants provided objective trace data on time spent on smartphones and applications, as well as self-reported social media addiction, social media use intensity, online social comparison, emotion dysregulation, and psychological distress. Latent class analysis (LCA) with total smartphone use categorized participants into three classes. Participants in Class 3 (19%) showed a more impaired functioning profile, with a tendency towards social media addiction and greater levels of distress. LCAs with the amount of time devoted to specific applications are more heterogeneous, and results showed that heavy use of social media apps was not consistently connected to the most impaired psychosocial profiles. Although the amount of mobile screen time can be a characteristic of problematic users, the link between social media usage and an adolescent's psychological characteristics is mixed. More research is needed to explore the interplay between mobile screen time and social media usage among adolescents.

Unveiling the influence of the Italian mafia as a Dark Triad threat on individuals' affective states and the power of defense mechanisms.

The present research investigated whether the Italian mafia as a Dark Triad threat increased threat-related affective states and explored how thinking about defense mechanisms may help to reduce these states. For this, we conducted a multi-method experimental study with Italians (N = 253). The quantitative results show that the mafia as a threat manipulation increased threat-related affective states in terms of higher behavioral inhibition (BIS) and lower behavioral activation (BAS). The qualitative results further depict proximal and distal defense mechanisms to reduce this threat, which can be categorized into models of threat and defense. Exploratory analyses indicate that naming distal defenses positively affected the increase of BAS. Additionally, when participants had higher levels of BIS after the threat, naming more defenses and proximal defenses positively affected the decrease of BIS. Further qualitative results provide valuable information on effective personal and societal buffers for the perceived threat of the Italian mafia.

Psychosocial predictors of trajectories of mental health distress during the COVID-19 pandemic: A four-wave panel study.

Previous research suggested that during the COVID-19 pandemic, mental distress did not affect all people equally. This longitudinal study aims to examine joint trajectories of depressive, anxiety, and stress symptoms in a sample of Italian adults during the pandemic, and to identify psychosocial predictors of distress states. We analyzed four-wave panel data from 3,931 adults who had received assessments of depressive, anxiety and stress symptoms between April 2020 and May 2021. Trajectories of individual psychological distress were identified by Latent Class Growth Analysis (LCGA) with parallel processes, and multinomial regression models were conducted to identify baseline predictors. Parallel process LCGA identified three joint trajectory classes for depression, anxiety and stress symptoms. Most individuals (54%) showed a resilient trajectory. However, two subgroups showed vulnerable joint trajectories for depression, anxiety and stress. Expressive suppression, intolerance to uncertainty, and fear of COVID-19 were risk characteristics associated with vulnerable trajectories for mental health distress. Moreover, vulnerability to mental health distress was higher in females, younger age groups and those unemployed during the first lockdown. Findings support the fact that group heterogeneity could be detected in the trajectories of mental health distress during the pandemic and it may help to identify subgroups at risk of worsening states.

Interrelations between clinical-psychological features and bone mineral density changes in post-menopausal women undergoing anti-osteoporotic treatment: a two-year follow-up.

Introduction: Psychological features have been bidirectionally associated with osteoporosis, but it is still unclear whether patient's anxiety fluctuations during the anti-osteoporotic treatment can have an impact on bone mineral density (BMD) variation. The aim of this study was to investigate the interrelations between psychological distress features, such as anxiety, depression, health-related QoL (HRQoL) and bone health in women receiving anti-osteoporotic treatment. Methods: 192 post-menopausal osteoporotic women were treated with alendronate or risedronate according to the standard procedure. The levels of anxiety, depression, and perceived HRQoL, along with BMD, were assessed at baseline and at a 2-year follow-up. Results: At the end of the study, the patients showed a statistically significant increase of both psychic and somatic anxiety (p<0.0001) and exhibited a worsening of depressive symptoms (p<0.0001), whereas HRQoL showed no change. BMD improved and no incident fractures occurred. BMD variation (ΔBMD) at lumbar spine was significantly associated with anxiety levels (r=0.23, p=0.021). Multiple regression analysis showed that both patients' worsening anxiety levels (ß = -0.1283, SE=0.06142, p=0.04) and their treatment adherence (ß=0.09, SE=0.02, p=0.0006) were independently associated with ΔBMD. Discussion: The findings of the current follow-up study suggest that BMD in post-menopausal women undergoing anti-osteoporotic treatment was predicted by treatment adherence and anxiety change over time.

Italian validation of the Clinical Outcomes in Routine Evaluation-10 (CORE-10): a short measure for routine outcome monitoring in clinical practice.

The customization of the intervention using patient feedback is an evidence-based practice aimed at the continuous evaluation, during treatment, of the patient's change at a clinical level. There are few easy-to-use tools for common assessment of psychological distress, designed to be used for screening and during treatment to monitor progress. The Clinical Outcomes in Routine Evaluation-10 (CORE-10) is definitely one of them. Thus, the aim of the present study was to examine the psychometric properties of the Italian version of the CORE-10. A sample of 548 participants (females, N=463, 84.5%; mean age 23.29±7.21 years) was recruited in the study and filled out a battery of measures. The internal validity of the CORE-10 was investigated through a confirmatory factor analysis which evidenced a good fit to the data, suggesting a unidimensional factorial structure of the measure. Further, the scale had a good internal reliability and was significantly associated with other measures of distress, interpersonal problems, well-being, and insecure attachment. Finally, it showed excellent diagnostic accuracy, as well as intrinsic and post-test diagnostics. Given its validity and reliability, the CORE-10 may be adopted by Italian-speaking psychotherapists and researchers to evaluate the outcomes of mental health interventions as well as to track the session-to-session changes over time in psychological distress among patients.

Interplay Between Fear of Missing Out and Loneliness: A Three-Wave Panel Study During the COVID-19 Pandemic.

Although the concept of Fear of Missing Out (FoMO) is permeated with individual fears about the lack of social connection, the relationship between FoMO and feelings of loneliness has been the subject of limited research. The aim of this study was to examine bidirectional associations between FoMO and loneliness via a three-wave, random intercept, cross-lagged panel model. Drawing on a survey with 494 adult participants across three waves (45.3 percent participated in Time 2 and 38.7 percent participated at Time 3) during the COVID-19 pandemic, we found that participants with higher FoMO also reported heightened levels of loneliness across the three waves, at a between-person level. Furthermore, loneliness had significant negative cross-lagged associations with subsequent FoMO, at within-person level. The cross-lagged paths between FoMO and subsequent loneliness were not significant. Participants who usually spend more daily time using social media reported higher levels of FoMO. The findings of the study contribute to clarifying the temporal relationship between FoMO and loneliness, by suggesting that FoMO may not represent a risk factor for heightened feelings of loneliness, but it can be triggered by feelings of social isolation and lack of relationships.

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.

The interplay between emotion regulation, interpersonal problems and eating symptoms in individuals with obesity: A network analysis study.

INTRODUCTION: A complex and bidirectional relationship between eating and psychological symptoms in individuals with obesity has been proposed. This study aims to identify the specific processes playing a role in this association, using a data-driven approach. METHODS: Two hundred ninety-four adults with obesity, including 106 (36 %) with binge-eating disorder, were consecutively admitted to a specialized public center. They completed self-report questionnaires to assess emotion regulation, interpersonal problems, self-esteem, binge-eating symptoms, and expectancies regarding eating behaviors. To assess the interplay among eating and psychological variables, a network analysis was used. The bridge function analysis was also performed to identify the bridge nodes among three communities (eating symptoms, interpersonal and emotional problems). RESULTS: The network was stable. Limited access to emotion regulation strategies, eating helps manage negative affect, and non-assertiveness were the nodes with the highest strength centrality. Lack of emotional clarity, non-assertiveness, socially inhibition, and binge-eating were the nodes with the highest bridge strength. LIMITATIONS: The main limitation of the study is the cross-sectional nature of the findings which prevents to infer causality regarding the association between symptoms in the network. DISCUSSION: An interplay between eating symptoms and affective and interpersonal factors characterizes individuals with obesity. Across the variety of psychological problems associated with obesity, the present study suggests specific psychological variables and their connections that could be addressed to improve treatment outcome.

Patient and mentor language style matching as a predictor of working alliance, engagement with treatment as usual, and eating disorders symptoms over the course of an online guided self-help intervention for anorexia nervosa.

OBJECTIVE: The aim of this study was to examine the processes involved in a guided self-help (GSH) pre-treatment intervention (RecoveryMANTRA) for patients with anorexia nervosa (AN), by measuring the levels of patient/mentor Language Style Matching (LSM). RecoveryMANTRA was supported by student mentors or peer mentors (recovered individuals) over six weekly chat-based sessions. We examined whether LSM during RecoveryMANTRA predicted patients'working alliance with the clinic therapist, motivation, eating disorder (ED) and general psychopathology. A further aim was to examine differences in LSM between student mentors and peer mentors. METHOD: 87 AN adults received RecoveryMANTRA plus treatment as usual. The LSM algorithm was used to calculate verbal attunement between patient and mentor. Participants were assessed at baseline and at the end of the intervention. RESULTS: Both early (1st session) and late (6th session) LSM predicted higher working alliance with the clinic therapist. Moreover, late LSM predicted lower EDs symptoms at the end of the RecoveryMANTRA intervention. Patient/peer mentor dyads showed higher late verbal attunement than patient/student mentor dyads. CONCLUSIONS: These findings suggests that in the early phase of treatment relational aspects can impact on engagement with treatment. Verbal attunement in a GSH for AN is associated with working alliance and better clinical outcome.

Psychological impairment in inflammatory bowel diseases: the key role of coping and defense mechanisms.

A comprehensive investigation of psychological features in chronic patients is very important for tailoring effective treatments. In this study we tested anxiety, depression, health related quality of life (HR-QoL), alexithymia, coping styles, and defense mechanisms, in eighty-four patients with Crohn disease (CD) and ulcerative colitis (UC). Participants reported low to moderate HRQoL and anxiety, apart from alexithymia. Women experienced lower QoL and higher levels of anxiety and depressive symptoms. Coping and defense strategies were related to distress symptoms and QoL. Positive attitude and principalization, showed negative associations with depression, anxiety and alexithymia and were also found to be associated with mental health. CD patients used significantly more turning against objects (p=0.02) and projections (p=0.01) and UC patients used more reversal (p=0.04). Elderly women showed higher anxiety symptoms and lower perceived QoL. Multiple regression analysis revealed anxiety and depression were independently associated with QoL. Significant differences emerged in defense styles among CD and UC. CD participants used more maladaptive coping and defense styles which were related to mental distress, depression and anxiety, together with higher level of alexithymia. Findings suggest that psychological aspects play a key role in mental health in patients suffering from inflammatory bowel diseases. A multi-integrated clinical strategy including psychotherapeutic interventions should be considered in treating CD and UC.

A longitudinal investigation on problematic Facebook use, psychological distress and well-being during the second wave of COVID-19 pandemic.

The social isolation and the subsequent, increased use of Social Networking Sites due to the COVID-19 pandemic have had an impact on subjective well-being around the world. The present longitudinal study examined whether changes in psychological distress and well-being during the Italian second wave of the pandemic differ among people with different levels of Problematic Facebook Use (PFU). A total of 493 participants (Mage = 24.55 ± 7.25; 80.3% females) completed measures of passive use of Facebook, social comparison orientation on Facebook, fear of missing out, psychological distress (depressive symptoms and fear of COVID-19 pandemic) and well-being across three waves. Latent class analysis (LCA) categorized participants into three groups with different PFU levels: healthy users, moderate PFU users, and high PFU users. Hierarchical linear modeling (HLM) showed that the between-person level (class membership) accounted for most of the variability in psychological distress and well-being. No significant changes were found in psychological distress and well-being over time, but the High PFU users showed greater levels of psychological distress and lower levels of well-being at each time point. The findings of this study suggest that the relationship between PFU, psychological distress and well-being may reflect trait-like time-invariant differences between individuals rather than state-like changes.

Online consultations in mental healthcare: Modelling determinants of use and experience based on an international survey study at the onset of the pandemic.

Introduction: While online consultations have shown promise to be a means for the effective delivery of high-quality mental healthcare and the first implementations of these digital therapeutic contacts go back nearly two decades, uptake has remained limited over the years. The onset of the COVID-19 pandemic dramatically altered this relative standstill and created a unique turning point, with a massive amount of both professionals and clients having first hands-on experiences with technology in mental healthcare. Objective: The current study aimed to document the uptake of online consultations and explore if specific characteristics of mental health professionals across and beyond Europe could predict this. Methods: An international survey was designed to assess mental health professionals' (initial) experiences with online consultations at the onset of the pandemic: their willingness to make use of them and their prior and current experiences, alongside several personal characteristics. Logistic mixed-effects models were used to identify predictors of the use of online consultations, personal experience with this modality, and the sense of telepresence. Results: A total of 9115 healthcare professionals from 73 countries participated of which about two-thirds used online consultations during the initial COVID-19 outbreak. The current study identifies multiple determinants relating to the use and experience of online consultations, including the professionals' age, experience with the technology before the outbreak, the professional context, and training. Conclusions: Despite strong evidence supporting the relevance of training in digital mental health, this is clearly still lacking. Nevertheless, the COVID-19 pandemic presented a first, and potentially transformative, experience with online consultations for many healthcare professionals. The insights from this study can help support professionals and, importantly, (mental) healthcare organisations to create optimal circumstances for selective and high-quality continued use of online consultations.

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.